Pediatric Dermatologic Conditions and Fitzpatrick Skin Tone: Assessment of Diagnostic Accuracy and Associated Familiarity with Dark Skin

Abstract

Research Question: How often do physicians correctly diagnosis pediatric skin conditions between different Fitzpatrick skin types? Further, which skin type(s) have the most correct rate of diagnosis and how is accuracy of dermatological diagnosis in people of color impacted by physicians¿ skin type?

Background and Significance: Healthcare disparities in the United States are well documented. These disparities disproportionately affect people of color leading to poorer health outcomes across the care spectrum. Dermatology is no exception and has documented delays in care and increased mortality in people of color. Researchers have speculated that lack of familiarity with dermatological conditions in people of color is the primary explanation for this specific issue, as dermatology textbooks often unequally depict fair skin. As the United States becomes more racially diverse, these healthcare disparities, will affect an even greater number of individuals. One previous study has investigated this same issue but quizzed medical students instead of physicians on adult rash presentation. They also did not compare the accuracy of the quiz to the physicians¿ own skin color.

Materials and Methods: With the help and direction of Dr. Sloan, my SPT mentor, we developed a survey. This survey quizzes providers on 5 pediatric skin conditions i.e., Giannotti Crosti, Erythema infectiosum, Pityriasis rosea, Scarlatina, and Mollescum contagiosum. Conditions, ranging from benign to urgent, common to rare, that mostly only affect children or adolescents. The survey features different clinical images and associated questions depicting rash presentations in different Fitzpatrick skin types. Ten questions depicting light skin and ten questions depicting darker skin tones. This was sent to pediatricians and urgent care providers across Texas. After completing the survey, Doctors assess their own skin type, as well as provide background information about their familiarity with skin of color.

Results: Of the 57 physicians surveyed, 47 completed the survey. Contrary to our assumptions and previous studies, our results indicated only one condition with significant difference in diagnostic accuracy, that being pityriasis rosea in the Fitzpatrick skin group 4-6. Additionally, we intended to compare accuracy with provider¿s skin color, or attendance of an HBCU, but the sample size was too small for proper statistical power.

Conclusion: Our study results found that for diagnostic accuracy only pityriasis rosea demonstrated a significant difference between physicians. The small study sample is perhaps a potential reason for lack of other identifiable differences and it also precluded the investigation of various physician factors concerning familiarity with skin of color that may have an important considerations for working with patients of various skin tones.