Raj Chovatiya, MD, PhD: Broadening Clinical Research and Education for Skin of Color

Last week, HCPLive had the privilege of hosting several conversations regarding skin of color, from clinical manifestations of skin diseases on darker skin types to limitations in health care access informed by institutional racism and other inequities.

Late last year, Raj Chovatiya, MD, PhD, Assistant Professor at the Department of Dermatology, Northwestern University Feinberg School of Medicine helped lead the conversation on racial disparities in dermatology care, as part of our This Year in Medicine series.

Naturally, the conversation regarding this subject remains open-ended, and Chovatiya returned to speak to HCPLive of current trends and limitations in the study of skin of color.

“This is a topic that we weren't talking about as much (before), but was probably always in the back of our mind until the last few years when people really started taking a deeper dive into some of these topics and realizing ‘you know, the way that we actually teach, talk, (and) learn about, let’s not say dermatology but the medicine in general, is actually quite skewed,” Chovatiya said.

He went on to attribute this skewed vision of dermatology care, partially, to the relatively homogenous nature of clinical images. Despite being the “treasure trove” in which residents and physicians are taught with, these images have often been limited to White, often Northern European populations.

For the rest of the skin type spectrum, physical manifestations, treatments, and outcomes can all vary depending on a patient’s skin color. Fortunately, there has been an increase in studies related at skin of color, in addition to how manifestations of skin diseases can change across skin types and what treatments work best for darker skin types.

Of course, these changes rely on the diversification of clinical studies.

“Randomized clinical trials are the gold standard for us to really understand both safety and efficacy when it comes to the newest and latest treatments,” Chovatiya said. “Even treatments that we've been using for years and years, many of them don't even have sort of strong data across different skin types, let alone the new ones. For the studies, and I applaud them, that have been done for some of the newer therapies out there and they've tried to sort of do these post hoc analyses or actually work on trying to increase the diversity of the population, many of them have suggested that there is really good efficacy across different types. But this is really a small number, and the only way that we're really going to know is by actually making a targeted effort to increase that diversity.”

Progress in this area has been gradual, with a myriad of challenges associated the diversification of studies including managing skin types with richer pigmentation, difficulty gaining follow-ups in skin of color populations due to limited health care access, common recruitment issues, and historical relationships related to the mistrust of the medical system.

“I think that we just need to break down whatever barriers exist and get everyone to start talking (and) make sure using the common language so we know what we're all talking about,” Chovatiya said. “Oftentimes, different groups, different individuals have different preferences when it comes to their skincare; different ways that they describe what they're looking at, different ways they think about even treating, and I think that we really need to make sure that those aspects of the patient preference are out in the open because many providers may not be familiar with it.”

In addition to changes in how patients and dermatologists interact with one another, a degree of responsibility should also be placed on media sources including clinical publications and other educational material and resources.

“This is where a lot of the job of publications and media sources, communication and education material really comes in, in terms of how we can bridge that gap to make sure that our patients no matter what their diverse background is are talking the same language as our providers, no matter what their diverse background is, as well as making for a much better shared decision making process between providers and patients,” Chovatiya said.

To hear more from Dr. Chovatiya on establishing a more inclusive environment in dermatology care, watch the full video above.