Worsening AD disparities result from lack of diversity in clinical trials
Persistent disparities in Atopic Dermatitis research linked to underrepresentation of minorities in trials (1,900 words, 9 minutes)
Despite scientific advancements and the development of new medications to treat atopic dermatitis (AD), racial and ethnic health disparities have worsened, said Edgar Akuffo-Addo in a presentation at the 3rd annual Indigenous Skin Spectrum Summit on Nov. 25, 2023. One reason for this discrepancy may be a lack of diversity in clinical trials for AD, he said.
Akuffo-Addo, a fourth-year medical student at the University of Toronto Temerty Faculty of Medicine, was part of a study exploring the representation of Indigenous and Black participants in global clinical trials over a 10-year period to note any increase in the percentage. The researchers also explored key barriers that prevent adequate representation in clinical trials and identified proven strategies that could be adopted to increase Black and Indigenous participation.
Akuffo-Addo said the study included trials completed from 2013 to 2023, based on data from the U.S. National Library of Medicine clinical trials database.
Study results showed that Indigenous people are underrepresented in clinical trials, he said. While Indigenous people account for roughly 1.9% to 2.6% of the U.S. population, Indigenous participants in the clinical trials accounted for only 0.9% of participants. The study found that only 7.1% of international clinical trials had adequate representation of Indigenous participants, compared to the percentage of Indigenous peoples in the U.S. population.
The study also looked at the barriers to Indigenous participation in the trials, said Akuffo-Addo. One finding was a lack of diversity among those conducting the trials. If more Indigenous physicians and healthcare workers were involved, it might encourage and attract Indigenous participants to enroll. Another barrier was mistrust of the medical community based on past injustices.
There was also a lack of awareness of the trials among most of the Indigenous population, he said. The trials were also often geographically inaccessible to many who might have participated. Inadequate monetary compensation meant that many Indigenous people could not afford to take time off work.
Bottom Line: Despite new treatments, disparities in the prevalence of AD between racial groups remain, partially because of the lack of Indigenous participation in clinical trials. Over the past 10 years, only 7.1% of clinical trials have had adequate Indigenous representation. Barriers include a lack of diversity among those running the trials, a lack of awareness in Indigenous communities of the trials, a mistrust of the medical community, and inadequate financial compensation.
Register now for this Saturday’s Acne Summit
On June 22, 2024, from 10 a.m. to 1 p.m. EDT, Skin Spectrum Summit presents the inaugural Acne Summit, a one-day virtual medical education event seeking the highest-quality acne education to help Canadian patients receive the best care possible. Drs. Geeta Yadav and Jerry Tan are the co-chairs of the event.
With the support of our sponsors Bausch Health, Cipher Pharmaceuticals, Dermtek Pharma, Sun Pharma, Galderma, and L’Oreal, you can join your colleagues to learn more about the incidence of and the latest therapies for acne through live Q&As and lectures.
The Acne Summit is a landmark opportunity to learn to:
Effectively communicate about acne with patients and their families
Diagnose acne across all skin phototypes
Manage post-acne sequelae, including scarring and pigmentary changes
No-cost registration and agenda details are available at https://www.skinspectrum.ca/acne-summit
From the current literature
Gender, racial, ethnic, and Fitzpatrick skin type representation in Acanthosis nigricans clinical trials
Researchers conducted a study to uncover gender, race, ethnicity, and Fitzpatrick skin type (FST) representation in clinical trials of Acanthosis nigricans (AN). They performed a systematic literature search across PubMed, Embase, and Cochrane databases to identify participant characteristics in clinical trials focused on AN treatment.
This review yielded 21 clinical trials, totalling 575 participants, with an identified predominance of female participants (69.0%) and no race or ethnicity data. Out of the 11 studies that included FST data, 1.2% of participants were type II, 20.6% were type III, 50.0% were type IV, and 28.2% were type V. None of the participants were FST I or VI.
The authors write that their findings show a need for improved race and ethnicity reporting and the importance of including all FSTs in clinical studies.
Canadian Skin of Colour & Diversity Scholarship 2024
This year, the Skin Spectrum Summit Conference & Pfizer Canada are pleased to announce the 2nd annual Canadian Skin of Colour & Diversity Scholarship program.
The scholarship invites dermatology residents across Canada to propose projects to address an education or care gap not wholly or already fulfilled in medical dermatology within underrepresented populations, including Canadians with deeper skin tones, Indigenous people, and other racialized groups.
Selected recipients will be awarded $20,000 to support the development and implementation of their project, which will have a tangible impact on dermatology. The deadline to apply is August 26th, 2024.
Links to apply:
Dermatology Diaries:
Practioners’ Perspectives and Insights
In this week’s edition, Skin Spectrum Weekly introduces a new feature.
This section will showcase the personal experiences of healthcare practitioners and students that highlight the intersections between skin of colour and the healthcare system.
For the inaugural installment, Canadian medical student Hailey Land, RN (University of Ottawa) shares her observations of high rates of atopic dermatitis and severe disease during her family practice rotation in remote communities in northern Ontario.
Skin Spectrum Weekly invites healthcare practitioners to contribute their stories of dermatology in skin of colour for publication in upcoming editions. Stories of up to 500 words may be submitted to health@chronicle.org.
A medical student’s atopic dermatitis initiative in Moose Factory, Ont.
Bringing awareness to the obstacles faced by remote Indigenous communities in accessing quality skincare products for the management of atopic dermatitis
By Hailey Land, RN, BScN,
Medical Student, Faculty of Medicine, University of Ottawa
I had never heard of Moose Factory, Ont. before my third year of medical school, but now this small community of approximately 2,500 people at the southern end of James Bay is all I can think about.
During my family medicine rotation in 2024, I spent nearly five weeks in the remote communities of Moose Factory, Moosonee, and Kashechewan, where almost every other patient that I encountered, either in the emergency department or clinic, had some form of atopic dermatitis (AD) ranging from moderate to severe. Consequently, I regularly addressed patients with skin and soft tissue infections secondary to severe forms of AD that included methicillin-resistant Staphylococcus aureus infections and scabies. Unfortunately, the disparities I observed were not new or novel and remain inadequately documented in the literature.
AD is one of the world’s most common chronic inflammatory conditions. It is estimated that up to 20% of Canadians have eczema and that 17% are diagnosed with AD. According to the First Nations Regional Health Survey in 2010, AD was among the top three commonly reported health conditions, and Canadian literature also suggests that “one-year prevalence of atopic dermatitis in children on reserve may be up to 16.5%.”
During my time, I was able to witness first-hand the obstacles in the treatment of AD, encompassing systemic and institutional racism, poverty, overcrowded housing conditions, extreme weather temperatures, as well as challenges related to accessing and affording fundamental skincare routines and clean water.
Staff in the Moose Factory emergency department that I spoke with shared this observation. They told me that patients with eczema in rural areas need advocates for increased access to lotions and moisturizers to help manage their condition. These resources would help improve their quality of life.
This need was evident not only to me and the medical staff in the clinic but also to the patients, who recognized how important skincare products were in managing AD and achieving desired outcomes. However, the cost of these products was a large barrier for them and their families. So, patients were immensely grateful when I partnered with CeraVe Canada to provide more than 4,000 moisturizers and cleansers to those in the community affected by AD.
I recognize that this initiative is only a small step in the long journey concerning this concept. I also acknowledge that there are other significant actions we must undertake to tackle these underlying barriers, but I hope my eagerness to raise awareness of these challenges helps mobilize additional efforts to provide remote Indigenous communities with better access to quality skincare products.
This week
June 18 is International Day for Countering Hate Speech
June 20 is World Refugee Day
June 21 is National Indigenous People’s Day in Canada
Something to think about in the week ahead . . .
—Milton Glaser, U.S. graphic designer (1929-2020)
Next week
In new research, researchers assess the impact of vitiligo severity, lesion location, and body surface area involved on patient health-related quality of life.
Clinical trials primer June 27
The Skin Investigation Network of Canada, the Canadian Society of Investigative Dermatology, and the Canadian Dermatology Foundation are hosting a subspecialty session in conjunction with the Canadian Dermatology Association’s 2024 annual conference.
The session will be held on June 27, 2024, at the Westin Ottawa Hotel from 1:40 p.m. to 4:00 p.m..
Participants will learn about:
Fundamental randomized clinical trial methods
Conducting trials in community clinics
Translating lab discoveries to patient care
Getting your research published
Speakers include Drs. Melinda Gooderham (SkIN Centre for Dermatology), Zaki Taher (Lucere Dermatology), An-Wen Chen (University of Toronto), Veronique Moulin (LOEX Centre), and Liren Tang (Resolvex Pharmaceuticals Inc.)
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Michelle Ramien (Calgary) describes developing a new categorization system for pediatric blistering disease that more accurately captures how these conditions present in younger patients.
Dr. Maxwell Sauder (Toronto) details the relationship between cancer treatments and skin reactions and advises managing those reactions while supporting the oncologic treatment.
Drs. Jennifer Lipson (Ottawa), Catherine Zip (Calgary), Jerry Tan (Windsor, Ont.) and Marcus Tan (Ottawa) provide an overview of new and in-development therapies for rosacea.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.