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Why Every Skin Tone Needs Ceramides

As we may know, everyone’s skin produces more or less melanin. Skin of color tends to produce more melanin than lighter skin. But melanin isn’t the only thing that makes our skin unique. Beneath the surface of the skin, there’s actually a lot going on in the skin, and there are important differences in the skin’s barrier, specifically in our ceramides, which are a form of lipid. In this article, we’ll explore 

1) What exactly are ceramides? 

2) How do ceramide levels differ between darker and lighter skin?

3) And why does understanding these differences matter for choosing the right skincare products?

Let’s get into it!

Ceramides = lipids?

 As we’ve briefly mentioned, ceramides are lipids. Lipids are fat molecules that help form the skin’s protective barrier and prevent moisture from escaping. Ceramides, in particular, make up more than half of this barrier, helping our skin stay strong, protected (against bacteria/irritants), and hydrated!

Differences in ceramide levels

Interestingly enough, ceramide levels differ across skin tones. In fact, a research study has shown notable differences across skin types, with Asian skin having the highest, Caucasians following, and African skin having the lowest levels. 

Well, why is this? Scientists believe it’s because of variations in our enzyme activity and lipid production within the skin. This means that how well our skin can hold onto moisture depends a lot on our skin biology and genetics. So this might explain why many people with darker skin experience dryness or ashiness. It’s important to note that this doesn’t necessarily mean darker skin can’t be oily. Anyone can have oily skin. But these patients are more prone to dehydrated skin, meaning their skin may produce plenty of oil but still lack water underneath. 

Why does this matter?

Understanding these differences in our ceramide levels and skin biology across skin tones is very important! It can help us make more informed skincare decisions. For darker skin, it’s more about repairing the barrier than layering on moisture. For lighter skin, keeping the barrier calm and hydrated helps prevent redness and irritation.

Also, choosing products that contain ceramides and fatty acids can further help rebuild your protective barrier and lock in hydration! Be sure to look out for these in the ingredients list of your products, especially your moisturizers.

Takeaway!

What have we learned? Well, every skin tone is different in its biology and ceramide levels, meaning that everyone has different/unique needs. By understanding how ceramides and skin biology differ, we can better care for our skin, from repairing the barrier to keeping it calm, hydrated, and healthy!

References

Sugino, K., et al. “Immunotitration Experiments Suggested That the … of Black and White Skin.” Journal of Investigative Dermatology, 1990. ScienceDirect, https://www.sciencedirect.com/science/article/pii/S0022202X9090147X.

“Skin Pigmentation Results from Complex … the Physiopathological Mechanisms of Melanogenesis.” PubMed Central (PMC), U.S. National Library of Medicine, https://pmc.ncbi.nlm.nih.gov/articles/PMC12295737/.

Sangha, Archana M. “Physiological Nuances in Skin of Color.” JCAD Online, 2023, https://jcadonline.com/physiological-nuances-in-skin-of-color/.

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I Built an App That Makes Learning About the Skin Fun and More Inclusive — SkinSage

SkinSage logo

I’m sure we can agree that understanding skin conditions and skincare products is confusing enough.

As a young patient of color who struggled to find clear, inclusive information, I wanted to create a resource that makes learning about skin health simple, engaging, and representative of all skin tones.

About nine months ago, I started creating exactly that. Now, I’m proud to announce the release of SkinSage—a free gamified educational app available on the Play Store! Instead of reading textbooks or scrolling through dense articles, users can test themselves through quick and short multiple-choice questions (with cartoon diagrams!), earn badges, and learn from friendly animal mascots!

How cool is that?

Most importantly, the app represents skin conditions across ALL skin tones. This matters because too often resources show only lighter skin, leaving many patients of color overlooked.

Home screen


With over 6 categories (shown below) and 160+ multiple-choice questions, you’ll get a thorough, well-rounded understanding of skin health and dermatology!

Collect badges!

“But I don’t know anything about the skin yet. ” Don’t worry! SkinSage promotes learning. Most of the time, the cartoon diagram can help guide you towards the right answer. Don’t be afraid to use your intuition! Let’s take a look at some of the questions:

Spoiler: it’s blackheads!

If you happen to get the question wrong, you can ‘star’ it and return later!
You’ll be greeted by a starfish!

Download ‘SkinSage’ now, available only on the Play Store!

Alex Siauw is a senior at Inglemoor High School in Washington. Once a patient himself, he is very passionate about dermatology equity. He has published research, developed an educational app, and written op-eds for outlets including KevinMD. 

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Psoriasis in Darker Skin: What You Need to Know


Skin conditions can fall under various categories. Inflammatory, autoimmune, infectious, bacterial—to name a few. Inflammatory conditions, such as psoriasis, acne, and eczema, are all too common for a lot of people. These occur when the skin becomes inflamed due to an overreactive immune system. Depending on your skin tone, these conditions can look very different. This is especially true for patients with darker skin, which makes diagnosis and treatment more difficult.

So, in this article, we’re gonna break down why psoriasis looks different on darker skin and why it’s super important to understand those differences.

First of all: What is psoriasis?

Psoriasis is an autoimmune and inflammatory disorder. This basically means that the immune system is too active, causing skin cells to grow at an exaggerated rate and pile up on the skin surface. These patches that are thick and scaly are the ones that patients associate with psoriasis. Here is a handy diagram showing the process:

Skin cell buildup from psoriasis

Why does psoriasis look so different across skin tones?

The main reason that the symptoms of psoriasis look different depending on skin tone is someone’s level of melanin, the pigment responsible for the color of our skin. Melanin not only helps the skin protect itself from UV damage but also has a role to play in the way the skin recovers after being injured or inflamed. A person with dark skin who has a psoriasis flare-up will have more melanin produced in their skin during the healing process. This not only causes the patches of psoriasis to become darker but also makes them less visible.

Whereas for people with light skin, signs and symptoms of psoriasis that are typical will be more pronounced, thus making it easier both to detect and cure. Specifically, these symptoms show up as red, inflamed areas that are covered with a silvery-white scaly layer.

Not only melanin, but blood flow below the skin is another factor that influences the manifestation of psoriasis. In light-skinned individuals, the blood vessels are quite visible, and this is what causes the redness usually accompanying inflamed skin. However, in dark skin, the blood flow is less visible because the increased melanin masks it, making the inflammation harder to see. Hence, psoriasis can be less visible in terms of redness than it actually is.

The challenges of diagnosis and treatment

Diagnosing psoriasis in patients with dark skin can be really frustrating because the lack of both redness and visible scales might lead a dermatologist to overlook some of the early signs of the disease and thus mistakenly delay treatment and diagnosis.

A different approach to psoriasis care

To improve psoriasis care for people with darker skin, better education is key for both patients and healthcare providers. Dermatologists need to be trained to recognize how conditions like psoriasis show up on different skin tones and learn how to adjust treatments to avoid causing pigmentation changes.

Communication is key. Not only for patients to openly discuss their skin condition and the effectiveness of their medications, but also to determine whether they have noticed changes in their pigmentation. Do not hesitate to instruct your dermatologist about what psoriasis looks like on your skin tone and whether the treatment you are using is appropriate.

Takeaway

Psoriasis is a disease that anyone can get. Nevertheless, the appearance of the disease largely depends on your skin color. Classic symptoms of redness and scaling in people with darker skin may be less visible, which could delay diagnosis and treatment. By understanding these differences and improving care for all skin tones, we can make treatments more effective for everyone. A better understanding of how skin conditions show up on different skin tones will help us get faster diagnoses, fewer complications, and ultimately, better skin health for everyone!

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Your Water Could Be Ruining Your Skin

When we think about skincare, most of us go straight to products. We obsess over finding the right serum, the perfect cleanser, or moisturizer everyone on TikTok is raving about (like beef tallow…). But here’s something we often overlook: the water coming out of your faucet. Yes, your water. The truth is, your water might be quietly sabotaging your skin, and the effects can be dangerous, varying depending on where you live.

Well, why is this?

Hard water. It’s basically water that has a high mineral content, usually calcium and magnesium. On your skin, they can do more harm than good. If you combine hard water with your soap or cleanser, it doesn’t rinse off as well. Instead, it leaves behind this soapy/slimy residue that can clog pores and cause your skin to feel tight or dry. In the long term, that gunk interferes with your skin barrier. If you have conditions like eczema or acne, that interference can totally make flare-ups even worse. Additionally, leftover minerals can even interfere with the active ingredients in your products, making them less effective. Think of it like trying to spread lotion over sandpaper—your skin just can’t absorb things the same way.

 One quick way I check for hard water is by noticing how products lather. As you rub your cleanser, or even hand soap, and you notice it feels slimy in your hands and doesn’t foam as well as it usually does, that’s a sign the water might be hard. And if you ever travel and suddenly notice your skin acting up, it’s worth checking the local water hardness through a quick Google search. Here’s a handy chart illustrating water pressures across states in the US.

Now here’s where the conversation gets bigger than just skincare tips. Water quality and access are not the same everywhere. Hard water is more common in certain geographic regions, but it’s also more likely to affect communities with aging or underfunded infrastructure. In some poor neighborhoods, individuals just can’t afford to equip their homes with water softeners or quality shower filters that wealthier communities take for granted. Even in the same city, plumbing and maintenance variations may lead to some households receiving consistently harsher water than others.

For individuals of color, these issues are even bigger. Eczema, hyperpigmentation, or scalp problems might not appear the same on darker skin, so they’re dismissed or treated improperly. Add hard water to the mix—exacerbating dryness and redness—and it’s even worse. But still, you never really hear water quality discussed in skincare advice or even in dermatology recommendations. This silence shows that the larger environmental and systemic issues impacting marginalized groups tend to get swept under the rug in health discussions.

So what can you do if you feel your water is part of the solution? The good news is that several low-cost measures can help. Shower filters will reduce mineral content and although some models are expensive, there are cheaper ones that work. For people who have very sensitive skin, applying a rinse with micellar water or even a splash of distilled water makes the residue more loosenable. Selecting gentle, pH-balanced cleansers (and not foamy ones) also makes your skin less susceptible to the harsh effects of hard water. And something easy everyone can do: apply moisturizer as soon as possible after showering to trap in the moisture before minerals and evaporation dry out your skin. The best choice in the long term would ultimately be to install a water softener system in your whole house, but those are quite expensive, costing thousands. 

The bottom line? Skincare isn’t just about your products. Fresh, skin-friendly water should be the standard for all people, no matter where they live. But now it’s a luxury. Our products do matter a lot—yes. But so do the subtle environmental factors that influence our skin health every night. By learning how something as prevalent as water pressure or mineral levels impacts us, not only do we better care for our own skin, but we come to realize why having access to healthy, safe water is a matter of equity, not a luxury. 

How is your water?

References

H₂O Distributors. Hard-Water Map. H₂O Distributors, n.d., https://www.h2odistributors.com/info/hard-water-map/. Accessed 24 Aug. 2025.

U.S. Geological Survey. Hardness of Water. Water Science School, U.S. Geological Survey, n.d., https://www.usgs.gov/water-science-school/science/hardness-water. Accessed 24 Aug. 2025.

Roland, James. “Hard Water vs. Soft Water: Which One Is Healthier?” Healthline, reviewed by J. Keith Fisher, MD, 30 July 2019, https://www.healthline.com/health/hard-water-and-soft-water. Accessed 24 Aug. 2025.

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How Eczema Looks on Asian Skin: Signs and Treatment Options

Eczema, or atopic dermatitis, is one of the most common chronic skin conditions out there. But it doesn’t look the same on everyone. Medical textbooks and images tend to primarily show eczema on lighter skin. This is a huge problem. This lack of representation makes it harder to identify and treat eczema in individuals with darker skin tones. It can be especially hard when trying to identify eczema on those with Asian skin because the inflammation may present as discoloration. Not to mention, eczema is also very common among Asians and Pacific Islanders! In this article, we will explore how eczema looks on Asian skin and its importance to adequately represent all skin tones in dermatology.

So, first things first—what exactly is eczema?

It’s a long-term condition that causes itching, dryness, redness, and rashes. Basically, it happens when the barrier of the skin – the outer layer that helps to keep moisture in and irritants out – is simply not operating properly. Countless factors can play a role in this. These include genetics, a bad immune system, environment (the weather), and stress. In turn, this causes the skin to be susceptible to allergens, microbes, and irritants that induce inflammation. Eczema is not at all contagious, but is often a lifelong condition that tends to flare up in cycles.

Eczema on different skin tones

Inflammation can look quite different depending on your skin type. On light skin, redness can show up bright and obvious; on dark skin, instead, it will look more purple, brown, or gray. Other symptoms — e.g., swelling, dryness, or thickened skin — can potentially be easier to detect than colour changes. So if you think you might have eczema, try looking more into the texture of your symptoms rather than the color. In fact, most clinical images and training focus on lighter skin, so subtle signs of eczema in darker skin, especially early on, can be overlooked.

How might eczema look on Asian skin specifically?

Asian skin has characteristics of both lighter and darker skin, but is also its own unique variation. With flare-ups, redness may appear dusky, violet, or reddish-brown instead of the typical bright red that may usually be seen. With a chronic history of eczema, patients may have thickened, leathery patches angled with skin lines that are more pronounced. The most common change, however, is pigmentation—patches that become darker or lighter and can linger for months. Follicular eczema is also common, that is, itchy small bumps around hair follicles, most often on the arms and torso. Finally, stronger topical steroids or skin-lightening creams may worsen symptoms or mask them, making diagnosis more difficult.

Treatment options for eczema on Asian Skin
To manage eczema on Asian skin, your goal would be to both treat the rash and the color changes it can leave behind. Moisturizers and gentle skin care are the first steps, while prescription creams like steroids or non-steroid anti-inflammatory creams can be used to help calm flare-ups. Since Asian skin is more likely to develop dark or light spots after eczema, it’s important to avoid overusing strong steroids or skin-lightening products, which can make things worse. If you’re unsure, a dermatologist who understands different skin tones can help you find the safest treatment plan.

Takeaway

Overall, it is very, very important to identify eczema early on Asian skin. Don’t just be misled by redness. Be sure to consider texture and swelling, and a subtle color change (but again, color changes can be misleading due to differences in melanin!). If you suspect that you have eczema, consult a dermatologist who sees patients across all skin tones. Also, when you make your appointment, be sure to discuss the treatment options that will address both inflammation and pigmentation changes. The more we understand about the way eczema presents across all skin tones, the faster we can help close the gap in dermatologic care and provide a proper treatment that everyone requires and deserves.

References

National Eczema Society. “Skin Pigmentation and Eczema.” National Eczema Society, eczema.org/information-and-advice/living-with-eczema/skin-pigmentation/. Accessed 15 Aug. 2025.

Ruwa, Rashida. “Eczema in Asian Skin: What You Need to Know.” Healthline, 1 Oct. 2024, www.healthline.com/health/eczema-in-asian-skin. Accessed 15 Aug. 2025.

Zhang, J., et al. “Epidemiology and Characterization of Atopic Dermatitis in East Asian Populations: A Systematic Review.” PubMed Central, pmc.ncbi.nlm.nih.gov/articles/PMC8163933/. Accessed 15 Aug. 2025.

Sutter Health. “Atopic Dermatitis (Eczema).” Sutter Health, www.sutterhealth.org/health/atopic-dermatitis-eczema. Accessed 15 Aug. 2025.

WebMD. “Eczema Epidemiology.” WebMD, www.webmd.com/skin-problems-and-treatments/eczema/eczema-epidemiology. Accessed 15 Aug. 2025.

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How to Deal with Those Stubborn Marks Left by Acne on Darker Skin

We can face it; acne is already enough of a pain. But for those with darker skin, that struggle begins once the blemishes leave. In most cases, they don’t vanish entirely; they sometimes leave behind dark marks that can take months or even years to fully fade. The formal medical name for these markings is post-inflammatory hyperpigmentation (PIH), and it’s seen more frequently in those with darker skin tones.

What is PIH, and why does it occur?

Then why do these marks take longer to fade away, even for individuals blessed with melanin-rich skin? Well, it all boils down to how sensitive your skin is. In other words, when you get a pimple, it means that your skin is inflamed. In response, it prevents similar damage from happening (for a little while at least) by increasing the production of melanin, which is essentially the pigment that gives your skin its color.  People with darker skin have melanin-producing cells that are more active, meaning that they tend to have darker patches that last longer when inflammation occurs.

How PIH looks different on darker skin

PIH generally appears red or pink on lighter skin and usually fades sooner. On darker skin, though, those same marks will show up brown or purple to gray and turn into more internalized as well. These can last for much longer, especially if not treated well or are irritated further.

The problem with dermatology representation

The representation of skin color in dermatology has a big gap currently. This is because most medical resources — especially textbooks and training materials, and also skincare advertisements — show acne and pigmentation concerns on predominantly fair skin types, which is one of the reasons it remains an unmet need. And because of this, patients and doctors have less experience with how these disease processes look in brown skin. You may have never seen how it appears on deeper skin tones if you only experience red acne on pale skin. That could lead to real issues like not receiving the required care or attention.

What you can do about it

If you have dark skin, the good news is that PIH can be treated. 

By following a regular skin care routine, you can see dark spots fade back, and it helps minimize their appearance. Azelaic acid, niacinamide, or kojic acid are some of the key ingredients to look out for. And don’t forget sunscreen! While darker skin does not burn as easily, it can still be damaged by the sun, which only serves to exacerbate PIH. Also, be sure not to use harsh scrubs or over-exfoliate since it may aggravate the skin and make things worse. If possible, go to a dermatologist who knows how to treat PIH in the same skin color. They will tell you what is best for your skin type and will guide you to the best treatment to have.

Final thoughts

After all, acne marks on darker skin are completely normal and easily treatable. But the absence of representation in skincare and dermatology can make it more difficult to treat if you have darker skin. The more we learn about all skin tones equitably, the closer we get to fair skin health!

References

“Hyperpigmentation.” Cleveland Clinic, Cleveland Clinic, 7 Oct. 2021, my.clevelandclinic.org/health/diseases/21885-hyperpigmentation.

Fisher, Jennifer. “Demystifying Hyperpigmentation: Causes, Types, and Effective Treatments.” Harvard Health Publishing, 11 Mar. 2024, www.health.harvard.edu/diseases-and-conditions/demystifying-hyperpigmentation-causes-types-and-effective-treatments.

Ludmann, Paula. “How to Fade Dark Spots in Darker Skin Tones.” American Academy of Dermatology, 10 Mar. 2025, www.aad.org/public/everyday-care/skin-care-secrets/routine/fade-dark-spots.

Markiewicz, Ewa, et al. “Post-Inflammatory Hyperpigmentation in Dark Skin: Molecular Mechanism and Skincare Implications.” Clinical, Cosmetic and Investigational Dermatology, vol. 15, 25 Nov. 2022, pp. 2555–2565, Dove Medical Press, doi:10.2147/CCID.S385162. PubMed Central, PMC9709857.

Veazey, Karen. “What to Know about Hyperpigmentation on Dark Skin.” Medical News Today, 21 Sept. 2023, www.medicalnewstoday.com/articles/hyperpigmentation-black-skin.

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Thinking About a Cosmetic Procedure? Read This First if You Have Darker Skin

What is a keloid?

Say you have a tiny scar on your skin, hoping it would eventually fade away over time—only to realize it’s expanding instead. What starts as a tiny bump becomes hard, raised, and sometimes sore or itchy skin. It even becomes bigger than the initial wound, as if your skin doesn’t know when to stop healing. This is what it feels like to have a keloid scar, one of several scars that occur to millions of individuals and seem to attack at random or without a clear reason! This article explores the science behind keloids and the risks of cosmetic procedures if you have a darker skin tone.

Simplified diagram of keloid formation
Keloid formation

What causes a keloid?

When the body’s healing mechanism just goes a bit too far, a keloid occurs. Your skin would otherwise start healing by producing collagen, which helps to mend injured tissue, after a cut, piercing, acne infection, or even a bug bite. The body normally gets the message to stop after the cut has healed. That “stop” signal isn’t answered with keloids, though. Fibroblasts just keep on producing collagen, and what comes out is a thick, raised scar that goes beyond the original wound. These tend to be tender or itchy, and they’re typically rubbery and shiny in texture. In addition, they barely ever seem to go away by themselves.

Some individuals are more likely to develop keloids than others, but no one is immune. You are much more likely to have keloids if you have darker skin, particularly if you are Middle Eastern, African, Hispanic, or Asian. Caucasians are significantly less likely to develop keloids, whereas 16% of highly darkly melanated people might develop them.

Why is this?

Well, genetics come into play. Some genes involved in inflammation and collagen synthesis have been demonstrated to increase keloid predisposition, possibly familial in nature. Skin biology is involved as well. Melanin itself does not directly contribute to keloids, but darker skin types have a thicker dermis, increased fibroblast activity, and heightened inflammatory response after injury. These differences may be the reason that keloids are most frequently found, especially in the skin around the earlobes, jaw, shoulders, and chest. Tugging tight over a wound, age, and hormones also play a role.

But biology is just half of it. Medical education and studies have long ignored keloids, especially when they appear on skin of color. It may be harder for some doctors to diagnose keloids in darker-skinned individuals since most reference images and textbooks contain mostly lighter skin. This disparity leads to treatments not being specific to other colors, a lower chance of their prevention, and delayed diagnosis.

That keloids are generally preventable—if the risk is caught early enough—is especially disquieting. The danger of keloid can be reduced by taking simple steps such as using silicone gel sheets, receiving steroid injections, or using pressure earrings following piercing. Choosing non-surgical cosmetic treatments is also advantageous. But if your practitioner does not know about your risk factor, he or she will not alert you. And that might make you surprised when a little scar becomes larger.

Takeaway

In all, learning about keloids isn’t just about scars—it’s about recognizing and respecting all skin types. Everyone and their unique skin tone deserves to be seen, supported, and given care that reflects their skin’s unique needs. So if you have darker skin and are thinking about a piercing, surgery, or cosmetic treatment, don’t hesitate to ask about keloid risk.

References

  1. Marneros, Alexander G., and John J. Uitto. Keloids and Hypertrophic Scars. StatPearls Publishing, 2024. NCBI Bookshelf, https://www.ncbi.nlm.nih.gov/books/NBK507899/.
  2. American Academy of Dermatology Association. “Keloids: Causes.” AAD, https://www.aad.org/public/diseases/a-z/keloids-causes.
  3. Draelos, Zoe Diana. “Dermatological Conditions in Skin of Color: Managing Keloids.” Journal of Clinical and Aesthetic Dermatology, 2021, https://jcadonline.com/dermatological-conditions-in-skin-of-color-managing-keloids/.
  4. Ogawa, Rei. “The Pathogenesis of Keloids.” Plastic Surgery Key, 2015, https://plasticsurgerykey.com/the-pathogenesis-of-keloids/.
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The Cost of Being Unheard in Washington’s Healthcare System

          Racism in healthcare is “Undeniable, irrefutable—the data is there.” Those were the words of Dr. Benjamin Danielson, one of Seattle’s most respected pediatricians. In 2020, he resigned from Seattle Children’s Hospital, citing years of systemic racism and prejudice against healthcare workers and patients. Last December, a jury awarded him $21 million in non-economic damages. But his victory is not just personal—it’s a wake-up call for Washington’s healthcare system and a reminder that for many patients of color, being unheard can be fatal.

Dr. Benjamin Danielson: 'Profound trauma and joy can coexist ...
Dr. Ben Danielson

              Seattle Children’s delayed the release of its internal racism investigation for over a year—an act that deeply undermined public trust. That investigation reportedly confirmed the very patterns of racial harm that Dr. Danielson and others had long described. During the trial, the jury was presented with evidence of racial discrimination directed not only at Dr. Danielson but also at his colleagues and the hospital’s patients and families. This reveals a critical truth: racism in healthcare is systemic, institutional, and impacts both providers and patients. When hospitals allow these patterns to persist, they not only fail their staff but also endanger the very communities they are meant to serve.

16-year-old Sahana Ramesh’s tragic story reinforces the implicit racial biases embedded in our healthcare institutions. Sahana was a bright and healthy teenager living in Bothell, Washington, when she developed painful rashes and swelling on her face, hands, and feet. Her family urgently took her to the ER at Seattle Children’s Hospital, where she was diagnosed with DRESS—a rare and severe drug reaction. 

Discrimination and negligence at Seattle Children's hospital led to teen's death, family alleges in lawsuit | CNN
Sahana and her mother

As her symptoms worsened, her parents desperately called the hospital 16 times and sent 22 emails in search of answers. Yet despite Sahana’s exacerbating health and her family’s urgent pleas, they were repeatedly downplayed by clinicians. By the time she and her family were taken seriously, it was too late. Sahana’s death is not an isolated incident—it is part of a pattern in which the concerns of patients of color are too often dismissed or deprioritized. “Evidence shows that if Sahana and her parents had been white, they would have had a better chance of getting admitted to the hospital,” as the Rameshs’ attorney, Martin McLean, asserted. Her story, like Dr. Danielson’s, reveals the life-threatening consequences of implicit bias and institutional neglect.

         These disparities extend beyond emergency care and into specialized fields like dermatology, where racial bias begins in medical training. “Physicians must identify conditions from photos of skin in textbooks or shared in the classroom. But most of the patients in those images are white, and only 4.5% of the images show dark skin,” states dermatologist Jasmine Onyeka Obioha, MD. As a result, clinicians often struggle to diagnose conditions in patients whose appearances and symptoms fall outside of the narrow standards they were taught, leading to higher rates of misdiagnosis among patients of color. In fact, “Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis,” said Johns Hopkins professor David Newman-Toker. This becomes especially dangerous in communities like South Seattle, where many families of color reside and access to dermatologists familiar with diverse skin tones remains limited.

        To begin addressing these failures, Washington’s healthcare institutions must change structurally. Hospitals like Seattle Children’s must promote an ethnically inclusive workforce and improve patient advocacy systems—so that when families like Sahana’s speak up, they are heard, regardless of their background or race. Medical schools—including the University of Washington—must diversify their curricula by incorporating diagnostic imagery that equitably represents all skin tones—not just white skin.

      Beyond a legal reckoning, the Seattle Children’s verdict was a stark reflection of the failures embedded in our healthcare institutions. If we don’t respond with urgency and structural reform, we risk repeating the same harm to the patients, families, and communities who need care the most. 

Bibliography

Recht, Hannah. “Misdiagnosed: Women and People of Color Face Widespread Medical Diagnostic Errors.” KFF Health News, 26 Feb. 2024, https://kffhealthnews.org/news/article/medical-misdiagnosis-women-minorities-health-care-bias/.

Cedars-Sinai. “Why Skin Issues in Patients of Color Are Neglected, Mistreated.” Cedars-Sinai Newsroom, 1 Mar. 2023, https://www.cedars-sinai.org/newsroom/why-skin-issues-in-patients-of-color-are-neglected-mistreated/.

Crowder, Madison Wade. “Bothell Family Alleges Racism at Seattle Children’s Hospital in Daughter’s Death.” KING 5 News, 12 Dec. 2023, https://www.king5.com/article/news/investigations/investigators/bothell-family-alleges-racism-seattle-childrens-hospital-daughters-death/281-50d708b3-3b06-422b-a19a-cc3b766d82b6.
Schroeter Goldmark & Bender. “Jury Awards Former Seattle Children’s Doctor $21M in Race Discrimination Lawsuit.” SGB Law, 19 Dec. 2024, https://sgb-law.com/news/jury-awards-former-seattle-childrens-doctor-21m-in-race-discrimination-lawsuit.

Williams, Race and Justice Reporter Erica. “Dr. Ben Danielson Speaks out on Systemic Racism in Health Care.” KING 5 News, 18 Dec. 2020, https://www.king5.com/article/news/community/facing-race/doctor-ben-danielson-seattle-childrens-hospital-systemic-racism-health-care/281-94b16198-3c41-4db8-96d1-1dfc257d98e5.

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Botox Explained: How a Neurotoxin Became a Beauty Staple

In 2022, over 9 million Botox injections were given worldwide, making it one of the most popular cosmetic treatments today. Known for its ability to reduce wrinkles and give skin a smoother, younger appearance, Botox is particularly popular among celebrities looking to maintain a youthful appearance. But what exactly is Botox, and how does it work?

What is Botox?

 Botulinum toxin, or Botox, is a neurotoxic protein derived from a bacteria known as bacterium Clostridium botulinum. Neurotoxic proteins are substances that disrupt the function of the nervous system. Botulinum toxin works by blocking the release of acetylcholine, a neurotransmitter that plays a critical role in muscle contraction, by interfering with the vesicles responsible for releasing acetylcholine. Located in neurons, vesicles are small sacs that store neurotransmitters, like acetylcholine. Botox targets and breaks down the proteins that help these vesicles release acetylcholine, preventing it from being released into the space between the nerve and the muscle.

This prevention of muscle contraction ultimately leads to reduced wrinkles, fine lines, improved skin texture, and overall a more youthful appearance.

While Botox is best known for its cosmetic benefits, it also provides several other medical benefits. This versatile procedure can also mitigate neck spasms and chronic migraines under the same mechanism. Additionally, Botox is effective in treating excessive sweating (hyperhidrosis). Not only is acetylcholine responsible for muscle contraction, but it also plays a key role in triggering sweat production in sweat glands. Botox can be injected in the affected areas, preventing them from producing excess sweat. Botox injections can also treat lazy eye by relaxing the overactive muscle in the eye—specifically, the extraocular muscle, which controls eye movement. 

Different muscles vary in size and strength, so they require varying amounts of Botox to effectively relax the target muscle. Botox injections are administered in units, with 1 unit being a standardized measure of biological potency.

Where is Botox injected?

Botox can be used wherever facial muscles are creating lines. Here are the most common injection sites:

Forehead – to relax those horizontal lines that show up when you raise your eyebrows. 10-30 units of Botox.

Between eyebrows (glabella) – to soften the vertical lines caused by frowning. 5-15 units of Botox on each side.

Outer corners of eyes (crow’s feet) – to soften the orbicularis oculi muscles at the outer corners of the eyes. 10-15 units of Botox per side.

Around the mouth – to reduce smile lines (nasalabial folds) by pulling the corners of the mouth down. 3-6 units of Botox on each side.

How long does Botox last?

Botox injections generally last 3 to 4 months, depending on the dosage and site of injection. In areas with more muscle activity, like around the eyes or mouth, the effects of Botox will wear off faster compared to areas with less movement, like the forehead.

Side effects of Botox

As we’ve learned, Botox prevents the release of acetylcholine and ultimately muscle contraction. After injection, the targeted muscle remains entirely inactive for the treatment’s duration—typically 3 to 4 months. This prolonged inactivity can cause muscle atrophy, meaning that the muscle will reduce in mass, size, and strength. Some studies have shown that if a patient continues to undergo Botox injections in the long term, their skin might experience increased susceptibility to sun damage, premature aging, and dehydration. Granted, the current research on the long-term effects of Botox remains inconclusive.

Takeaway:

Known for its effective ability to smooth wrinkles by temporarily paralyzing facial muscles, Botox continues to reign as one of the most popular cosmetic treatments. Beyond aesthetics, Botox also treats medical conditions like migraines, excessive sweating, and muscle spasms. However, while generally safe, long-term use may lead to muscle atrophy and potential skin changes. As with any procedure, it’s important to weigh the benefits against possible risks and consult a healthcare provider for personalized care.

Bibliography

“Botox.” MedlinePlus, U.S. National Library of Medicine, 2 Aug. 2023, https://medlineplus.gov/botox.html.

“Vesicle.” NCI Dictionary of Cancer Terms, National Cancer Institute, https://www.cancer.gov/publications/dictionaries/cancer-terms/def/vesicle.

“What Areas Can Be Treated with Botox?” Westlake Dermatology & Cosmetic Surgery, https://www.westlakedermatology.com/blog/what-areas-can-be-treated-with-botox/.

“The Long-Term Effects of Botox: What Research Says.” Your Laser Skin Care, https://www.yourlaserskincare.com/blog/the-long-term-effects-of-botox-what-research-says.

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Ringworm Isn’t Always Red: Spotting the Rash on Darker Skin Tones

Ringworm, or it’s professional name, “tinea corporis,” is one of the most common fungal skin conditions in the world! Interestingly, ~25% of the population worldwide is expected to experience ringworm at some point during their life…

If you look up “ringworm” online, you’ll notice that a lot of the images show light skin. And in all those images, ringworm symptoms manifest as a bright red, circular patch.

In this article, we’ll explore what the internet fails to show us: how ringworm looks on darker skin tones.

So first, what causes ringworm?

Shockingly, it’s not caused by a worm. Well, ringworm is a fungal infection, meaning that it is contagious (like direct skin contact) and caused by a fungi. Specifically, ringworm is caused by the group of fungi called dermatophytes. 

Unfortunately, dermatophytes can be found almost anywhere. Like most fungi, they love warm, humid environments like locker rooms and saunas. To avoid ringworm, be sure to stay clean, washing your hands/body thoroughly!

Back to the skin. These rascals feed on a crucial protective protein on your skin, hair, and nails, called keratin. As they digest keratin, they invade and irritate the outer layer (epidermis) of your skin, triggering inflammation. This then leads to ringworm, characterized by itchy, circular patches.

Simplified diagram of dermatophyte fungi invading keratin layer of the skin

Why does ringworm look red on lighter skin?

On lighter skin tones, inflammation typically shows up as a clear, visible redness. So when these dermatophytes feed on keratin, the inflammatory response will kick in, increasing blood flow to the area. Which, naturally, will appear more red in color since lighter skin contains less melanin.

https://my.clevelandclinic.org/health/diseases/4560-ringworm


But…what about darker skin?

Since darker skin will have more melanin (the pigment that gives skin its color), inflammation doesn’t typically appear as red like lighter skin. Instead, the inrceased melanin can mask the inflammation, making it look gray, purple, or brown. Also, increased melanin can make the “border” of the rash can appear subtler on darker skin tones. For these reasons, ringworm rashes might be harder to spot on darker skin, or might look like a totally different condition.

✅Identifying a ringworm lesion on darker skin—a checklist

Shape: Does it form a circular, ring-like patch with a clearer center?

Texture: Are the edges slightly raised/scaly?

Color: Is the lesion gray, brown, or purplish instead of red?

Itchiness: Is it often itchy? Especially around the border of the lesion?

Note: don’t rely on this checklist for medical advice! I’m no expert… Also, ringworm is often confused with inflammatory conditions like psoriasis and eczema, so be wary of that.

Spread: Is the rash growing outwards over time?

Takeaway

Knowing what ringworm actually looks like on everyone can help us close this representation gap, allowing everyone to receive the treatment they deserve. It means faster and more accurate diagnoses. Plus, it reminds us that medical info and pictures should show all shades of skin, not just one type.

References

Cleveland Clinic. “Ringworm (Tinea Corporis): What It Looks Like, Causes & Treatment.” Cleveland Clinic, 21 Oct. 2022, my.clevelandclinic.org/health/diseases/4560-ringworm. Accessed 20 Oct. 2025. Cleveland Clinic


WebMD. “Ringworm: Causes, Symptoms, Treatments & How to Identify.” WebMD, 19 Dec. 2023, www.webmd.com/skin-problems-and-treatments/what-you-should-know-about-ringworm. Accessed 20 Oct. 2025. WebMD

Centers for Disease Control and Prevention. “Clinical Overview of Ringworm and Fungal Nail Infections.” CDC, 15 July 2024, www.cdc.gov/ringworm/hcp/clinical-overview/index.html. Accessed 20 Oct. 2025.

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What Underrepresentation Taught Me About My Skin

Recently, I developed a very frightening skin condition. Out of nowhere. It was these little bumps that ran from my feet all the way up to the palms of my hands.

So, as most people would do, I went online. Typing my symptoms into Google, I struggled to find images that matched my condition. Not only were the symptoms different (and honestly too confusing to compare), but a lot of the images showed light skin tones. I am Southeast asian (Indonesian), and so my skin is around a tan to golden color. The deeper the rabbit hole I went, I even started to question: was my skin somehow less important?

I’m writing this article to speak on this issue. Dermatology, “the branch of medicine concerned with the diagnosis and treatment of skin disorders,” should reflect ALL skin tones. And this doesn’t just affect me. I’m sure countless others out there with colored skin have felt or are feeling the way I am.

I’ve had a lot of time to reflect. Instead of feeling like darker skin like mine is the “problem,” I now question the system.

I started seeing my skin differently. Each little bump reminds me of the emotional turmoil I had to fight through. But it was bound to happen.

I’m open to talking with anyone else who has experienced something similar, personally feeling like their skin is “left out.” Hopefully this blog can be the space for just that.

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Stratum Corneum Thickness Explained: Why It Matters for Skin of Color

Our skin is incredibly adaptive. Depending on your ethnicity and the environment you live in, the way your skin looks and functions can vary quite a bit from someone else’s. One part of the skin where this really shows is in the stratum corneum.

First, what exactly is the stratum corneum?

You might already know that skin has three main layers: the hypodermis, the dermis, and the epidermis. The epidermis is the outermost layer, and it’s made up of several sublayers. Sitting right at the top is the stratum corneum.

Even though it is the thinnest layer, it still has the main function of the skin to keep it healthy. It works as a protective barrier, helps with water retention, and protects the skin against various types of environmental stress. What is interesting is how the stratum corneum can be very different in terms of thickness and structure between people and even more so among various ethnic groups. These differences are not just skin-deep—they can impact things like how well your skin holds hydration and the extent to which it may become reactive to inflammation or skincare products.

Why thickness matters

The stratum corneum is not identical in everyone. Studies indicate that the skin of East Asians normally has a stratum corneum that is not only thicker but also more compact in comparison with the strata of people with lighter skin. While this sounds like a positive aspect, and it is to some extent (a stronger barrier may prevent irritants from entering), it also implies that the skin may lose its water very fast. This can make the skin dry, and the occurrence of eczema can increase. Besides, Asian skin is prone to post-inflammatory hyperpigmentation (PIH), after the event of a minor breakout or irritation, a dark spot is the aftermath that stays for a long time.

In the same manner, African skin usually has a stratum corneum that is thicker and more compact. This gives the skin extra protection from external traumas, but the mentioned benefits come with some of the same problems. The skin is capable of losing water very fast, which is one of the causes of dryness, and also the condition which many people know as “ashy”. Hyperpigmentation is yet another issue that occurs frequently, and the reason is that even a slight irritation may result in dark marks that are indistinguishable from the skin and are there long after the skin has recovered.

On the contrary, Caucasian skin, in general, has a relatively thin stratum corneum. In this case, skincare products can penetrate the skin quite easily, and the effects can be seen quickly, but at the same time, the skin is more susceptible to environmental stress. The thinner the barrier, the less protective it is, which is the main reason why lighter skin is more highly predisposed to sunburn and certain types of skin cancer.

Why it all matters for your skincare routine

Product penetration is slowed down by a thick barrier, while a thinner one may indicate that the skin is more sensitive. This is the reason why knowing the structure of your skin is very important in the correct ways of treating it.

Takeaway

Of course, no matter what skin type and shade you have, healthy skin starts with taking good care of your skin barrier. This means regular use of emollients, gentle exfoliation, and avoiding the use of harsh products that may be doing more damage than good. The stratum corneum is different from person to person, and understanding this explains why there is no such thing as one-size-fits-all skincare.

References

Stratum Corneum. ScienceDirect, Topics in Agricultural and Biological Sciences, Elsevier, https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/stratum-corneum.

Murphrey, Morgan B., et al. “Histology, Stratum Corneum.” StatPearls, edited by StatPearls Publishing, https://www.ncbi.nlm.nih.gov/books/NBK513299/.

Rawlings, A. V. “Ethnic Skin Types: Are There Differences in Skin Structure and Function?” International Journal of Cosmetic Science, vol. 28, no. 2, pp. 79–93. PubMed, https://pubmed.ncbi.nlm.nih.gov/18492142/.