Bruises and other physical abuse signs can be difficult to identify on dark skin tones, making it harder for people of color to access care and legal support. Research into new detection tools may help address these disparities.
In medical settings, bruises are typically identified by natural light or using white light technology. However, both of these methods can often fail to detect trauma to brown and black skin.
New studies suggest that an alternate light source (ALS) may help bridge this gap and provide more effective and quality dermatological care for people of color. ALS options include devices that project light of a specific wavelength, like yellow, blue, or violet light, which may be more effective at showing bruises in dark skin tones.
How current bruise detection methods may create barriers
Bruises may vary in appearance depending on skin tone. On dark skin, they may appear brown or darker
than the surrounding skin, which isn’t always easy for a healthcare professional to spot, largely due to underrepresentation in medical research and education.
White light (all the wavelengths of visible light) is currently the most common method to identify bruises. However, this medical technology cannot effectively detect bruising on dark skin tones. This means that people of color are far less likely to have injuries from physical abuse accurately identified or documented by a professional. This disparity can impact:
Access to care
Failure to detect bruising can prevent the delivery of care, such as healing and pain management. It can also reduce lifesaving support and care options that address mental health needs following abuse-related trauma.
Legal outcomes
For people who have experienced domestic violence as well as other forms of abuse, medical documentation of their injuries is crucial and can contribute to a key foundation toward seeking justice. As bruises can fade quickly, early and accurate documentation of these abuse signs is vital.
A failure to record trauma to the body is not only a lost opportunity for evidence collection but can also delay potentially lifesaving charges and restraining orders, particularly in cases of intimate partner violence (IPV).
How does disparity in bruise detection further affect some populations?
Women of color, and Black women especially, can often be at greater risk
of misdiagnosis and medical dismissal. The inability to detect bruises on dark skin tones may leave them further vulnerable to other instances of violence.
Children and older adults with dark skin tones can also face obstacles to receiving care. It may be more difficult to voice what they’ve experienced or ask for help if no one can see their injuries.
White light vs. alternate light: How current research may improve bruise detection
A 2023 study funded by the National Institute of Justice and led by Dr. Katherine Scafide, a forensic nurse and scientist, analyzed how implementing ALS options into clinical practice could help improve bruise detection across diverse populations.
People with dark skin tones who have injuries from physical abuse may not receive “appropriate medical care necessary to prevent them from suffering long term, health complications,” Scafide told Healthline. However, ALS devices could “help address these disparities.”
The study found that using a yellow filter was five times
more likely to detect bruising than white light on dark skin tones, which could enhance injury documentation and support evidence creation in situations of domestic violence.
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How can healthcare professionals deliver better care?
It can be challenging for a healthcare professional to deliver effective care if they cannot detect bruising or if a person hides physical abuse signs out of fear.
These tips can help medical professionals deliver diverse and quality care to achieve the best outcome for those who experience domestic violence and abuse:
- Develop diverse medical knowledge: It’s crucial for healthcare professionals to continually develop their understanding of diverse dermatological signs and care to ensure they can provide the support all their patients need.
- Look for other indicators of abuse: A person experiencing violence may attempt to hide physical signs of abuse out of fear or shame. However, they may show behavioral signs, such as flinching at a perceived touch or acting uneasy around their partner.
- Use compassionate care: A 2021 review
- Trusted Source
- found that people who’ve experienced domestic abuse frequently used healthcare services but rarely disclosed what they were going through as they felt judged. Prioritizing compassion and respect may help someone feel safer and more likely to ask for help.
In the absence of ALS devices, Scafide suggests continuing to screen while “maintaining an awareness that an injury’s appearance will not be the same across skin tones.”
How to advocate for yourself as a person of color
People of color experiencing abuse may have a harder time having healthcare professionals acknowledge their injuries.
The following tips may help:
- Voice your desired treatment options: If you feel a doctor is dismissing your pain or not taking your symptoms seriously, it may be helpful to voice your health needs using specific and direct language. Examples include:
- “I am in a severe amount of pain from an injury. I need medical support to help manage my pain right now.”
- “I am finding it difficult to cope with my anxiety. I really need mental health support.”
- Document the dismissal: If you feel like a doctor is dismissing your symptoms, consider asking them to record your concerns in your medical notes. This can help hold them accountable and may even lead to them revisiting your concerns.
- Explore other avenues of professional support: If you have experienced physical abuse and are not able to have your injuries medically documented, consider speaking with a support organization specializing in abuse. Their advocates and support staff can typically help you record your experiences in a safe and confidential manner.
When should you self-document?
If you’re unable to have your injuries medically recorded or see a healthcare professional, it can be helpful to self-document any abuse. This could involve taking pictures or videos of injuries on a safe and private device or keeping a journal recording the details of the assault, including times and dates.
Finding support for domestic abuse
If you or someone you know is experiencing domestic abuse, the following hotlines can provide support:
- National Domestic Violence Hotline: call 800-799-7233
- National Deaf Domestic Violence Hotline: call 855-812-1001 or text START to 88788
- Childhelp National Child Abuse Hotline: call or text 800-422-4453
If you are experiencing domestic abuse and need legal support, the following organizations can provide guidance:
- WomensLaw.org: state-specific information on protective laws
- Legal Services Corporation: financial support for those who are low-income
- Immigrant Legal Resource Center: advice and advocacy for non-U.S. citizens
You should call 911 immediately if you or someone else is in danger or needs medical attention.
The bottom line
Bruises can be difficult to detect in dark skin tones. This can create obstacles when it comes to people of color who’ve experienced abuse having their injuries identified and documented, which can affect access to care and legal outcomes.
Recent studies have identified how alternate light sources, which may be up to five times more effective at identifying bruising on dark skin, may be able to help bridge this gap.
In the meantime, compassionate care and continually developing diverse dermatological knowledge may help healthcare professionals improve outcomes for people of color who experience domestic violence and abuse.