Website on Covid-19 skin rashes criticised for lack of BAME examples

A website dedicated to publishing pictures of and identifying Covid-19-related skin rashes has been criticised for sharing just two BAME examples.

The British Association of Dermatologists’ Covid-19 Skin Patterns website features around 400 images of Covid-19 associated rashes, but the collection features very few pictures of people with darker skin tones.

It shares images of rashes which were gathered by the Covid Symptom Study app in response to growing evidence that they are a side effect of the disease.

The list ranges from prickly heat and chickenpox-type rashes to raised itchy hives and chilblain-like “Covid fingers and toes.”

Evidence from the app showed the rashes were present in around 9 per cent of app users who had tested positive for Covid-19. Meanwhile, a sixth of children experienced a rash and no other symptoms.

Cosmetic doctor and founder of Adonia Medical clinic, Dr Ifeoma Ejikeme, told the Standard the lack of BAME examples being used in the medical sector is a “huge problem”.

She said: “This is a huge problem in our medical sector, this even occurs in medical literature as there is often a lack of representation especially in regards to black skin.

“I was disappointed when I saw the lack of black or brown skin but I was not surprised.”

Ore Odubiyi, the director of BME Medics, told the Guardian: “When we consider that certain BAME communities in the UK are disproportionately impacted by Covid-19, it is crucial that visual resources which show how Covid-related skin changes may appear in darker skin tones are made readily available at a similar standard seen in resources exemplifying signs of disease in fairer skin tones.”

A spokesman for the British Association of Dermatologists’ site said that only 173 of 3,000 picture submissions came from individuals from BAME ethnicity.

But he said, following feedback, the site is “now planning to upload images of darker skin tones even where the rash is less clear”.

The spokesman said: “We received just under 3,000 pictures of suspected Covid rashes via the app during our survey.

“Although the skin survey specifically requested that individuals from BAME ethnicity also submit pictures, only 173 were received.

“This may be explained, in part, by cultural factors but also because rashes are less visible on darker skin and may have been difficult to photograph.”

Dr Ejikeme, who has extensive experience in global training in Medicine and Surgery, said medical professionals and charities need to adapt their approach when working with those from the BAME community.

She said: “I’m not sure what cultural factors they are referring to but the only thing I can think of is the Black, Asian and minority ethnic group have been historically left out in research and literature and therefore they may be more hesitant to speak up or come forward.

“When we (black people) have a rash we don’t go red, there is no change in skin tone, so you need to make sure your surveys or questionnaires bare that in mind.

“Perhaps ask whether there has been a change in the texture of their skin or if there are any changes on their skin that concerns them.”

Co-author of a handbook of clinical signs on black and brown skin and senior lecturer in diversity and medical education, Margot Turner, raised a similar point when speaking with the Guardian.

She said: “There are so many situations in which black people may not present themselves to medical professionals because they may not recognise themselves in the language or the pictures that we use typically use.”

A spokesman from the British Association of Dermatologists’ said: “Following feedback, we are now planning to upload images of darker skin tones even where the rash is less clear, as this may be preferable to not featuring images that fully represent all skin types.

“Our overall intention with this project was to provide a public service to help people during a difficult time, certainly not to cause division or distress, and we sincerely hope we can achieve this.”