Dec 7, 2020
Reviewing how we describe skin symptoms – what the BAD is doing
For a wider statement on the the British Association of Dermatologists’ commitment to minority ethnic group inclusivity please click here. The workstream described in this statement is just one strand of a broader effort to improve representation of skin of colour in educational resources and patient materials.
Describing rashes accurately is critical for making the correct diagnosis. In dermatology, the words used to describe rashes and lesions (meaning areas of skin affected by a skin disease) originated in Western Europe in the 18th century, at a time when dermatology was being established as a distinct medical specialty. Given the historical origins of dermatology, the descriptors that are currently routinely used for rashes/lesions are biased, catering mostly to people of European ancestry, with lighter skin tones (Reference 1). This presents significant challenges and limitations when these descriptors are used universally, applying to people from diverse geographic ancestral backgrounds, with a wide spectrum of skin tones. This spectrum of skin tones is far broader than currently recognised by commonly used classification systems.
For example, certain rashes/lesions are described as being ‘erythematous’ in colour. This refers to a symptom called ‘erythema’* (from the Greek for ‘red’), which is a change in colour of an area of skin, caused by increased blood flow in certain capillaries. Symptoms may even be described as ‘salmon-coloured’, for example, in psoriasis. Such descriptors are of limited usefulness when applied to individuals with darker skin tones, in whom redness may not be so easily appreciated or for whom colour may take on a different appearance.
It is therefore vital that the language used for describing skin rashes/lesions in dermatology is updated, to be inclusive and reflective of the UK’s ethnic diversity.
The British Association of Dermatologists (BAD) has assembled an international group of dermatologists, with extensive experience in treating people with darker skin tones (including Dr Ophelia E. Dadzie (UK), Prof Ncoza Dlova (South Africa) and Dr Antoine Petit (France)) to tackle this issue, with a view to updating current skin descriptors used in dermatology, with new descriptors that are applicable to all ethnicities. The findings of this expert group will be incorporated into all the resources produced by the BAD, from our patient leaflets to our academic journals, as well as being made available to other organisations, such as the NHS.
*Our full statement on erythema can be read here
Nast A, Griffiths CEM, Hay R, Sterry W, Bolognia JL. The 2016 International League of Dermatological Societies’ revised glossary for the description of cutaneous lesions. Br J Dermatol 2016; 174(6): 1351-8