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Addressing Underrepresentation in Psoriasis and the Broader Field of Dermatology

There are resources available to help providers treat patients with skin of color.

Psoriasis affects more than 3% of adults in the U.S., including 1.9% of Black and 1.6% of Latinx individuals.[1] However, research has shown that Black, Asian, and other minorities, excluding Hispanic, are less likely to see a dermatologist than White people. [2] This is even though they may have more severe disease and poorer quality of life. It is important to note that prevalence estimates may be impacted by the lack of understanding of presentation on skin of color as well as lack of care.

Even when minority patients are seen, there remain barriers to accessing treatment. Data show that in the U.S., Black patients are less likely to receive biologic treatment for their psoriasis, compared to White patients. Research has shown that there are definitive differences between the perceptions and understanding of psoriasis therapies by race and treatment history, such as Black patients who were biologic naïve were unfamiliar with self-injectable biologics. This differed from White patients who were also biologic naïve. Further analyses showed that neither income nor education levels were predictive of familiarity with self-injectable biologics. According to a research paper authored by Junko Takeshita, M.D., Ph.D., et al, these findings show that Black patients with psoriasis may be less aware of biologic treatment options, even though biologic treatment options are highly efficacious for the treatment of psoriasis. [3]

It is not only that minorities are less likely to be seen, they are less also less likely to be dermatologists. African American and Hispanics represent only 3% and 4.2% of all dermatologists, respectively. In fact, dermatology is the second least diverse specialty in medicine, even though data have shown that race concordant visits result in greater patient satisfaction [4]. There are efforts underway to increase diversity in dermatology, focusing on encouraging underrepresented minorities to pursue higher education careers in dermatology. However, this is not without barriers. A survey of underrepresented minority students showed that those students see multiple perceived barriers to applying for a dermatology residency. Those barriers includes potential risk of not matching, lack of diversity in the specialties, lack of mentorship, as well as GPA and USMLE board examination scores impacts. [4]

Additionally, racial and ethnic minorities have been historically underrepresented in clinical trials. A 2020 report from the FDA showed that Black/African American, Asian, and Hispanic/Latinx individuals make up 8%, 6%, and 11% of the clinical trial populations, respectively. [5] Comparatively, White individuals make up 75% of the clinical trial populations. Presentations by Niti Goel, M.D., have shown that this lack of diversity in clinical trials is an important challenge to face, as people of different backgrounds could react differently to treatments, among other reasons. While there is room for improvement in this area, when comparing the 2020 FDA Drug Trial Snapshot with one from 2018, there are notable increases in inclusion of the Black/African American, Asian, and Hispanic/Latinx individuals who participated in clinical trials.

The National Psoriasis Foundation (NPF) remains committed to not only helping underrepresented minority communities but increasing awareness about psoriasis on skin of color. Aside from the great patient resources the NPF Patient Navigation Center can share, there are also resources for health care providers.

Resources

Psoriasis and Skin of Color: An Advanced Online article featuring an interview with Dr. Takeshita as she discusses psoriasis in skin of color, including undertreatment and special treatment considerations.

Tips for Diagnosing and Treating Psoriasis in Skin of Color (CME): a CME podcast featuring a discussion with Seemal Desai, M.D., about the presentation, diagnosis, and treatment of psoriasis in skin of color.

A Call for Diversity in Clinical Trials (CME): a CME podcast featuring Dr. Goel as she addresses issues tied to diversity and improving inclusion in clinical trials

Diversity in Clinical Trials Webinar: CME available on-demand, HCPs can join Dr. Goel as she discusses how to expand diversity in clinical trials

NPF also offers mentorship opportunities for practicing providers and researchers at all stages of their career to connect with experts and learn from them. This invaluable connection can help provide the next generation of clinicians and researchers with career guidance and feedback for challenging cases.

Recently, NPF held a Dermatology-Rheumatology Collaborative with a Focus on Skin of Color. During this meeting, leaders in the field, Drs. Seemal Desai, Erin Boh, Sheetal Desai, Tiffany Mayo, Niti Goel, Junko Takeshita, and Paras Karmacharya came together to discuss comorbidities, risk factors, diagnostic challenges, and more that patients with skin of color may face in either dermatology or rheumatology.

If you would like to know more about the Dermatology-Rheumatology Collaborative and accessing the enduring content, please email medicalaffairs@psoriasis.org.

Learn More About Psoriasis and Skin of Color

A look at diagnosis and treatment disparities.

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