in medicine.2 Previous literature has demonstrated that 71% of black patients prefer to see a black (or race-concordant) dermatologist, and that black men are more likely to consent to influenza vaccinations and cardiovascular disease screenings from physicians who are black than from physicians who are white.3,4 Our findings further emphasize the need for increasing racial diversity within the dermatology workforce and even more importantly, ensuring all trainees receive adequate training, both of which will potentially increase utilization of dermatologists for scarring alopecias. Additionally, educational campaigns highlighting the importance of early dermatologic interventions in cicatricial alopecias—targeting the affected patient populations and referring physicians—may prompt patients to obtain treatment earlier in the disease course.5 It is also unclear if the perception of scalp and hair symptoms differs between racial or ethnic groups, or if the lack of familiarity with ethnic hair amongst dermatologists, are contributing to the study results.
This study is limited by several factors. Firstly, the lack of histopathologic confirmation of the cicatricial alopecia diagnoses, as we uncommonly perform scalp biopsies for these conditions because of the largely overlapping treatment modalities. Supporting the scarring nature of the alopecias, there were only minimal improvements in SALT II scores at study completion. A more important limitation is that this study was a retrospective chart review and unfortunately investigators were not able to ask patients to categorize themselves or identify their race. The designations used were the perceptions of the investigators and therefore are inherently biased. Race is truly subjective and it is no longer acceptable to place our implicit biases on others by categorizing them as how we perceive them. Future studies are necessary to assess if there are racial differences in the perception of hair loss and to better identify barriers to obtaining dermatology specialist care for cicatricial alopecias.
This study is limited by several factors. Firstly, the lack of histopathologic confirmation of the cicatricial alopecia diagnoses, as we uncommonly perform scalp biopsies for these conditions because of the largely overlapping treatment modalities. Supporting the scarring nature of the alopecias, there were only minimal improvements in SALT II scores at study completion. A more important limitation is that this study was a retrospective chart review and unfortunately investigators were not able to ask patients to categorize themselves or identify their race. The designations used were the perceptions of the investigators and therefore are inherently biased. Race is truly subjective and it is no longer acceptable to place our implicit biases on others by categorizing them as how we perceive them. Future studies are necessary to assess if there are racial differences in the perception of hair loss and to better identify barriers to obtaining dermatology specialist care for cicatricial alopecias.
REFERENCES
1. Fleischer AB, Feldman SR, Bradham DD. Office-based physician services provided by dermatologists in the United States in 1990. J Invest Dermatol. 1994;102(1):93-7.
2. Pandya AG, Alexis AF, Berger TG, Wintroub BU. Increasing racial and ethnic diversity in dermatology: A call to action. J Am Acad Dermatol. 2016;74(3):584- 7. DOI: 10.1016/j.jaad.2015.10.044.
3. Gorbatenko-roth K, Prose N, Kundu RV, Patterson S. Assessment of black patients' perception of their dermatology care [published online ahead of print August 21, 2019]. JAMA Dermatol. 2019. DOI:10.1001/ jamadermatol.2019.2063
4. Alsan M, Garrick O, Graziani GC. Does diversity matter for health? Experimental evidence from Oakland. The National Bureau of Economic Research. 2018; June. https://www.nber.org/papers/w24787. Accessed December 19, 2018.
5. Kim BK, Lee S, Jun M, Chung HC, Oh SS, Lee WS. Perception of hair loss and education increases the treatment willingness in patients with androgenetic alopecica: A population-based study. Ann Dermatol. 2018;30(4):402-408. DOI: 10.5021/ad.2018.30.4.402.
2. Pandya AG, Alexis AF, Berger TG, Wintroub BU. Increasing racial and ethnic diversity in dermatology: A call to action. J Am Acad Dermatol. 2016;74(3):584- 7. DOI: 10.1016/j.jaad.2015.10.044.
3. Gorbatenko-roth K, Prose N, Kundu RV, Patterson S. Assessment of black patients' perception of their dermatology care [published online ahead of print August 21, 2019]. JAMA Dermatol. 2019. DOI:10.1001/ jamadermatol.2019.2063
4. Alsan M, Garrick O, Graziani GC. Does diversity matter for health? Experimental evidence from Oakland. The National Bureau of Economic Research. 2018; June. https://www.nber.org/papers/w24787. Accessed December 19, 2018.
5. Kim BK, Lee S, Jun M, Chung HC, Oh SS, Lee WS. Perception of hair loss and education increases the treatment willingness in patients with androgenetic alopecica: A population-based study. Ann Dermatol. 2018;30(4):402-408. DOI: 10.5021/ad.2018.30.4.402.
AUTHOR CORRESPONDENCE
Adam J. Friedman MD ajfriedman@mfa.gwu.edu
