Advancing Inclusive Outcome Measures in Dermatology
Despite growing awareness of health disparities, outcome-measure frameworks in dermatology have historically failed to capture the nuanced clinical presentation and lived experience of patients with diverse skin tones. In a recent panel discussion at the 2026 Masterclasses in Dermatology Annual Meeting, Oyetewa Asempa, MD, and Andrew Alexis, MD, MPH, emphasized that without inclusive trial design and culturally responsive terminology, we risk biased severity assessments and inequitable treatment decisions. Traditional endpoints, particularly those heavily reliant on erythema, may underestimate disease activity in darker skin tones, where inflammation can appear violaceous, gray, or hyperpigmented rather than bright red.
The panel underscored that true inclusivity begins with how we define and describe patient populations. Race and ethnicity alone are insufficient proxies for skin tone. Objective measures such as the MONK Skin Tone Scale and multidimensional tools that assess pigmentation, dyspigmentation, and phototype provide a more precise framework. For example, Fitzpatrick phototype captures ultraviolet response, whereas pigmentary indices assess baseline melanin and post-inflammatory change. Using multiple instruments in combination offers a more complete clinical picture than any single scale alone.
Dyspigmentation was highlighted as a critical yet historically underrepresented endpoint. In conditions such as acne, atopic dermatitis, and psoriasis, pigmentary alteration may represent the most distressing and persistent manifestation for patients of color, even after inflammation resolves. Validated tools such as the Post-Acne Hyperpigmentation Index and emerging dyspigmentation-specific assessments in atopic dermatitis reflect meaningful progress toward capturing outcomes that matter most to patients.
Language and cultural context also influence measurement accuracy. Terms such as “xerosis” vs “ashiness” may reflect different clinical and patient-centered realities, and subtle linguistic choices can affect how symptoms are documented across populations. The panel emphasized that refining terminology and incorporating qualitative patient feedback into instrument development are essential steps toward equity.
Central to this evolution is direct patient engagement. Incorporating structured conversations and asking what outcomes are most meaningful to the individual patient ensures that measurement tools align with lived experience rather than solely clinician-defined benchmarks. As consensus-driven, inclusive methodologies gain traction in atopic dermatitis, psoriasis, acne, and alopecia research, dermatology appears to be at a turning point. Continued commitment to inclusive trial design, pigmentary endpoints, and culturally aware assessment strategies will be essential to ensuring that dermatologic innovation serves all skin types equitably.
Reference:
Asempa O, Alexis A. Involving ethnic skin in patient outcome measure development and other underrepresented populations. Presented at: Masterclasses in Dermatology; February 19–22, 2026; Sarasota, FL.
