This blog post was written by second-year Dalhousie Medical School students Kate McKesey and Eshan Arora, with editing by Dr. David Haase, Dr. Rylee Oosterhuis, and Jenelle Gowie (Co-president of the Black Medical Students’ Association) & Eva-Brenda Bandyayera (Co-president of the Black Medical Students’ Association).

When a new skin change appears, it’s natural to want answers quickly. You may turn to Google or AI-based online tools to understand what’s going on. While these tools can be helpful, they have important limitations, especially for people with darker skin tones.

Most medical information available online is based on research, textbooks and image databases that have historically focused on lighter skin. For example, many skin conditions are still described and illustrated using redness as the main sign of inflammation. On darker skin, inflammation often looks different and may appear purple, dark brown, grey or just swollen instead of red.

Google and AI tools rely on the information they are trained on. When darker skin tones aren’t used in the training data, these tools may struggle to recognize how conditions appear on darker skin. This can lead you to think that nothing is wrong, which might delay you seeking medical attention and allow your symptoms to progress. Your situation may also worsen when you seek medical attention and have a long wait to see a healthcare provider.

In addition, there are gaps in how skin conditions are taught, studied and displayed to medical learners. Few clinicians receive training on how dermatologic conditions affect darker skin. These gaps can delay proper diagnosis and treatment, resulting in further worsening of skin issues for people with darker skin.

Below are examples of how common conditions may appear on darker skin:

Eczema
Eczema on darker skin often does not appear red. Instead, flare-ups may look dark brown, purple or grey and the skin may feel thick, rough or leathery, especially in areas that are frequently scratched. After healing, it’s common for the skin to remain darker or lighter than before for weeks to months.

Acne
Acne may appear dark brown or purple rather than red. After pimples heal, post-inflammatory hyperpigmentation, a process that leaves dark marks on the skin after healing, is common. Additionally, some bumps may feel deeper or more painful, and scarring can become raised or thick if inflammation persists. However, this is not limited to darker skin tones.

Psoriasis
Psoriasis patches on darker skin may appear dark brown, purple or grey with thick scales or white/silvery flakes on top. The borders are often well defined. Even after improvement, changes in skin colour may persist and do not necessarily indicate that the condition is still active.

Melanoma
In people with darker skin, melanoma is more likely to appear on the palms of the hands, soles of the feet or under the nails, rather than on sun-exposed areas. Under a nail, it may look like a dark stripe or stain, especially if pigment spreads onto the surrounding skin.

Although melanoma is less common in darker skin tones, it is often diagnosed later, making early detection especially important.

When to seek medical care
Skin changes are common, but some changes should prompt urgent medical assessment.

See a healthcare provider quickly if a skin change:

• lasts longer than one to two weeks without improvement
• is painful, very itchy, bleeding or rapidly changing
• becomes swollen, warm or oozing
• changes in size, shape or colour, especially on the hands, feet or nails
• is associated with fever or feeling unwell

If you do not have a family doctor, your options may include walk-in clinics, virtual care services, community health centres or calling 811. The Nova Scotia Brotherhood and Sisterhood clinics are also available and provide healthcare services for Black Nova Scotians. A healthcare provider can help determine whether you need a dermatology referral and how urgently you should be seen.

Practical steps while waiting for care
Take clear photos over time to track any changes in your skin. Note things that make it better or worse, and if you start taking any new medications or skincare products. These steps can help healthcare providers understand progression and reduce delays.

Providing this information can help you get the care you need faster and, in some cases, allow healthcare providers to seek specialist input through virtual consultation pathways.

Helpful resources

• American Academy of Dermatology. Skin Conditions on Darker Skin
• Nova Scotia Brotherhood Program
• Nova Scotia Sisterhood Program
• Health Association of African Canadians
• Black Lives Living Well

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