Key Takeaways
- Hispanic patients with skin conditions often delay care due to cost, work, transportation, and language barriers.
- Dermatology has a significant diversity gap, with only 4.2% of dermatologists being Hispanic, despite Hispanics making up at least 18% of the US population.
- Clinical images and clinical trials lack diversity, with insufficient representation of patients with darker skin types and who are of Hispanic ethnicity.
- Skin conditions like atopic dermatitis and alopecia disproportionately affect Hispanic and Latino populations, leading to missed school, mental health issues, and a higher burden of disease.
Members of the Hispanic and Latino community have long faced barriers to access in medical care. This is no different when it comes to dermatologic care in this patient population.
Barriers to Care
According to a 2022 study1 published in the Journal of the American Academy of Dermatology, investigators found that Hispanic and Black patients with chronic inflammatory skin conditions were significantly more likely to delay care when compared to white patients. These delays could be attributed to cost, work, transportation, and more.
Additional obstacles may be also due in part to language barriers, a lack of health insurance coverage or primary care source, finances, cultural differences, stereotypes and bias, among others.2
Lack of Representation
Within the dermatology specialty, ethnic and racial diversity are lacking.
While 18.5% of Americans are Hispanic, only 4.2% of the dermatology specialty is comprised of Hispanic dermatologists, according to a 2022 reflection3 on dermatologic disparities published in the Journal of Clinical and Aesthetic Dermatology.
“We posit that increasing diversity among the provider workforce within the field of dermatology will lead to improved patient outcomes overall and to decreased disparities in dermatological care. While race-concordant visits are by no means a prerequisite for quality care, numerous publications have demonstrated that race-concordant visits last longer and that patients are more satisfied, rate their physicians as more participatory, and provide higher ratings of positive patient affect,” wrote authors Nour El-Kashlan, MD, and Andrew Alexis, MD, MPH. “Furthermore, physicians from underrepresented racial and ethnic groups improve the quality of patient care by increasing access to care, providing culturally competent care, and contributing culturally diverse perspectives within the specialty at large.”
Non-Diverse Clinical Images, Educational Tools, and Clinical Trials
When it comes to clinical images of dermatologic conditions in patients with skin of color and darker skin types, representation and diversity are few and far between.
One study4 found that despite varying cutaneous pathology in patients with darker skin types, only around 4.5% of images in medical textbooks feature patients with darker skin. Among 6 common dermatology textbooks, representation of patients with darker skin types ranged from 4% to 18% of images, with 5 of the 6 textbooks lacking significant improvements over the most recent 15 years.
During the COVID-19 pandemic, dermatologists devised an international registry of cutaneous symptoms associated with the virus in an effort to document skin-related manifestations. However, of the 716 cases submitted spanning 31 countries, only 34 represented patients were Hispanic.5
In clinical trial settings, Hispanic representation is not much better.
A 2017 study6 examined the relationship between factors such as race and ethnicity in clinical trial participation. They found that 74.4% of study participants amassing a broad range of common, well-studied conditions, were white.
When comparing estimates of clinical trial representation to US Census data, researchers involved in a study7 published earlier this year found that patients of Hispanic or Latino identity were underrepresented in study settings. 14.1% of studies that provided ethnic or racial demographic included Hispanic or Latino patients, despite them making up 18.9% of the US population.
Education, Mental Health, and Well-Being
According to a 2019 study8 published in JAMA Dermatology, Hispanic and Black children are more likely than their white peers to miss school due to chronic skin diseases such as atopic dermatitis (AD). In Latin America, AD prevalence is high, with prevalence of as much as 25% in children and 1% to 3% in adults.
“There are environmental factors such as the climate and geography of Latin America, which can see swings in both temperature and humidity, which is believed to influence AD prevalence and severity,” wrote Keith Loria in a Dermatology Times article published earlier this year. “Add in dangerous air pollution, factory emissions, and water hardness, and all of those play a role in an increased frequency of AD and other allergic diseases. For instance, children living near factories in Buenos Aires were found to be twice as likely to have AD.”
Another study9 found that Hispanic and Latino patients were more likely to experience depression and anxiety as a result of alopecia than white patients, carrying an overall greater burden of disease.
References
- Nock MR, Barbieri JS, Krueger LD, Cohen JM. Racial and ethnic differences in barriers to care among US adults with chronic inflammatory skin diseases: a cross-sectional study of the All of Us Research Program. J Am Acad Dermatol. Published online October 13, 2022. doi:10.1016/j.jaad.2022.09.054
- Escarce JJ, Kapur K. Access to and Quality of Health Care. National Library of Medicine. 2006. Accessed September 14, 2023. https://www.ncbi.nlm.nih.gov/books/NBK19910/.
- El-Kashlan N, Alexis A. Disparities in dermatology: A reflection. J Clin Aesthet Dermatol. 2022;15(11):27-29.
- Adelekun A, Onyekaba G, Lipoff JB. Skin color in dermatology textbooks: An updated evaluation and analysis. J Am Acad Dermatol. 2021;84(1):194–196.
- Freeman EE, McMahon DE, Lipoff JB, et al. The spectrum of COVID-19-associated dermatologic manifestations: An international registry of 716 patients from 31 countries. J Am Acad Dermatol. 2020;83(4):1118-1129. doi:10.1016/j.jaad.2020.06.1016
- Charrow A, Xia FD, Joyce C et al. Diversity in dermatology clinical trials: A systematic review. JAMA Dermatol. 2017;153(2):193–198.
- Mineroff J, Nguyen JK, Jagdeo J. Racial and ethnic underrepresentation in dermatology clinical trials. J Am Acad Dermatol. 2023;89(2):293-300. doi:10.1016/j.jaad.2023.04.011
- Wan J, Margolis DJ, Mitra N, Hoffstad OJ, Takeshita J. Racial and ethnic differences in atopic dermatitis–related school absences among US children. JAMA Dermatol. 2019;155(8):973–975. doi:10.1001/jamadermatol.2019.0597
- Denny JC, Rutter JL, Goldstein DB, et al, All of Us research program investigators. The 107 ‘‘all of us’’ research program. N Engl J Med. 2019;381:668-676
