Skin of color representation in cosmetic dermatology literature, 2018-2023

Growing racial diversity raises concerns about equitable dermatology care. Only 4.5% of US medical textbooks include diverse skin types, and dermatologic literature lacks focus on Skin of Color (SOC). This study examines SOC cosmetic research in five dermatology journals. Articles from Lasers in Surgery and Medicine, Journal of Cosmetic Dermatology, Cosmetics, Lasers in Medical Science, and Clinical, Cosmetic, and Investigational Dermatology (September 2018 - September 2023) were screened for cosmetic interventions on SOC, defined as studies with > 50% non-Caucasian patients. Studies without defined race or Fitzpatrick skin type (FST) were excluded. Article type, race, ethnicity, research country, and FST were recorded. Of 5,175 screened articles, 561 (10.84%) met inclusion criteria, and 214 (4.14%) provided FST data. FST 3 (40.74%) and 4 (40.53%) were most represented. East Asian (57.75%) and Middle Eastern-North African (24.06%) ethnicities were most represented, with most research from East Asia (56.15%). SOC articles often lacked specific FST details, focusing on hair issues and came mostly from predominantly Caucasian countries. There is significant underrepresentation of SOC in cosmetic dermatology research, with bias toward FSTs 3, 4 and East Asian populations. This highlights the need for standardized ethnicity reporting and inclusive research to ensure equitable dermatologic care.