The queer community faces unique dermatologic challenges due to a combination of factors, including hormonal treatments, sexual behaviors, and the psychosocial stress associated with stigma and discrimination. Nationally, June is recognized a Pride Month with multiple Pride events taking place to celebrate and hold space for LGBTQIA+ individuals and advocates fighting for human rights. In this article I share some of the most common dermatologic diagnoses seen in this community and share the lessons I learned by attending DC Black Pride and what they want healthcare professionals to know about providing inclusive care.
~9 minute read
Common Dermatologic Diagnoses in the Queer Community
1. Acne and Folliculitis:
- Acne: Hormone therapy, especially testosterone in transgender men, can exacerbate acne. This is due to the increase in sebum production associated with androgens.
- Folliculitis: Infections or inflammation of the hair follicles, often due to shaving or friction from clothing.
2. Human Papillomavirus (HPV) Infections:
- Genital Warts: HPV can cause warts on the genital and anal areas. Men who have sex with men (MSM) are at higher risk for HPV infections.
3. Sexually Transmitted Infections (STIs):
- Syphilis: Can present with a wide range of dermatologic manifestations, including the classic chancre (a painless ulcer) and secondary syphilis rash.
- Herpes Simplex Virus (HSV): Commonly causes genital sores and can be more prevalent in MSM.
4. HIV-Related Dermatologic Conditions:
- People living with HIV/AIDS often experience a range of skin conditions due to the immunocompromised state, including Kaposi's sarcoma, molluscum contagiosum, and various fungal infections.
5. Psoriasis and Eczema:
- Higher levels of stress and psychosocial factors in the queer community can exacerbate conditions like psoriasis and eczema.
6. Dermatitis and Contact Allergies:
- Allergies or irritations from cosmetics, lubricants, or latex can cause contact dermatitis, particularly in sensitive areas.
7. Skin Cancer:
- Higher prevalence of outdoor activities and tanning, combined with less consistent use of sunscreen, can increase the risk of skin cancers.
8. Hair and Scalp Conditions:
- Transgender individuals on hormone therapy might experience changes in hair patterns and scalp health, leading to conditions like androgenetic alopecia or hirsutism.
9. Anogenital Disorders:
- Conditions like lichen sclerosus and lichen planus, which affect the anogenital area, might be more common or more problematic in individuals engaging in receptive anal intercourse.
10. Psychodermatoses:
- Higher rates of anxiety, depression, and other mental health issues can lead to psychosomatic conditions like trichotillomania (compulsive hair pulling) or psychogenic excoriations (skin picking).
Understanding these common dermatologic issues is crucial for dermatology nurse practitioners to offer sensitive and appropriate care for the queer community. Addressing both the physical and psychosocial aspects of these conditions is essential for holistic treatment.
DC Black Pride
I’ve had the honor of interviewing Kenya Hutton, the Deputy Director of the Center for Black Equity for two years in a row to discuss the history and agenda of DC Black Pride in 2023 and 2024. As of August 2024, Kenya will be promoted to President and CEO when the current President and CEO, Earl Fowlkes, Jr., steps down. DC Black Equity hosts DC Black Pride which is free and open to the public. The mission and vision of the Center for Black Equity is as follows:
Mission:
To promote a multinational LGBTQ+ network dedicated to improving health and wellness opportunities, economic empowerment, and equal rights while promoting individual and collective work, responsibility, and self-determination.
Vision:
Build a global network of LGBTQ+ individuals, allies, community-based organizations, and Prides dedicated to achieving equality and social justice for Black LGBTQ+ communities through Economic Equity, Health Equity, and Social Equity.
“Black Pride Forever”
This year DC Black Pride took place at the Westin hotel in Washington, DC. Mayor Muriel Bowser proclaimed May 20-27, 2024 DC Black Pride Week. You can view the agenda here. It officially started at Thurst, the official DC Black Pride lounge, on Wednesday May 22, 2024. Note, while there were a variety of events hosted by different organizers some of which who charged for entry, all events hosted by the Center for Black Equity were free. On Friday, Rainbow Row opened which is the name for the vendor market. There we found a variety of businesses and entrepreneurs in the DMV region providing a variety of services including access to medical care, dental care, legal services, foster care support, and transgender historical artifacts.
I met a friend there who was working in the Health & Wellness Pavilion. Participants received access to complimentary services, including:
-HIV testing with on-the-spot testing and take home test kits
-Mpox vaccine
-Doxy PEP
-Massages
-Mini facials
-Vital signs
-Full panel STI screening
-Overdose prevention kits
Providers and entrepreneurs are welcomed and encouraged to sign up to work in the Health and Wellness Pavilion or to sell your goods and services in Rainbow Row. I pitched the idea of having IV infusion therapy next year. Hopefully, Kenya will take me up on my offer! Speaking of next year, DC will host World Pride where they are anticipating millions of people from around the world to be in attendance. DC Black Pride will kick of the celebration next year, followed by World Pride, a two-week long phenomena. I’m looking forward to either being a provider in the pavilion or a vendor in the market. I hope you’ll join me.
The term LGBTQIA+ stands for Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, Asexual or Ally, and the plus symbol (+) encompasses other sexual orientations, gender identities, and expressions that are not specifically represented by the initial letters.
Here's a brief explanation of each component:
1. L (Lesbian): A woman who is romantically or sexually attracted to other women.
2. G (Gay): A person, typically a man, who is romantically or sexually attracted to people of the same gender.
3. B (Bisexual): A person who is romantically or sexually attracted to more than one gender.
4. T (Transgender): A person whose gender identity differs from the sex they were assigned at birth.
5. Q (Queer/Questioning): 'Queer' is a broad term that includes anyone who doesn't strictly identify as heterosexual or cisgender. 'Questioning' refers to those who are exploring their sexual orientation or gender identity.
6. I (Intersex): Individuals who are born with any of several variations in sex characteristics that do not fit typical definitions of male or female bodies.
7. A (Asexual/Ally): 'Asexual' refers to a person who does not experience sexual attraction. 'Ally' refers to someone who supports and advocates for the LGBTQIA+ community.
8. + (Plus): Represents other identities, such as pansexual, genderqueer, non-binary, and more, that are not covered by the preceding letters.
The inclusive nature of LGBTQIA+ aims to recognize and validate the diverse experiences and identities within the community.
What the L?
In nurse practitioner school, we learned about the health disparities effecting the LGBTQIA+ community, including poor health outcomes, advanced disease states at the time of diagnosis, high suicide rates, workplace discrimination, older adults returning to ‘the closet’, and non-inclusive medical care. Since that time, I’ve been personally invested in learning more about the community, listening to how I can best support them, and creating safe spaces for them to be seen, heard, and cared for. I previously wrote about creating inclusive practices in dermatology.
While attending DC Black Pride, I initially wanted to participate in a workshop titled, Advocating for Black LGBTQ Youth in Foster Care: Continuous Support from Early Years to Aging Out. However, there was a schedule change that prevented me from attending. Instead, I joined the workshop titled, What the L? All things Lesbian, and it was the best decision I could have made.
My pronouns are she and her. I was born with female body parts and identify as a cisgender female. I am still learning terminology and etiquette. If I miss something or describe something inaccurately, please let me know. The room was filled with people who looked like me. The two speakers, curated the space to promote engagement. They led a discussion on a relevant topic and then we divided into small groups to share our experiences. When I first heard about the small groups, I immediately felt like I didn’t belong and that I should request their permission to hear their stories. Honestly, if it wasn’t for the small groups, I’m not sure how much talking I would have done. While I was nervous, it didn’t last long. I introduced myself, disclosed my pronouns, gender identity and gender sexuality. Everyone in the group was so welcoming and some were even appreciative of my effort to want to learn more about how to provide inclusive care and improve the patient experience.
L is Short for Lesbian
As mentioned, the title of the workshop was, What the L? L is short for lesbian which I learned is a word that is not being used today as widely as in the past. There has been a shift in generations, where older lesbians identify as lesbian and use the term, however younger generations tend to favor terms like queer, fluid, nonbinary, and bisexual. From what I heard and understand, the reason for this is that using the term lesbian made some people feel like they were being put in a box or had to choose between two restricted expressions of lesbianism: femme or butch. One person stated, lesbian is restrictive and that there is some societal pressure to give the impression that there is still an opportunity for men (hence, the use of the terms queer, fluid, and bisexual), even if in reality that is not true.
The Generational Divide
I found it really interesting to hear the varying perspectives from some of the youngest people in the room to those who were more seasoned and remember fighting for the right to say the word Lesbian. I learned that when the two generations stay in their respective corners, all sorts of misconceptions dominate the narrative. However, when given the opportunity to share the same space and hear each other’s perspective, they learned that they actually want to talk and learn from one another. In fact, one lady who reported to be in her 70s, said she was still learning and exchanged contact information with one of the younger participants. The younger participant expressed the desire to be taught and learn from the older generation. She eagerly exchanged her information as well. It was a beautiful demonstration of why it’s so important to engage in direct communication with people who have a different opinion instead of relying on hearsay.
What They Want You to Know
One person shared with me that when they interact with the healthcare system and healthcare professionals, they don’t want to have to disclose their pronouns every single time. They don’t want to have to retell their story or ‘come out’ at every visit. I think it’s a simple request that can easily be adopted into our clinical practice, front staff, and EMRs. Epic already has a space to enter pronouns, but last I checked it was hidden. It needs to be clearly displayed and placed near the patient’s name on every screen.
My Biggest Lessons
While I felt nervous at first, I also felt like I fit in based on appearance. As a Black Woman, I am often on the side of the conversation telling people to come in the room and sit at the table to learn more about other cultures and cultural experiences. It’s very easy to tell people to do that. My experience at DC Black Pride showed me how difficult that can be, especially when you don’t look like the people in the room. I could have easily have kept my mouth shut and no one would have ever known I didn’t identify as a lesbian. But, if the person entering the space is of a different race, ethnicity or gender, they stand out immediately. I have so much more empathy for the person who enters the room. It was a humbling and eye-opening experience.
We can always assume we know people’s lived experiences. We often analyze people and their experiences through the lens of our own perspective. However, by being in the room with people who are different or have a different set of opinions and just listening to them to learn, not to react, respond, or critique, can be immensely transformative. I had no idea there was this cultural shift in language and these varying explanations for the change, many of which are generational. I had no idea there have ever only been about 20 lesbian-only bars and now there are less than 10 nationwide. I would have never have known how much it matters to them to have a space to camp, play sports, and just be able to talk about the matters that concern them outside of the bar scene.
They shared that when the topic of conversation is, protect Black women, they don’t feel they are being protected by straight or gay men. Interesting enough, there was a time in history where Black lesbians cared for sick and dying Black gay men. Unfortunately, they don’t feel that tender care is reciprocated. They feel invisible even when the topic is about Gay people as the predominate narrative is generally centered around the White male experience. Many of them pointed out, that even at an event called DC Black Pride, they were relegated to a small room in the back corner and that particular workshop was the only event dedicated to lesbians the entire weekend- a detail I failed to notice until it was brought to my attention.
Had I not attended this specific workshop, I would have not realized the value of stepping outside of the clinical setting to get to know patients better. For one, there are dynamics at play and a hierarchy of power/knowledge in the clinical setting that immediately makes it an unfair playing field for patients. Two, the clinical setting just doesn’t permit the time or space that encourages the clinician to do more listening than talking. Lastly, there is a consensus among the public that we are only here for the money and we only see them as a number. By stepping outside of the clinical setting into spaces that matter to them, we show them just how much they matter to us.
I invite you to read my previous articles dedicated to improving health outcomes and the patient experience for the LGBTQIA+ community:
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