Assessment of Changes in Diversity in Dermatology Clinical Trials Between 2010-2015 and 2015-2020: A Systematic Review.

IMPORTANCE: Although there have been increased efforts in dermatologic research to improve representation of patient sex, race, and ethnicity, there are limited data evaluating resulting changes. OBJECTIVE: To characterize the diversity of participants in dermatologic clinical trials conducted in the US published from 2015 to 2020 pertaining to common dermatologic conditions affecting all patient demographic categories compared with findings from 2010-2015. EVIDENCE REVIEW: A systematic literature review through the PubMed database was conducted for randomized clinical trials published between July 1, 2015, and July 1, 2020, using keywords alopecia areata, acne, atopic dermatitis, lichen planus, psoriasis, seborrheic dermatitis, and vitiligo. Data collected included distribution of participant demographic characteristics, funding source, and journal type. Reflecting US Census data, studies were defined as unrepresentative of race and ethnicity if they included less than 20% ethnically or racially diverse participants or unrepresentative of sex if they included less than 45% women. Python was used for statistical analysis by χ2 tests or Fisher exact tests. FINDINGS: A total of 392 randomized clinical trials were included. In comparison with the period from 2010-2015, the reporting rate for race and ethnicity in US studies has increased from 59.8% to 71.9% (P = .05). However, the proportion of reporting articles including at least 20% non-White representation remains unchanged at 38.1% with 37 of 97 reporting randomized clinical trials in 2010-2015 and 53 of 139 reporting randomized clinical trials in 2015-2020 (P = .99). Psoriasis studies included the least diversity, with 12.1% of studies recording at least 20% non-White participants and 29.5% of studies recording at least 45% female participants. CONCLUSIONS AND RELEVANCE: The findings of this systematic review suggest that reporting racial and ethnic data since 2010-2015 has become more transparent. However, inclusion of representative patient populations may still be considered inadequate, particularly in psoriasis studies. Diversity in clinical trials is important for representation of the affected patient populations, and additional efforts are warranted in support of this endeavor.

Role of domestic migration stress in adapting precarious behaviours among interstate migrant workers in a semi-urban area of Tamil Nadu.

Background: Migration is a process in which a person moves from one cultural setting to another for a long period of time or permanently, which induces increased adaptation of risky behaviors due to migration stress. This study aimed to identify domestic migration stress and to determine its role in practising precarious behaviours among interstate migrant workers. Methodology: A community-based cross-sectional study was conducted among 313 migrant workers in the Kanchipuram district using a simple random sampling method for recruitment. A pretested semi-structured questionnaire was used to collect data with details on socio-demographic characteristics and precarious behavior profiles, and the 'domestic migration stress scale' was validated. For analysis, variables were described using frequencies, proportions and mean ± standard deviation, appropriately. Inferential statistics like the 'Chi-square test and multiple logistic regressions' were performed to establish the relationship between migration stress and high-risk behavior. Results: Among respondents, 286 (91.37%) were males. The majority were chronic alcoholics [151 (48.56%)], followed by tobacco chewers [106 (33.86%)], chronic smokers [83 (26.51%)], had illicit sexual activity [59 (18.84%)] and drug abusers [4 (1.27%)]. About 247 (78.93%) were under domestic migration stress. Smokers, tobacco chewers and those involved in illicit sexual activity were significant predictor factors. Conclusion: Stress management is paramount, and having the knowledge about their precarious behavior and stress among workers will help in the further development of health promotion strategies for migrant workers.

Photodocumentation in skin of color.

Photodocumentation is an important tool utilized across medical specialties and plays an especially pivotal role in dermatology given the visual nature of the field. Although it has been well-established that dermatologic diseases manifest differently in dark skin compared to light skin, there is under-representation of images of dark skin in dermatology textbooks and other educational resources. It is essential for dermatologists to work toward increasing the availability of images of dermatologic disease in dark skin by improving their own ability to successfully photograph dark-skinned patients. In this article, we describe our nuanced approach to photographing skin of color in regards to the ideal background type, lighting, and camera settings.

Cutaneous vascular lesions in the pediatric population: a review of laser surgery applications and lesion-specific device parameters.

Laser surgery is becoming an increasingly efficacious and customizable treatment modality for the management of pediatric vascular lesions. Proper use requires a thorough understanding of the scientific principles of laser surgery and knowledge of the various lasers available. Moreover, each laser has a multitude of settings that can be employed to properly target the lesion at hand. Each patient will present with unique challenges and variations in the presentation of their vascular lesion. This requires understanding of the most effective laser to use for each lesion and the factors that may alter the desired device settings. Using key search terms, a literature search was conducted on laser surgery for pediatric vascular lesions using PubMed/MEDLINE and Embase for articles published in English or French. Ultimately, 52 articles met our search criteria. The laser indications, limitations, and settings utilized for each type of vascular lesion were compiled for the purposes of this summative review. Laser surgery is an effective and appropriate option for the treatment of certain pediatric vascular lesions. Knowledge of optimal device parameters in every setting is essential to good clinical practice.

Patient Preference in Dermatologist Attire in the Medical, Surgical, and Wound Care Settings.

IMPORTANCE: Patients' perceptions of their physician can affect subjective and objective outcomes. Physician attire influences patients' perceptions of their physician and consequently may affect patient outcomes. OBJECTIVE: To determine patient preferences for different types of dermatologist attire in dermatology medical, surgical, and wound care clinics. We hypothesized that patients in the dermatology medical setting would prefer professional attire, while patients in the dermatology surgical and wound care setting would prefer surgical scrubs. DESIGN, SETTING, AND PARTICIPANTS: This study analyzed responses to a cross-sectional, anonymous survey by English-speaking dermatology patients (aged 18 years or older) at general, surgical, and wound care clinics in an academic center in Miami, Florida. Patients who could not read and understand the survey were excluded. Participants received pictures of a physician wearing business attire, professional attire, surgical attire, and casual attire, and responded by indicating which physician they preferred for each of 19 questions. Frequencies of responses were recorded, and χ2 and regression tests were performed. MAIN OUTCOMES AND MEASURES: Response frequencies. RESULTS: Surveys were administered to 261 persons, and 255 participated and completed enough of the questions to be included in the outcome analyses (118 men, 121 women, 22 unknown [did not answer sex question]), mean (SD) age, 56.3 (18.6) years; about 49% of those who reported their sex were men; 56% were Hispanic; and 85% were white. Approximately 72% of respondents held a college degree or higher. About 63%, 24%, and 13% of respondents were medical, surgical, and wound care dermatology patients, respectively. Roughly 73%, 19%, 6%, and 2% of cumulative responses were for professional, surgical, business, and casual attire, respectively. Respondents who received a picture of a black male or black female physician were more likely to exclusively prefer professional attire: unadjusted odds ratios (ORs) 3.21 (95% CI, 1.39-7.42) and 2.78 (95% CI, 1.18-6.51), respectively, compared with respondents who received a picture of a white male physician. Nonwhite and unemployed respondents were less likely to prefer professional attire exclusively: ORs, 0.28 (95% CI, 0.1-0.83) and 0.28 (95% CI, 0.08-0.99), respectively. Respondents preferred professional attire in all clinic settings, though respondents in the dermatology surgery clinic were less likely to prefer professional attire compared with respondents in the medical dermatology clinic: race-adjusted OR, 0.74 (95% CI, 0.56-0.98). Wound care and medical dermatology respondents preferred professional attire comparably. CONCLUSIONS AND RELEVANCE: In this study, most patients preferred professional attire for their dermatologists in most settings. It is possible that patients' perceptions of their physicians' knowledge and skill is influenced by the physicians' appearance, and these perceptions may affect outcomes.