Skin in the Game: Racial Disparities in Dermatology Trials and the Quest for Inclusivity

Original Article: Racial and ethnic underrepresentation in dermatology clinical trials

What are the key takeaways of this article?

The field of dermatology is crucial for the advancement of treatments related to cutaneous conditions. Yet, a recent in-depth analysis of ClinicalTrials.gov reveals a significant disparity: certain racial and ethnic groups, primarily Black/African Americans, are markedly underrepresented in dermatology clinical trials. This discrepancy becomes particularly concerning given the higher prevalence of certain skin conditions among these minority groups.

Mineroff et al. sourced participant data from dermatology trials conducted in the U.S. from 2017 to 2021 via ClinicalTrials.gov and compared it against census data. This comparison aimed to discern whether the representation of minority groups in these trials corresponded with their demographic proportions within the U.S. population. From 246 trials that fit their inclusion criteria, they unveiled that although Black/African Americans constitute 13.6% of the U.S. population, they made up just 7.9% of total participants in the analyzed studies. Disturbingly, only 21.9% of these studies mirrored or exceeded this 13.6% representation threshold. Moreover, this representation saw a decline in the final two years of the study, potentially exacerbated by the COVID-19 pandemic.

To lend more granularity to these findings, the study highlighted conditions with marked racial disparities such as Atopic Dermatitis (AD). While Black/African Americans exhibit a pediatric prevalence rate of 19.3% compared to the White population (16.1%), they were underrepresented in eczema/AD trials, accounting for only 11.6% as opposed to their 13.6% population proportion. Similarly in psoriasis studies, despite Black/African Americans having a prevalence rate of 1.3%, their representation was a mere 2.9% in studies. By comparison,white participants made up 84.9% of psoriasis study participants despite having a disease prevalence of 2.5%. Similar racial gaps were observed in conditions such as acne, rosacea, and alopecia, with the only exception being tinea capitis, where the representation matched prevalence.

Delving deeper, the article discusses numerous barriers that could explain this underrepresentation. These include, but are not limited to, financial limitations, accessibility challenges, medical distrust within minority communities, and potential investigator biases. Addressing these disparities is more than an academic exercise; it's a moral imperative. True inclusivity in clinical trials not only ensures broader generalizability of findings but also democratizes access to pioneering treatments. Potential remedies span enhancing community engagement, championing diverse provider representation, refining recruitment strategies, and emphasizing inclusivity at every research phase.

Publication Date: September 1st, 2023

Reference: Mineroff J, Nguyen JK, Jagdeo J. Racial and ethnic underrepresentation in dermatology clinical trials. J Am Acad Dermatol. 2023 Aug;89(2):293-300. doi: 10.1016/j.jaad.2023.04.011. Epub 2023 Apr 14. PMID: 37062462

Summary By: Parsa Abdi

Read an article on this topic from the author of this summary: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10412004/