The need for good dermatology education on skin of colour
Low awareness of how skin conditions and medication reactions manifest in darker skin not only impacts patient care, but the accuracy of clinical trial data (1,282 words, 6 minutes, 25 seconds)
If researchers conducting clinical trials are not familiar with how the skin manifestations of conditions or drug reactions appear in all skin types, it is challenging to collect the best possible efficacy and safety data in clinical trials.
Dr. Neil Shear raised this point during a live discussion on education, awareness, and cultural competency at the virtual Colloquium on Black Skin on Saturday, Aug. 21. The Colloquium was part of the Skin Spectrum Summit’s Summer of Dialogue on Black and Brown Skin.
One challenge regarding inclusive clinical trials is that many researchers do not have the education or experience to be familiar with skin changes in darker skin types, said Dr. Shear.
“Different manifestations generally seem to be not known to the many large companies who are doing clinical trials, and [those manifestations] are missed or misinterpreted,” he said. “[Recognizing skin changes] is important when we start deciding what is safe or not.” This is not only a matter of damage or inflammation of the skin, but skin manifestations of problems in other organs as well, he said.
Dr. Shear listed two approaches that may help researchers collect good efficacy and safety data for new medications in diverse populations:
Conduct more studies in an international, multi-site format. That would involve both diverse populations and researchers familiar with those populations.
Push for more post-marketing research as part of the licensing of new medications. The wider public will always be a more diverse population than a selected sample in a clinical trial.
Key take-aways
If clinical trials researchers do not know what skin manifestations of medication reactions or medical conditions look like in darker skin, those signs may be missed or misinterpreted. Steps need to be taken to ensure studies are capturing accurate skin manifestation data in all skin types.
From the literature on cultural competency and skin type education in dermatology:
Clinical trials and skin of color: The example of hidradenitis suppurativa
This commentary article explores the lack of representation of dark-skinned individuals in hidradenitis suppurativa (HS) studies. They examine the clinical trial locations within the U.S. and discuss potential barriers to the inclusion of this population.
They determined that though HS trials have been conducted in U.S. regions with diverse populations, dark-skinned patients with HS are poorly represented in these studies. This disparity hinders the complete understanding of HS, as well as its impact on different populations, the authors note. That disparity then decreases the access of some patients to potentially effective new therapies.
Assessment of skin of colour and diversity and inclusion content of dermatologic published literature: An analysis and call to action
This paper describes the development of a set of prespecified criteria for assessing diversity in the dermatologic literature. The authors used the criteria to analyze the archives of 52 dermatology journals from Jan. 2018 to Oct. 2020, selected based on Scopus ranking. They evaluated for journal characteristics and content regarding skin and hair of colour, diversity and inclusion, and socioeconomic/health care disparities that affect underrepresented populations with skin of colour (SoC).
The authors write that their findings show that the average percentage of overall publications relevant to SoC is quite low. They found the percentage of articles relating to SoC ranged from 2.04% to 16.8% with a mean of 16.3%.
Journal editors could use these developed criteria to increase the percentage of SoC-relevant articles in each issue, the authors write.
Skin of colour representation on Wikipedia: Cross-sectional analysis
This study evaluated the number and quality of skin of colour (SoC) photographs included in Wikipedia’s skin disease pages and explored the possible ramifications of these findings. The authors identified 949 images on 421 skin disease pages. Among those images, 20.7% were images of SoC.
The authors conclude that there is an underrepresentation of SoC in the gross number of images illustrating dermatologic conditions on Wikipedia pages. They suggest these pages should be updated to include more SoC photos to improve access to accurate dermatology information for the general public, and improve health equity within dermatology.
Assessment of skin phenotype representation in a popular medical licensing educational resource
This paper examines the representation of darker skin in the UWorld Step 2 Clinical Knowledge Question Bank. They explain that this question bank is a study tool to assist medical students in preparing for the second U.S. Medical Licensing Examination (USMLE).
The authors write that their findings suggest that darker skin phenotypes are underrepresented in the UWorld Step 2 question bank. They suggest that contributors to the question bank should broaden the representation of diverse skin phenotypes through both patient photographs and designer illustrations. This would help to ensure that clinicians can identify pathologic traits in darker-skinned patients. They note that a better demonstration of skin cancers across a range of phenotypes might also improve the treatment prognosis of those conditions.
VIDEO: Dr. McLawhorn - OU Dermatology’s skin of color 2021
At the intersection of skin and society
The Museum of Anthropology at the University of British Columbia in Vancouver will be hosting the exhibition Sankofa: African Routes, Canadian Roots from Nov. 4, 2021, to Mar. 27, 2022.
According to the museum website, the exhibition will examine some of the paths of political mobilization and the cultural assertion that African and Black people in the diaspora have taken. It presents stories, histories, and other projects, drawing connections to the historical contributions of Black Canadians in Vancouver as well as their growing current significance.
The exhibit is centred around works by contemporary artists from Lagos, Nigeria, and Vancouver. It will also include objects from the museum’s permanent collection.
Sankofa: African Routes, Canadian Roots is co-curated by Nya Lewis, founder and director, BlackArt Gastown; Nuno Porto, curator of the museum’s Africa collection; and Titilope Salami, a PhD candidate, Department of Art History, Visual Art and Theory, at the University of British Columbia.
Tickets can be booked at the Museum of Anthropology’s website.
This Week
Oct. 17 is International Day for the eradication of poverty
Oct. 18 is Anti-slavery Day in the UK
Oct. 17-23 is Healthcare Quality Week in the US
Something to think about in the week ahead...
Skin Spectrum Summit, Nov. 4 & 6, 2021
The conference secretariat for the 7th annual Skin Spectrum Summit has released additional details on the upcoming conference program.
With six educational modules over the two days of the conference, the Skin Spectrum Summit will provide valuable information on dermatology in skin of colour over a range of topics:
Module 1: Common skin conditions
Acne
Psoriasis
Rosacea
Melasma
Atopic Dermatitis
Pediatric Dermatology in Skin of Colour
Module 2: Complex skin issues
Hidradenitis Suppurativa
Scleroderma or vitiligo? Presentation of symptoms in patients with skin of colour
Inflammatory disease
Sickle cell disease and ulcers
Skin manifestations of Covid-19
Module 3: Aesthetic medicine in skin of colour
Aesthetic injectable considerations in Asian skin
Hair & scalp disorders in all skin types
Sun protection for skin of colour
Cosmeceuticals for skin of colour
Module 4: Wound care and skin cancer
Wound care for skin of colour patients
Skin cancer in skin of colour
Diabetic ulcers in Indigenous populations
Module 5: Skin conditions in underserved communities
Environmental and cultural health factors in Indigenous and remote communities
Access to dermatologic care in underprivileged communities in cities
Treating Black communities in the U.S.
Skin conditions in Indigenous communities and the use of teledermatology
Module 6: Technology and Education
Using AI to assess dermatologic conditions
Skin of colour images in medical studies
Teledermatology for remote communities
Skin of colour in medical education
We are also pleased to share that this Group Learning program has been reviewed by the College of Family Physicians of Canada and is awaiting final certification by the College’s Ontario Chapter.
Skin Spectrum Weekly will continue to provide our readers with additional details about the program, faculty, and more as we approach the date.
The Summit, Canada’s leading ethnodermatology medical conference for physicians, will be held on Nov. 4 and 6, 2021.
Skin Spectrum Weekly will receive a discount on registration fees by using the code “SSW”. Register today for the conference, or find more information on the 2021 and prior Summits at SkinSpectrum.ca