724 Patient race affects dermatologists’ assessments and treatment of psoriasis

      Racial disparities in psoriasis treatment have been suggested. Little is known about how physicians’ assessments and treatment patterns may contribute to these disparities. We aimed to evaluate whether patient race, gender, or socioeconomic status affect dermatologists’ assessment and treatment of psoriasis. We conducted a cross-sectional survey study of a random sample of dermatologists (N=3,352) who are members of the American Academy of Dermatology. Each dermatologist was randomly assigned one of eight identical survey options which differed only by either patient race (white vs black), gender (male vs female), or socio-economic status (high vs low). Each vignette described and visually depicted a 50-year old with severe psoriasis followed by questions assessing the dermatologist’s confidence in the diagnosis of psoriasis and their first line treatment recommendation. We performed multivariable logistic regression to evaluate the associations among patient characteristics and the dermatologist’s confidence in psoriasis diagnosis and treatment recommendation. In total, 668 dermatologists returned the survey yielding a response rate of 19.9%. Most dermatologists were between the ages of 35 and 54 years (54%), white (74%), and practiced in a single specialty private setting (49%). Dermatologists were less likely to be confident in the diagnosis of psoriasis among black patients compared to white patients (odds ratio [OR] 0.15, 95% confidence Interval [CI] 0.08-0.29). Lack of confidence in the diagnosis of psoriasis was also associated with a lower likelihood of recommending appropriate treatment for severe psoriasis with phototherapy, oral systemics or biologics (OR 0.35, 95% CI 0.17-0.71), independent of disease severity assessment and other patient and dermatologist characteristics. Our findings identify differences in the confidence of psoriasis diagnosis among dermatologists by patient race, which likely drive treatment recommendations whereby black patients are more likely to be underdiagnosed and undertreated for their psoriasis.