Milestones - the magazine of the Royal College of Paediatrics and Child Health - winter 2020

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t is remarkable that in 2020, we have the ability to choose from 60 different shades of make-up foundation and yet find no equity Dr Shaarna Shanmugavadivel in skin tone images NIHR Doctoral when we open a Research Fellow medical textbook University of Nottingham or search an online Media/Awareness medical education Lead for Skin Deep resource. @HeadSmartFellow This basic misrepresentation of the society we live in has potentially life-threatening repercussions for the children and young people that we see and treat as healthcare professionals. We know consciously that skin conditions will present differently depending on the skin tone, yet we still default to describing rashes with only light skin tones in mind. Erythema, pallor, cyanosis are all classic descriptors which are harder to recognise in darker skin tones, or may not be present at all. We can all close our eyes and picture a measles rash in a light skin tone, but how many of us can honestly do the same for darker skin tones? Purpura does not look purple on the darkest of skin tones and chances are that we would not notice as quickly as in light skin tones




when eyeballing the patient unless we are actively looking for it. This unconscious discrimination has occurred mainly due to these descriptions and images being handed down the “generational line” without being noticed or challenged. Recently, DFTB’s new project Skin Deep, together with Brown Skin Matters and Mind the Gap, have successfully brought this important issue into the spotlight. The GMC has also acknowledged the need for greater diversity within undergraduate and postgraduate medical education.

Free resource Skin Deep is an exciting new global collaboration led by DFTB and the Royal London Hospital (RLH). The aim is to develop a free, open-access bank of photographs of medical conditions in a range of skin tones for use by both the public and healthcare professionals for medical education and as a diagnostic resource. We hope that, with time, this will improve education and recognition of conditions in all skin tones, reducing inequalities and improving patient care by ensuring all children and young people receive a timely and correct diagnosis irrespective of the colour of their skin. If you haven’t already heard of DFTB, it is one of the largest free open-access medical education resources available

online and the team have strong international collaborative networks. Skin Deep started in June 2020, but the huge response has led to its launch as a stand-alone project with its own website and social media channels. The project uses a two-pronged approach targeting parents, guardians and carers as well as healthcare professionals to maximise the quality and quantity of images. All the submitted photographs are reviewed by dermatologists to provide the correct diagnoses and clinical terms. Images are only used with consent from parents, and case details are anonymised. As a team, we are calling on you all as our colleagues to collaborate with us. We have developed a streamlined process to set up the project at individual hospital sites, including the appropriate governance and consent processes to ensure patient confidentiality and secure transfer of photographs. We have 10 UK hospitals on board already and a number of others across Australia and South Africa. As a result, we are delighted to have over 275 images on our website and invite you all to have a look, learn and use the images in your own teaching. It is 2020, and no child or young person should be disadvantaged in the care they receive due to the colour of their skin. Let’s make change together!