Dr. Monica Li is a skin diversity expert. She explains ways dermatologists can update their education on knowing how to treat all skin types, and why it is important. PHOTO COURTESY: Dr. Monica Li

Lack of representation of skin and colour in dermatology has been an ongoing issue in the field. However, in recent years, there has been a trend of addressing this issue with adding more diversity, not only in education, but also in the field as a whole. 

Reporter Jazmine Canfield sat down with Dr. Monica Li, skin diversity expert for the Canadian Dermatology Association and board-certified dermatologist in Vancouver, to explore her opinions on the change happening in the dermatology field.  

Jazmine Canfield: Can you tell us what’s happening right now in the dermatology field in regard to representation of skin of colour?

Monica Li: We are seeing a growing and evolving demographic that represents skin of colour patients and for that reason it’s important as dermatologists, that we are able collectively as a group have the cultural competency as well as knowledge in order to treat different skin tones and the skin conditions that may be seen in this population. 

Recently, the Canadian Dermatology Association in corporate partnership with Johnson & Johnson, developed an educational series called the Skin Diversity Learning Series to highlight the differences, but also the similarities as well as, to share experiences in the management of care of the skin in those who are skin of colour, for our colleagues across the country. This is one of different efforts that have been initiated by my specialty in order to be able to meet the medical and health needs of this demographic.

The series itself highlights and features expert colleagues who have either a special practice focus or research focus in skin of colour, and it’s great because by initiating dialogue or starting those conversations, it helps to bring to light the differences and similarities for care of the skin across the spectrum. This is how as a group we can evolve with population changes in society. I’m very proud to be part of the organisation and these initiatives and to be a spokesperson for this purpose.

A recent study has found that the average percentage of overall dermatology publications relevant to people of colour is only 16 per cent and the higher ranked journals tend to publish a smaller proportion of articles on skin of colour compared to lower ranked journals. What’s your opinion on that?

Now that the dialogue and conversations are increasing, we’ll see positive changes. If we look at the scientific literature, we should actually take a step back and look at the research studies AND clinical trials themselves. 

Historically, we did not see a large representation of those that are in some of those research studies for us to even understand how new therapies, or approaches, in medicine could be applied, and how it would deliver for skin of colour patients. There are now deliberate ways to try to get and recruit more participants in research studies, and in clinical trials that represent the full skin spectrum. Because at that point, then we can then translate some of that research findings into publications to be able to be submitted to journals that can be considered for publication for a much wider and broader audience interpretation and understanding.

So some of the data that we’re seeing right now is representing more of what historically patterns are, but I do think that there are steps towards improving that as time goes on, and having a conversation with you right now on this matter, is part of also the incremental changes we’re making to make sure that we recognize that there’s a disparity in the care, in the research, in the knowledge of care for skin of colour patients and their skin, and then working towards improving that.

So why is it so important to include diversity of skin tones in dermatology?

It’s important to be inclusive and diverse because not everybody has the same skin tone; even for the same person, skin care and skin health needs are individualized. And part of that individuality means that we are mindful of the fact that there are different skin tones out there, and there are differences in presentation, in responses to treatment, even culturally how patients consider different management strategies. There’s going to be differences between ethnic makeup of individuals. So it’s not just important; it’s out of necessity, in order to actually tailor healthcare, skincare and dermatologic care to each of these different individuals in society that come from different backgrounds. So that we’re actually giving the best individualised evidence-based dermatology care for all.

Looking back at your own education, were there gaps in your training when pursuing dermatology and how did you overcome those gaps?

Historically, there were challenges in ensuring that textbooks or research papers, or even the patients that we were seeing, represent a more diverse spectrum. So during my training years, I actually didn’t necessarily have some of those exposures that I would have liked in order to increase my comfort and my competency with treating, for instance, darker skin tones. It was actually out of my training years when I’m in practice that I realised “wow, I actually see everybody of every single colour.” Then I realised that’s where my gap was. 

Medicine is all about lifelong learning, so we never just learn during our training years and stop there because we’ll never be updated and patients would not want that either.

It’s part of the lifelong learning process to reflect on our own gaps and to make sure we make efforts to close those gaps. And so when I recognize that in real world practice, unlike what I see in textbooks, or what I thought based on my training my patients would be – that’s when I sought out additional clinical training. 

I would speak to dermatologists who have had patients and take care of patients who have skin of colour. I myself have a large ethnic base patient population. So it made me reach out, for instance, to dermatologists and plastic surgeons in the far East, in Asia, to learn how they approach caring for their patients. So that I can take that knowledge back and through experience and application of that knowledge, I was able to build competency around treating skin of colour in North America.

So for someone who thinks they do not have adequate training on a diverse amount of skin tones, where would you suggest they look for that extra training?

Training can be as simple as taking the effort to look at the literature, or for instance, through the Canadian Dermatology Association with the skin diversity series, to take the time to attend. The recordings are available to our membership, so even if they didn’t have time to listen to it live, they can go back and listen to it afterwards. But those are things that are accessible, easily accessible, they don’t necessarily cost time and money to be able to learn from and that’s something that could be done right in the comfort of our own homes.

Then beyond that, there are societies such as in the U.S., such as the Skin of Colour Society. There are many conferences around the world that have a more global focus and even recently, I just came back from attending a conference in Boston where there were many sessions that focused on managing and treating skin of colour patients.

So beyond learning at home, there are many ways in which we can seek out learning about skin of color and the care of their skin. There are different dermatologists around the world who have a larger focus on skin of colour patients. And it’s always good to tap into that knowledge because they can provide a lot of real world life experiences with treating this demographic. So pursuing a preceptorship or spending a week or two working in their offices, will help build that confidence and that knowledge in treating skin of colour patients.

So for people who are looking for a dermatologist trained in their own skin tone, what would you suggest the client look for when seeking a dermatologist?

First of all, I think it’s important that if someone has skin needs, to make sure they speak to a Canadian Dermatology Association certified, or a board-certified dermatologist. A dermatologist is legitimately with our training and credentials, a skincare specialist. So we’ve gone through many years of training that’s focused on the skin. And I think first and foremost, that is a minimum criteria. 

Second of all, with social media being so popular these days, many of our colleagues have a presence and a profile online. So if patients who are skin of colour, wish to see a dermatologist who’s board certified that also has that research or practice focus in skin of colour. Then looking for that profile online or on Instagram, could also help patients select their dermatologist.

Finally, most importantly, is to have a conversation. So go for that consultation, if it’s a medical or a cosmetic concern, the first step is always that consultation because that dermatologist can identify management strategies. And if they don’t have the management strategies, they can provide different resources or refer to other colleagues that can support and provide the needed care. These are all different ways in which patients can seek out, ultimately, someone that would understand their skin care needs and be able to manage it appropriately.

And where do you think things are going in the future of dermatology?

I think we are living in a really promising and exciting time. I am thrilled over the last several years, especially to see a lot of that dialogue being continued and sustained for managing skin of colour patients. There are initiatives such as the one organized by the Canadian Dermatology Association, along with partnership from industry such as Johnson and Johnson in this case, to increase that knowledge and that awareness amongst our colleagues.

I am excited to see in conferences that there are more sessions, for instance, looking into this area to help our colleagues gain that knowledge as well. In the scientific literature, there are an increasing number of publications that look at the diagnosis, the management–whether it’s for cosmetic or medical reasons–of concerns for those who are skin of colour.

So we’re adding to that pool of knowledge and that collective clinical experiences in treating these patients. But I think we’re at a really important time point because finally when there has been that gap, we’re finally acknowledging that there’s a gap, and working to close it. 

I think the next important step is to make sure the conversations and dialogue and the efforts are sustained. So it should never be the flavour of the month. As I said, the population is so diverse. There are different patients, with different needs, of all different skin types and all different skin tones, and we need to make sure this focus is not a flavour of the month. This is not just because it’s now the hottest thing to talk about, but because it’s the right thing to talk about.

These conversations and information exchanges and self-reflection that improve our ability to provide care for our patients must continue. And it has to be sustained because we are seeing changes in the demographics of the general population, and we need to be able, as doctors first and foremost, to respond to that.

Editor’s Note: This interview has been edited for length and clarity

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