Original Article

Reasons for Visits to the Dermatologist Stratified by Race

Authors: Gabrielle M. Peck, BA, Forrest A. Roberson, BS, Steve R. Feldman, MD, PhD

Abstract

Objectives: The aim of this study was to examine, from the patient’s perspective, the most common reasons for seeking medical attention for skin disease and how this varies among different races.

Methods: We conducted a cross-sectional analysis on the National Ambulatory Medical Care Survey between 2007 and 2018, the most recent years available. The frequency of each reason for visits was determined using the survey procedures of SAS version 9.4.

Results: Among White patients, skin cancer screening (8.2%) was the most common reason for visits followed by skin lesions (7.8%) and discoloration/abnormal pigmentation (7.4%). Among Blacks/African Americans, acne (9.2%), progress visit (8.2%), and skin rash (7.0%) were the top reasons for visits. Acne (12%), skin rash (7.5%), and discoloration/abnormal pigmentation (7.3%) were the most common reasons for patient visits in the “other” race category.

Conclusions: Reasons for visits to the dermatologist vary with race. White patients appear to be aware of their increased risk of skin cancer, visiting frequently for skin cancer screenings and skin lesions, whereas Blacks/African Americans are more affected by conditions associated with chronic pruritus. To train dermatologists and nondermatologists to provide equitable care for cutaneous conditions to all races and skin types, especially for those groups experiencing barriers to receiving dermatologic care, it is important that we characterize the reasons why patients visit the dermatologist.
Posted in: Dermatology10

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References

1. Kundu RV, Patterson S. Dermatologic conditions in skin of color: part I. Special considerations for common skin disorders. Am Fam Physician 2013; 87:850–856.
 
2. Brenner M, Hearing VJ. The protective role of melanin against UV damage in human skin. Photochem Photobiol 2008;84:539.
 
3. Conway J, Gonzalez T, Wu SZ, et al. Persistent health inequities in self-payment for outpatient dermatology visits. J Am Acad Dermatol 2022;87:230–232.
 
4. Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol 2010;3:20.
 
5. Valentin VL, Sanderson W, Westneat S, et al. Late-stage melanoma: be sure to screen uninsured, unmarried men. South Med J 2018;111:649–653.
 
6. Sohn H. Racial and ethnic disparities in health insurance coverage: dynamics of gaining and losing coverage over the life-course. Popul Res Policy Rev 2017;36:181.
 
7. Sturgeon A, Pate DA, Patel R, et al. Incidence of non-melanoma skin cancer in the uninsured. J Health Care Poor Underserved 2017;28:1327–1332.
 
8. Hashim MJ. Patient-centered communication: basic skills. Am Fam Physician 2017;95:29–34.
 
9. Marinella MA. Residents and medical students noting the chief complaint during verbal presentations. Acad Med 2000;75:289.
 
10. Davis SA, Narahari S, Feldman SR, et al. Top dermatologic conditions in patients of color: an analysis of nationally representative data. J Drugs Dermatol 2012;11:466–473.
 
11. Landis ET, Davis SA, Taheri A, et al. Top dermatologic diagnoses by age. Dermatol Online J 2014;20:22368.
 
12. Cooper RS, Kaufman JS, Ward R. Race and genomics. N Engl J Med 2003; 348:1166–1170.
 
13. Ahn CS, Allen MM, Davis SA, et al. The National Ambulatory Medical Care Survey: a resource for understanding the outpatient dermatology treatment. J Dermatol Treat 2014;25:453–458.
 
14. Arafa AE, Anzengruber F, Mostafa AM, et al. Perspectives of online surveys in dermatology. J Eur Acad Dermatol Venereol 2019;33:511–520.
 
15. National Center for Health Statistics, Centers for Disease Control and Prevention. Ambulatory health care data: estimation procedures. https://www.cdc.gov/nchs/ahcd/ahcd_estimation_procedures.htm. Accessed January 13, 2022.
 
16. Gloster HM, Neal K. Skin cancer in skin of color. J Am Acad Dermatol 2006; 55:741–760.
 
17. Buchanan Lunsford N, Berktold J, Holman DM, et al. Skin cancer knowledge, awareness, beliefs and preventive behaviors among black and hispanic men and women. Prev Med Rep 2018;12:203–209. .
 
18. Buster KJ, You Z, Fouad M, et al. Skin cancer risk perceptions: a comparison across ethnicity, age, education, gender, and income. J Am Acad Dermatol 2012;66:771.
 
19. Ingrasci G, El-Kashlan N, Alexis A, et al. Chronic itch in African Americans: an unmet need. Arch Dermatol Res 2022;314:405–415.
 
20. Tey HL, Yosipovitch G. Itch in ethnic populations. Acta Derm Venereol 2010;90:227–234.
 
21. McColl M, Boozalis E, Aguh C, et al. Pruritus in Black skin: unique molecular characteristics and clinical features. J Natl Med Assoc 2021;113:30–38.
 
22. Silverberg JI, Hinami K, Trick WE, et al. Itch in the general internal medicine setting: a cross-sectional study of prevalence and quality-of-life effects. Am J Clin Dermatol 2016;17:681–690.
 
23. Sanders KM, Akiyama T. The vicious cycle of itch and anxiety. Neurosci Biobehav Rev 2018;87:17–26.
 
24. Cevikbas F, Lerner EA. Physiology and pathophysiology of itch. Physiol Rev 2020;100:945–982.
 
25. Shaw FM, Luk KMH, Chen KH, et al. Racial disparities in the impact of chronic pruritus: a cross-sectional study on quality of life and resource utilization in United States veterans. J Am Acad Dermatol 2017;77:63–69.
 
26. Wagner MM, Hogan WR, Chapman WW, et al. Chief complaints and ICD codes. Handb Biosurveillance 2006:333–359.
 
27. Imadojemu S, James WD. Increasing African American representation in dermatology. JAMA Dermatol 2016;152:15–16.
 
28. McMichael AJ, Jackson S. Issues in dermatologic health care delivery in minority populations. Dermatol Clin 2000;18:229–233.
 
29. Perlman KL, Williams NM, Egbeto IA, et al. Skin of color lacks representation in medical student resources: a cross-sectional study. Int J Womens Dermatol 2021;7:195.
 
30. Hansra NK, O’Sullivan P, Chen CL, et al. Medical school dermatology curriculum: are we adequately preparing primary care physicians? J Am Acad Dermatol 2009;61:23–29.e1.