AUTOIMMUNE & INFLAMMATORY NMD: EP.11 Racial disparities in skin tone representation of dermatomyositis rashes

Abstract

Health disparities in medicine are due to multifactorial causes, one of which is disproportionate racial representation in educational materials. One example is the lack of diverse skin tones represented in dermatology material. Dermatomyositis (DM) has a prominent dermatologic component, and the underappreciation of rashes due to darker skin tones may hinder diagnosis and treatment. African-American patients with DM frequently have worse outcomes than others. This study assesses skin tone representation in images of dermatomyositis rashes. DM images were analyzed from dermatology, rheumatology, internal medicine, neurology, and neuromuscular textbooks published in the last ten years and online image databases that were available through an online medical library. Authors graded skin tone independently on the Massey and Martin Skin Color Scale (MMSCS) from 1 (very light) to 10 (very dark), which was then averaged for a final score for four groupings: MMCS 1-2, 3-4, 5-7, and 8-10. In cases of large discrepancies (scores were not in adjacent MMCSC groups) or poor skin visibility, the image was excluded. 561 images were analyzed from 93 textbooks (59 dermatology, 11 neurology, 10 neuromuscular, 7 rheumatology, 6 internal medicine) and 3 online databases (UpToDate, VisualDx, DermNet NZ). The majority (73.1%) of images represented skin tones in MMSCS 1-2, followed by 3-4 (13.4%), 5-7 (11.8%), and 8-10 (1.8%). Of the images in MMSCS 5-7 or 8-10, 59.2% were in online databases and 80.6% of textbook images were in dermatology books. Only 5.9% of images from rheumatology and neuromuscular textbooks included images of MMSCS 5-10 classification. Patients with lighter skin tones were represented in a higher number of dermatomyositis related educational materials compared to patients with darker skin tones. Non-dermatology resources lacked varied skin tone representation in dermatomyositis. Our findings add to current research implicating that darker skin tones are underrepresented in dermatology, specifically DM. This leads to the inability to properly characterize skin involvement in DM and may lead to inappropriate exclusion from clinical trials due to erroneous skin scoring.