How to advance equity, diversity, and inclusion in dermatology: Recommendations from an expert panel

Clinical research

Another way to help close racial gaps in dermatology is to improve access to mentorships and clinical research, according to panelist Chesahna Kindred, MD, of Kindred Hair & Skin Center in Columbia, Md. “We should be thoroughly embarrassed by the lack of diversity in our clinical trials,” she said.

“At the end of the day, the whole point is to make our patients better,” said Dr. Kindred, associate professor of dermatology at Howard University, Washington. “That comes down to the procedures and treatments that we offer, which is based on evidence – clinical trials and research.”

In her role as chair of the dermatology section of the National Medical Association (NMA Derm), Dr. Kindred helped launch the NMA Derm research committee, which trains members to run clinical trials in their practices – an undertaking that was largely prompted by claims from pharmaceutical industry representatives that they struggle to find Black participants for clinical trials. “The truth of the matter is, if a Black patient doesn’t choose to go to Dr. Smith as a patient, they’re certainly not going to choose to go to Dr. Smith as a research participant,” Dr. Kindred said. “We have to meet those diverse populations where they are. By and large for Black patients, those are Black dermatologists.

In addition to meeting with primary investigators, she has been meeting with industry representatives, who she said are very interested in improving clinical trial diversity. “When a trial does not include a diverse population, we can call it out and say it is subpar,” she said.

In 2020, the Food and Drug Administration announced the availability of a guidance document, “Enhancing the Diversity of Clinical Trial Populations – Eligibility Criteria, Enrollment Practices, and Trial Designs,” which includes recommendations for sponsors on how to increase enrollment of underrepresented populations in their clinical trials of medical products.

Dr. Kindred has created a clinical research unit in her own practice, in partnership with Howard University’s department of dermatology and NMA Dermatology.

Studies Dr. Kindred is involved with include those looking at the relationship between hair care products targeted to Black women and the development of central centrifugal cicatricial alopecia (CCCA). CCCA is getting worse with each generation, “and we think the cause might be environmental,” she said. “Studies show that there are almost zero percent carcinogens in hair care products that target Whites. But close to 100% of hair care products that target Blacks contain carcinogens and endocrine disrupting chemicals, the most common being phthalates, which are found in relaxers, chemicals that patients use to straighten their hair.”

Urinary phthalate concentrations have been found to be much higher in Black women than in White women, and one of the pilot studies she is involved with is checking the urinary phthalate levels in Black women with and without CCCA, to see if there is a correlation.
 

Mentorships

DiAnne S. Davis, MD, of North Dallas Dermatology Associates, rounded out the panel discussion by underscoring the importance of mentorships for underrepresented minority medical students, which includes providing guidance through the application process. “Mentorship is key to closing some of these gaps, particularly in our field of dermatology,” Dr. Davis said.

“Next to orthopedic surgery, dermatology has the fewest Black physicians in the field of medicine. This must change because by the year 2050, over half of the U.S. population will comprise skin of color individuals. We want to be well equipped to treat them, and to make sure they have access to dermatologists who look like them. That was one of the main reasons I went into dermatology, because I didn’t see many dermatologists who looked like me, and I wanted to make that change.”

Through NMA Derm, Dr. Davis was tasked by one of her mentors, Dr. Kindred, to spearhead a mentorship program that pairs medical students with a mentor in the dermatology field, “so we can help guide them not only on their medical school process but help in coordinating research projects, and make them successful in matching to dermatology,” she said. “When students reach out to you, it’s important to take them under your wing or connect them to somebody you know so that we can increase the number of minority dermatologists.”

None of the panelists reported having disclosures relevant to their presentations.