Caroline Opene, MD, had deeply personal reasons for becoming a dermatologist. Growing up, she saw family and community members struggle with skin conditions that compromised their quality of life, and others who dealt with aesthetic skin issues that affected their confidence and self-esteem.
“I thought it would be really cool if I could step in and help them not only function better but feel better, look better,” Dr. Opene says.
That passion inspired her to establish the Skin of Color Clinic at UCLA Health after joining the faculty of the David Geffen School of Medicine in 2022.
“It’s the reason I went into dermatology,” she says. “I wanted to make sure there was a hub for skin of color patients at UCLA, so they could find a home there. And I’m also really interested in teaching the residents, so I wanted that to be a focus in their training as well.”
Disparities in dermatology
Dermatology is among the least diverse medical specialties in the U.S. compared to the overall population – second only to orthopaedic surgery – according to a review in Clinics in Dermatology. Just 3% of dermatologists are Black and 4.2% are Hispanic, while 13.4% of Americans are Black and 18.5% are Hispanic.
The majority of California residents are people of color, including 40% Hispanic or Latino, 16% Asian and 6.5% Black, according to 2023 census figures.
Images of people with darker skin have also traditionally been left out of dermatology textbooks. A 2021 analysis published in the Journal of the American Academy of Dermatology of more than 7,000 images in dermatology textbooks found that 81% of dermatologic diseases were depicted only on fair skin. This is beginning to change in more recently issued textbooks, Dr. Opene says.
People of all skin tones can develop the same skin conditions, but their presentation can vary depending on skin shade. Darker skin tones don’t show as much redness; rashes may be raised or a deep purple color, Dr. Opene says, so inflammation may not be as obvious.
“It really takes a trained eye who’s used to seeing certain presentations in darker skin tones to say, ‘That’s still eczema, and it’s still active,’ despite the fact that it’s grayish or purple and not red,” she says. “It’s important to me, from an educational perspective, to make sure that the residents coming out of UCLA are comfortable appreciating those subtleties in all skin tones.”
Darker skin can also respond to common skin conditions, such as acne, eczema and rosacea, with post-inflammatory hyperpigmentation or post-inflammatory hypopigmentation – darker or lighter spots where the lesion had been.
“Sometimes the patient will have both,” Dr. Opene says. “And that can be distressing because they say, ‘I feel better, but I look worse.’”
Keeping skin healthy
Dr. Opene suggests people of all skin tones prioritize using sunscreen daily to keep their skin healthy.
“Sun protection is probably the easiest, most cost-effective thing that’s done over the long term to improve your appearance and reduce your skin cancer risk,” she says.
Over time, unprotected sun exposure results in replacement of our normal collagen (which gives the skin a youthful appearance) with thick elastic fibers. This contributes to the leathery appearance that is seen at times in older skin. The epidermis thins, leading to more visible blood vessels that are prone to bruising with minimal skin trauma. Sunlight also contributes to patchiness and hyperpigmentation, and can cause skin cancers, she says.
Though skin cancer affects people of all skin tones, not all skin cancers are because of the sun, which is especially true for people with darker complexions.
“In general, people of color have a lower risk of skin cancers that are induced by the sun, but where they are equal to those of European descent is in the type of melanoma that’s called acral lentiginous melanoma,” Dr. Opene says.
This type of cancer can show up in “hidden places, like palms of the hands and soles of the feet,” she says.
Though not everyone can see a dermatologist annually for a skin check – and there’s not enough scientific evidence showing everyone needs to, Dr. Opene says – everyone should check out their own skin regularly to get a “lay of the land.”
She recommends people look at themselves naked in the mirror with good lighting to get familiar with their moles, especially those in hidden areas. Examine fingernails and toenails and the nail beds for any streaks or lines that may be changing over time. The American Academy of Dermatology offers guidelines for performing a skin self-exam.
“If you’ve been looking at your skin periodically, every couple of months for a while, and you notice a spot is growing or changing over time, that is a reason to come in,” Dr. Opene says. “It’s not infrequent that the patient is the one who finds their diagnosis, so I can’t overstate the importance of tracking your own skin.”
Loving the skin you’re in
Dr. Opene most enjoys the breadth of patients she gets to see as a dermatologist – “It’s one of the few medical specialties where you can see people from birth to end of life” – and getting to make the kind of difference in their lives she’d hoped to make for her family members.
“In medicine, we’re all kind of fixers,” she says. “With the exception of skin cancers, it’s not that common that we ‘cure’ a patient’s condition. But we are quite good at helping manage the burden of symptoms, improve quality of life, and achieve clear skin. And this truly feels great.”
The skin is also the only organ we see daily, and it deserves a little kindness, Dr. Opene adds.
“The skin is the only organ that we get to scrutinize with a magnifying glass and bright lights from different angles, and then look at other people’s organ and compare,” she says. “So I think we all need to have a lot more grace for ourselves and for natural things like wrinkles and freckles and just kind of be patient with some of that stuff.
“The skin is a front-facing organ that takes a lot of beating, both from the sun and from environmental pollutants, so be kind to it. And for things that don’t seem quite right, if you’re able, see a dermatologist.”
