Decreasing Health Disparities among Patients with Darkly Pigmented Skin by Utilizing Social Media

Many textbooks and medical websites continue to lack representation for identification of skin disorders and pressure ulcers in darkly pigmented skin only giving brief descriptions regarding the differences in presentation.1, The role of clinicians and their assessment of the cardinal signs of inflammation in the skin is imperative especially for those with darker pigmentation.1 The rate of pressure injuries in darkly pigmented skin is 1.5 x higher than their Caucasian counterparts in long term care facilities.1 Pressure injuries tend to be identified at later stages in African Americans.2 We have a clinical obligation to recognize these differences during examination of the integumentary system.3
Clinicians would benefit from educational materials that provide visual representation of erythema, blanching, subepidermal moisture, skin dryness, and changes in persons with darker pigmented skin.3,4,5 Providing photographic resources can prepare them for the skin variations observed in the clinic. Currently only 15% of the photos on a national pressure injury prevention website are of darkly pigmented skin.6
Utilizing additional patient created social media resources, including sites such as the Brown Skin Matters page on Instagram, may be helpful to increase awareness of integumentary differences.7 This site documents dermatological conditions, including eczema and other rashes, in non-white skin to address the disparity in current resources. The use of social media to improve early recognition of pressure injuries in darkly pigmented skin could further clinicians understanding and develop a framework to identify dermatological disparities. Without furthering our knowledge regarding these integumentary differences, we risk missing key diagnoses. The need for multiple resources to educate students and clinicians on recognition of skin conditions in dark skin is imperative to improve health outcomes for patients.

Trademarked Items (if applicable):

References (if applicable): 1. Myers BA. Pressure Injuries. Wound Management: Principles and Practices, 4th ed. Hoboken, NJ: Pearson; 2020:319.
2. Clark M. Skin assessment in dark pigmented skin: a challenge in pressure ulcer prevention. Nursing Times. https://www.nursingtimes.net/clinical-archive/dermatology/skin-assessme…. Published August 2, 2019. Accessed November 21, 2019.
3. Bates-Jensen BM, McCreath HE, Pongquan V. Subepidermal moisture is associated with early pressure ulcer damage in nursing home residents with dark skin tones: pilot findings. J WOCN. 2009; 36(3):277-284.
4. Diridollou S, deRegal J, Querleux B, Leroy F, Holloway V. Comparative study of the hydration of the stratum corneum between four ethnic groups: influence of age. Int J of Dermatol. 2007; 46(1):11-14.
5. Suurmond J, Dokter J, Van Loey N, Essink-Bot ML. Issues to address in burn care for ethnic minority children: a qualitative study of the experiences of health care staff. Burns 2012; 38: 730-737.
6. PI Photos: National Pressure Ulcer Advisory Panel. PI Photos | National Pressure Ulcer Advisory Panel. https://npiap.com/page/Photos. Accessed November 21, 2019.
7. Brown Skin Matters (@brownskinmatters) • Instagram photos and videos. Instagram. https://www.instagram.com/brownskinmatters/. Accessed November 21, 2019.