Race in dermatology clinical guidelines: A systematic review of impacts on health equity

Introduction: Clinical practice guidelines (CPGs) synthesize evidence to guide dermatologic care and improve outcomes. However, the use of race in CPGs has the potential to perpetuate or mitigate health inequities. Race is a sociopolitical construct rather than a biological determinant of health, and its misuse in clinical recommendations may reinforce structural inequities. This study systematically reviews the use of race in dermatology CPGs to assess its impact on health care equity and identify opportunities for improvement.

Methods: This study included dermatology CPGs published between January 1, 2019, and April 30, 2024, providing guidelines for patients aged 18 years or older in the United States. CPGs not published in English, irrelevant to dermatology, or aimed at populations outside the United States were excluded. A comprehensive search was conducted, and identified CPGs were organized into Rayyan or a Google Sheet. Duplicate records were removed. Two authors independently screened all CPGs for eligibility in a masked, duplicate manner. Discrepancies were resolved through discussion, with a third-party reviewer mediating unresolved disagreements.

Results (Expected): Preliminary analysis anticipates dermatology CPGs utilizing race in their recommendations or background. It is expected that a proportion of these will use race in a manner that could negatively affect health care equity, such as conflating race with biological risk factors or perpetuating stereotypes. Conversely, a proportion is expected to use race positively by addressing health disparities or promoting inclusivity. Final results will be compiled, analyzed and finalized by January 20, 2025, in preparation for the symposium.

Conclusions: This study anticipates highlighting critical opportunities for improving the use of race in dermatology CPGs to enhance health equity. The findings are expected to inform recommendations for national medical organizations to develop guidelines that address systemic inequities and promote equitable dermatologic care. A finalized conclusion will be presented at the symposium upon completion of the analysis.