A few years ago, scientists studying Lyme Disease in an area of Appalachia (United States) noticed something strange.
A lot more people with fair skin than people of color were being diagnosed with Lyme Disease.
The researchers got curious.
They asked, is the difference simply because white people are more likely to live in “endemic areas,” areas heavy with Lyme Disease?
The answer was no.
Even when you control for where people live, and the activities they engage in, the discrepancy holds true—fewer people of color are diagnosed with Lyme.
Then researchers noticed something else: Fewer people of color were being diagnosed with Lyme, but many more were being diagnosed with arthritis.
What was going on?
Ultimately, researchers made a critical connection.
When someone has symptoms of acute Lyme Disease, doctors look for one thing: the distinctive bull’s eye rash.
On fair skin, that rash jumps right out at you.
On darker skin, it can be easy to miss.
And doctors were missing it.
With serious consequences.
Patients whose Lyme Disease is missed in its early stage can face chronic and late Lyme Disease, with months of unexplained suffering and serious health complications.
What does all this have to do with lactation?
As it turns out … a lot.
Skin Tone and Lactation Assessments
Lactation professionals usually have great observation skills.
When you first see a client, you are probably looking for many clues as to what is causing their challenges.
But how often in an assessment do you consider the client’s skin tone?
What if we told you that many, many common breast/chest and nipple conditions can look very different depending on the skin tone of the person you’re seeing?
They can.
And like the doctors diagnosing Lyme Disease, if you’re not aware of the differences, you are likely to miss something.
Same Condition, Different Presentation
Here are three common examples.
Mastitis. In both clients with fair skin and darker skin, mastitis involves flu-like symptoms and an unresolved clog. The difference? In a light-skinned client, there is likely a defined area of redness—erythema—or red streaking. And we’re trained to notice that redness as part of the diagnostic picture. It looks painful and emergent. A client with darker skin may actually have mastitis that is more severe, but because an area of erythema (redness) isn’t evident, we can miss the diagnosis.
Vasospasm. You see a client with nipple pain and a characteristic blanched/white spot on the nipple after their baby feeds. What happens next? You’re expecting to see the skin turn from white to blue and back to red/pink. But for this client, the skin simply fades back to brown. What is happening? The answer: In clients with dark skin, this is a normal presentation of vasospasm. But if you don’t realize that, your assessment may miss it.
Surgical scars: You probably check for breast/chest surgery scars. But they can be harder to see on those with darker skin tones, leading you to fail to ask key questions.
These are far from isolated examples.
Many other breast/chest and nipple conditions present differently on different skin tones.
Adding to the issue, the vast majority of lactation training textbooks and courses show almost exclusively fair-skinned breasts and pink nipples.
This is true even though 70 percent of the global population—the overwhelming majority of people in the world— do not have the fair skin pictured.
Action Steps
As a lactation care provider, what can you do?
Here are four tools:
Build awareness. Remember that your exposure to diverse and representative imagery has been limited, and so your default concept of how a breast/chest will look with various conditions is limited.
Seek out diverse images. Look for opportunities to study images of non-white breasts/chests, nipples, and common conditions. An excellent tool is The Melanated Mammary Atlas.
Truly engage. During assessments, truly observe. Ask questions and listen to the answers (both body language and words). Believe what your client tells you.
Thinking flexibly. Especially when symptoms are atypical or not obvious, it becomes critical to consider all the pieces of the clinical picture before drawing conclusions. When you’re staying aware of the full clinical picture, you’re less likely to be thrown by seeing or not seeing one element.
For example, the client with flu-like symptoms and a clogged duct, but with no visibly red area?
Listen to their experiences, truly hear what they’re telling you, pay attention to the totality of signs and symptoms, and you will probably draw the right conclusion.
There’s much more to learn on this important topic.
This information is drawn from our new class, “How Did I Miss That? Breast Assessment in Non-White Skin Tones: Enhanced.”
The course is taught by Nekisha Killings, MPH, IBCLC, practicing IBCLC and Director of Equity, Inclusion, and Belonging at LER.
Killings is also the creator of The Melanated Mammary Atlas, an online tool dedicated to displaying mammary-related conditions on Asian, Indegenous, Black, and Brown skin.
Visit the Melanated Mammary Atlas here.
A few years ago, scientists studying Lyme Disease in an area of Appalachia (United States) noticed something strange.
A lot more people with fair skin than people of color were being diagnosed with Lyme Disease.
The researchers got curious.
They asked, is the difference simply because white people are more likely to live in “endemic areas,” areas heavy with Lyme Disease?
The answer was no.
Even when you control for where people live, and the activities they engage in, the discrepancy holds true—fewer people of color are diagnosed with Lyme.
Then researchers noticed something else: Fewer people of color were being diagnosed with Lyme, but many more were being diagnosed with arthritis.
What was going on?
Ultimately, researchers made a critical connection.
When someone has symptoms of acute Lyme Disease, doctors look for one thing: the distinctive bull’s eye rash.
On fair skin, that rash jumps right out at you.
On darker skin, it can be easy to miss.
And doctors were missing it.
With serious consequences.
Patients whose Lyme Disease is missed in its early stage can face chronic and late Lyme Disease, with months of unexplained suffering and serious health complications.
What does all this have to do with lactation?
As it turns out … a lot.
Skin Tone and Lactation Assessments
Lactation professionals usually have great observation skills.
When you first see a client, you are probably looking for many clues as to what is causing their challenges.
But how often in an assessment do you consider the client’s skin tone?
What if we told you that many, many common breast/chest and nipple conditions can look very different depending on the skin tone of the person you’re seeing?
They can.
And like the doctors diagnosing Lyme Disease, if you’re not aware of the differences, you are likely to miss something.
Same Condition, Different Presentation
Here are three common examples.
Mastitis. In both clients with fair skin and darker skin, mastitis involves flu-like symptoms and an unresolved clog. The difference? In a light-skinned client, there is likely a defined area of redness—erythema—or red streaking. And we’re trained to notice that redness as part of the diagnostic picture. It looks painful and emergent. A client with darker skin may actually have mastitis that is more severe, but because an area of erythema (redness) isn’t evident, we can miss the diagnosis.
Vasospasm. You see a client with nipple pain and a characteristic blanched/white spot on the nipple after their baby feeds. What happens next? You’re expecting to see the skin turn from white to blue and back to red/pink. But for this client, the skin simply fades back to brown. What is happening? The answer: In clients with dark skin, this is a normal presentation of vasospasm. But if you don’t realize that, your assessment may miss it.
Surgical scars: You probably check for breast/chest surgery scars. But they can be harder to see on those with darker skin tones, leading you to fail to ask key questions.
These are far from isolated examples.
Many other breast/chest and nipple conditions present differently on different skin tones.
Adding to the issue, the vast majority of lactation training textbooks and courses show almost exclusively fair-skinned breasts and pink nipples.
This is true even though 70 percent of the global population—the overwhelming majority of people in the world— do not have the fair skin pictured.
Action Steps
As a lactation care provider, what can you do?
Here are four tools:
Build awareness. Remember that your exposure to diverse and representative imagery has been limited, and so your default concept of how a breast/chest will look with various conditions is limited.
Seek out diverse images. Look for opportunities to study images of non-white breasts/chests, nipples, and common conditions. An excellent tool is The Melanated Mammary Atlas.
Truly engage. During assessments, truly observe. Ask questions and listen to the answers (both body language and words). Believe what your client tells you.
Thinking flexibly. Especially when symptoms are atypical or not obvious, it becomes critical to consider all the pieces of the clinical picture before drawing conclusions. When you’re staying aware of the full clinical picture, you’re less likely to be thrown by seeing or not seeing one element.
For example, the client with flu-like symptoms and a clogged duct, but with no visibly red area?
Listen to their experiences, truly hear what they’re telling you, pay attention to the totality of signs and symptoms, and you will probably draw the right conclusion.
There’s much more to learn on this important topic.
This information is drawn from our new class, “How Did I Miss That? Breast Assessment in Non-White Skin Tones: Enhanced.”
The course is taught by Nekisha Killings, MPH, IBCLC, practicing IBCLC and Director of Equity, Inclusion, and Belonging at LER.
Killings is also the creator of The Melanated Mammary Atlas, an online tool dedicated to displaying mammary-related conditions on Asian, Indegenous, Black, and Brown skin.
Visit the Melanated Mammary Atlas here.