Skin Color Matters

Abstract

Evaluating skin of color (SOC) demands that clinicians avoid solely relying on visual inspection, which can lead to diagnostic error. For example, redness, one of the most obvious signs of cutaneous inflammation, is subtle, appears violaceous, hyperpigmented, or is not apparent in SOC. Erythema in all skin tones is evidence of inflammation, but in darker skin, so is hyperpigmentation. Several inflammatory conditions hallmarked by erythema, such as atopic dermatitis (AD), psoriasis, or pressure injuries (PI), may be misdiagnosed in darker skin because the clinical presentation is inconsistent with textbook descriptions. Moreover, some cancers may go undiagnosed.