What Is An Expert? And What Does That Mean For 'Skin of Colour' Dermatology?

The word expert is used freely these days.
In medicine, however, expertise isn’t something we self-assign — it is earned through rigorous training, lived clinical experience, and demonstrable competence. Yet in conversations around “skin of colour,” the label is sometimes granted far too easily, often on the basis of appearance/identity alone.

As the field evolves and public awareness grows, it’s worth asking: What truly defines expertise in skin of colour dermatology?
And why does it matter?

Skin of Colour Is Dermatology — Not a Side Niche

There is a persistent misconception that skin of colour is a small corner of dermatology, some separate add-on or niche topic.
It isn’t.

Skin of colour is dermatology.
It encompasses the entire discipline as it applies to people with moderate to darkly pigmented skin. Every condition — from eczema to psoriasis to skin cancer — can present differently depending on skin tone, genetics, and biological variation. Understanding these nuances requires the full breadth of dermatological training, not a reduced version of it.

True Expertise Requires Comprehensive Knowledge

Expertise in skin of colour cannot be improvised or inferred. It demands:

• Deep grounding in general medicine
• Completion of full dermatology training
• Understanding of cutaneous pathology
• Insight into genetic, biological, and photobiological differences
• Awareness of sociocultural factors that shape health behaviours and access to care

This is not a shortcut field.
It is not “simpler.”
It is more knowledge, not less — and it requires the same (if not greater) diagnostic precision as any other subspecialty.

My Own Path to Expertise

My expertise was not conferred by my skin tone or identity.
It was built through:

• General medical training, with a Fellowship of the Royal College of Physicians
• Specialist dermatology training, with my CCST in Dermatology
• Additional training in skin pathology, with a Diploma in Dermatopathology by the Royal College of Pathologists
• Research, including genomic studies focused on populations with darker skin tones, with a Masters degree in Genomic Medicine

These foundations allow me to evaluate conditions accurately, interpret evidence, and contribute meaningfully to advancing the field. That is the nature of true expertise: it comes from real work, not personal identity.

When Appearance Is Mistaken for Authority

In no other area of medicine do we confuse appearance with expertise.
We would not call someone a melanoma specialist simply because they have moles.
We would not label someone a cardiologist because they have a heart condition.

Yet somehow, when it comes to skin of colour, having darker skin is sometimes seen as sufficient to claim authority. This lowers the bar in ways that ultimately harm the very communities we aim to serve.

Representation Matters — But It Is Not Expertise

Representation matters — profoundly. It enhances trust, improves communication, and brings necessary perspectives into the clinical environment.

But representation alone is not clinical expertise.

Conflating the two can inadvertently:

• Spread misinformation
• Undermine patient safety
• Create public confusion about who is qualified
• Reinforce lower standards for populations already facing disparities

Communities with darker skin deserve higher standards, not lower ones.

Why Image Banks Alone Are Not Enough

The recent push to expand image libraries showing skin conditions in darker skin is welcome and necessary. For decades, the underrepresentation of darker skin tones in textbooks and teaching materials left clinicians without crucial visual references.

But we must be careful not to assume that simply presenting more images equates to true progress or expertise.

Diagnosis is never a matter of matching a patient to a picture.
A photograph cannot tell you:

• the patient’s clinical history
• the progression of symptoms
• associated systemic signs
• environmental or medication triggers
• subtle textural or morphological features
• the broader diagnostic context

Image banks can facilitate intuitive, pattern-based thinking, which is useful for common presentations.
But dermatology — particularly in darker skin — often requires much more.

When cases present atypically, subtly, or overlap with other conditions, clinicians must rely on analytical reasoning rooted in:

• deep medical and dermatological knowledge
• understanding of disease mechanisms
• familiarity with variants unique to or more common in darker skin
• sophisticated differential diagnosis skills

This is where true expertise becomes indispensable.
Representation in images is vital — but it is not the endpoint.
Improving care for people with darker skin requires clinicians who can move beyond pattern recognition and interpret complexity with precision.

This Is Ultimately About Health Equity

People with darker skin already face:

• Higher rates of misdiagnosis
• Delays in detecting serious conditions
• Underrepresentation in research and educational resources

Ensuring that “expertise” is grounded in training, evidence, and experience — rather than appearance — is one piece of addressing these long-standing inequities.

Health equity demands accuracy, consistency, and honesty about what expertise actually is.

A Call to the Medical Profession

If we want to improve outcomes for people with darker skin, we must:

• Apply the same rigorous standards used in any other subspecialty
• Base credibility on training and clinical experience
• Ensure that expertise is independent of personal identity
• Uphold evidence, not optics, as the defining measure

Excellence must remain the benchmark.

A Call to the Public and the Media

Before giving someone your trust, platform, or attention:

• Check their qualifications
• Ask about their training and experience
• Look for evidence-based voices, not just visible ones

Your skin health is too important to rely on anything less than genuine expertise.

Closing Thoughts

Improving dermatological care for people with darker skin — the population often grouped under “skin of colour” — starts with accuracy, transparency, and high standards.

Image representation matters.
Representation among clinicians matters.
But expertise — real, earned expertise — is what ultimately improves outcomes.

When expertise is real, care is safer.
When standards rise, everyone benefits.

Image Caption: Diagnosis in skin of colour often requires more than visual pattern recognition. Clinical history and analytical reasoning are essential. This case shows a man with facial nodules, which were found to be a granulomatous reaction to soft tissue filler injections.

Author’s Note: As clinicians, we hold a responsibility not just to participate in conversations about equity, but to uphold the standards that make equity possible. My hope is that this piece encourages a more honest, rigorous and meaningful approach to dermatology in darker skin — one grounded in evidence, not optics, and driven by a genuine commitment to patient care.