Advancing Representation in Dermatology Research

As the U.S. population becomes increasingly more diverse,¹ dermatology continues to be one of the least diverse of all medical specialties,² emphasizing the critical need to increase representation of practicing dermatologists in the field.

A recent report by the National Academies of Sciences, Engineering, and Medicine highlights the persistent issue of racial and ethnic inequities in healthcare. Specifically, Black Americans have had worse health outcomes across the board, including skin conditions.³ Despite Black Americans comprising 13 percent of the U.S. population, only three percent of dermatologists in the country are Black.⁴ Research in the Archives of Dermatological Research suggests that patient-provider race concordance – where a patient and their physician share a racial identity – is associated with higher satisfaction and better communication. Diversity in dermatology brings about better science, treatments, and patient care overall.⁵ Dedicating investments and resources to cultivate a diverse dermatologist provider workforce is a crucial first step to propel innovative and inclusive solutions that yield better patient outcomes.

As part of its long-standing Our Race to Health Equity (ORTHE) initiative, which aims to eradicate injustice as a public health threat and eliminate health inequities for people of color, Johnson & Johnson has built a network of powerful collaborations with universities, hospital systems and medical societies to establish a diverse workforce across all aspects of dermatology practice, to close racial health gaps and to co-create solutions that address racial and social health determinants.

Through ORTHE, Johnson & Johnson has supported innovative research programs like the Skin of Color Society Diversity in Clinical Research (DiCR) Mentoring Program and the Howard University Dermatology Readiness Program that aim to increase diverse dermatology representation through mentorship and sponsorship. The company also supports initiatives in developing digital tools to support more inclusive participation in dermatology clinical research.

Diversity in dermatology research equals excellence in patient care

The Skin of Color Society is known for providing comprehensive training and resources that address unique needs of people of color. The Skin of Color Society DiCR Mentoring Program, developed in collaboration with the National Medical Association and supported by Johnson & Johnson, was inspired by the overwhelming lack of diversity in dermatology research and practice overall, and the need for mentors who are experienced in dermatology clinical research.

DiCR, one of the only mentoring programs of its kind, aims to improve recruitment, retention, compliance, satisfaction and outcomes of patients from diverse racial and ethnic backgrounds in clinical trials to reduce healthcare disparities and ultimately achieve health equity. To do this, they mentor underrepresented minority dermatologists in clinical research to enhance skills, propel career development, educate on conducting high-quality, industry-sponsored clinical research and build a diverse research workforce that can foster trust among underserved populations.

DiCR participants take part in an online course (Phase I), an in-person training (Phase II) and a year-long mentorship experience (Phase III). The online and in-person training curricula are curated to provide broad-based knowledge and insights, and the mentorship component augments the experience by providing access to networking and tangible career development opportunities. At the end of the training phases, mentees are offered an opportunity to participate in Johnson & Johnson clinical dermatology trials, leveraging the mentors’ support, and operational support from Johnson & Johnson to ensure a positive experience and successful participation and completion of clinical trials.

“Mentors are critical to success in dermatology practice and dermatology research. Getting access to top experts who openly share the nuances of the field and how to not just survive, but also to really thrive has been one of the biggest benefits of the DiCR Mentoring Program for my career. The confidence I’ve gained knowing I’ve earned the trust of a life-long mentor who advocates for me cannot be overstated.” – Akua Sarfo, MD, PhD, FAAD, DiCR Mentoring Program Alumna

Access and early exposure spawn enhanced clinical skills

Howard University is home to the only Historically Black College and University (HBCU) dermatology department in the U.S. The Howard University Dermatology Readiness Program, which has maintained a relationship with Johnson & Johnson since 2022, strives to enhance the number of healthcare providers from underrepresented racial and ethnic groups who specialize in dermatology through early exposure, mentorship, and involvement with clinical and dermatology research.

The program first builds interest in dermatology as a career and, over time, offers scholarships, workshops and formalized mentorship. It provides a wide range of didactic and clinical experiences to enable trainees to deliver specialized care to patients with diseases of the skin, hair, nails and mucous membranes.

“Since starting, I have helped with clinical trials, led my own research project and attended an annual dermatology conference. Overall, this fellowship award has fueled my passion for dermatology and has increased my chances of securing a residency.” – Jewell Dinkins, Howard University Dermatology Readiness Program Alumna

In 2022, five applications were received, and one was selected by a panel of attending physicians. The program grew in 2023, receiving 13 applications and ultimately selecting two program participants. The program’s first-ever graduate has since completed her medical fellowship and will be completing her dermatology residency at Wake Forest University. One of the 2023 Dermatology Readiness Program fellows was accepted to a clinical trials fellowship at the University of Alabama Department of Dermatology, which provides additional clinical research training prior to entering a dermatology residency training program.

"I have had the immense honor to spend the year investigating the effects of systemic racism on the health and well-being of historically marginalized patients and providers. Through this fellowship, I was also introduced to my phenomenal mentor. Together, we have authored abstracts, manuscripts and presentations shared at conferences across the country.” – Cruz Riley, Howard University Dermatology Readiness Program Alumna

Fit-for-purpose digital solutions to transform dermatology clinical research

Dermatological conditions are physician-rated, which is time-consuming and limits scalability of data capture in clinical research. Patient engagement, data collection and patient diversity across geographies, socio-economic status, race and ethnicity are critical to clinical trial success. Remote image collection is a potential solution that helps patients engage in the clinical research process wherever they are and empowers researchers to collect powerful information efficiently and at-scale, and to do so in a manner that helps remove biases from the system.

Powered by Computer Vision (Artificial Intelligence [AI]) modeling and built upon fit-for-purpose data sets, researchers at Johnson & Johnson have undertaken an innovative research program in plaque psoriasis and atopic dermatitis where patients send cellphone images of themselves remotely for observation and analysis. The study is designed to generate a comprehensive skin image dataset that will be used to train AI models to assess disease severity across all Fitzpatrick skin tones I-VI comprising light to dark skin.

The study features a digital platform for secure and healthcare compliant engagement with patients, ensuring patient privacy through digital tools like ePRO and eConsent. This study also features a skin-imaging tool embedded within the platform that allows patients to take skin images with real-time quality control and with seamless workflows to ensure a positive patient experience.

The remote imaging assessment design that is central to this study will be used to monitor plaque psoriasis and atopic dermatitis disease severity in order to: 1) enable remote screening of patients for future trials, 2) assess patient response to treatment from the remote collection of data in between visits to trial sites and 3) facilitate patient efficacy assessments during long-term extensions of clinical trials through remote assessments rather than in-person visits. All of this helps reduce the burden on trial participants by allowing them to complete assessments and report outcomes from home, improving compliance and adherence. As such, this remote imaging approach helps increase diversity and inclusivity with patients of various ethnic backgrounds and skin types, representative of a wider geographic area, being recruited and retained, and ultimately enabling more generalizable results. Deployment of such tools in clinical research and adoption of digital solutions by patients add up to changing the trajectory of health for humanity, one step at a time.

“We ALWAYS put the patient’s needs at the center. We are ultimately striving to produce digital solutions that enable inclusion, diversity and equity for dermatology patients who need innovative medicines.” – Gabriela Oana Cula, PhD, Senior Director, J&J Research & Development Data Science and Digital Health, Immunology

Representation matters!

A more diverse dermatology workforce directly leads to improved patient outcomes, particularly for communities that have been historically underserved. By increasing representation among dermatologists, we ensure that care is tailored to the unique needs of patients with diverse skin types and conditions. Programs like the Skin of Color Society DiCR Mentoring Program and the Howard University Dermatology Readiness Program play a critical role in shaping the future of dermatology by providing mentorship, networking and fellowship opportunities for emerging leaders from underrepresented communities. These initiatives not only cultivate talent but also drive innovation in how care is delivered. And by investing in digital solutions like remote image collection, we are breaking down barriers in dermatology clinical research, ensuring it becomes more equitable and inclusive. As we work towards achieving health equity in dermatology, representation isn’t just a matter of fairness, it’s a proven path to better care and outcomes for all.

¹ U.S. Census Bureau. 2020 U.S. population more racially and ethnically diverse than measured in 2010. Available at https://www.census.gov/library/stories/2021/08/2020-united-states-population-more-racially-ethnically-diverse-than-2010.html#:~:text=In%20this%20format%2C%20the%20DI,of%20diversity%20across%20the%20country. Accessed October 2024.

² Akhiyat S, Cardwell L, Sokumbi O. Why dermatology is the second least diverse specialty in medicine: How did we get here? Clin Dermatol. 2020 May-Jun;38(3):310-315. doi: 10.1016/j.clindermatol.2020.02.005. Epub 2020 Feb 19. PMID: 32563342.

³ National Academies of Sciences, Engineering, and Medicine. Eunduring unequal treatment. Strategies to achieve equitable health care and equitable health for all. Washington, DC. The National Academies Press. Available at https://nap.nationalacademies.org/read/27820/chapter/1. Accessed October 2024.

⁴ El-Kashlan N, Alexis A. Disparities in dermatology: a reflection. J Clin Aesthet Dermatol. 2022 Nov;15(11):27-29. PMID: 36381186; PMCID: PMC9651153.

⁵ Narla S, Heath CR, Alexis A, Silverberg JI. Racial disparities in dermatology. Arch Dermatol Res. 2023 Jul;315(5):1215-1223. doi: 10.1007/s00403-022-02507-z. Epub 2022 Dec 12. PMID: 36508020; PMCID: PMC9743121.