The Importance of Cultural, Social, and Clinical Diversity in Treating Plaque Psoriasis

As the patient population diversifies, dermatologists and clinicians need to be able to treat patients with skin of color with psoriasis who may require different treatment regimens to fit their lifestyle, says Mona Shahriari, MD, assistant clinical professor of dermatology at Yale University and associate director of clinical trials at Central Connecticut Dermatology.

Transcript

Are there any specific cultural or social factors that impact the management of plaque psoriasis in people of color?

As clinicians, having that cultural awareness and sensitivity when we're interacting with our patient is really important. Because we might have the right treatment for them, but if you don't understand where they're coming from, if you're not offering them treatment options that are going to work for them and their unique self, that trust that needs to be built is going to be broken. And a lot of our patients from different backgrounds with different skin tones, they come from cultures where maybe paternalistic medicine is the norm, so they're going to expect you to tell them what to do. Other people are used to their racial and ethnic background having been used experimentally, not with consented clinical trials, but just different drugs were experimented on them. So they may think, "Hey, you're offering me this systemic medication, maybe you're just trying to experiment on me, maybe it's not safe." So the trust factor, I do think, is a big part of that visit that they need to keep in mind, because if you can't gain the trust of the patient, they're less likely to comply with the regimen.

One key thing I always bring up in terms of just understanding the patient in front of you is a lot of my colleagues, when they're treating women with scalp psoriasis, they give them a regimen that requires daily hair washing. If you have tight, coiled hair, you cannot be washing your hair every day; you cannot be using formulations that dry out the scalp. So, just having that little bit of sensitivity when you're talking to the patient, and not offering them a regimen that doesn't work for their lifestyle, allows them to understand that you actually get where they're coming from.

How can dermatologists tailor treatment plans to address these factors?

One thing from a clinical trial standpoint they can do is to really make an effort to enroll those patients who come from diverse skin tones, because as a clinical trialist it is challenging, the psychosocial issues that some of our patients with skin of color face. But the reality is, in order for us to be able to broadly apply some of the results of a clinical trial to our general population, you do need better representation of these patients, because the society we're living in is diversifying every single day. And a lot of clinicians that I speak to are like, “Well, I have a primarily White population, so why does this even matter to me? Why do I need to care?” The reality is, in the next 20 years, that population is going to become much more diverse, and you are going to have a majority of people who really need you to understand what their unique needs are. But I think we just need a much more understanding society.

And maybe as clinicians, we need more time to spend with our patients. Because sometimes, in a busy day, when you're bouncing between room to room, you don't really get a chance to take the extra 5 minutes and ask a patient what their unique goals are. So, a lot of times actually, when I'm doing my discussions about treatments with patients, I tell them, “Okay, these are the options. What do you think? Is this in line with your treatment goals?” And that kind of gives them the opportunity to jump in and share any reservations they have [or] any questions they may have. Like that particular patient with the hair. If I tell her that I'm going to give you a regimen that's going to be every single day hair washing, and I'm like, “What do you think about that?” I can see her turn around and say, “Well, you know what, I wash my hair once a week. I don't know if this is going to work for me.” If I write the prescription and walk out of the room, she never has the opportunity to share those goals with me. So, I think with time, our society will definitely improve. But as clinicians, this needs to be some that's important to us because it's important to our patients.