You have full access to this article through your organization.
Dermatology is a deep optical specialization. Diagnosis is rooted in color and pattern monitoring. However, although we rely on these visual signals, dermatologists lack the ability – and vocabulary – to describe one of the most human features: skin color. Instead, we relied on agents such as sweat, race and raw skin classification scheme. These frameworks are dangerous and dangerous. It is the procrastination of differences, real shareholders in the disease, and ultimately affects the provision of care.
Sweat and race are social structures, not rooted in biological reality. However, these categories are routinely included in clinical and integrated experiences in care instructions. This leads to a poor interpretation of data and failure to identify factors that contribute to the disease – not only to skin diseases, but also in other areas. For example, sweat -based corrections in algorithms that estimate kidney health lead,1.
Nature expectations: skin
In skin diseases, the issue is more frequent. The skin color, which is often seen as a physical embodiment of sweat, is creative with the same sweat – although pigmentation varies greatly in ethnic groups. These ideas can affect clinical decisions. One study found that medical trainees who recognized false beliefs about biological differences between ethnic groups were more likely to give up pain in black compared to white people, which leads to insufficient management of pain for black patients2.
The FST (FST) is not designed – which is often described as the golden standard for skin classification – to measure pigmentation. It has been developed to estimate the sensitivity of UV light in white people with psoriasis, and has evolved into an agent of skin colors in research and clinical care. Her wide appeal lies in its simplicity and pain. FST depends on a person’s evaluation about whether his skin burns or tan after exposure to sunlight. However, studies have repeatedly showed that they are defective: it has a bad reliability between the back, the narrow purpose and fails to represent the spectrum of dark skin tones sufficiently3. In practice, it is often misused as a substitute not only for pigmentation, but also for sweat and sweat.
The Monk Skin-LOTE scale is trying to process these gaps by offering an expand4. However, it is short because it is still associated with the tight references and lacks clinical benefit. It is the beginning, but not a solution.
We know that the degree of pigmentation in the skin of a person is clinically related: it affects the risk of skin cancer, vitamin-D deficiency and pigmentation disorders. It also affects the accuracy of the diagnosis due to the differences in the clinical show through various skin tones. But we lack the language to describe the skin color accurately require it. In research and practice, we resort to mysterious descriptions such as “light” or “darkness” that means little on the seat or beside the bed. This terminology gap weakens research cloning and weakens personal treatment.
As artificial intelligence and machine learning enter the clinic, the risks become higher. When the data sets that teach these techniques are non -representative, we risk the inclusion of bias in tools that aim to equal the field5.
Dermatologists understand the shortcomings in the current situation and the inspection of reform. So we are in a unique position to lead change. But moving forward will require more than criticism-it requires collective efforts to develop skin classification tools that provide scientific accuracy, and the courage to reassess the use of sweat in research and skin practice.
More nature expectations
This shift will need time, continuous financing and cooperation across multiple sectors. If academic institutions and professional societies join the development of classification systems, they will provide a strict basis for their use. Organizational agencies will need to create instructions to implement them and ensure a fixed application through studies. Scientific magazines will need to promote careful and transparent reporting of sweat and skin color. Partnerships with community groups will be extremely important to support continuous awareness efforts, build public confidence and understanding about these initiatives.
What should replace the current patching system? Imagine a non -hierarchical pigmentation system free from ethnic signals and is based on objective measurement, and perhaps using techniques such as reflection. This system will be strictly verified through the population and is designed to predict a clinical meaningful consequence, such as the possibility of post -inflammatory pigmentation, the risk of developing skin cancer and the therapeutic response pattern. It can have a simplified clinical shape and a more detailed research version. More importantly, biology, not social identity, will reflect.
Continuing to rely on inaccurate structures, undermining the essence of our field. Getting the correct skin tone is not just an academic exercise – it is a scientific and laritan necessity. Critical skin pigmentation, which is biologically related and it is extremely important to leave guessing.
Competitive interests
VH works as a consultant for Abbvie, Bristol Myers Squibb, Janssen, Johnson & Johnson, L’oréal, Cereve Honorara; It works as a consultant member of the Board of Directors at Skinceuticals, and receives honor.