Race Reporting in Dermabrasion Clinical Trials: A Systematic Review

J Clin Aesthet Dermatol. 2025;18(4):28–32.

by Sana Kamboj, BA, and Travis W. Blalock, MD

Ms. Kamboj is with Emory University School of Medicine in Atlanta, Georgia. Dr. Blalock is with the Department of Dermatology at Emory University School of Medicine in Atlanta, Georgia.

FUNDING: No funding was provided for this article.

DISCLOSURES: The authors declare no conflicts of interest relevant to the content of this article.

ABSTRACT: Objective: The authors sought to determine the frequency and methods of race reporting in dermabrasion clinical trials. Methods: A PubMed search for terms: “dermabrasion,”  “derm-abrasion,” and “derm abrasion” was conducted, yielding 1,786 papers. The “Clinical Trial” and “Randomized Control Trial” filters were applied. Non-English manuscripts were excluded. Remaining manuscripts were manually screened. Forty-one papers met final inclusion criteria. Results: Forty-six percent (n=19) of studies included mention of race, skin color, or Fitzpatrick skin type (FST). Four studies reported FST of 78 dermabrasion participants. Of these, 19 percent had FST I, 27 percent had FST II, 32 percent had FST III, 17 percent had FST IV, and 1 percent had FST V. Three patients (4%) were lost to follow-up and did not have FSTs reported. Twenty-two percent (n=9) of the studies including 513 patients reported race or skin color. The races of 107 (21%) could be definitively extracted. Of these 107 patients, 94 percent were White, five percent were Black, and one percent were Asian. Limitations: Our search was limited to PubMed-indexed articles which were categorized as 1) clinical trials or 2) randomized control trials. Articles that were incorrectly indexed in accordance with the search tool may have been inadvertently excluded. Conclusion: Our analysis suggests that the collection and reporting of racial demographic information has been rare in dermabrasion clinical trials. The absence of this demographic information limits the generalizability of the results. Given the health disparities that arise due to racism, investigators should collect and report participant races to improve risk stratification and transparency.

Keywords: Dermabrasion, skin of color, health disparities, research practices, data collection

Introduction

Skin resurfacing via dermabrasion is a popular intervention for many dermatological concerns, such as rhytides, scarring, and vitiligo. Traditional dermabrasion modalities mechanically disrupt the skin at the dermis in order to promote reepithelialization. These devices commonly include sandpaper, diamond fraises, and rotating wire brushes, which allow penetration as deep as the reticular dermis, making mechanical dermabrasion an effective intervention for many conditions at or above this level. Contraindications for mechanical dermabrasion include active herpes simplex virus infection, isotretinoin usage, and history of Koebnerization.¹ Additionally, patients with Fitzpatrick Skin Types III to VI have a higher risk of dyspigmentation.^1,2 Though not intended as a racial categorization and poorly correlated, Fitzpatrick skin type (FST) has been used as a proxy for race, with lower types approximating fair skin and higher types approximating darker skin.³ 

Dermatology patients of color are often misdiagnosed or fail to receive effective treatments at the same rates as White patients, even when disease severity is greater.⁴ Similarly, racial minorities have been underrepresented in dermatological clinical trials for many pathologies.⁵ However, little research has been done to elucidate the demographics of clinical trials for dermatological procedures, including dermabrasion. Clinical trials that are racially homogenous or do not report race limit the generalizability of the results, particularly for patients who may have a higher risk of adverse effects. Therefore, we conducted a systematic review to determine how often and in what ways race was measured in dermabrasion clinical trials.

Methods

We searched PubMed for studies conducted up until September 4, 2023, for the search terms “dermabrasion,” “derm-abrasion,” and “derm abrasion.” This search returned 1,786 papers. 

Inclusion criteria. Papers were included in our review if they were indexed on PubMed as either clinical trials or randomized control trials. Meta-analyses, reviews, and systematic reviews were excluded. Ninety-six papers met these criteria. Five papers were excluded as English versions of the full texts could not be found. The remaining 91 papers were screened [SK] to determine if dermabrasion was the studied intervention, leading to the exclusion of 50 further papers. Forty-one papers including 1,199 patients who received dermabrasion from 1979 to 2023 met all criteria and were included in the final review. See Figure 1 for the flowchart of study selection.

Results

Of the 41 studies (Table 1), 14 were conducted in the United States, eight in India, five in Brazil, two in Sweden, and one each in Mexico, France, Egypt, Iran, Thailand, Germany, Chile, Denmark, Canada, the Netherlands, Saudi Arabia, and Japan. The most common condition studied was vitiligo, followed by scarring, wound healing, and wrinkles. Acne, bleeding, burns, Hailey-Hailey disease, leukoderma, nevus of Ota, rhytides, herpes simplex virus (HSV), psoriasis, skin grafts, solar lentigo, striae distensae, xeroderma pigmentosum, and tattoo removal were also studied. Across these studies, 1,199 patients received dermabrasion treatments and were included in our analysis.

Fitzpatrick skin type. Only four (10%) surveyed studies involving 78 patients in total reported the FST of each patient who received dermabrasion.^18,23,27,39 Of these participants, 15 (19%) had FST I, 21 (27%) had FST II, 25 (32%) had FST III, 13 (17%) had FST IV, and 1 (1%) had FST V. Three patients (4%) were lost to follow-up and did not have FSTs reported. 78 percent of participants in studies which reported FST had FSTs I to III. 

Nine other papers (22% of total studies) accounted for FST during the study without sharing numerical breakdowns.^{11,14,15,17,19,21,25,38,46} Three of these studies used FST IV or higher as an exclusion criterion, while the other six broadly described FST of participants without providing numbers of participants with each type. Of the 41 studies surveyed in this paper, 32 percent used FST in the study design. 

Measurements of race. Twenty-two percent of the studies (n=9) including 513 patients reported race or skin color (Table 2). Of these, three (7%) studies with 356 participants reported skin color. One study described all participants as being “yellow to brown” and another categorized patients as white, brown, or yellow.^13,26 The third selected for “fair skin” during recruitment.⁴⁴

Three of the nine studies involving 58 patients reported race.^18,23,27 One study did not specify the races of patients in the dermabrasion group.²⁷ 

The three remaining studies involving 99 participants reported demographics using terms, such as “white” and “black” that could have referred to either racial groups or skin tones without specifying.^7,12,22

In these nine studies, the races of 406 out of the 513 (79%) participants were unknown. Of these, 324 were described as having “yellow to brown” skin, 20 as “fair skinned,” and 12 as “[skin color] white.” Of the remaining 107 participants whose races were reported, 94 percent were White, 5 percent were Black, and 1 percent were Asian. These 107 patients whose races were reported represent 9 percent of the 1,199 participants included in our overall study.

Discussion

Dermabrasion is an important technique used to treat a variety of common and debilitating skin conditions. In our review of 41 dermabrasion clinical trials spanning 44 years, only 46 percent of studies included any discussion or consideration of race, skin color, or FST. Furthermore, many of these studies used skin color or FST as an inclusion or exclusion criteria. When this occurred, darker skin and higher FSTs were typically excluded. Out of 1,199 included participants, the races of only 107 (9%) could be definitively extracted. Of these, patients were almost exclusively White (94%). Additionally, 5 percent were Black and 1 percent were Asian. 

Thirteen papers (32%) considered FST in their analysis. However, only four studies reported FST including 78 dermabrasion participants. Of these, 19 percent had FST I, 27 percent had FST II, 32 percent had FST III, 17 percent had FST IV, and 1 percent had FST V. Three patients (4%) were lost to follow-up and did not have FSTs reported. FST is sometimes used as an alternative to race and considered more standardized. However, despite being used as a proxy at times, FST is not intended to be a measurement of or correlated to race.³ Indeed, the original Fitzpatrick scale generally only included types I to IV and additional FSTs V and VI were added in 1988 to encompass many skin tones associated with people of color.⁴⁸ However, it would still be erroneous to associate lighter FSTs with White race and darker types with skin of color. For example, Japanese people are generally considered to be people of color, and Japanese women often self-report their FST as type II.³ Therefore, we gain little understanding of race through measurements of Fitzpatrick skin type. 

Patient demographics may be affected by the locations where studies are performed. The majority of studies were conducted in the United States (n=14) followed by India (n=8) followed by Brazil (n=5). However, these are all countries with great diversity, and ethnicity is not an accurate proxy for race.⁴⁹ 

It is unclear whether the measurements of race in our surveyed studies were based on patient self-identification, investigator assignment, or a different criteria. Additionally, our study included investigations conducted worldwide, and definitions of race can vary between different cultural groups, as race is commonly accepted to be a social rather than biological construct. Terms commonly used to report race can be ambiguous and take on different meanings in different settings.⁴⁹ This ambiguity creates difficulty in establishing a common standard for collecting and reporting information about race in clinical trials, like the ones that we reviewed. Terms that are too general, such as “people of color“, may be too broad for many discussions and color-related descriptions such as, “brown or yellow“ may be offensive. Categories, such as “Other“ or “Unknown“ similarly suggest an aversion to specificity. Even terms that may be considered more specific, such as Asian or African, encompass large groups of extremely diverse people and multiracial people are often forced to identify as a single race.⁵⁰ Self-reported race is often suggested as a better alternative to investigator-reported race, but discrepancies can arise due to shifting conceptions of one’s race over time.⁵¹ 

Our analysis suggests that the collection of racial demographic information has been the exception rather than the norm in dermabrasion clinical trials. When races were reported in our surveyed studies, patient populations were predominantly White, though whether this reflects problems with recruitment or reporting of demographic information is unclear. Some may feel that it is better to exclude patients of color from dermabrasion trials given the higher rates of hyperpigmentation in patients with darker skin.⁵² However, patients of color have been included in some of the surveyed studies, while many other studies did not report race. The absence of this demographic information limits the generalizability of the results.⁴ While patients of color may have a higher risk of side effects from dermabrasion, the lack of generalizability from their exclusion in these studies may lead to barriers for patients of color who would desire and benefit from dermabrasion despite the risks. Despite the risk of dyspigmentation, dermabrasion is effective for many conditions, so excluding patients with darker skin from dermabrasion treatment would eliminate access to an effective treatment. Instead, patients should be counseled about risks of the procedure and be offered additional treatment to reduce dyspigmentation.² 

Additionally, complete demographic information in dermabrasion clinical trials moving forward would allow for improved understanding of complications, such as dyspigmentation. This would allow clinicians to better evaluate the risk of undesired effects and provide more effective, individualized counseling to patients. 

Conclusion

Dermabrasion clinical studies have overall been ineffective in providing essential demographic information pertaining to race. Moving forward, we recommend that dermatology clinical trials include and report race. Furthermore, given the lack of an agreed upon standard for classifications of race, we believe the development of a validated and standardized tool for reporting race in dermatology is of the utmost importance to promote health equity and further understand disease burden and treatment options for different populations. 

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