More awareness, study recruitment needed for psoriasis in Black patients
A lack of public and professional awareness of psoriasis in more richly pigmented skin types contributes to unequal health outcomes (1,200 words, 5 minutes 30 seconds)
In a discussion published online on February 21, 2023, Dr. Bruce Sherman suggested raising awareness and reducing the stigma associated with psoriasis in populations with dark skin.
He also discussed the need for improving clinical trial participation by these populations. Dr. Sherman is the Medical Director of the U.S.-based National Alliance of Healthcare Purchaser Coalitions, and the presentation talk was hosted by the American Journal of Managed Care.
The lack of awareness of psoriasis in U.S. minority populations is one of the most significant issues contributing to disparities in care, said Dr. Sherman.
Dr. Sherman is a clinical faculty member at Case Western Reserve University School of Medicine in Cleveland and an adjunct professor in the department of Public Health Education at the University of North Carolina in Greensboro. He has ongoing research interests in race and socioeconomic disparities and inequities in healthcare.
He said that stigmatization surrounding the skin condition in these populations might also discourage treatment-seeking.
“I think when issues are potentially patient-generated, perhaps clinicians will be more likely to take note. The challenge is that individuals and minorities experience implicit bias,” Dr. Sherman said.
He noted part of the issue in the U.S. are payment models and their related quality metrics that may incentivize physicians to pay more attention to some conditions—such as diabetes—to the detriment of psoriasis care.
As a result, he said that addressing disparities of care “requires a comprehensive effort” with no single change sufficient to solve the whole problem.
“Enhancing patient awareness of a condition they may have, encouraging them to seek care, and raising the question with their clinician, is at least a substantial first step.”
From the literature on psoriasis in skin of colour
Unmet need in people with psoriasis and skin of colour in Canada and the United States
The authors of this literature review aimed to understand the challenges and unmet needs associated with access to care, diagnosis, and treatment of psoriasis among people with skin of colour (SoC) in Canada and the United States.
They reviewed 919 studies published in the last five years, ultimately including 26 studies.
Vital unmet needs identified included:
A lack of culturally competent care
Cost of care and cultural views of psoriasis influencing care-seeking
Differences in baseline patient characteristics in psoriasis studies and the prevalence/incidence of psoriasis may reflect differences in the rate and timing of diagnosis
Differences in disease presentation across racial/ethnic groups may contribute to challenges in proper and timely diagnosis
Individuals with SoC may be less familiar with and have different rates of treatment with biologic therapies for psoriasis, are more likely to be hospitalized for psoriasis, and their access to physicians may differ
People with SoC are underrepresented in clinical trials of psoriasis therapies
Efficacy and safety of calcipotriene/betamethasone dipropionate foam in the treatment of psoriasis in skin of colour
This study investigated the efficacy of a combination calcipotriene/betamethasone dipropionate (Cal/B.D.) aerosol foam 0.005%/0.064% in treating psoriasis vulgaris in Fitzpatrick skin types IV to VI.
Researchers randomized 25 adult subjects 4:1 to Cal/B.D. foam or foam vehicle once daily for four weeks, followed by four weeks of open-label treatment. From week four to week eight, subjects randomized to Cal/B.D. foam once daily switched to Cal/B.D. foam twice weekly for four weeks, while those randomized to vehicle applied Cal/B.D. foam once daily.
At week four, four of 19 (21%) Cal/B.D. foam patients achieved clear/almost clear Investigator Global Assessment (IGA) status with a two-grade improvement compared with none of vehicle patients (p=0.54). As well, 12 of 19 (63%) Cal/B.D. foam patients achieved a 50% reduction in Psoriasis Area and Severity Index (PASI 50) at week four, compared with none of the vehicle patients (p=0.04).
Comparison of risk allele frequencies of psoriasis-associated single-nucleotide polymorphisms in different population groups
Researchers investigated 147 psoriasis-related single-nucleotide polymorphisms (SNPs) and compared the difference in frequencies of alleles in 27 populations.
In many cases, East Asians exhibited allele frequencies opposite that of Europeans. The genetic risk score was higher in Europeans (average: 0.487) and Americans (average: 0.492) than in East Asians (average: 0.471). The prevalence of psoriasis correlated with the average genetic risk score of the population.
Evolving concepts in psoriasis: Special considerations for patients with skin of colour, skin barrier dysfunction, and the role of adjunctive skincare
Researchers conducted a structured literature search, a panel discussion, and an online review to explore the best clinical practices in treating psoriasis patients with skin of colour and providing expert guidance for skincare use, including gentle cleansers and moisturizers.
In addition to differences in genetic factors, clinical presentation, and disease burden, the authors identified some studies noting differences in skin barrier properties and suggested a role for adjunctive skin care in managing psoriasis. However, data in this area is limited.
VIDEO: Black History/Black Health 2023: Interview with Denise Bronner, Ph.D., Part I
Denise Bronner, Ph.D., Janssen Pharmaceutical Director of Diversity and Inclusion in Clinical Trials, discusses racial disparities in clinical trial recruitment and participation.
At the intersection of skin and society
A recent study has found that most images related to health topics on stock photography sites are of light-skinned people within a relatively narrow age range. This makes creating health education materials targeted to other populations is more complex and expensive.
“Many organizations that produce health outreach materials rely on stock photography sites to produce those materials,” said Michelle Jewell, co-author of the study, in a North Carolina State University press release.
Jewell is a science communicator in the Department of Applied Ecology at North Carolina State University.
“In many cases, organizations that create outreach materials for minoritized groups or populations with lower socioeconomic status have limited resources, which exacerbates the challenges they face in producing effective materials that reflect the publics they serve,” she said.
The researchers also found a significant difference between the diversity in images available on free stock photography sites versus on sites requiring users to pay for stock photos.
Sites that charged for subscriptions or images were significantly more likely to have images that depicted individuals with darker skin tones and were less likely to have images portraying high socioeconomic status.
The researchers launched the study after they struggled to find a stock image of a pregnant Latina woman for an unrelated science communication effort.
“Anecdotally, this lack of representation in stock photography is a widely known problem among professional communicators,” Jewell said. “We wanted to quantify the problem to get a better understanding of the scope of the problem.”
Images that portrayed individuals of minority racial or ethnic groups were less likely to show the person’s face. Very few images of older adults of any racial or ethnic group were found.
This week
March 27 is International Medical Science Liaison Day
March 28 is American Diabetes Alert Day
March 30 is Doctor’s Day in the U.S.
Something to think about in the week ahead. . .
Carl Friedrich Gauss, German mathematician, 1777-1855
Next week
Dr. Joël Claveau (Québec City) discusses some differences in sites and presentation of skin cancer in darker skin types in a presentation at the 8th annual Skin Spectrum Summit.
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