As recent events have evidenced, racial disparities permeate the healthcare system adversely affecting minority patient populations across specialties. Inequities can be detected in the practice of dermatology as well, where access to care and therapeutic options remain limited especially when compared to that available to White patients. In addition to these factors, there is a widespread lack of training and comprehensive medical education to guide clinicians in the treatment of skin of color, which is made more difficult by varying presentations of symptoms. Currently, dermatologic training does not adequately encompass the unique presentations of cutaneous disorders in the increasingly diverse Black population thus, furthering disparities in dermatologic care.
At the same time the specialty has the second lowest percentage of minority representation with only 3% of dermatologists being Black leading to a cultural barrier compromising care. Today, it is critical to address the racial disparities in dermatologic care in order to improve treatment efficacy, patient satisfaction, and outcomes.
Understanding Racial Disparities in Dermatology
Inequities in dermatologic care stem from a complex variety of factors including genetic variations between racial groups, disparities in access to care, varying socioeconomic levels, as well as lacking awareness, education, and specialty training. Many of the disorders disproportionately affecting populations of color – pigmentary disorders, hair and scalp disorders including scarring alopecia, and keloids – are understudied and have limited treatment options.
At the same time, not only are patients of minority groups often less likely to receive care for certain skin conditions from dermatologists, but they are also significantly less likely to seek treatment and care. Experts believe this is primarily a result of reduced exposure to the specialty, historical lack of funding for research, as well as socioeconomic factors which impede accessibility. Current literature reveals the pressing nature of dermatologic disparities, urging healthcare organizations and professionals to take decisive action.
Addressing Inequities in the Field
Although dermatologic disorders affect different racial and ethnic groups to varying degrees due to a combination of genetic, environmental, and structural cutaneous factors, the standard of and access to care must be equal across patient demographics. This requires a multi-pronged, strategic initiative that focuses on the expansion of access to patient-centered healthcare for minority populations.
A significant component of addressing these issues is an increased emphasis on research efforts and the study of dermatologic conditions in patients of color. There is an urgent need for new drug development for disorders that disproportionately affect racial minorities including vitiligo, melisma, and post-inflammatory hyperpigmentation. Additionally, there must be an emphasis on the inclusion of more diverse participant cohorts in clinical trials with the aim of increasing data available to guide treatment approaches in patients of color.
Another necessary aspect is the improvement of documentation of diverse patient populations. Dermatologists should prioritize increasing medical photographs of darker skin types to contribute to medical literature and data for artificial intelligence algorithms – and they are already doing so. Recent research reports far greater representation of dark skin in web-based resources than in traditional printed literature.
A national shortage of physicians, lack of recruitment, and inadequate training within the dermatology specialty highlights the need for more comprehensive medical education and increased diversity programs. In order to recruit more board certified dermatologists of color, healthcare organizations and facilities need to implement diversity initiatives focused on recruiting and training promising candidates from different racial backgrounds.
Finally, dermatology practices and large-scale organizations can unite efforts in developing and disseminating diversity-oriented patient education materials as well as programs that aim to raise awareness among minority populations of dermatologic health.
Working toward bridging racial gaps in aesthetic medicine, dermatologists must be aware of the existing disparities in training, access, and patient outcomes as well as the lack of representation among practitioners and healthcare leaders. While the path to equity in the practice of dermatology may be long, it requires strategic action at an individual level; clinicians can continue to work toward furthering trust and communication as well as strengthening the patient-provider relationship by ensuring diversity in their practice.
To further assist clinicians in bridging the racial gaps in dermatologic care, LivDerm is offering a novel Deep Dive: Racial Disparities in Dermatology online learning program on March 6, 2021 that aims to equip dermatologists with the most effective and up-to-date strategies to combat inequities in the clinical practice.