Today, we’re speaking to Dr Eliza Hutchinson, a dermatology registrar and academic clinical fellow based at the Centre for Applied Excellence in Skin and Allergy Research at the University of Bristol.
Title of paper: Eczema, acne, and psoriasis in people with skin of colour: a qualitative UK-based study
Available at: https://doi.org/10.3399/BJGP.2025.0720
This study is the first, to the authors’ knowledge, to explore the experiences of living with an inflammatory dermatosis specifically in people with skin of colour. We generated eight themes important to participants: delayed or missed diagnosis; preferences regarding healthcare professionals; lack of online information and social media use; misunderstandings in cultural communities; concerns about treatment and lack of research; complementary medicine use; experiences and impact of dyspigmentation; and challenges with structural racism. These findings offer insight into the complex experiences and challenges faced by UK adults with skin of colour living with eczema, acne, and psoriasis. Our practical points for primary care clinicians are a step towards facilitating mutual understanding and improving care for people with skin of colour.
Transcript
This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.
Speaker A
00:00:00.560 - 00:00:53.150
Hi and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the BJGP. In today's episode, we're speaking to Dr. Eliza Hutchinson.
Eliza is a dermatology registrar and an academic clinical fellow and she's based at the Centre for Applied Excellence in Skin and Skin Allergy Research at the University of Bristol. We're here to talk about the paper she's just published in the bjgp and the paper is titled Eczema Acne and Psoriasis in People with Skin of Color.
A Qualitative UK based Study. So, Eliza, it's lovely to meet you and thanks again for joining us to talk about this paper.
But before we talk about the paper itself, I'm just wondering what made you specifically interested in researching skin conditions in skin of color?
Speaker B
00:00:53.550 - 00:01:34.700
Yeah, thank you so much for having me.
So I think people with skin of color have been and still are massively underrepresented in kind of medical curricula, learning resources, clinical trials. And I certainly remember when I was at medical school, I don't think I had any teaching on diverse skin tones at all.
And so it was as I sort of learned more dermatology, I just became very aware that they are so underrepresented. And I think earlier work in this area, I really tried to improve education for medical students and healthcare professionals around skin of color.
That was kind of my starting point.
And then I realised actually there's very little, if anything actually on the experiences of people with skin of colour, which is kind of what led me to this project.
Speaker A
00:01:35.820 - 00:01:38.380
And you work in dermatology, is that right?
Speaker B
00:01:38.460 - 00:01:42.300
Yes, yes, I'm a dermatology registrar based in the Bristol Bath area.
Speaker A
00:01:42.540 - 00:02:06.890
Great. So it's wonderful to have your expertise in this especially.
And we may get into this sort of about sort of your perspective from secondary care as well, looking back into general practice as well. But this paper focuses on eczema, acne and psoriasis and these are conditions that we see a lot as gps.
So why did you feel that this was an important area to look at for people with skin of colour?
Speaker B
00:02:07.290 - 00:02:41.470
Yes, I mean, as you said, we know that skin conditions are super common.
They make up over 14% of GP consultations and eczema, acne and psoriasis are some of the most common inflammatory skin conditions we see and we know that they have a significant burden on everyone that experiences them.
But I think particularly in people with skin of colour, we already know that these people experience kind of increasing things like Dispigmentation, so skin tone getting lighter or darker from their skin condition. And yeah, I think I just wanted to focus on some of the more common conditions that are seen kind of day to day in primary care.
Speaker A
00:02:42.110 - 00:02:54.890
And this was a qualitative study and you emphasized that you really wanted to understand the experiences of people here. So talk us through a bit what you did. You spoke to people who had these conditions and had skin of colour?
Speaker B
00:02:55.050 - 00:03:26.060
Yes. So we recruited using online methods for a couple of reasons, but really wanted to get kind of diverse range of experiences from across the uk.
So we started off with an online survey and that was open to people of all skin tones. And we have written this up as a separate paper which should be out hopefully in the next few months.
But based on these responses, we then kind of purposefully recruited people with skin of color to take part in an online one to one interview. And so we spoke to 20 different people with skin of colour as part of this.
Speaker A
00:03:26.460 - 00:03:40.300
And I think one of the really interesting things that came out and is running as a strong theme through the paper is that skin conditions can present really differently in skin of colour. Can you explain a bit about what that means in practice as well?
Speaker B
00:03:40.700 - 00:04:49.210
Yeah. So we know that skin conditions can look and behave very differently in people with skin of colour compared to white skin.
So for example, eczema is typically in a kind of flexural distribution in people with white skin, so like in the elbow creases behind the knees.
But in people with skin of colour it might be more likely to be on the extensor surfaces, it might be in a sort of discoid type pattern, so kind of well defined round patches or sort of a follicular pattern is another one we see. So if you look at medical textbooks and what we're taught at medical school, we just don't see pictures of these presentations.
And I think another big thing is obviously redness is much less obvious in skin of colour. So that's typically what we would associate with skin inflammation is redness and it is much less obvious.
And instead in darker skin tones it might look kind of purpley. Brownie might not be as obvious. And certainly in the interviews we found that patients were aware of this as well.
So they were looking at their own skin and not picking up that it was kind of actively inflamed. They didn't know what it was and they'd go and see a GP or another healthcare professional in primary care and they also wouldn't know.
And then it's just kind of leading to Delayed diagnosis, misdiagnoses.
Speaker A
00:04:50.140 - 00:05:16.780
Yeah, And I think that's certainly something. So the people you spoke to described these delays in diagnosis and also this uncertainty from clinicians.
And I do wonder if that is reflected in what we learn and what the wider public understand is what inflammation might look like as well. So I wonder what really stood out to you from these experiences.
So how did people and clinicians sort of navigate those delays and uncertainty as well?
Speaker B
00:05:17.320 - 00:05:44.760
What was quite shocking was in terms of the misdiagnosis a lot of the time, infection and infestation.
So, for example, scabies was a big one that people were misdiagnosed with, and that in some circumstances did lead to kind of stigmatisation, psychological distress, embarrassment, and then people were more afraid to seek help. Further delays in diagnosis. Yeah, I think that was the thing that struck me the most in terms of this problem.
Speaker A
00:05:45.240 - 00:06:00.040
And you've mentioned this, you talked about dyspigmentation, and that came through as well very strongly in the interviews. And I think that's probably a problem that's specific to skin of color as well.
And can you talk through why that came up as such an important issue for patients in this study?
Speaker B
00:06:00.760 - 00:06:46.890
Yeah, of course. So I think we already know that dyspigmentation.
So skin tone usually getting darker, but sometimes lighter as a result of skin inflammation, we know that it is more common in darker skin tones just because they've got more melanin there to start with. But the thing that struck me in these interviews was just the profound impact that this can have on patients.
So embarrassment, isolation, body dysmorphia. There's a lot of misunderstanding as well, kind of within certain communities about what causes it.
And some people experience negative comments from within their own community, from friends and family, which really exacerbated that kind of psychosocial impact even more. And obviously, skin tone is massively tied into kind of identity, and the impact on people's wellbeing was just. Yeah, it was huge.
Speaker A
00:06:47.690 - 00:06:58.490
And coming from a general practice perspective, it sometimes feels like the treatment options for dyspigmentation are really...
