Darker Skin Absent from Medical Texts

According to a recent paper, people with black and brown skin tones are underrepresented in medical textbooks that teach doctors on how to recognize skin disease. The shortfall in darker skin representation could contribute to racial disparities in diagnosis and treatment. The research was conducted via the use of machine learning and AI.

Darker Skin Segmentation
Darker Skin Segmentation and Pixels. Source: Tadesse, G.A., Cintas, C., Varshney, K.R. et al. Skin Tone Analysis for Representation in Educational Materials (STAR-ED) using Machine Learning.

Skin Tone Analysis for Representation in Educational Materials

The original paper was published in August 2023 and included reserchers from the US and Kenya. It is titled: “Skin Tone Analysis for Representation in Educational Materials (STAR-ED) using machine learning”. They analyzed skin-related pixels and non-skin related pixels and made comparisons using the Jaccard index. STAR-ED works on a wide range of file formats, including pdf, png, jpeg, pptx and docx.

One of the lead authors is Dr. Roxana Daneshjou, a dermatologist and biomedical data scientist from Stanford University. In her words:

Unfairness in the teaching materials equates to unfairness in society.

There’s lots of news out there of bias in AI models, but in this case we’ve trained an AI model that detects human bias.

STAR-ED is open source. Both the code and dataset are available for download via GitHub.

Underrepresentation of Darker Skin Tones

The research team trained STAR-ED on thousands of images in medical textbooks, lecture notes, presentation slides, and journal articles. They found that only one in ten images throughout these materials is in the black-brown range on the Fitzpatrick Scale used to evaluate skin tone.

The researchers envision this unique STAR-ED technology to be used as a tool for dermatology educators and publishers. It will help assess educational materials and automatically identify and significant lack of diverse skin tone representation.

Besides the technology’s use for various cosmetic concerns, there is an even bigger issue at play. At present, the diagnosis of life threatening conditions such as skin cancer (melanoma and squamous cell carcinoma) is often delayed in patients of color, leading to increased mortality rates.

Some dermatologists are taking the matter into their own hands. Dr. Jenna Lester started the Skin of Color Program at the University of California, San Francisco in 2018. She wanted to train dermatology residents in treating skin of color. Skin conditions such as eczema, psoriasis, inflammation, acne and hyperpigmentation show up differently in people of different colors and ethnicities.

Laser Types for Dark Skin Tones

Laser treatments for dark skin tones require careful consideration, as individuals with more melanin are at a higher risk of complications such as hyperpigmentation and scarring. Traditional laser types and therapies were initially designed for lighter skin tones. These lasers can absorb too much melanin from darker skin, leading to adverse effects.

However, advancements in technology have introduced laser treatments specifically designed for individuals with darker skin tones. In this post I discuss some of the best laser types for dark skin.

Laser Types for Hair Removal
Laser types for hair removal. Source: StatPearls Publishing. Vaidya et al. 2023.

Laser Types for Darker Skin Tones

  1. Nd:YAG Lasers:
    • How it works: Nd:YAG lasers use a neodymium-doped yttrium aluminum garnet crystal as the laser medium. They emit light with a longer wavelength of 1064 nanometers, which allows for deeper penetration into the skin without significant absorption by melanin in the epidermis.
    • Suitability: Nd:YAG lasers are particularly suitable for individuals with darker skin tones because the longer wavelength minimizes the risk of hyperpigmentation and other adverse effects. Makse sure to see my list of ND:YAG laser brands.
    • Uses: Common applications include hair removal, treatment of vascular lesions (such as spider veins), and skin rejuvenation. This laser is versatile and widely used in dermatology.
  2. Diode Lasers:
    • How it works: Diode lasers use semiconductor technology to generate a coherent beam of light with a wavelength typically ranging from 800 to 810 nanometers. This wavelength is effective for targeting melanin in hair follicles while minimizing impact on surrounding skin.
    • Suitability: Diode lasers are considered safe for individuals with various skin tones, including darker skin. One can also use blend diodes these days, although only on skin types III-IV on the Fitzpatrick scale and nothing higher.
    • Uses: Diode lasers are popular for hair removal on all skin types. They are also used for skin rejuvenation, with applications such as reducing pigmented lesions and improving overall skin texture.
  3. Fractional Laser Therapy:
    • How it works: Fractional lasers create microthermal zones in the skin, leaving areas of untreated skin between them. This promotes faster healing and reduces the risk of complications.
    • Suitability: Fractional lasers, especially those with longer wavelengths, are considered safe for dark skin tones. They provide an effective solution for addressing various skin concerns while minimizing the risk of hyperpigmentation.
    • Uses: Fractional lasers are employed for treating acne scars, fine lines, wrinkles, and overall skin texture improvement. They can be ablative or non-ablative, depending on the specific skin concern and the depth of treatment required.
  4. Erbium YAG Lasers:
    • How it works: Erbium YAG lasers use a crystal medium that produces light at a wavelength of around 2940 nanometers. They are often used for ablative skin resurfacing.
    • Suitability: Erbium YAG lasers are considered safer for dark skin compared to some other ablative lasers, as they have a shorter wavelength that is less likely to be absorbed by melanin.
    • Uses: Skin resurfacing with Erbium YAG lasers can address concerns such as scars, fine lines, and wrinkles. The controlled removal of outer skin layers stimulates collagen production and rejuvenates the skin.

Note that Alexandrite lasers should not be used on people with darker skin. Intense Pulsed Light (IPL) products are also usually not suitable for people with darker skin. However, several IPL products can be used for at-home body hair removal in people with skin types III and IV. Moreover, the Me Sleek IPL and RF hair reduction device is suitable for all skin types.

When considering laser treatments for dark skin tones, it is essential to emphasize the importance of an individualized approach. Factors such as the patient’s specific skin type, the condition being treated, and the expertise of the practitioner play significant roles in ensuring both safety and efficacy.

Always consult with a qualified dermatologist or laser specialist who has experience working with diverse skin types to determine the most appropriate treatment plan for your specific needs. Additionally, adherence to pre- and post-treatment care instructions is crucial for minimizing potential side effects and optimizing results.

Dark Skinned People Warned to take Precautions with Laser Hair Removal

Since I started this site, I have written several articles about the most suitable lasers for hair removal in people with dark skin. A new article from ABC warns about the dangers of laser hair removal in people with darker skin. One has to exercise the utmost caution before proceeding with such a treatment if you have highly pigmented skin.

Laser Hair Removal Dark Skin
Laser hair removal in darker skinned people can be dangerous if the incorrect laser is utilized.

Dark Skinned People Urged to Take Precautions with Laser Hair Removal

In the new ABC article, it is emphasized that not all hair removal lasers are suitable for use in people with darker skin. On Nightline, they interviewed Eshanka Jayasinghe, a darker skinned South Asian origin woman who got major scarring and sun sensitivity after her laser hair removal procedures.

With the laser hair removal industry booming, an ever increasing number of clinics are treating people of color without suitable equipment or relevant experience.

It’s estimated about a million people get laser hair removal annually, and the industry rakes in around $300 million a year, according to the American Society of Plastic Surgeons.

According to board-certified dermatologist Dr. Jeanine Downie, laser hair removal machines are strong and can cause permanent skin damage and scarring when in the wrong person’s hands. High demand for this procedure has resulted in clinicians who do not have proper training or medical knowledge about the risks to darker skin.

In general, Nd:Yag lasers are the most suitable in removing hair from people with skin types 4-6 on the Fitzpatrick scale. However, there are also other machines nowadays that combine several different wavelengths into one handpiece.

It should also be noted that not all dark skin is the same. People with African skin tones require a different treatment strategy in comparison to people with East Indian skin. See my post on laser hair removal in Indian skin.

If you do not take precautions, the use of an inappropriate laser for darker skin types can even cause potentially permanent burns on your skin. Make sure to go to a clinic that has significant experience in treating people of your skin type and ethnicity. And they need to show you a range of before and after photos of their past darker skinned patients.

Also of major importance, do not undergo any kind of laser procedure if you have had significant recent sun exposure. And if you have grey or white body hair, the laser will not succeed in eliminating the follicles.