By Mike Gladstone, global president of Inflammation & Immunology, Pfizer
Skin disease can have profound impact on people’s physical and psychological well-being1. Imagine feeling all-too-often stares, discomfort or pain, and even judgment from others2 because of a condition you may have had since you were a child. Millions around the world living with atopic dermatitis (AD)3 face this reality.
People of color living with AD and other skin conditions face a disproportionate toll because of increased prevalence and distinct needs related to treatment and support.4 In the United States, for example, atopic dermatitis (AD), the most common chronic inflammatory skin disease5 with the highest overall disease burden among skin conditions6, is more common among Black children (19.3%) compared to White (16.1%) and Latino children (7.8%)7.
Despite the impact of skin conditions like AD and others on people of color, they are under-diagnosed8 and under-represented in medical dermatology9 and clinical research10. One U.S. analysis found that about 60% of patients of color who had AD symptoms reported being diagnosed, compared to nearly 67% of non-Latino Whites11.
At Pfizer, we believe in equity: the idea that every person deserves to be seen, heard and cared for. From our perspective, there are efforts making inroads to support the unique needs of all people with inflammatory skin conditions:
In the U.S., 3% of all dermatologists are Black and 4.2% Latino, despite Black and Latino Americans making up nearly 13% and 16% of the population, respectively12. Patient advocacy groups and professional medical organizations have already made progress toward improving this disparity in representation by encouraging greater diversity among practicing dermatologists and striving for more equitable community engagement and care for people of all races and ethnicities.
For example, the American Academy of Dermatology (AAD) released a three-year diversity initiative focused on improving inclusion in AAD leadership, expanding representation of darker skin in texts, amplifying the concerns of patients of color, and recruiting underrepresented minority dermatologists13.
The Skin of Color Society, meanwhile, is working with the New England Journal of Medicine Group and AAD on Project IMPACT, which raises awareness and adoption of educational and clinical resources to improve clinicians’ expertise in diagnosing skin disease in people with skin of color14. But we know that this work is just a start and more needs to be done to achieve real progress, and Pfizer is committed to supporting the dermatology community’s ongoing work to address the inequities people of color face in healthcare.
Designing clinical trials that represent people from diverse geographies, racial and ethnic backgrounds can help ensure treatments work for all patients who need them. Designing clinical trials so that enrollment reflects the racial and ethnic diversity of the epidemiology of diseases we intend to treat or prevent is especially important in dermatology because of how certain conditions present differently in patients of color. But there is work to be done.
Earlier this year, we published diversity data15 from our clinical trials going back 10 years, which offered a baseline for improvement and served as a catalyst for us to build an epidemiology library to guide future decisions on how to recruit more diverse patient populations for clinical trials — including those related to treating skin conditions.
We know we, as an industry, must work towards additional actions that can help expand clinical trial access, and technology can help. Virtual clinical trials can support expanded patient access as they allow participation without barriers such as geography, mobility concerns, or schedules. Incorporating technologies into trials that allow for remote monitoring of participating patients, meanwhile, also could provide a more realistic picture of the potential treatment’s efficacy and impact on a more diverse group of patients.
We are encouraged to see the industry embracing technologies that could improve clinical research going forward. Across Pfizer, we’ve made a commitment to work towards a goal of designing clinical trials so that enrollment can reflect both the racial and ethnic diversity of the countries where we conduct studies and the epidemiology of the diseases we intend to treat or prevent. We hope virtual studies will support this commitment by allowing us to reach patients who would otherwise face barriers in participation.
We must confront the fact that while skin diseases occur in all racial and ethnic groups, these diseases may disproportionately affect people of color, and work to ensure equitable access to empower patient choice. On top of navigating treatment options and the impact the disease has on their quality of life, many patients of color face outsized barriers to affordable, effective care16.
Increasing access to biosimilars is one important way of expanding equitable access to treatments. Biosimilars can drive market competition that can lower the cost of care. Improving patient access to biosimilars may help create long-term cost savings and efficiencies for health systems and free up resources for other important aspects of care.
When it comes to helping all people living with skin conditions, these three actions are just starting points; we have more to do as an industry. That is why, at Pfizer, we continue to work alongside global research communities, advocacy and educational organizations, and patients to advance healthcare equity for patients with skin of color. Through these initiatives, we hope to continue to bring awareness and improve upon the care of all patients with dermatological conditions.
Learn more here.
About the Author
1 Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134:1527-1534.
2 Mayo Clinic. 2021. Atopic dermatitis (eczema) – Symptoms and causes. [online] Available at: <https://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/syc-20353273#:~:text=person%20and%20include%3A-,Dry%20skin,and%20crust%20over%20when%20scratched>.
3 Silverberg, Public Health Burden and Epidemiology of Atopic Dermatitis, Dermatol Clin 35 (2017) 283–289.; PFE projections for peak.
4 Alexis AF, Sergay AB, et al. Common dermatologic disorders in skin of color: a comparative practice survey. Cutis. 2007;80:387-394.
5 Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups-Variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27:340-357.
6 Hay RJ, Johns NE, Williams HC, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134:1527-1534.
7 Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups-Variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27:340-357.
8 Pfizer data on file. 2019 United States National Health and Wellness Survey (US NHWS). Kantar Health, New York, NY.
9 Chen A, Shinkai K. Rethinking how we select dermatology applicants—turning the tide. JAMA Dermatol. 2017;153(3):259-260.
10 Price KN, Krase JM, Loh TY, et al. Racial and ethnic disparities in global atopic dermatitis clinical trials. Br J Dermatol. 2020;183(2):378-380.
11 Pfizer data on file. 2019 United States National Health and Wellness Survey (US NHWS). Kantar Health, New York, NY.
12 Chen A, Shinkai K. Rethinking how we select dermatology applicants—turning the tide. JAMA Dermatol. 2017;153(3):259-260.
13 Chen A, Shinkai K. Rethinking how we select dermatology applicants—turning the tide. JAMA Dermatol. 2017;153(3):259-260.
14 Skin of Color Society. Reducing Healthcare Disparities, Bridging Gaps of Knowledge and Improving Outcomes for Patients of Color through Project IMPACT. Available at: https://skinofcolorsociety.org/reducing-healthcare-disparities-bridging-gaps-knowledge-improving-outcomes-patients-color-project-impact/. Accessed on June 10, 2021.
15 Rottas, Melinda et al. Demographic diversity of participants in Pfizer sponsored clinical trials in the United States. Contemporary Clinical Trials. 2021;106: 106-421.
16 Bell MA, Whang KA, Thomas J, Aguh C, Kwatra SG. Racial and Ethnic Disparities in Access to Emerging and Frontline Therapies in Common Dermatological Conditions: A Cross-Sectional Study. J Natl Med Assoc. 2020 Dec;112(6):650-653. doi: 10.1016/j.jnma.2020.06.009. Epub 2020 Jul 5. PMID: 32641259.