Burn Care Disparities in Skin of Color

Image Credit: © Gorodenkoff

Approximately 450,000 patients receive hospital and emergency treatment for burns annually in the United States. Of these cases, around 40,000 require hospitalization, and 3,400 deaths occur each year.¹ Research indicates that minority populations, particularly Black and Hispanic individuals, experience disparities in burn care and outcomes.² A recent study examined the challenges faced by individuals with darker skin tones, including assessment difficulties, disparities in treatment, and post-burn complications such as hypertrophic scarring and hypopigmentation. While some progress has been made in understanding these disparities, the study concluded further research and clinical adjustments are necessary to improve care for all burn patients.³

Background

Despite advancements in burn treatment, disparities persist among racial and ethnic minorities. Studies show that Black patients represent 20% and Hispanic patients 14% of those treated at burn centers, while White patients account for 59%.² Racial disparities are evident in survival rates, with Black patients experiencing lower survival rates than White patients, which has been linked to delayed treatment and limited access to specialized burn units.⁴ "Black burn patients have been found to have lower survival rates compared to White patients, a difference partly attributed to delays in receiving care and limited access to specialized burn units," researchers wrote. Comprehensive research on burn outcomes specifically for individuals with darker skin remains limited, contributing to gaps in clinical practice.

Challenges in Burn Assessment for Diverse Skin Tones

The study noted individuals with Fitzpatrick skin types IV–VI face unique challenges in burn assessment due to physiological differences in skin response. Researchers stated traditional assessment tools such as the Vancouver Scar Scale and DermaLab Combo may yield inconsistent results due to the presentation of erythema as darker or purplish-blue discoloration instead of redness. "Erythema may appear as darker or purplish-blue discoloration rather than redness in darker skin, potentially leading to misdiagnosis or treatment delays," they wrote.This discrepancy underscores the need for assessment tools that are valid and reliable across diverse skin tones. Failure to accurately assess burn severity can delay appropriate interventions, increasing the risk of complications.

Post-Burn Scarring and Hypopigmentation in Darker Skin

The study found hypertrophic scarring and keloid formation disproportionately affect individuals with darker skin tones, with these scars being more severe and requiring surgical intervention in some cases. Accurate assessment of burn depth is critical, researchers noted, as conservative management is sufficient for superficial burns, whereas deeper burns benefit from early surgical intervention to prevent hypertrophic scarring and contracture. Additionally, they found post-burn hypopigmentation is a significant concern, often resulting in psychological distress. "This condition arises from the destruction or dysfunction of melanocytes in the burned areas, creating a sharp contrast between hypopigmented areas and surrounding normal skin," the study stated.Effective treatment options for post-burn hypopigmentation in darker skin remain underexplored, emphasizing the need for inclusive research.

Addressing Disparities and Moving Forward

Gaps in medical literature and clinical guidelines contribute to disparities in burn care for individuals with darker skin tones, according to the study. Researchers recognized limited representation in research and educational materials has resulted in a lack of tailored assessment tools and treatment protocols. They suggested efforts should focus on improving representation in clinical trials, developing inclusive diagnostic tools, and providing culturally competent training for healthcare providers. By aligning clinical practices with the needs of diverse populations, the study stated the medical community can move towards equitable burn care. Bridging these gaps will enhance diagnosis, treatment, and long-term outcomes, ensuring that all burn patients receive optimal care, regardless of skin color.

References

1. World Health Organization. Burns. Updated 2023. Accessed January 29, 2025. https://www.who.int/news-room/fact-sheets/detail/burns
2. Peters J, Bello MS, Spera L, et al. The impact of race/ethnicity on the outcomes of burn patients: A systematic review of the literature. J Burn Care Res. 2022;43(2):323-335. doi:10.1093/jbcr/irab174
3. Nguyen A, Duckworth E, Abu-Romman A, et al. Exploring the gaps: A scoping review of burn injury research in skin of colour. Wound Repair Regen. 2025;33(1):e13252. doi:10.1111/wrr.13252
4. Bedri H, Romanowski KS, Liao J, et al. A national study of the effect of race, socioeconomic status, and gender on burn outcomes. J Burn Care Res. 2017;38(3):161-168. doi:10.1097/BCR.0000000000000416