Rural Health Disparities in Skin Cancer Amplified Among Skin of Color.

Limited studies explore the role social determinants of health have on urban-rural health disparities, particularly for Skin of Color. To further evaluate this relationship, a cross-sectional study was conducted on data from five states using the 2018 to 2021 Behavior Risk Factor Surveillance Survey, a national state-run health survey. Prevalence of skin cancer history and urban/rural status were evaluated across these social determinants of health: sex, age, race, insurance status, number of personal healthcare providers, and household income. Overall, rural counterparts were significantly more likely to have a positive skin cancer history across most social determinants of health. Rural populations had a higher prevalence of skin cancer history across all races (P<.001). Rural non-Hispanic Whites had greater odds than their urban counterparts (OR=1.40; 95% CI 1.34 - 1.46). The odds were approximately twice as high for rural Black (OR=1.74; 95% CI 1.14 - 2.65), Hispanic (OR=2.31; 95% CI 1.56 - 3.41), and Other Race, non-Hispanic (OR=1.99; 95% CI 1.51 - 2.61), and twenty times higher for Asians (OR=20.46; 95% CI 8.63 - 48.54), although no significant difference was seen for American Indian/Alaskan Native (OR=1.5; 95% CI 0.99 - 2.28). However, when household income exceeded $100,000 no significant difference in prevalence or odds was seen between urban and rural settings. Despite increasing awareness of metropolitan-based health inequity, urban-rural disparities in skin cancer prevalence continue to persist and may be magnified by social determinants such as income and race. J Drugs Dermatol. 2024;23(6):480-484.    doi:10.36849/JDD.8094.

Sunscreen use and affordability attitudes based on ethnicity, socioeconomic status, and Fitzpatrick skin type.

IMPORTANCE: One in five Americans will develop skin cancer during their lifetime. While use of sunscreen can help prevent the development cutaneous cancer, regular use remains low nationwide. OBJECTIVE: To assess and better understand health care consumer preferences for sun protection products and perceived product accessibility and availability based on socioeconomic factors, race, and ethnicity. DESIGN: This quantitative survey study was conducted March through June of 2023. SETTING: Participants were recruited from two university family medicine clinical sites in the Buffalo, New York area, one located in a low and one located in a middle-to-upper socioeconomic neighborhood. PARTICIPANTS: Eligible participants were 18 years or older, fluent in English, and residents of the Buffalo, New York area. Surveys and consent forms were distributed by scripted verbal invitation, inviting all clinic patients who met eligibility criteria to participate. Participants were asked to self-report their racial/ethnic group as well as other demographic information including age, gender identification, household income, and household size. Information regarding sun exposure behaviors, and affordability/access was obtained using a combination of multiple choice and yes/no questions. A total of 405 participants were recruited. After excluding 235 incomplete responses, 170 surveys were available for analysis. INTERVENTIONS: None. MAIN OUTCOMES AND MEASURES: Our study aim was to expose health care consumer preferences as well as barriers to access based on socioeconomic factors, race, and ethnicity. RESULTS: Using a 25-question anonymous survey, 405 participants from two university family medicine clinical sites representing low- and middle-to-high-income neighborhoods, participated in the survey. 170 participants completed the survey questions and were included for analysis. Of those, 61.8% identified as female, 37.6% as male, and 0.6% as other. 51.2% of participants identified as lower income, 38.2% as middle-income, and 10.6% as upper income. The results of the survey revealed disparities in sunscreen use and affordability perceptions across demographic groups. Compared with Hispanics, Caucasians exhibited higher rates of sunscreen use (85 Caucasians, 7 Hispanics; p = 0.0073), prioritized SPF (95 Caucasians, 10 Hispanics; p = 0.0178), and were more likely to perceive sunscreen as unaffordable (6 Caucasians, 4 Hispanics; p = 0.0269). Analysis by Fitzpatrick Skin Type demonstrated differences in sunscreen utilization, with Types I-III using more compared to Types IV-VI (70 Types I-III, 51 Types IV-VI; p = 0.0173); additionally, Type I-III individuals were significantly more likely to cite cost as barrier to sunscreen purchase (40 Type I-III, 65 Types IV-VI; p < 0.0001). Moreover, lower-income individuals were significantly more likely to perceive sunscreen as unaffordable (12 lower-income, 1 middle & upper income; p = 0.0025) and cited cost as a barrier to purchase (46 lower-income, 59 middle & upper income; p = 0.0146) compared to middle-to-upper income counterparts. Though statistical significance was not established, respondents from middle & upper income groups reported higher sunscreen usage rates compared with their lower-income peers. CONCLUSIONS AND RELEVANCE: These findings highlight the importance of socioeconomic factors and ethnicity on accessibility to sunscreen and the impact of disparities in utilization among different ethnic and socioeconomic groups.

What influences the inclusion of skin tone diversity when teaching skin assessment? Findings from a survey.

BACKGROUND: Understanding the variances in visual skin changes across all skin tones is important in clinical care. However, the experiences of those teaching skin assessment to pre- and post-registrant nurses are unknown. AIMS: To determine the barriers and facilitators experienced in teaching skin assessment across a range of skin tones to pre- and post-registrant nurses. METHODS: A cross-sectional, mixed-methods online survey was undertaken throughout February and March 2023 based on the Theoretical Domains Framework of behaviour change. FINDINGS: In this self-selecting sample, most participants were aware of why it was important to include all skin tones when teaching skin assessment and were professionally motivated to include this in their practice. However, resources and support are needed to overcome an unconscious bias in teaching skin tone diversity, resulting in a lack of availability of good quality photographs and educator confidence in their own skills. Educators not considering skin tone when selecting patient cases and relying on people with dark skin tones to highlight where practice is not inclusive may also lead to insufficient exposure for students. CONCLUSION: There is some awareness of the importance of including diverse skin tones in teaching, but further education and resources are needed.

Inequities in the distribution of adverse childhood experiences and their association with health among transgender people of color.

BACKGROUND: Racism and cisgenderism expose transgender people of color to adversity across the life course. However, little is known about the prevalence of adverse childhood experiences (ACEs) in this population or their association with health in comparison to other groups. OBJECTIVE: Guided by the structural trauma framework, we examined race/ethnicity/gender group differences in the prevalence of ACEs and their association with adult mental and physical health. PARTICIPANTS AND SETTING: 2019-2021 Behavioral Risk Factor Surveillance Survey. METHODS: Transgender participants (n = 551) were matched with two cisgender men (n = 1102) and two cisgender women (n = 1102) on key covariates. We compared age-adjusted predicted probabilities of nine ACEs by race/ethnicity/gender group. We then fit adjusted logistic regression models predicting poor mental and physical health by each ACE and compared marginal effects between groups. RESULTS: Transgender people of color had higher age-adjusted probabilities of six ACEs than at least one other group; for example, household incarceration was 0.16 (95 % CI: 0.11-0.22) compared to 0.09 (95 % CI: 0.06-0.13) for cisgender men of color (p = 0.032). The relationship between five ACEs and poor mental health was greater for transgender people of color than at least one other group. For instance, the marginal effect of household alcoholism on poor mental health was 0.28 (95 % CI: 0.11-0.45) compared to 0.07 (0.01-0.14) for White cisgender men (p = 0.031). There were no statistically significant differences regarding effects on poor physical health. CONCLUSIONS: ACEs inequitably impact transgender people of color, reflecting the need to restructure the interlocking systems that drive adversity among transgender children of color and exacerbate ACEs' health effects among adults.

Visibility of inflicted bruises by alternate light: Results of a randomized controlled trial.

Difficulty visualizing bruises resulting from interpersonal violence, especially in individuals with dark skin, contributes to disparities in access to justice. The purpose of this analysis was to compare bruise visibility of detected injuries using white light versus alternate light sources (ALS). Visibility was assessed using the 5-point Bruise Visibility Scale (BVS) for white light and the ALS Visibility Scale (AVS) for ALS. Bruises were induced using controlled application of a paintball to the upper arm on 157 healthy adults across six skin color categories. Using a crossover design, the light source used first to assess the bruise (white light or ALS) was randomized. Each bruise was examined up to 21 times over 4 weeks using white light and 10 combinations of wavelengths (350 nanometer [nm] - 535 nm) and colored filters (yellow, orange, and red). Multilevel modeling was used to analyze the repeated measures data with a total 20,103 bruise assessments. Results revealed 415 nm with yellow filter resulted in an almost 0.5-point increase in BVS/AVS score across all skin colors (Estimate = 0.46; 95% CI: 0.43, 0.49; p < 0.001), a clinically significant improvement in ability to visualize bruises. Conversely, 515 nm (Estimate = -0.80; 95% CI: -0.84, -0.76; p < 0.001) and 535 nm (Estimate = -0.64, 95% CI: -0.67, -0.60; p < 0.001) with red filter resulted in more than 0.5-point decrease in BVS/AVS score. The use of ALS is supported by the data and results in improved bruise visibility during medical forensic examinations.

Racial and skin color mediated disparities in pulse oximetry in infants and young children.

Race-based and skin pigmentation-related inaccuracies in pulse oximetry have recently been highlighted in several large electronic health record-based retrospective cohort studies across diverse patient populations and healthcare settings. Overestimation of oxygen saturation by pulse oximeters, particularly in hypoxic states, is disparately higher in Black compared to other racial groups. Compared to adult literature, pediatric studies are relatively few and mostly reliant on birth certificates or maternal race-based classification of comparison groups. Neonates, infants, and young children are particularly susceptible to the adverse life-long consequences of hypoxia and hyperoxia. Successful neonatal resuscitation, precise monitoring of preterm and term neonates with predominantly lung pathology, screening for congenital heart defects, and critical decisions on home oxygen, ventilator support and medication therapies, are only a few examples of situations that are highly reliant on the accuracy of pulse oximetry. Undetected hypoxia, especially if systematically different in certain racial groups may delay appropriate therapies and may further perpetuate health care disparities. The role of biological factors that may differ between racial groups, particularly skin pigmentation that may contribute to biased pulse oximeter readings needs further evaluation. Developmental and maturational changes in skin physiology and pigmentation, and its interaction with the operating principles of pulse oximetry need further study. Importantly, clinicians should recognize the limitations of pulse oximetry and use additional objective measures of oxygenation (like co-oximetry measured arterial oxygen saturation) where hypoxia is a concern.

Shedding new light for nurses: Enhancing pressure injury prevention across skin tones with sub-epidermal moisture assessment technology.

AIM(S): To assess the effectiveness of sub-epidermal moisture (SEM) assessment technology in the detection of early-stage pressure damage in a critical care unit (CCU) and dark skin tone patients and its impact on hospital-acquired pressure injury (HAPI) incidence. DESIGN: Quality improvement study employing Kurt Lewin's change model emphasizing planning, implementation, evaluation and sustainable change. METHODS: The study evaluated 140 adult patients admitted to the CCU over a 24-week period, from July to December 2022. Retrospective analysis of standard PI care pathways was performed in 90 patients admitted during a 12-week pre-implementation period. Fifty patients were admitted through the subsequent 12-week implementation period. SEM assessments were performed daily at the sacrum and heels and interventions were applied based on SEM assessments; SEM delta ≥0.6 indicating localized oedema or persistent focal oedema. Statistical analyses were performed on anonymized data. RESULTS: Pre-implementation HAPI incidence was 8.9% (N = 8/90). All eight patients were African American with varying skin tones. A 100% reduction in HAPI incidence was achieved in the implementation period which included 35 African American patients. The relative risk of HAPI incidence was 1.6 times higher in the pre-implementation group. CONCLUSION: Implementing SEM assessment technology enabled equitable PI care for all population types and resulted in a 100% reduction of PIs in our CCU. Objective SEM assessments detected early-stage PIs, regardless of skin tone and enabled providing interventions to specific anatomies developing tissue damage as opposed to universal preventive interventions. IMPLICATIONS: PI care pathways relying on visual and tactile skin assessments are inherently biased in providing equitable care for dark skin tone patients. Implementing SEM assessments empowers healthcare practitioners in driving objective clinical interventions, eliminates bias and enables positive PI health outcomes. IMPACT: Implementing SEM assessment technology had three main effects: it detected early tissue damage regardless of skin tone (detection effect), enabled anatomy-specific interventions (treatment effect) and prevented PIs across all population types (prevention effect). The authors have adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE) 2.0 guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. What does this paper contribute to the wider global clinical community? Addressing health inequities in pressure injury prevention; Demonstrated effectiveness across patient populations; Resource optimization and enhanced patient safety.

Assessment of prevalence of sunscreen use and related practices among people living in Saudi Arabia: A cross-sectional survey-based study.

BACKGROUND: The use of sunscreen significantly reduces the risk of skin cancer and helps maintain skin health; however, improper use can decrease its effectiveness. This study aimed to investigate the prevalence and factors associated with sunscreen use in Saudi Arabia as well as identifying areas of weakness in sunscreen practices. METHODS: A cross-sectional survey-based study was conducted with a diverse population sample in Saudi Arabia. Participants were asked about their sunscreen usage habits, motivations, and knowledge of proper application techniques. Demographic information, including age, gender, and skin type, were also collected. RESULTS: A total of 2321 individuals participated in the study. More than two-thirds of the participants reported using sunscreen either always, regularly, or often, primarily to maintain a light skin color and prevent skin cancer. Factors associated with sunscreen use included younger age (18-40 years old), female gender, history of sunburn, and fair skin. Despite the majority reporting healthy sun exposure habits, several shortcomings were identified in sunscreen practices, including incorrect application and suboptimal reapplication frequency. CONCLUSION: While sunscreen use is common among the study population, there is a need for improved education on proper application techniques. National awareness campaigns, especially those utilizing popular social media and digital platforms in Saudi Arabia, should focus on disseminating accurate sunscreen use guidelines to maximize sun protection and skin health.

Detecting Early-Stage Pressure Injury in Patients With Dark Skin Tones Using an Enhanced Physical Assessment Technique and Halogen Lighting.

PURPOSE: The purpose of this quality improvement project was to identify stage 1 pressure injuries (PIs) in patients with darker skin tones using an enhanced skin assessment (Skin Assessment for Dark Skin, SADS) and halogen lighting. PARTICIPANTS AND SETTING: This quality improvement project was conducted on 3 units at a large university teaching hospital in Southeast Michigan. The project was originally designed so that participating patients were identified by bedside nurses as having sufficient melanin to obscure blanching on the hand/forearm using regular lighting, but this goal was not met. Data analysis is based on patients who self-identified as African American or Black, Native Hawaiian or Pacific Islander, Asian, American Indian, and Native Alaskan. Bedside nurses participating in this project were also asked to complete a questionnaire describing their knowledge and experiences with this project and assessment of early-stage PI in patients with darker skin tones. APPROACH: The Iowa Model of Evidence-Based Practice was used to guide this quality improvement initiative. Following a trigger event, we reviewed pertinent literature and developed an enhanced technique for assessing patients with darker skin tones that involved use of halogen lighting (SADS) and documentation of findings. We selected units from our facility and taught nurses to apply the SADS approach. Data from the electronic medical record and a survey of participating nurses were used to compare findings before and after project implementation. Comparisons were based on descriptive data analysis. OUTCOMES: Following implementation of the enhanced physical assessment, the participating units experienced a 6% decrease in the total number of facility-acquired PIs during the implementation period. IMPLICATIONS FOR PRACTICE: The enhanced physical assessment, when paired with halogen lighting, enhanced identification of stage 1 PI in persons with dark skin. The assessment method was easy to teach, learn, and can be performed at the bedside as part of a shift assessment which routinely includes inspection of skin.

Skin Pigmentation Impacts the Clinical Diagnosis of Wound Infection: Imaging of Bacterial Burden to Overcome Diagnostic Limitations.

Underrepresentation of diverse skin tones in medical education and providers' implicit racial bias drives inequities in wound care, such as disproportionally poor outcomes for Black patients. Diagnostic indicators (e.g., erythema) can present differently depending on skin pigmentation. This post hoc analysis of 350 chronic wounds from a prospective 14-site clinical trial aimed to determine how the perception of clinical signs and symptoms of infection (CSS) differs by patient skin tone and if fluorescence-imaging can offer a more objective diagnostic solution. Participants were grouped by skin tone (low, medium, high) as measured by the Fitzpatrick Skin Phototype Classification (FSPC) scale. CSS and total bacterial load (TBL) were compared across FSPC groups, along with sensitivity to detect TBL >104 CFU/g using CSS alone and combined with fluorescence-imaging. Erythema was reported less often with increasing FSPC score (p = 0.05), from 13.4% (low), to 7.2% (medium), to 2.3% (high), despite comparable bacterial loads (median = 1.8 × 106 CFU/g). CSS sensitivity in the high group (2.9%) was 4.8-fold to 8.4-fold lower than the low (p = 0.003) and medium groups (p = 0.04). Fluorescence-imaging significantly improved the detection of high bacterial load in each group, peaking in the high group at 12-fold over CSS alone. These findings underscore the threat of pervasive racialized health inequities in wound care, where missed diagnosis of pathogenic bacteria and infection could delay treatment, increasing the risk of complications and poor outcomes. Fluorescence-imaging is poised to fill this gap, at least in part, serving as a more objective and equitable indicator of wound bacteria. Clinicaltrials.gov #NCT03540004 registered 16-05-2018.

Communication Between Pregnant People of Color and Prenatal Care Providers in the United States: An Integrative Review.

INTRODUCTION: Racism and discrimination negatively affect patient-provider communication. Yet, pregnant people of color consistently report being discriminated against, disrespected, and ignored. The purpose of this integrated review was to identify studies that examined communication between pregnant people of color and their prenatal care providers and evaluate the factors and outcomes arising from communication. METHODS: We searched the PubMed, Embase, CINAHL, and PsychINFO databases for studies published between 2001 and 2023. Articles were eligible for inclusion if they reported on primary research conducted in the United States, were written in English, and focused on patient-provider communication with a sample that included pregnant people of color, defined as those who self-identified as Black, African American, Hispanic, Latina/x/e, Indigenous, American Indian, Asian, Asian American, Native Hawaiian, and/or Pacific Islander American. Twenty-six articles were included in the review. Relevant data were extracted and compiled into an evidence table. We then applied the rating scale of the Johns Hopkins Evidence-Based Practice model to assess the level of evidence and quality of the studies. Themes were identified using a memoing technique and organized into 3 a priori categories: factors, outcomes, and recommendations. RESULTS: Two overarching themes emerged from our analysis: racism/discrimination and unmet information needs. Subthemes were then identified as factors, outcomes, or recommendations. Factors included provider behaviors, language barriers, structural barriers, provider type, continuity of care, and fear. Outcome themes were disrespect, trust, decision-making power, missed appointments, and satisfaction with care. Lastly, culturally congruent care, provider training, and workforce development were categorized as recommendations. DISCUSSION: Inadequate communication between prenatal care providers and pregnant people of color continues to exist. Improving access to midwifery education for people of color can contribute to delivering perinatal care that is culturally and linguistically aligned. Further research about digital prenatal health communication is necessary to ensure equitable prenatal care.

Assessment of skin pigmentation-related bias in pulse oximetry readings among adults.

PURPOSE: Recent reports that pulse oximeters may overestimate oxygen saturation in individuals with darker skin pigmentation have prompted concerns from regulatory authorities regarding racial bias. We investigated the performance of TruSignal SpO2 sensors (GE Healthcare, Helsinki, Finland) in adults with varying skin pigmentation. METHODS: A retrospective study was conducted using a set of pooled assessments of SpO2/SaO2 measurements from nine studies to assess bias, accuracy (Arms), and precision of TruSignal sensors in healthy adults under induced hypoxia. Subgroup analyses were performed based on oxygen saturation levels (band 1, ≥ 70 and ≤ 80%; band 2, > 80 and ≤ 90%; band 3, > 90 and ≤ 100%). RESULTS: Of the 10,800 data points from 131 individuals, 8,202 (75.9%) and 2,598 (24.1%) were assigned to the light and dark pigment groups, respectively. Bias was 0.14% overall and less than 1% across oxygenation bands. The difference in bias between dark and light pigment groups was statistically significant at the low oxygenation band with SpO2 ≥ 70 and ≤ 80% (+ 0.58% and + 0.30% respectively; p = 0.0035). Throughout the saturation range, Arms was 1.64% in the light and 1.71% in the dark pigment group, within device specifications and regulatory requirements. Oxygenation was the dominating factor in stepwise ANOVA modeling. The mixed model also showed that bias was strongly affected by the oxygenation range. CONCLUSION: TruSignal sensors demonstrated higher bias at lower oxygen saturation, with less than 0.5% difference between pigment groups. These findings raise new questions, such as ways to improve pulse oximetry measurements during challenging clinical conditions, including low perfusion.

Racial Disparities in Diagnosis and Treatment of Patients With Dermatomyositis of Different Skin Tones.

BACKGROUND: Delays in the diagnosis and treatment of dermatological conditions in minorities are a well-documented health disparity. We aimed to determine if there was a delay in detection and treatment initiation for dermatomyositis (DM) and amyopathic dermatomyositis (ADM) in patients of different skin tones. METHODS: Patients from Montefiore Medical Center who met the criteria for DM and ADM were included in this cohort study. Records were reviewed for date of first documented rash, creatine kinase levels, muscle weakness complaints, and date of first steroid or disease-modifying antirheumatic drug initiation. The median number of days between rash documentation and therapy initiation was compared for patients of different races, including non-Hispanic White, non-Hispanic Black, Hispanic, and other (Asian and unknown). Data were compared in White versus non-White skin. RESULTS: Sixty-three DM and 9 ADM patients met the inclusion criteria. There was a shorter time to treatment initiation in White versus non-White patients, with a median number of 8 days compared with 21 days, respectively ( p = 0.05). Kaplan-Meier curves showed prolonged time to diagnosis and treatment in all other races when compared with White patients ( p = 0.03). DISCUSSION: It took clinicians longer to diagnose and treat DM and ADM in patients of color. The trends observed emphasize the importance of increasing dermatology education of non-White skin to improve detection and treatment of DM and ADM and minimize health disparities.

Measuring skin color inequality in women's health in Northeast Brazil: Evidence from the PCSVDFMulher survey.

In this paper, we investigate whether skin color is a source of inequality in women's health by exploring the longitudinal framework of the PCSVDFMulher survey in Northeast Brazil. Specifically, we measure the skin color gradient in women's general and mental health, as well as in showing health risk behavior. We find that darker-skinned women show poorer mental health outcomes and a higher likelihood of drinking and smoking more frequently than their lighter-skinned counterparts. The skin color gradient is persistent and systematic, even when modeling different sources of unobserved heterogeneity and accounting for the existing socioeconomic inequalities and racial identity. We also find that racial identity is an important source of heterogeneous responses of women's health to skin tone.

A survey of students' and junior doctors' confidence in diagnosing in skin of colour.

INTRODUCTION: To combat ethnic inequalities in health, medical students should be prepared to treat all patients. Denmark has become an increasingly diverse society and therefore needs a medical curriculum that reflects the change in population composition. This study aimed to assess if the dermatology curriculum in Denmark prepared medical students to diagnose dermatological diseases in patients with skin of colour (SoC). METHODS: From 20 September to 12 October 2022, a survey was distributed to medical students and junior doctors who had completed the dermatology curriculum at one of the medical schools in Denmark between 2010-2022. The participants were recruited mainly via Facebook. The statistical data were analysed in STATA, and free-text responses were analysed using thematic analysis. RESULTS: A total of 592 medical students (n = 285) and junior doctors (n = 307) completed the survey. In SoC, 43.9% and 32.6% felt confident to a poor or very poor degree in diagnosing dermatological diseases versus 5.9% and 2.5% in white skin. Among others, the respondents suggested to increase visual examples in the curriculum and integrate SoC in exams to increase their confidence level when diagnosing in SoC. CONCLUSION: Danish medical students and junior doctors are significantly less confident when diagnosing dermatological diseases in SoC than in white skin. Revision of the dermatology curriculum is needed to increase the students' confidence level and knowledge of SoC to prepare them to treat all patients, ultimately reducing ethnic inequalities in health. FUNDING: None. TRIAL REGISTRATION: Not relevant.

Diagnosis, assessment and management of atopic dermatitis in children with skin of colour.

BACKGROUND: It is important to be able to manage patients regardless of ethnicities. The understanding of skin diseases, including atopic dermatitis, in patients with skin of colour (SOC) is lagging compared with that in patients with lighter skin and has been identified as an educational gap among medical practitioners. OBJECTIVE: This paper synthesises the latest literature on the diagnosis, assessment, treatment outcomes and cultural considerations for managing atopic dermatitis in children with SOC in the general practice setting. DISCUSSION: Atopic dermatitis in children with SOC can vary from traditional descriptions and appear psoriasiform, lichenoid, scaly, papular, hypopigmented or violaceous. It can be misdiagnosed and its severity underestimated. Complications from atopic dermatitis, as well as the treatments provided, might result in inadequate treatment unless the treating doctor is aware of specific nuances in children with SOC.

Color Does Matter: Nursing Assessment of Varying Skin Tones/Pigmentation.

BACKGROUND: The observation of color is an integral part of the nursing assessment. However, the current understanding of individual skin qualities and pigmentation has not yet been integrated thoroughly into foundational assessment courses, clinical education, simulation, and textbooks. EVIDENCE ACQUISITION: Literature is scarce regarding racial groups, skin color, and physical assessment for patients across the lifespan, but even more so for the neonatal population. Historically, many nursing textbooks did not provide visual pictures or observational assessment strategies for the assessment of the Black, Indigenous, and people of color (BIPOC) population. This is improving in some nursing textbooks; however, the descriptors of and visual differences and anticipated assessment findings for the BIPOC population are not comprehensive. RESULTS: Evidence-based assessment findings, which may occur in newborns with varying skin tones/pigmentations, are presented. IMPLICATIONS FOR PRACTICE AND RESEARCH: The most essential step to having an accurate assessment is acknowledging the importance of color awareness. Color blindness, while thought to support inclusivity, only contributes to exclusion of one of the most important components of a person's being-their color.