To address racial disparities seen in patients of color within O&P, we are developing an evidence-based, digital handbook that will include images and descriptions of various skin problems related to O&P as they appear on black and brown skin. The purpose of the handbook is to improve the skin assessment skills of O&P clinicians, promote equitable care, and produce an educational resource more representative of the population we serve. Prosthesis and orthosis users frequently develop skin problems; scientific literature suggests that up to 75 percent of lower-limb prosthesis users eventually develop a skin problem.1 Because skin evaluations are such a fundamental component of how prosthetists and orthotists assess socket fit, orthosis fit, residual limbs, and wound healing, the omission of black and brown skin tones in educational materials likely contributes to disparities in patient outcomes.
It is well established that racial disparities within the United States healthcare system negatively affect the health and well-being of nonwhite individuals due to implicit and explicit biases, institutional structures, and interpersonal relationships.2 This holds true regarding treatment outcomes for people with black and brown skin who experience skin problems. Dermatological conditions are often misdiagnosed, have a more advanced presentation at the time of diagnosis, or go unnoticed in people with black and brown skin.3 Black patients, in particular, have a significantly higher incidence of pressure injuries, later-stage pressure injuries, and major leg amputation following a diabetic foot ulcer compared to white patients.4,5
We are seeking images of black and brown skin with conditions such as callusing, dermatitis, epidermoid cyst, hematoma (bruising), keloid, skin breakdown, skin infection, ulcer, verrucous hyperplasia, excessive pressure from a device, hyperpigmentation from a device, and other skin issues.
To submit images, clinicians will need to request postcards for their clinics by filling out our Google form. The postcards, which come in both English and Spanish, include a color swatch that must be present in all submitted images to allow for color correction. Once you have the postcards, patients may independently, or with the assistance of their clinicians, submit images through the survey on our website, which provides additional instructions on the photo-taking process and examples of acceptable photo submissions. Patients whose images are selected for inclusion in the handbook will receive a $75 compensation for their contribution.
Other members of the project team are Cody McDonald, PhD, MPH, LCPO; Sue Spaulding, MS, LCPO, FAAOP; Sarah Cheever, CPO; and Kristen Wan, CO.
To request postcards with the color swatch, visit https://docs.google.com/forms/d/e/1FAIpQLScetPDjCWx2x9ngVEQtMtnUqjByaAC2W87mGd4sAwXwpFzIwg/viewform.
To submit photographs, visit https://sites.google.com/view/opskintoneproject/home
Gabby Richardson, LCPO, is a clinician at Douglass Certified Prosthetics and Orthotics, Washington.
Daniela Phillips, CO, is a prosthetics resident at VA Puget Sound Healthcare Center, Washington.
References
- Highsmith MJ, Highsmith JT. Identifying and Managing Skin Issues With Lower-Limb Prosthetic Use.
- Buonsenso D, Liu JF, Shanmugavadivel D, Davis T, Roland D. Impact of Diversity in Training Resources on Self-Confidence in Diagnosing Skin Conditions Across a Range of Skin Tones: An International Survey. Front Pediatr. 2022;10:837552. doi:10.3389/fped.2022.837552
- Shango KH, Abdole FA, Gonzalez SM, Farshchian M, Moossavi M. Medical Student Confidence in Diagnosis of Dermatologic Diseases in Skin of Color. CCID. 2022;Volume 15:745-750. doi:10.2147/CCID.S357743
- Oozageer Gunowa N, Hutchinson M, Brooke J, Jackson D. Pressure injuries in people with darker skin tones: A literature review. Journal of Clinical Nursing. 2018;27(17- 18):3266-3275. doi:10.1111/jocn.14062
- Brennan MB, Powell WR, Kaiksow F, et al. Association of Race, Ethnicity, and Rurality With Major Leg Amputation or Death Among Medicare Beneficiaries Hospitalized With Diabetic Foot Ulcers. JAMA Netw Open. 2022;5(4):e228399. doi:10.1001/jamanetworkopen.2022.8399
