COMMENTARY
Should we refer to skin as ‘‘ethnic?’’
Adewole S. Adamson, MD, MPP
Chapel Hill, NC
Key words: disparities; diversity; ethnic; ethnicity; ethnic skin; Fitzpatrick skin type; race; skin of color.
E thnicity describes a population subgroup
defined by a shared national, linguistic, or
cultural tradition. By that measure, every
person has an ethnicity, and in an increasingly
diverse society many identify with more than one
ethnic group. So why do we continue to use the
adjective ‘‘ethnic’’ to describe skin of darker com-
plexions? The word ethnic is rarely used to describe
the skin of people of Irish, Scottish, Italian, or Greek
ethnic descent. The implication is that people of
European descent have no ethnicity, which is of
course not true.
The term ‘‘ethnic’’ is a heavily loaded and coded
term often used as a reductive synonym to describe
things generated by or associated with nonwhite
people. It is frequently used to describe food that is
not European cuisine and clothing that does not have
Western origins. In cinema, ‘‘ethnic’’ describes phys-
ical characteristics of actors and actresses that are not
considered white. The term is also used to categorize
personal care products placed in the ‘‘ethnic’’ section
within the beauty aisle of the drug store.
The term ‘‘ethnic skin’’ re-enforces the idea that
white skin is the biological standard. An inexact,
but more appropriate term to use is ‘‘skin of color.’’
The term is imperfect because white skin also has
color, best exemplified in the depigmentation of
vitiligo. Despite this imperfection, ‘‘skin of color’’
more accurately distinguishes darker skin
complexions.
People of color who identify as Black, Asian,
Native American, or Hispanic are diverse both
genotypically and phenotypically. Skin color and
hair texture varies greatly among and within these
groups. Using the term ‘‘ethnic’’ to lump together this
large, heterogeneous group demeans and dimin-
ishes their diversity. It also makes it easier to relegate
and ignore the unique challenges in treating patients
From the Department of Dermatology, University of North Car-
olina at Chapel Hill.
Funding sources: None.
Conflicts of interest: None declared.
Correspondence to: Adewole S. Adamson, MD, MPP, Department
of Dermatology, University of North Carolina, Genome Science
1224
with darker skin of varying complexions and hair
types.
Appreciation for these differences should be an
important part of dermatology training.
Unfortunately, skin and hair care in people of color
are not often incorporated into training curricula.
One survey of dermatology chief residents and
program directors showed that only 52.4% of chief
residents and 65.9% of program directors reported
including teaching sessions on diseases in skin of
color incorporated into their curricula.1 If residents
do receive instruction regarding skin of color, it is
often separate, discrete training instead of incorpo-
rated into standard curricula. This pedagogical
approach has had real effects on the profession. In
response, dermatologists have created centers of
excellence and the Skin of Color Society to promote
research and advance treatments in patients with
darker skin types. Some of these centers use ethnic in
their designations, which might perpetuate the idea
that skin of color is somehow unconventional when
in reality most of the world has skin of color.
Dermatology is a unique medical specialty in that
a patient’s race/ethnicity, a proxy of Fitzpatrick skin
type and hair texture, can directly influence diag-
nosis and treatment decisions independent of other
sociological factors associated with race/ethnicity.
As a result, unlike other specialties in medicine,
dermatology has textbooks dedicated exclusively to
the diagnosis and treatment of nonwhite patients.2
While separate texts highlight conditions historically
ignored and underresearched in dermatology, sepa-
rate does not always mean equal.3,4 We must ensure
that a separate focus on these conditions does not
result in the marginalization of them or make it easier
to simply tack them on to existing curricula or texts.
Instead, we must thoroughly integrate them into our
holistic understanding of the skin. At a time when
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J AM ACAD DERMATOL
VOLUME 76, NUMBER 6
dermatology is striving to become more inclusive,
efforts to include skin of color into resident training
should be emphasized.5 Improving how dermatolo-
gists discuss skin and hair in patients of color is an
important step.
Using the term ‘‘ethnic skin’’ is an inaccurate,
Eurocentric way of referring to skin of color and its
usage should be discouraged. This is particularly
salient in the United States where individuals with
skin of color will represent the majority by 2050.6
The way we use language around race and
ethnicity matters and should evolve as derma-
tology becomes a more diverse specialty and the
United States becomes a more diverse nation.
Because dermatology training emphasizes accu-
rately describing subtle skin findings, we should
consider developing better ways of describing skin
of color. Both objective and subjective suggestions
have been made in the past.7 Perhaps we can take
a cue from the beauty industry and expand how
we describe skin color in general. Independent of
ethnicity, skin color can be referred to in many
ways. Skin can be light, fair, brown, deeply
pigmented, dark, or rich in melanin. Hair can be
Adamson 1225
straight, curly, loosely curled, or tightly curled.
Skin and hair are not ethnic.
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