2024 study exposes how flawed research fuels racial myths in health
Careful study design is needed to avoid attributing differences in skin health between ethnic groups to genetic causes without merit (1,400 words, 7 minutes)
In a 2024 paper in Frontiers in Public Health, authors warn that research study designs may unintentionally support racist ideas about biological differences between ethnic groups by not adhering to reporting guidelines, improperly extrapolating small studies to population scales, and failing to adjust data analyses for social determinants.
By discussing other research papers that purported to identify phenotypes of atopic dermatitis distinct between European Americans, Asians, and African Americans, the authors highlight several aspects of study design that can contribute to supporting preconceptions of biological differences between ethnic groups. Among these aspects are:
Conflating racial claims with ancestral categories.
Overextrapolation from small, unrelated studies.
Failure to assess for environmental factors or social determinants of health.
Overlooking counter-evidence when suggesting innate biology as a hypothesis for explaining racial disparities in disease
“The scientific community must better adhere to reporting guidelines, avoid extrapolating small studies into population scales, assuring analyses are appropriately adjusted for social determinants, transparently reporting their study’s limitations, and prioritize the evidenced-based research into AD risk factors,” the authors write in their discussion.
Bottom line: Inadequate study design may perpetuate ideas regarding biological differences between ethnic groups. Improving the diagnosis and management of disease to ensure equitable care and outcomes requires recognizing and avoiding past research practices that have introduced biases and suggested race-linked biological differences that do not exist.
From the literature on dermatology in skin of colour
Effects of a skin type diversity seminar on undergraduate medical students' self-assessed competence in managing skin diseases in patients with skin of colour
Researchers developed a seminar on skin type diversity to address the underrepresentation of skin diseases in dermatology training in patients with skin of colour (Fitzpatrick skin types IV to VI). They implemented it in an undergraduate medical curriculum. This study examined the effects of the seminar on the self-assessed competence of medical students in managing skin conditions in patients with skin of colour.
Researchers conducted the questionnaire survey among fourth-year undergraduate medical students at the University of Hamburg in Germany between Oct. 2023 and Feb. 2024. Investigators compared students' self-assessed competence before and after the obligatory seminar.
In total, 158 students participated in the survey. The authors note that after the seminar, knowledge of the presentation of skin diseases in patients with skin of colour and the associated psychological burden, differences in the incidence of skin diseases in different skin types, and the ability to diagnose skin diseases in darker skin types increased. Most participants stated that they wanted to attend more courses on this topic.
Treatment of post-inflammatory hyperpigmentation in skin of colour: A systematic review
This systematic review summarizes the treatment outcomes for post-inflammatory hyperpigmentation (PIH), focusing on skin of colour (SOC) individuals.
Researchers conducted a literature search using MEDLINE (from 1946), Embase (from 1974), PubMed, and Cochrane databases in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline.
They analyzed results from 48 studies, summarizing 1,356 SOC individuals. The mean patient age was 29 years, and 78% were female (n=786). The ethnic prevalence was 70% Black, 27% Asian, and 3% Latin. Overall, 20% had Fitzpatrick skin type (FST) III, 40% FST IV, 34% FST V, and 6% FST VI.
Most cases were precipitated by inflammatory conditions (89%) and localized to the face (83%).
The most frequently reported interventions were topical retinoids (22%) and laser therapy (17%). In 85% and 66% of participants, partial improvement was seen. Laser was the only intervention that offered complete resolution in a subgroup of patients (26%); however, there were cases of reported PIH exacerbation following treatment. Chemical peels (9%) and hydroquinone (7%) were among other treatments with less effective outcomes.
The authors conclude that PIH and its persistence are prevalent issues, significantly affecting many individuals with darker skin tones. The findings also show a lack of robust efficacy across all treatment modalities and room for improvement in interventions for at-risk populations.
Exploring fractional pigment toning: A novel approach for treating benign pigmented lesions in Asian patients with Fitzpatrick skin types III-V
Researchers conducted a prospective, self-controlled study to comprehensively evaluate the safety and effectiveness of 532-nm picosecond laser, both with and without a microlens array (MLA), for the management of solar lentigines in patients with Fitzpatrick skin types (FST) III-V.
The investigators recruited 27 patients with bilateral SL on the face. Each patient was treated on one side of the face with a 532-nm picosecond laser coupled with an MLA, utilizing the fractional pigment toning (FPT) technique. The other side received treatment without the MLA, following the conventional technique (CT). The FPT technique utilized a 9 mm spot size with a fluence of 0.47 J/cm2 for two passes covering 40% of the area. In contrast, the CT used a 4.5 mm handpiece with fluence ranging from 0.3 to 0.7 J/cm2. Patients received a single treatment and were evaluated for pigment clearance, post-inflammatory hyperpigmentation (PIH) occurrence, and other adverse effects at two weeks and one, three, and six months posttreatment.
Analyzing pigment clearance, measured via 3D photography, researchers observed significant improvement from two weeks to six months posttreatment for both the FPT technique (p<0.001) and CT (p=0.004). PIH occurred in 64%, 80%, 96%, and 88% of cases on the CT side, compared to 8%, 32%, 36%, and 16% on the FPT technique side at two weeks and one, three, and six months posttreatment, respectively. The incidence of PIH was significantly lower on the FPT technique side compared to the CT side throughout the follow-up periods. Additionally, transient and mild hypopigmentation occurred in one participant (4%) on the FPT technique side and five participants (20%) on the CT side. Investigators observed no other adverse effects.
VIDEO: Beyond Clinical Walls podcast, episode 017: Addressing health equity in dermatology
Podcast host Dr. Bayo Curry-Winchell, Medical Director for Saint Mary’s Urgent Care Group in Reno, Nev., speaks with dermatologist and Mohs surgeon Dr. Samantha Schneider (Sparks, Nev.). The two discuss the importance of skin cancer awareness, debunk myths about sun protection, especially in communities of colour, and stress the significance of early detection through routine self-exams and professional screenings.
At the intersection of skin and society
A new report published by Statistics Canada and written by the National Indigenous Fire Safety Council (NIFSC) has revealed that inadequate housing, lack of smoke detectors, underfunding of fire services and a lack of legislation “mandating adherence to building and fire codes” are contributing to a higher death rate in residential fires among Indigenous peoples.
As reported by APTN National News, the new document clarifies the human cost of these issues.
Among the findings in the report, Inuit are 17 times more likely to die in a fire compared to the Canadian population, and First Nations people living on reserve are 10 times more likely to do so. Métis rates were not “significantly different.”
“In addition, multiple factors, such as lower socioeconomic status (e.g., low income), overcrowded living conditions and limited access to healthcare services in rural locations, place Indigenous people at an elevated risk of various types of unintentional injuries, including fire-related morbidity and mortality,” reads the report.
The data also show that fire deaths were more prevalent for Indigenous males. Indigenous people who died were younger compared with non-Indigenous people, and one in eight “residential fire-related deaths” occurred in a residence without a working smoke alarm.
“About 56 per cent of Indigenous people who died in a residential fire lived in a house that needed major repairs compared with 13 per cent of non-Indigenous people,” the report reads. “Indigenous people (20 per cent) who died in a fire were more often involved in residential fires causing two or more deaths than non-Indigenous people (7 per cent.)”
Len Garis, a researcher with the NIFSC, told the news outlet there are changes jurisdictions can make to ensure people’s safety.
“In British Columbia, it’s the opposite of all the other provinces in terms of the ratio of fire deaths associated to the population,” he told APTN News. “In 2012 [British Columbia] started an aggressive smoke alarm campaign between 2012 and today. They installed nearly 20,000 smoke alarm stations and there we’re seeing the death rates are phenomenally lower.”
More details can be read in the report.
This week
Aug. 19 is World Humanitarian Day
Aug. 22 is National Surgical Oncologist Day in the U.S.
Aug. 23 is International Day for the Remembrance of the Slave Trade and its Abolition
Something to think about in the week ahead . . .
—Klas Pontus Arnoldson, Swedish author (1844 – 1916)
Next week
In a 2024 Colloquium on the Black Patient presentation, Dr. Renée Beach provides practical pearls for cosmetic therapies in patients with skin of colour.
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