Doctors, can you identify monkeypox (MPV) in dark skin tones?

Doctors, can you identify monkeypox (MPV) in dark skin tones?

Medical schools, textbooks, diagnostic guides, and public health campaigns often skip over vital information to help clinicians identify skin conditions in dark skin tones. That’s why Health in Her HUE and Violet teamed up to create a guide to assist the medical community in identifying MPV in dark skin tones.

Monkeypox (MPV) is a rare disease in the Variola family of viruses, the same family as smallpox, where skin bumps, pustules, and pockmarks are symptoms. As MPV threatens to reach epidemic levels, it is vital that clinicians—from primary care physicians to dermatologists—can identify MPV in various skin tones.

Dr. Kiyanna Williams, a dermatologist and Health in Her HUE affiliate physician, expressed concern over her peers not knowing how to identify dermatological conditions in dark-skinned patients, impacting the quality of care doctors can provide.

“To ensure that we as [clinicians] can provide the best care to all patients, it is imperative that there be adequate representation of all skin tones, especially in medical images. Many conditions, specifically skin conditions, can present differently in darker skin tones. Therefore, diverse images are necessary to ensure [a] proper diagnosis is made and appropriate treatment is initiated when needed” says Dr. Williams.

MPV can impact all people, including people of various skin tones and complexions. Unfortunately, identifying dermatological conditions in patients with dark skin tones isn't widely taught in medical school, shown in diagnostic guides, or seen in public health campaigns.

According to Health in Her HUE affiliate physician Dr. Jeaneen A. Chappell,the incubation period for monkeypox is typically 7-14 days. It classically begins with flu-like symptoms followed by a rash in a few days that starts on the face or extremities. However, there are current reports of cases beginning in the groin and not having the associated flu-like symptoms.”

As of September 2022, there have been approximately 52,000 confirmed cases of Monkeypox (MPV) globally and about 19,000 confirmed cases in the United States. Despite the urgency, many clinicians aren’t prepared to take on this virus considering the insufficient vaccine supplies and a poor understanding of symptoms presented in diverse populations, especially for dark-skinned individuals.

A history of insufficient representation.

Here’s just one example of many instances where diversity matters in medicine. According to the New England Journal of Medicine, “a 2020 study comparing oxygen levels measured by [pulse oximeters] with readings taken from ‘gold standard’ arterial blood samples found pulse oximeters were three times less likely to detect low oxygen levels in Black patients than in white patients…[ultimately] overestimate[ing] blood oxygen levels in darker-skinned individuals and mak[ing] them appear healthier than they actually are.” Ultimately, the study concluded that some BIPOC patients may have been turned away from getting hospitalized during COVID-19 because of false oxygen levels.

In a society rife with anti-Blackness and systemic racism, there is no surprise that dark-skinned individuals have fewer medical resources and their specific needs aren’t properly addressed in medical school or by technology. This is a history that repeats itself.  And it's heartbreaking.

The case for better representation of MPV.

For clinicians and patients alike, how many times have you googled a concerning rash and all examples were displaying lighter skin tones? If you searched MPV right now, the majority of image results would be of light-skinned people despite MPV impacting everyone regardless of skin tone. This knowledge gap has the potential to endanger patients, especially during the current MPV outbreak when the telltale symptom is raised bumps along the skin.

To help identify MPV symptoms presented in dark skin tones, please use the following companion guide based on photos documented by the Centers for Disease Control and Prevention (CDC):

It is important that “people be on the lookout for painful, spreading bumps that look similar to very large pimples or blisters. Check the hands, feet, [groin], and mouth for involvement as well,” says Dr. Chappel.

It is also essential to continue to follow trusted health information outlets like the Center for Disease Control (CDC), the World Health Organization (WHO), and your local Department of Health for updates on the latest news pertaining to the MPV outbreak.

Black is beautiful and having the right tools and resources to properly care for all patients keeps skin healthy, a vital aspect of overall health and wellbeing.

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