Strong solutions for increasing dermatology research diversity: Trust me, I’ve got skin in the game

As a woman of colour, I am very careful about the skin care products I use. I must be.

Before incorporating a new at-home chemical skin treatment into my routine, like a peel that promises “clearer” or “brighter” skin, I turn to the internet, searching for information on whether it has been tested on darker skin tones. Because, if it wasn’t, who knows how my skin will react? More often than not, my search proves futile, due to the lack of research on over-the-counter (OTC), at-home chemical treatments on darker skin.

As disheartening as these shopping experiences are, this issue is so much more than my personal quest for a new at-home peel. The limited availability of diverse dermatological research affects people of colour the world over, profoundly impacting our diagnosis, treatment results, and – ultimately - essential quality-of-life factors, such as self-confidence and self-image.

Skin colour plays an essential role in the pathophysiology, epidemiology, presentation, and treatment of many dermatological conditions.¹ To illustrate the real-life consequences of inadequate diversity in dermatological research, I recall a patient’s experience during a routine visit: she had developed post-inflammatory hyperpigmentation on her chin after undergoing laser hair removal, an adverse reaction that was the direct result of inadequate consideration of her skin type when choosing the laser. The patient’s frustration, self-image concerns, and eroded trust in medicine were palpable. How would you feel if your face were permanently altered because a healthcare professional didn’t consider something as obvious as your skin tone?

To address these challenges and develop effective treatments that cater to people of all skin colours, it is imperative that we increase diversity within dermatology research. Only through inclusive studies can we begin to bridge the gaps in knowledge and understanding, and pave the way for a stronger, more equitable future in dermatological care.

Understanding the lack of diversity in dermatology research

Diversity is a pervasive problem within dermatology research, and the implications of this disparity are significant. One review found only 38.1% of analysed trials included a minimum of 20% non-white participants.² This statistic stands in stark contrast to the demographic makeup of the US, where, per the 2022 Census, 40.7% of the US population is non-white.³ Why does this glaring lack of diversity persist?

One key factor is the disparity in access to dermatological care. Private dermatologists are less inclined to accept patients with Medicaid or Medicare, leaving minority patients with disproportionately longer wait times for care, inferior health outcomes, and limited access to studies run in large dermatology practices.⁴ The underrepresentation of images showcasing the skin of racial and ethnic minorities in dermatology textbooks, journals, and other publications further exacerbates the problem. This inadequacy hampers physicians’ proficiency in providing care to patients from diverse backgrounds, leading to a reasonable reluctance among these patients to seek dermatological care.⁵

The racial diversity within the dermatology physician workforce itself is also strikingly low. In fact, dermatology is one of the least racially diverse medical specialties. According to the Association of American Medical Colleges, Black and Hispanic dermatologists comprise only 3% and 4% of the dermatology workforce, respectively.⁶ The discomfort experienced by people of colour when seeking care from white dermatologists greatly contributes to the lack of diversity in dermatology research. This unease erodes their confidence and diminishes their likelihood of pursuing dermatologic treatments, including participation in clinical trials.

The consequences of reduced patient engagement with dermatologists extend beyond access to routine healthcare. If individuals from minority communities are deterred from visiting dermatologists, they will remain uninformed about and excluded from opportunities to participate in dermatology research. This lack of engagement perpetuates a cycle of underrepresentation and limited understanding of dermatological conditions within these communities.

Strategies for increasing diversity in dermatology research

Diversity is a problem in dermatology research - but it doesn’t have to be. Here are several strategies we can use to create more inclusive research practices that will beget better skin care for people of every race and ethnicity:

1) Encouraging diversity in dermatologists 
We can promote diversity in dermatology by actively encouraging underrepresented individuals to pursue careers in the field. Targeted outreach programmes, scholarship opportunities, mentorships, and other support solutions will help ensure aspiring dermatologists from diverse backgrounds have the resources and guidance necessary for success.

2) Educating dermatologists on treating skin of colour
Incorporating comprehensive education on the diagnosis and treatment of skin conditions across different ethnicities in medical school curricula will go a long way towards reducing distrust of dermatology and dermatology research. To better equip dermatologists with the necessary skills and knowledge to effectively diagnose and treat skin conditions in individuals from different ethnic backgrounds:

• Textbooks and learning materials should include a diverse range of images depicting conditions such as psoriasis, atopic dermatitis, and more on various skin colours
• Schools should offer hands-on training opportunities in experienced dermatology offices that serve diverse populations

3) Engaging community providers to create healthcare-first sites for dermatology research 
Involving community providers, such as local dermatology practices, in research initiatives will increase diverse participation in several key ways. First, bringing dermatology research into underserved communities - rather than keeping it in large research centres - will reduce the participation burden and cost. Second, trials conducted within familiar healthcare environments provide patients with a more comfortable and convenient trial experience. Third, the pre-established relationships between patients and their primary care providers are powerful and can play a crucial role in encouraging patients to participate in research.

4) Expanding healthcare-first sites to include non-specialised providers 
Including general practitioners and primary care clinics in dermatology research efforts allows for a larger patient population to be involved in dermatological trials, particularly those who may have limited access to specialist care due to financial constraints. General practitioners are more likely to accept Medicare/Medicaid, making dermatology trials even more accessible to individuals with reduced means. Furthermore, the existing trust and rapport between patients and their primary care providers will further encourage participation.

By implementing these strategies, we can break down barriers, increase diversity within dermatology research, and ultimately improve the quality and effectiveness of dermatologic care for individuals from all racial and ethnic backgrounds.

My skin depends on it

I would love to go to the store and easily find a safe, mild chemical peel I can confidently use at home. I would love for people who look like me to effortlessly access effective, safe therapies for their skin conditions. Both are possible, but only if we advocate for diversity in dermatology research by increasing minority representation in the field, fostering educational programmes that enhance dermatologists’ understanding of diverse skin types and conditions, and, perhaps most importantly, embracing the concept of healthcare-first sites. These sites have the potential to usher in a future where skin care products and therapies cater to all skin types, and where everyone’s skin health is valued, supported, and celebrated.