Embracing diversity in dermatology: Creation of a culture of equity and inclusion in dermatology

Gender equity in academic dermatology: Problems aplenty, yet paths ahead

Efforts to achieve gender equity of health professionals should be a priority in all fields of medicine, including academic dermatology. This review aimed, first, to summarize available evidence about the status of gender equity in various domains of academic dermatology-headship positions, salary, editor and editorial board appointments, publications, conference presentations, receipt of research grants and academic prizes-second, to identify challenges to achieving gender equity and, third, to articulate the components of a multifaceted strategy for gender parity. A variety of databases were searched. Manual searching of reference lists and searching of grey literature were also undertaken. It was found that, despite improvements in some domains, the gender inequity persists in all of the above-mentioned areas of academic dermatology. Challenges to achieve gender parity include time in pregnancy, disproportionate participation in childrearing and domestic tasks compared with men, suboptimal legislation in many jurisdictions for parenting and childcare leave, and unconscious biases about women. Elements of a multipronged approach include strengthening women's dermatology societies that advocate for women in academia; celebrating the careers of distinguished female academic dermatologists; mentoring; promoting leadership courses; striving for a greater representation of women among editors-in-chief, authors, and conference presenters, among others; seeking better pay, leave conditions and other work entitlements; conducting high-quality research about gender inequity in academic dermatology; imposing sanctions for violations of gender equity; supporting dermatologists' health; and learning from the experience of other fields of academic medicine.

Prayer-Related Dermatoses in Muslims

Prayer rituals are an integral part of the daily lives of Muslims worldwide. This comprehensive review aims to explore the common dermatoses associated with prayer among Muslims and provide insights for dermatologists to facilitate accurate diagnosis and reduce unnecessary investigations. A systematic literature search returned 367 published articles, of which 21 met the inclusion criteria. Friction-induced dermatitis was the most frequently reported dermatosis, primarily affecting the forehead, knees, dorsum of the feet, and lateral malleoli. Friction-related marks often present as hyperpigmented lichenified plaques, and are more common in elderly individuals and males. Cases of contact dermatitis and fungal infections were also reported. Allergic contact dermatitis was linked to perfume application before Friday prayers, whereas fungal infections were attributed to increased water retention between toe webs, possibly related to communal ablution and prayer areas. Awareness of these prayer-related dermatoses enables dermatologists to provide holistic care for diverse populations and targeting specific interventions with respect for patients' religious beliefs. For example, Muslim patients with symptomatic frictional dermatoses may benefit from use of padded prayer rugs, especially diabetic patients whose lesions carry an increased risk of progressing to neuropathic ulcers.

Allergic Contact Dermatitis Associated With Religious Practices: Review of the Literature

Allergic contact dermatitis (ACD) may occur secondary to devotional practices in various religions. A systematic review of PubMed was conducted from inception of database to September 9, 2022. Key terms were "contact dermatitis" or "devotional dermatosis" in association with major world religions including "Christianity," "Islam," "Hinduism," "Buddhism," "Sikhism," and "Judaism." Inclusion criteria were determined by presence of a religious practice and associated ACD. Articles referencing other cutaneous reactions such as chemical leukoderma were excluded. In total, 36 of 102 unique articles identified met inclusion criteria. Twenty-two articles referenced Hinduism, 8 referenced Judaism, 5 referenced Islam, 3 referenced Christianity, and 1 article each mentioned Buddhism and Sikhism. Four articles referenced multiple religions. Para-phenylenediamine was the most common contact allergen overall and is found in blackening ingredients mixed with henna for temporary tattoos. Henna tattooing is a cultural practice associated with Hinduism, Islam, and Judaism. Nine unique contact allergens associated with religious practices were identified. Increasing awareness of religious practices that cause ACD will facilitate culturally competent dermatological care.

Factors facilitating shared decision making in eczema: Met and unmet needs from the patient perspective

Background

Research has shown that eczema patients prefer some degree of shared control over treatment decisions, but little is known about factors perceived to be important to facilitate shared decision making (SDM).

Objective

To determine factors eczema patients and caregivers consider to be important for SDM, and how often they experience them with their eczema healthcare provider (HCP).

Methods

A cross-sectional survey study (64 questions) was conducted, which included factors related to SDM rated by respondents on a Likert scale for importance, and how often these factors were true with their current eczema HCP.

Results

Respondents (840, response rate 62.4%) most frequently rated their health literacy and communication skills as important for SDM. Factors which indicated a strong provider-patient relationship, and HCPs who initiate treatment conversations were also deemed beneficial. Low importance was placed on concordant HCP race/ethnicity, however, of those who did rate it as important, 53/91 identified as Black (half of all Black respondents).

Limitations

A high proportion of respondents were aware of the term SDM prior to the survey.

Conclusions

SDM is more likely to be facilitated when patient education and empowerment are coupled with HCPs who initiate treatment discussions, maintain compassion resilience, and listen to patient perspectives.

Cultural Competence and Humility

The increasing diversification of the United States has led to more racially and ethnically discordant visits between health care providers and patients; this is especially true in dermatology due to the lack of diversity in the field. Diversifying the health care workforce has been shown to reduce health care disparities and is an ongoing goal of dermatology. Improving cultural competence and humility among physicians is an important part of addressing health care inequities. This article reviews cultural competence, cultural humility, and practices dermatologists can incorporate to address this challenge.

Diversity, Equity, and Inclusion in Dermatology Residency

Improving diversity, equity, and inclusion (DEI) in dermatology is a critical aim for the specialty to improve the workforce, clinical care, education, and research. This article outlines a framework for DEI initiatives at the residency training level: improving mentorship and residency selection process to improve representation of dermatology trainees; curricular development to train residents to provide expert care to all patients and to better understand principles of health equity and social determinants of health as they pertain to dermatology; establishing inclusive learning environments and mentoring structures that support residents to become successful future clinicians and leaders of the specialty.

Diversity, Equity, and Inclusion Initiatives in Dermatology Organizations

Over the past few years, there have been concerted efforts to increase diversity in the field of dermatology. This has been achieved through the creation of Diversity, Equity, and Inclusion (DEI) initiatives in dermatology organizations that strive to provide resources and opportunities for trainees who are underrepresented in medicine. This article compiles the ongoing DEI initiatives in the American Academy of Dermatology, Women's Dermatologic Society, Association of Professors of Dermatology Society, Society for Investigative Dermatology, Skin of Color Society, American Society for Dermatologic Surgery, The Dermatology Section of the National Medical Association, and Society for Pediatric Dermatology.

Impact of Diversity in Training Resources on Self-Confidence in Diagnosing Skin Conditions Across a Range of Skin Tones: An International Survey

BACKGROUND

Medical images are invaluable in facilitating recognition of clinical signs. Recent studies highlight a lack of diversity of skin tone images used within medical education. However, there is a paucity of data on the impact of this on patient care.

AIMS

To investigate diversity in training resources used by users of an International online teaching platform and self-confidence in diagnosing skin conditions in all skin tones.

METHODS

Users of an online teaching platform (www.dftbskindeep.com) were invited to participate in a survey evaluating key points including geographical location, ethnicity, profession, specialty, years of experience, training resources and confidence in diagnosing skin conditions. Data analyses were performed using SPSS. Categorical variables were presented as proportions. Chi-squared or Fisher's exact tests were used to compare the distribution between groups as appropriate.

RESULTS

Of 600 participants, 74% reported training resources featuring predominantly white skin. Participants were "generally uncertain" in 43% cases, "sometimes uncertain but clinically safe" (52%), and "confident across a range of skin tones" in a minority (5%). Self-confidence was associated with location [higher in Africa (29%) and Latin America (11%), (p < 0.001)]; diversity of training resources [higher with a mix (10%) or darker tones (20%) (p < 0.001)]; clinical experience [6-10 (5%) or >10 years of practice (11%) (p < 0.001)] and specialty [highest in dermatologists (53%, p < 0.001)]. Self-confidence was lowest among pediatricians, emergency medicine and pediatric emergency medicine specialists (<5%).

CONCLUSIONS

These data provide preliminary evidence that training resources used by healthcare professionals on a global scale may lack enough diversity on representation of skin images, and a lack of self-confidence in diagnosing pediatric skin conditions. Further work is needed to understand the impact on knowledge and patient care to ensure equitable healthcare for all.