UCLA Health dermatologist Caroline Opene, MD treats patients of all skin tones, but as director of the UCLA Health Skin of Color clinic, she has special expertise in treating skin of color. Below are some of the topics she is often asked about.
Why are Skin of Color clinics important?
While people of all skin tones can develop the same skin conditions, their presentations can vary on different shades of skin. Darker skin tones don’t show as much redness or bright color change, so a rash or other inflammation may not be as visibly evident. It takes a trained eye used to seeing certain presentations in darker skin tones to say ‘that’s still eczema and it’s still active,’ despite that it’s dark brown or grayish or purple, not red. And darker skin can also respond to acne, eczema or psoriasis with post-inflammatory hyper- or hypo-pigmentation – darker or lighter spots -- where the lesion has been which may need further treatment. That’s why it’s important to have dermatologists who are knowledgeable about treating all types of skin tones – and to have clinics where patients can come to be treated most effectively. And of course, we often hear from patients how great it is to see dermatologists that look like them and can relate to their skin.
Why are there not more designated clinics like UCLA’s?
Dermatology is among the least diverse medical specialties, according to a review in Clinics in Dermatology, with underrepresentation of Black and Hispanic dermatologists relative to the population. Only 3% of dermatologists are Black and 4.2% are Hispanic, while 13% of Americans are Black and 18.5% are Hispanic. That’s one thing that needs to change. Another is changing the way we educate new dermatologists. That’s why the clinic here is also a teaching clinic – residents at the David Geffen School of Medicine at UCLA work alongside staff dermatologists so they can learn and apply this knowledge when they become dermatologists themselves.
Does the sun cause as much damage to skin of color?
Melanin does provide some protection against the sun’s harmful rays, but less than people think. Those with medium to darker skin tones usually develop fewer pre-cancerous growths and have later onset of wrinkles that are due to sun damage. However, in these populations sun damage can present as uneven skin tone or dark spots. To mitigate this, I often recommend tinted broad spectrum sunscreens to provide not only UVA and UVB protection, but also protection against visible light. Visible light is found in both daylight and in our devices and is a major driver of hyperpigmentation in people of color.
Are people with darker skin less likely to develop skin cancer?
In general, those with fairer skin who sunburn easily are at highest risk for skin cancer, as are those with a family history. That said, I have diagnosed a fair number of skin cancers on the face or hands of Asian, Hispanic or African American patients who have worked outdoors for many years. People of color can also develop skin cancer in ‘hidden’ areas such as the palms of the hands and bottoms of the feet. Skin cancer is generally treatable if it is caught early, but people of color often experience barriers to dermatologic care and tend to present at more advanced stages.
What are some other tips to keep skin healthy?
People of all skin tones should use sunscreen daily – and not just on your face; you need to cover your neck, hands and ears as well. That’s probably the easiest and most cost-effective thing to do to improve your appearance, minimize age spots and reduce your skin cancer risk over the long term. Over time, unprotected skin exposure thins the dermis, or the ‘cushiony’ layer of the skin that makes you look youthful, and leads to a leathery look.
And while not everyone can –or necessarily needs– to see a dermatologist for an annual skin check, everyone, no matter what their skin tone, should examine their skin in front of a mirror regularly to get the ‘lay of their land.’ If you’ve been looking at your skin and nails every few months and you notice something is evolving over time, that’s a reason to see your healthcare provider. It’s not infrequent that the patient is the one who finds their diagnosis, so I can’t overstate the importance of closely monitoring your own skin.
Dr. Opene is a board-certified dermatologist and is a clinician in UCLA Health’s Department of Dermatology.
