January 2021: Skin of color images

According to the Centers for Disease Control and Prevention COVID Data Tracker, 52% of all US coronavirus disease 2019 (COVID-19) cases had reported racial demographic data. Of these, 46.2% of all COVID-19 cases and 37.1% of all COVID-19–related deaths were in black or Hispanic patients.¹ As of July 2016, blacks represented 13.4% and Hispanics represented 18.5% of the US population.² The reasons why minority populations are disproportionally affected by COVID-19 are complex, with disparities in health care representing one major facet.

In 2019, Lester et al³ eloquently illustrated the disparities and subsequent effects in recognizing diseases in skin of color. They pointed out the lack of representation of images of skin of color in major textbooks and teaching sets and proposed a proactive approach to photographing and publishing more images of diseases in patients with darker skin types. Earlier this year, Lester et al⁴ searched 36 publications with 130 photographs of COVID-19–related skin findings. Of these published photographs, 92% (120 of 130) were of skin types I to III, only 6% (7 of 130) were of skin type IV, and none were of skin types V to VI.

In the September edition of JAAD Case Reports, Daneshjou et al⁵ attempted to narrow this practice gap by presenting a case series documenting 15 images of pernio-like eruptions in 7 persons with Fitzpatrick III to V skin. They pointed out that red and pink hues are more difficult to appreciate in darker skin types, potentially delaying a diagnosis.⁵ The clinical importance of this article and the practice gap highlighted by Lester et al⁵ have prompted JAAD Case Reports to develop a skin of color collection. In an attempt to narrow this gap, the collection will provide an ongoing repository of case reports and images in darker skin types.