Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Editorial
88 (
5
); 583-585
doi:
10.25259/IJDVL_750_2022
pmid:

Skin of Colour: The IJDVL View

Editor-in-Chief, Indian Journal of Dermatology, Venereology & Leprology, Kolkata, India
Consultant dermatologist, Kolkata, India

Corresponding author: Dr. Saumya Panda, Consultant Dermatologist, Belle Vue Clinic, Kolkata, 700028, West Bengal, India, ijdvleditor@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Panda S, Bandyopadhyay D. Skin of Colour: The IJDVL View. Indian J Dermatol Venereol Leprol 2022;88:583-5.

In this issue we have three articles which have ‘skin of colour’ as their direct context: one is a letter titled ‘Evaluating skin colour representation in the Indian Journal of Dermatology, Venereology and Leprology’ by a group of authors based in the West;1 another is a ‘history of hydroquinone’ providing a background of the rise of colourism as an ideology concomitant to the rise of the multibillion dollar skin whitening market;2 and, the last one, a touching poem, ‘The Mirror’ by Feroze Kaliyadan, one of our Associate Editors, depicting the irony of onset of patches of vitiligo on the skin of a dark-hued girl who has been longing for all her life to lighten her colour.3

The authors of the letter make a recommendation to the IJDVL for standardising ‘presenting patients with Fitzpatrick’s skin type and using the keyword “skin of colour” when applicable.’1 This gives us an opportunity to clarify the IJDVL policy regarding these and related issues.

IJDVL, over the years, has positioned itself as a reliable medium for transmission of dermatological knowledge by contributors from all over the world, particularly from countries or regions which are primarily non-English speaking. The countries that have contributed the highest number of papers in this journal during the last three years include China, Spain, South Korea, Taiwan, Egypt, Italy and Turkey, apart from India.4 Other than being non-English speaking, the population in most of these countries, incidentally, have skins that are colour-rich. It is but natural that most of the articles published in IJDVL would represent conditions relevant to such skin.

That being the case, why have we not made it a mandatory practice for the authors: a) to provide Fitzpatrick skin types of the patients included in their studies or reports, and b) to include the phrase ‘skin of colour’ in the titles or keywords whenever a study or a report deals with the segment of the population having such skin, or in other words, a very large proportion of studies or reports that is published in IJDVL? After all, incorporation of such a practice in our editorial policy could lead to a windfall for the Journal Impact Factor! These are important issues which, we realize, we have to clarify to our readers and contributors.

IJDVL is a scientific journal engaged in dissemination of scientific knowledge in the fields of dermatology, venereology and leprology. Being in the business of generating scientific data, we define science as the act of asking specific, testable questions and answering those. Going by this definition, we need to answer whether, by not applying the two points mentioned above in our instructions to the authors in a blanket fashion, we are exposing ourselves to the risk of missing significant scientific data in our publications, or we are doing to the scientific world a service by eliminating some noise and spin from published data.

Regarding presentation of data by means of Fitzpatrick’s skin types, we submit that we view the widely prevalent practice of using these types as surrogates for degree of constitutive skin colour to be inaccurate, erroneous even. In fact, Fitzpatrick saw the need of typing skin because of differential reactivity to light in different ‘white’ populations, for accurate dosing of ultraviolet A in oral photochemotherapy in patients with psoriasis.5 Originally, there were four skin types, all of whom characterized by Fitzpatrick as white. Later on, somewhat as an afterthought, two more skin types were added to encompass the brown and black-skinned populations as well.6 Skin type V was added for individuals with brown skin of Asian and Latin American origin, and skin type VI for dark skin of African extraction. Skin types I–IV are thus based on clinical response to sunlight, whereas classification into types V–VI is based on constitutive pigmentation or ethnic origin. Other than exposing the methodological error of mixing phototypes and constitutive skin colour phenotypes in the same typing system, the original Fitzpatrick papers (including one editorial in which the state of the art of skin typing was enunciated in great detail7) lay bare the inbuilt arbitrariness of the typing system where a single type was considered enough for the brown and black skins, respectively, when the white-skinned population needed to be subdivided into four phototypes. Fitzpatrick himself reckoned with the possibility that his skin typing might be misused in future as shorthand for skin colour, and thus, ethnicity, or the non-biological categorisation of race, and had warned against the same.7 In this background, it is our position that the continued usage of Fitzpatrick’s skin types in dermatological literature simply as basic skin phenotypes is, strictly speaking, not scientific, without submitting the subject populations in such studies through the rigours of immediate and delayed sun reactivity responses. We consider the same as bad practice and symptomatic of wrong methodology.

Now, let us come to the term ‘skin of colour’. In our view, the phrase is etymologically incomplete and unsatisfactory, as it immediately raises the question: ‘Which colour’? Every human being, except albinos, are endowed with ‘some’ colour. As we know, however, ‘skin of colour’ is an omnibus category that lumps all colours of skin, except white - yellow, red, brown, black - together. And, therein lies a problem. However much the proponents of this phrase would protest, it does nothing but reinforce the category of ‘others’ vis-à-vis white skin. In our view, that promotes nothing but a racial categorisation, as opposed to anything related to science.

Also, what purpose does it serve? Should a yellow-skinned individual have the same degree of concern regarding cosmetic disability caused by vitiliginous patches on exposed areas compared to someone with a deep brown or black skin? Or, do we really need to treat acne differently depending on someone’s skin colour? As the authors batting for ‘skin of colour’ point out: “Several conditions, such as acne keloidalis nuchae and pseudofolliculitis barbae, are more common in darker skin types.”1 We agree. We might also venture to add that we have noticed that out of hundreds of dermatoses, western authors always mention these two hugely important global public health disasters while underscoring the relevance of the phrase. As a counterpoint, may we also point out that there are variables in the epidemiology of skin diseases that are frequently more important than skin colour? These may be in the forms of cultural/religious practices, food habits, occupation, sexual orientation, et cetera et cetera. Will we not be amiss if we fail to mention these too in the titles of all our future articles? Here is an example of how an article title may sound if we apply this logic in its entirety: “Lichen planus in Hindu, vegetarian, heterosexual, skin of colour young men of eastern India”.

Scientifically speaking, the category ‘skin of colour’ promotes unnecessary and inefficient aggregation that might pose problematic in quantitative analysis as it encompasses a hugely heterogeneous segment of population, likely to have wholly divergent health concerns regarding their skin. However, from the standpoint of ‘race’, it does a very efficient job in separating the ‘others’ from the ‘white’. IJDVL has no doubts whatsoever which side it should stand here – science or race.

So, is IJDVL a ‘colour blind’ journal then? Nothing can be farther from truth. We hold that the pigmentation of every individual is an integral component of their skin. We find it unnecessary either to downplay or to overstate it. As Bill Bryson quotes the surgeon Ben Ollivere in his book: “That is where all your skin color is … a sliver of epidermis.”8

Other than providing pigmentation, the melanocyte-keratinocyte complex of epidermis has certain biological functions. There has been a modicum of evidence that suggests that heavily pigmented skin biologically differs in its response to a variety of inflammatory stimuli compared to less pigmented skin, though this claim remains controversial.9 Individuals with light skin form more pre-vitamin D3 from a given amount of ultraviolet B than do individuals with darker skin.10 The current evolutionary hypothesis for skin colour diversity is that a compromise may exist between the requirements for photoprotection on one hand and vitamin D3 synthesis, on the other.11 Dark skin would have a biological advantage under high ultraviolet radiation to protect from UV-induced sunburn, skin cancer and immune suppression, while light skin would have a biological advantage in regions far from the equator exposed to lower levels of UV radiation where UVB corresponds to the effective wavelengths for transformation of 7-dehydrocholesterol to vitamin D3 in the skin, and results in multiple effects on health, ranging from bone metabolism, innate immune response and cell proliferation.12 Thus, the lower incidence of nonmelanoma skin cancer and malignant melanoma in exposed darker skin compared to that in poorly coloured skin. So, stating the basic or facultative skin colour of individuals or groups while describing diseases or attributes of the skin keeping the above background in mind is entirely justified. Our humble submission is that the phrase ‘skin of colour’ is very much inadequate for such a description, as it sacrifices the power of scientific accuracy at the altar of political ‘correctness’.

Our understanding of human skin colour is that it is a continuous spectrum comprising white, yellow, brown and black, where the borders mingle with each other rather than being rigid partitions. Thus, any typing based on human skin colour is bound to be somewhat arbitrary and artificial.13 This is because, over a fairly long natural history, dark and light skin have been adaptations to environments of high and low ultraviolet light exposure, respectively, among members of the species Homo sapiens, who share a common ancestry.14

It is another common pitfall in our scientific literature to identify the phrase ‘skin of colour’ with people of fixed ethnicity or ancestry from a common geographical origin. Fitzpatrick cautioned against such oversimplification long back when he said: “Some Indians in southern Asia who are Caucasian have black skin, and there are blacks in North America who have light brown skin.”7 Ironically, it was the methodological laxity or incompleteness of Fitzpatrick’s skin typing system that made the confusion worse confounded by mixing up phototyping and skin colour phenotyping, rendering the part of the classification based on ethnic origin particularly irrelevant for non-white skin types, as well as for multi-ethnic populations.15 The artificiality of mechanical skin colour classification gets more pronounced in the description of the borderline types in the literature. While Fitzpatrick himself classified type IV skin as being white, a recent review mentions types IV-VI as being skin of colour and types I-III as being of light skin tones.16 The application of such typing in genetic melting pots such as India is unreliably heterogeneous. A recent typing study, done in North India, that modified the original Fitzpatrick questionnaire by removing a couple of questions not deemed relevant for the Indian skin by the researchers, found the spectrum of skin types to range from II to VI,17 whereas earlier studies mostly limited the Indian phototypes to IV and V.18 These findings are similar to the more modern individual typology angle-based skin colour classification system findings, using colorimetric values, that has recorded wide variation in Indian skin, ranging from light to dark, in a six-group classification system (very light, light, intermediate, tan, brown and dark).19

Should we entertain the idea of using the term ‘skin of colour’ in a standard manner in our journal when its proponents are not even sure about the definition: Is it related to reaction to UV, race, or ethnicity? Just take a look at the multifarious definitions abounding in the literature:

  • ‘Skin of color traditionally refers to that of persons of African, Asian, Native American, Middle Eastern, and Hispanic backgrounds.’20

  • ‘Dermatologic health care disparities disproportionately affect patients with skin of color (SoC) (defined as Fitzpatrick skin phototypes IV-VI),…’21

  • ‘People with skin of color constitute a wide range of racial and ethnic groups—including Africans, African Americans, African Caribbeans, Chinese and Japanese, Native American Navajo Indians, and certain groups of fair-skinned persons (e.g., Indians, Pakistanis, Arabs), and Hispanics.’22

  • ‘The term skin of color identifies individuals of racial groups with skin darker than Caucasians, such as Asians, Africans, Native Americans, and Pacific Islanders.’23

‘Caucasians’, really? Why should anyone be allowed to use such archaic and outdated concepts and terms in modern dermatology?24 Should we, then, use a device to colorimetrically classify the skin types based on individual typology angle? Until we have a consensus on the definition and a more appropriate phrase, we cannot agree to the regular use of ‘skin of colour’ in scientific literature.

In the light of these facts, the IJDVL editorial policy, as of now, is neither to employ Fitzpatrick’s skin typing as a marker of basic skin phenotypes, particularly as most of the cases and studies published in the journal belong to people who are rich in skin colour, nor to use the term ‘skin of colour’ in every report pertaining to the non-white population, as we find employment of the term to be scientifically inaccurate and unhelpful in enhancing the clarity of scientific reporting. Finally, we find the use of both the terms in the literature to be useful in the practise of racial profiling and stereotyping, a practise not endorsed by IJDVL as a matter of editorial policy.

References

  1. , , , , . Evaluating skin colour representation in the Indian Journal of Dermatology, Venereology and Leprology. Indian J Dermatol Venereol Leprol. 2022;88:678-9.
    [CrossRef] [Google Scholar]
  2. , . History of hydroquinone. Indian J Dermatol Venereol Leprol. 2022;88:696-9.
    [CrossRef] [Google Scholar]
  3. . The mirror. Indian J Dermatol Venereol Leprol. 2022;88:700-1.
    [CrossRef] [Google Scholar]
  4. . Journal Citation Reports 2022.
    [Google Scholar]
  5. . Soleil et peau. J Med Esthet. 1975;2:33-4.
    [Google Scholar]
  6. . Ultraviolet-induced pigmentary changes: Benefits and hazards. Curr Probl Dermatol. 1986;15:25-38.
    [CrossRef] [PubMed] [Google Scholar]
  7. . The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124:869-71.
    [CrossRef] [PubMed] [Google Scholar]
  8. . The Body: A Guide for Occupants. Doubleday; .
    [Google Scholar]
  9. . How complicated are black and white? J Am Acad Dermatol. 2005;54:1071-2.
    [CrossRef] [Google Scholar]
  10. , , , . Increased skin pigment reduces the capacity of skin to synthesize vitamin D3. Lancet. 1982;1:74-6.
    [CrossRef] [PubMed] [Google Scholar]
  11. , . Human skin pigmentation as an adaptation to UV radiation. Proc Natl Acad Sci USA. 2010;107:8962-8.
    [CrossRef] [PubMed] [Google Scholar]
  12. . Vitamin D: A D-Lightful health perspective. Nutr Rev. 2008;66:S182-94.
    [CrossRef] [PubMed] [Google Scholar]
  13. . Skin color—in perspective. J Am Acad Dermatol. 2005;54:1072-3.
    [CrossRef] [PubMed] [Google Scholar]
  14. . The vital role of the skin in human natural history. Int J Dermatol. 1998;37:821-4.
    [CrossRef] [PubMed] [Google Scholar]
  15. , , . Clinical and biological characterization of skin pigmentation diversity and Its consequences on UV impact. Int J Mol Sci. 2018;19:2668.
    [CrossRef] [PubMed] [Google Scholar]
  16. , , , , . Misconceptions of photoprotection in skin of color. J Am Acad Dermatol. 2022;86:S9-17.
    [CrossRef] [PubMed] [Google Scholar]
  17. , , , . Modification of the Fitzpatrick system of skin phototype classification for the Indian population, and its correlation with narrowband diffuse reflectance spectrophotometry. Clin Exp Dermatol. 2018;43:274-80.
    [CrossRef] [PubMed] [Google Scholar]
  18. , , . Determination of minimal erythemal dose for narrow band-ultraviolet B radiation in north Indian patients: comparison of visual and Dermaspectrometer readings. Indian J Dermatol Venereol Leprol. 2007;73:97-9.
    [CrossRef] [PubMed] [Google Scholar]
  19. , , , . Skin complexion and pigmentary disorders in facial skin of 1204 women in 4 Indian cities. Indian J Dermatol Venereol Leprol. 2014;80:395-401.
    [PubMed] [Google Scholar]
  20. , . Dermatologic conditions in skin of color: Part I. Special considerations for common skin disorders. Am Fam Physician. 2013;87:850-6.
    [PubMed] [Google Scholar]
  21. , , , , , , et al. Medical students’ ability to diagnose common dermatologic conditions in skin of color. J Am Acad Dermatol. 2020;83:957-8.
    [CrossRef] [PubMed] [Google Scholar]
  22. . Skin of color: Biology, structure, function, and implications for dermatologic disease. J Am Acad Dermatol. 2002;46:S41-62.
    [CrossRef] [PubMed] [Google Scholar]
  23. , , , . Taylor and Kelly’s Dermatology for Skin of Color. McGraw Hill/Medical; .
    [Google Scholar]
  24. . What is a Caucasian? J Invest Dermatol. 1996;106:800.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
5,174

PDF downloads
4,658
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections