622 - Shifting the care paradigm for individuals with skin of color (SOC): a comprehensive review of care gaps and emerging initiatives in dermatology
Authors: Alexis Andrew , Chovatiya Raj , Taylor Susan , Elbuluk Nada , Kindred Chesahna , Hansen Meena , Atwater Amber Reck , Rueda Maria Jose , Becker Tanja Bosshard , Shi Vivian 
Published: August 2024

Abstract

Introduction
Historically, dermatology research and clinical practices have overlooked important considerations in the care of individuals with skin of color (SOC). The ongoing disparities in dermatological care and increasing proportion of non-White individuals in the United States (US) underscores the need to understand and address existing care gaps through targeted initiatives. The dermatological medical community seeks to shift towards a more equitable, patient-centered model of care that considers the distinct needs of racial and ethnic groups across the US.

Objectives
To provide an updated literature search with publications from April 2022 to October 2023, that offers insights into new versus persisting care gaps in dermatology for individuals with SOC and detect if any gaps have closed from our previous search. We also reviewed past and present initiatives in the dermatological care of patients with SOC to identify current focus of efforts and if there are opportunities for improvement.

Methods
A comprehensive literature review was performed using PubMed to identify care gaps in SOC dermatological care in the US. Articles published between April 1, 2022, and October 1, 2023, were filtered based on predefined search-term combinations related to subpopulations, indications, healthcare systems, stakeholders, and established researchers in the field. Titles and abstracts of resulting publications were prioritized based on their relevance (i.e., low, medium, or high) and those identified as highly significant were further analyzed to extract relevant care gaps. Using a similar search and prioritization strategy, we examined initiatives focusing on addressing gaps in the dermatological care of patients with SOC. Resulting initiatives (e.g., awards, congresses, curricula, campaigns, and events) were classified by type of organization (e.g., medical society, pharmaceutical industry, patient organization) and assessed for their relevance to each literature-identified care gap. Finally, a comparison of past (from 2020 to 2022) versus current initiatives was conducted to reveal how initiatives have evolved.

Results
The literature review identified 18 gaps in SOC dermatological care, which were further categorized based on their relevance to patients, access to care, HCPs, and clinical research. Of the 18 care gaps, 17 were previously identified and are therefore shown to be persistent challenges. We identified an additional gap that has since emerged: advances in artificial intelligence (AI)-based diagnostic tools lack accuracy in patients with SOC due to their underrepresentation in image databases.
We reviewed the growing landscape of dermatology-specific initiatives for patients with SOC and found approximately 191 initiatives across national and international organizations, including medical societies, patient advocacy organizations, and non-profit organizations. There exists a large focus on initiatives pertaining to healthcare professional (HCP) medical education (MedEd), SOC dermatology research, and diversity in the dermatology profession. Compared to our previous search, we found that the number of initiatives has increased, with approximately 100 new initiatives since April of 2022. The largest increase in number of initiatives was in HCP MedEd curricula and SOC research. Nevertheless, there are still care gaps with insufficient focus; very few initiatives target HCP communication or access to treatment.

Conclusions
Previously identified care gaps remain as persistent issues in the dermatological care of patients with SOC, but a new care gap has since emerged due to developments in AI-based diagnostic tools in dermatology. There was a significant rise in SOC-related dermatological initiatives, with the largest increases in HCP MedEd curricula and SOC research. However, opportunities still exist in HCP communication and access to treatment, where there continues to be limited activity. This study provides a crucial overview of both progress and shortcomings in the SOC-related dermatological landscape and highlights that a coordinated approach may be needed to create impactful change and address the dermatological care gaps affecting patients with SOC.