Though cardiovascular are common in the UK (about one in three adults has high blood pressure; nearly 60% of us have elevated levels of “bad” cholesterol), many common complaints have no symptoms. 

High blood pressure has been called a “silent killer”, for instance, even though it can damage your arteries and heart over time. 

Occasionally, though, our bodies can give us much-needed tells.

Those with a genetic high cholesterol condition called familial hypercholesterolaemia might notice a pale ring around the iris of their eye or small yellowish lumps on their knuckles or around their eyes.

But in a recent video, surgeon and author Dr Karan Rajan explained that even more visible warning signs can be hard to spot for people with darker skin types because of widespread misrepresentation in medical literature and images.

How do heart conditions change your skin after a shower?

The doctor began by showing another person’s footage of their vein-patterned legs after taking a shower. 

Networks of veins were visible through their skin, creating a web-like discolouration. 

This, the doctor explained, is a condition called livido reticularius, “a vascular issue which, more often than not, is completely benign.” 

However, it can sometimes also be caused by chronic conditions (like rheumatoid arthritis) or certain medications. 

But Dr Karan Rajan says there’s a huge problem ― a lot of the medical advice and imagery on the issue often ignores darker skin. 

On lighter skin types, the issue presents as a “lacy, pink-violet” pattern. 

For darker skin types, “the pattern may be brown or dark red,” leading it to be “overlooked.” 

“Lack of visual representation creates a gap in recognising and diagnosing skin problems ― in people with darker skin, it can lead to misdiagnoses, inappropriate treatment, or even under-diagnosing problems.”

Speaking to the BBC, Debbie Hubbard, a senior lecturer from UWE, said: “White skin is presented as the normal ― there isn’t a consideration for other skin tones” in medical images and even textbooks.

Are there any resources for people with darker skin?

Though people with darker skin types are still hugely underrepresented in medical images, the NHS has begun work on a project called Reframe-Diversifying Images.

The aim is to create a more diverse bank of images of skin conditions which will eventually be available to everyone ― professionals and non-professionals alike ― via the NHS site. 

In the meantime, Skin Deep by Don’t Forget the Bubbles offers a range of pictures of conditions on different skin types.

A medical student called Malone Mukwende also started a project called Mind The Gap in 2020.

He created a handbook that includes images of skin conditions on different skin types.