Under‐representation of skin of colour in dermatology images: not just an educational issue

Lester, Jonathan; Taylor, Susan C.; Chren, Mary Margaret

doi:10.1111/bjd.17608

Cited by 110 publications

(114 citation statements)

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“…We hypothesize that the rash may also be less visible on the skin of people of color and that providers in non-endemic areas may have less experience or education diagnosing EM in patients of color [7]. Very few examples of EM rashes have been published in the literature, and while attempts have been made to expand educational materials related to dermatological findings in patients with deeply pigmented skin, ongoing concerns remain regarding provider training for diagnosis and management of skin diseases in people of color [13,14]. Underexposure to examples of disease presentations in patients of color, coupled with a lower incidence of Lyme disease among African-Americans, may have contributed to misdiagnosis of both our patient's rash and his facial swelling.…”

Section: Discussionmentioning

confidence: 99%

“…Demographic factors can influence many aspects of health care access, delivery, and management, including trust between patients and providers; patient education about disease prevention, symptoms, and when to seek care; insurance status; income, including cost and impact; and the potential roles of poverty, discrimination, and stigma [7][8][9]14,20]. Given shifting populations in the United States, and the increased risk of long-term complications from Lyme disease after delayed diagnosis, there is great need for further study to understand how these types of factors may present obstacles to early diagnosis and treatment of Lyme disease [6,14].…”

Section: Discussionmentioning

confidence: 99%

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Lyme Disease with Erythema Migrans and Seventh Nerve Palsy in an African-American Man

Dennison

Novak

Rebman

et al. 2019

Cureus

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Lyme Disease with Erythema Migrans and Seventh Nerve Palsy in an African-American Man

Dennison

Novak

Rebman

et al. 2019

Cureus

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“…3 Another interesting observation, that nonetheless also contributes to a potential discomfort of skin physicians when dealing with SOC patients, is the underrepresentation of cutaneous disorders in ethnic patients in dermatology teaching images, as presented in textbooks or other teaching tools. 7 In the light of the above-mentioned data, we strongly believe that European dermatology residency programmes need to incorporate a structured training in the field of 'SOC dermatology', in order to avoid healthcare disparities among our ethnic patients, that could eventually lead to suboptimal care results for the latter. 7 The occurrence of such incidents is not rare and can potentially damage the image of our field, especially among the patients of different ethnic subgroups, leading them to view the physician-patient relationship with scepticism and mistrust.…”

Section: Referencesmentioning

confidence: 99%

“…7 In the light of the above-mentioned data, we strongly believe that European dermatology residency programmes need to incorporate a structured training in the field of 'SOC dermatology', in order to avoid healthcare disparities among our ethnic patients, that could eventually lead to suboptimal care results for the latter. 7 The occurrence of such incidents is not rare and can potentially damage the image of our field, especially among the patients of different ethnic subgroups, leading them to view the physician-patient relationship with scepticism and mistrust. 7,8 Leading European dermatological societies can contribute towards embracing skin diversity in the teaching procedures by promoting the adoption of SOC training in our postgraduate dermatology residency programmes.…”

Section: Referencesmentioning

confidence: 99%

“…7 The occurrence of such incidents is not rare and can potentially damage the image of our field, especially among the patients of different ethnic subgroups, leading them to view the physician-patient relationship with scepticism and mistrust. 7,8 Leading European dermatological societies can contribute towards embracing skin diversity in the teaching procedures by promoting the adoption of SOC training in our postgraduate dermatology residency programmes.…”

Section: Referencesmentioning

confidence: 99%

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Comment on the supplement article: trainingrequirements and recommendation for the specialty of dermatology and venereology European Standards of Postgraduate Medical Specialist Training: the necessity for adequate training of European dermatology residents in skin of colour

Plachouri

Georgiou

2020

Acad Dermatol Venereol

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Baseline clinical characteristics were balanced across treatment arms (Table 1). 6 At baseline, 2245 (58%) patients were employed full-time and 479 (12%) were employed part-time. More patients achieved the MCID for work productivity loss with etanercept (151/236, 64.0%), IXEQ4W (293/398, 73.6%) and IXEQ2W (290/394, 73.6%) vs. placebo (76/270, 28.1%, Fig. 1a; allP < 0.001 vs. placebo). Similarly, more patients achieved the MCID for activity impairment with etanercept (332/444, 74.8%), IXEQ4W (586/704, 83.2%) and IXEQ2W (652/749, 87.0%) vs. placebo (178/490, 36.3%; Fig. 1b; all P < 0.001 vs placebo). Furthermore, more patients achieved both MCIDs with IXEQ2W vs. etanercept (Fig. 1a,b; work productivity loss: P = 0.004; activity impairment: P < 0.001). Similarly, more patients treated with IXEQ4W achieved the MCID for activity impairment vs. etanercept (Fig. 1b; P = 0.015). Most patients treated with ixekizumab or etanercept had meaningful improvements in work productivity and activity impairment. The proportions of patients treated with IXEQ2W that achieved the MCIDs were higher than with etanercept. This information is useful for clinicians, patients and payers when evaluating treatment options, given that psoriasis has a major negative impact on work productivity. 7-9 .

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Why Diversity in Dermatology Clinical Trials Should No Longer Be Optional

2022

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While race and ethnicity reporting in dermatology clinical trials has slightly improved in the last 5 years, 1,2 the proportion of studies with adequate racial and ethnic diversity remains unchanged. Despite National Institutes of Health (NIH) diversity mandates 3 and 2020 Food and Drug Administration (FDA) guidelines, 4 dermatology continues to underreport race and ethnicity demographic data in clinical trials.Why is diversity in clinical trials a critical aim for dermatology as a specialty? Reporting race and ethnicity in clinical trial publications signifies its value and importance. Ensuring diversity among clinical trial participants should no longer be optional, as it accomplishes several important aims: it increases generalizability of the trial results, ensures safety and clinical benefit for diverse populations, and imparts fairness and equity. 5 A diverse study population helps to ensure that all members of society, regardless of race, ethnicity, gender identity, age, sex, or socioeconomic status, have access to new therapies and to incur the benefits and risks of a trial intervention equally. This includes both the potential benefits of high-quality tertiary care, new advanced therapies, and access to subspecialty physicians, as well as the potential risks of adverse effects of novel agents or interventions. Lack of equitable participation in clinical trials is a manifestation of systemic racism. If the dermatologic research community prioritizes addressing the systemic racism that results in the lack of equitable participation in clinical trials, previously marginalized patients move one step closer toward improved health outcomes and justice.Why does a lack of diversity in dermatologic clinical trials exist? Dermatology's troubled relationship with racism in clinical research may serve as part of the underpinnings of the mistrust of institutionalized medicine by racial and ethnic minority communities. For example, the ethical abuses of the Tuskegee syphilis study are widely known-Black study participants were prevented from accessing syphilis treatment even as they were incurring permanent morbidity, including, but not limited to, dermatologic gummas, tissue destruction, and death from an otherwise treatable illness. But few may know of the experiments conducted at Holmesburg Prison in Philadelphia , led by dermatologist Albert Kligman, MD. 5,6 For 23 years, Kligman performed clinical trials using mostly incarcerated Black men to test the efficacy and safety of several dermatological treatments with funding from both pharmaceutical companies and government agencies. The most notable drug developed from these experiments is the widely used acne medication tretinoin. In the Holmesburg Prison experiments, research participants were subjected to significant harms of participation in clinical trials by way of exploitation, lack of informed consent, and coercion. These experiments highlight a disregard for margin-Opinion EDITORIAL jamadermatology.com (Reprinted)

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Under‐representation of skin of colour in dermatology images: not just an educational issue

Cited by 110 publications

References 3 publications

Lyme Disease with Erythema Migrans and Seventh Nerve Palsy in an African-American Man

Lyme Disease with Erythema Migrans and Seventh Nerve Palsy in an African-American Man

Comment on the supplement article: trainingrequirements and recommendation for the specialty of dermatology and venereology European Standards of Postgraduate Medical Specialist Training: the necessity for adequate training of European dermatology residents in skin of colour

Why Diversity in Dermatology Clinical Trials Should No Longer Be Optional

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