Tucked down a narrow hallway in Davindra Singh's sprawling Toronto dermatology clinic is a tanning booth. It's about as tall as Dwyayne Wade and outfitted with 48 slender fluorescent bulbs. At a time when most dermatologists are urging their patients to drop their fake 'n' bake habits, Singh spent $20,000 on the machine, which some of his patients use three times a week.
The contraption is less about vanity, however, than it is about medical treatment: It provides phototherapy for patients suffering from vitiligo, a skin disorder that causes patches of depigmented skin. And it's a dramatic departure from the typical dermabrasion and laser hair removal Canadians are used to seeing at the dermatologist's office, but that's because Singh's practice specializes in so-called "ethnic dermatology."
Just as a black woman's Afro-style locks need a different kind of care than her blond-haired counterpart's, a one-size-fits-all approach doesn't work for skin care. Dark skin is often mistaken as more resilient than light, when really it's quite sensitive to and can be damaged by many common dermatological treatments.
This relatively new specialization has taken off in the U.S., where dark-skin-focused dermatologists have established themselves in Miami, Los Angeles and New York. And it makes sense: As demographics shift in major urban centres - Statistics Canada predicts that one in three Canadians will belong to a visible minority by 2031 - dermatologists should be able to treat all skin types.
Earlier this month, specialists gathered in New York for the second annual Skin of Color Seminar Series. The first Canadian clinic focused on ethnic dermatology - Dr. Singh's - opened its doors in February.
When he first began practising medicine several years ago, Singh often mistook simple conditions in dark-skinned patients for other, more serious ones. "Eczema looks a certain way in white skin but it looks very purple and funny in darker skin," he explains. "I'd think those were weird things like lymphoma and I'd biopsy them a lot."
The problem, he says, is the bulk of research and resources are focused on light skin. "Every [dermatology]textbook shows white people and everything [in their skin]looks red. But when you start to get brown or black people, it all of a sudden starts to look purple."
Singh has completed international courses to better understand how to examine and treat dark skin and has poured thousands of dollars into outfitting his office with equipment - such as lasers and hydrating dermabrasion machines - that are less likely to damage dark skin. Because the dark-skinned market in the Greater Toronto Area is enormous and largely untapped, he expects his investment will soon pay off.
The cosmetic side of the ethnic dermatology trade is certainly booming.
Singh spent four months training at the clinic of Eliot Battle, a Washington, D.C. dermatologist who caters to patients with dark skin. Laser hair removal was once the most popular treatment at the practice, but it was recently surpassed by "complexion blending," a laser procedure that evens out a patient's skin tone," Singh says.
New York dermatologist Mohiba Tareen, who specializes in treatments for South Asians, says she writes 30 to 40 prescriptions a day for bleaching creams to treat pigmentation problems. Among South and East Asian populations, fair skin is held up as the ideal tone; many drugstore moisturizers sold in Asian countries include bleaching agents. At Tareen's clinic, much of the demand for the potent treatments comes from patients who seek her out without a doctor's referral. "I have these women begging for full-body depigmentation," she says. "They don't want to even out things but to achieve the whitest, lightest skin possible." In those cases, Tareen adds, she prefers to chat with patients about why they wish to lighten their skin rather than simply writing a prescription.
The rise of ethnic dermatology clinics is concerning to Amina Mire, an assistant professor in Carleton University's department of sociology and anthropology in Ottawa. She worries that people with dark skin will increasingly turn to dermatologists for non-medical reasons, resulting in little incentive for the multi-billion-dollar skin-lightening industry to separate the purely aesthetic pursuit of light skin from legitimate medical treatment.
"Where do you draw the line between pigmented skin and skin that has a medical issue?" the professor says. "Increasingly, this is a market driven by aesthetic desire for light skin."
In Toronto, Singh hasn't yet had a patient ask for full-body bleaching, but he's prepared for it. "I'm sure I'll get it, but what can you do? We're not going to do anything like that. If you really don't want to get darker, just wear sunscreen and stay out of the sun or use a parasol."