Beyond the Skin Surface: Melanocyte Biology and the Spectrum of Health Inequities

A striking physiological variance between human beings is the color of their skin, which is evident across human populations. Skin color is determined by the amount of eumelanin, a subtype of the pigment melanin in the skin, with higher levels resulting in darker skin phototypes. An ongoing concern within the dermatological community is the lack of skin disease diagnosis algorithms for different skin tones, with many symptoms being defined as type I skin according to the Fitzpatrick skin type scale. There are racial disparities in participant inclusions, with an underrepresentation of darker skin phototypes in clinical trials. In addition, the lack of representation of skin diseases on darker skin tones in medical literature can result in insufficient education on the nuanced presentations of dermatoses across different skin types, leading to potential misdiagnosis. Recognising these variations is essential to improve early diagnosis and healthcare outcomes for underrepresented groups. This review examines the impact of skin pigmentation on disease presentation, clinical diagnosis, treatment, and susceptibility, highlighting the challenges faced by patients with darker skin tones. It also explores healthcare disparities and emphasises the need for inclusive research and personalized treatment approaches to improve dermatological outcomes for underrepresented groups.