Eczema, acne and psoriasis in skin of colour: a qualitative UK-based study

Eliza Juno Hutchison; Roxanne Parslow; Hannah Wainman; Matthew J. Ridd

doi:10.3399/BJGP.2025.0720

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Beyond the surface: Representation in dermatology
Gabriel Sherliker

Published on: 27 April 2026

Published on: (27 April 2026)
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Beyond the surface: Representation in dermatology
Gabriel Sherliker, General Practitioner, The Friarsgate Practice, Winchester
I read the study exploring the experiences of eczema, acne and psoriasis in people with skin of colour with great interest.¹ The identified themes such as delayed diagnosis, dyspigmentation, cultural misunderstanding, and structural inequities provide an important and patient-centred perspective on dermatological care.

The finding of delayed or missed diagnosis is striking. Dermatology relies heavily on pattern recognition, yet this is largely informed by images and teaching derived from lighter skin tones. When inflammation presents not as erythema but as violaceous, grey, or hyperpigmented change, diagnostic uncertainty can arise. This reflects not the rarity of the disease, but a gap in representation within medical literature with direct consequences for timely, accurate care. This suggests recognition of diverse skin presentations should be a core focus of GP training.

Regarding dyspigmentation, there can be a tendency to prioritise control of inflammation, with the expectation that pigmentary change is secondary and will resolve over time. This may not align with patient priorities. For many, dyspigmentation represents a primary concern with significant psychosocial impacts. It is valuable learning that acknowledging this explicitly within consultations through validation and explanation may represent a simple but meaningful shift in care.

The authors’ findings resonate with recent powerful examples of inequity in dermatologic...
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I read the study exploring the experiences of eczema, acne and psoriasis in people with skin of colour with great interest.¹ The identified themes such as delayed diagnosis, dyspigmentation, cultural misunderstanding, and structural inequities provide an important and patient-centred perspective on dermatological care.

The finding of delayed or missed diagnosis is striking. Dermatology relies heavily on pattern recognition, yet this is largely informed by images and teaching derived from lighter skin tones. When inflammation presents not as erythema but as violaceous, grey, or hyperpigmented change, diagnostic uncertainty can arise. This reflects not the rarity of the disease, but a gap in representation within medical literature with direct consequences for timely, accurate care. This suggests recognition of diverse skin presentations should be a core focus of GP training.

Regarding dyspigmentation, there can be a tendency to prioritise control of inflammation, with the expectation that pigmentary change is secondary and will resolve over time. This may not align with patient priorities. For many, dyspigmentation represents a primary concern with significant psychosocial impacts. It is valuable learning that acknowledging this explicitly within consultations through validation and explanation may represent a simple but meaningful shift in care.

The authors’ findings resonate with recent powerful examples of inequity in dermatological representation. During the COVID-19 pandemic for example, images of cutaneous manifestations of COVID-19 in darker skin were notably scarce. Lester et al. reported that 92% of published images in their review were of Fitzpatrick types I–III skin, only 6% were type IV and 0% were types V–VI.² This is a stark observation which suggests the findings described could be extrapolated beyond eczema, acne, and psoriasis.

The study highlights that the challenge extends beyond knowledge gaps to one of perspective and collective mindset. Continued attention to this under-researched area is needed. The study further reminds us that equity in dermatology is not solely about access to treatment, but about recognition of how disease presents, how it is experienced, and how patients are seen within the consultation. Approaching each patient with this awareness is an important step towards more equitable and effective care.

References

1. Hutchison EJ, Parslow R, Wainman H, Ridd MJ. Eczema, acne and psoriasis in skin of colour: a qualitative UK-based study. Br J Gen Pract. 2026; DOI:10.3399/BJGP.2025.0720
2. Lester JC, Jia JL, Zhang L, Okoye GA, Linos E. Absence of images of skin of colour in publications of COVID-19 skin manifestations. Br J Dermatol. 2020;183:593–595. doi:10.1111/bjd.19258
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Competing Interests: None declared.