Dr. Temitayo Ogunleye started her presentation by defining health equality and health equity. Using a bike analogy –if everyone wants to go for a bike ride, it is not most important that everyone needs the same bicycle, but everyone needs the bike that fits their needs. Health equity means that everyone has a fair and just opportunity to be as healthy as possible. Dr. Ogunleye reports that ensuring health equity and equality requires we are “aware of our own biases, different conditions and thoughts, and backgrounds that contribute to the disparity of care”. It is essential as medical providers that we are purposeful in “showing a wide range of skin tones” in our research and medical education.
Recently published research in the field of psoriasis reveal an underreporting of psoriasis in skin of color, likely due to lack of recognition and decreased reporting in this patient population. Dr. Ogunleye emphasized that one of the reasons for this underreporting and recognition may be due to lack of erythema in skin of color making the diagnosis more difficult. Black patients with moderate to severe psoriasis in the US are 70% less likely to receive biologics due to a lack of familiarity and education of this option in this patient population.
Next, Dr. Ogunleye discussed alopecia areata (AA) in patients of color. A recent publication revealed AA may have a higher incidence in patients of color than reported due to disparities in diagnosis. For example, patients of color are likely over-diagnosed with traction alopecia. Further, acne in patients of color was reviewed revealing black patients in the US are more likely to be prescribed topical antibiotics and less likely to be prescribed oral and systemic agents. In summary, acne severity didn’t account for the differences in treatment patterns but patient refusal due to lack of education resulting in risk aversion as well as provider bias.
Finally, skin cancer in patients of color was highlighted by Dr. Ogunleye. Time from diagnosis to treatment is longer for patients of color resulting in increased mortality in black patients. It has been revealed patients of color have an increased average time to surgery and longer time to initiate immunotherapy for stages 1-3 of melanoma. Dr. Ogunleye notes part of this delay could be a result of the most common type of melanoma in this patient population, acral lentiginous melanoma, and the inherent challenges of surgery in this region. She concludes the take away from this information is that this disparity exists, black patients are waiting for months for treatment, and a “call for being more aware of our own behavior to ensure timely treatment for your skin of color patients with melanoma.”