P176 ‘I didn’t want to be a darker shade of me’: a qualitative study exploring experiences of eczema, acne and psoriasis in people with skin of colour in the UK

Abstract

Inflammatory dermatoses have a varied prevalence and appearance in diverse skin tones. The under-representation of people with skin of colour in medical education and clinical trials is widely acknowledged. However, there has been limited research on experiences from a patient perspective. Our aim was to explore the experiences of eczema, acne and psoriasis in adults with skin of colour in the UK, with a specific focus on their experience of diagnosis and management. Participants with a range of skin tones were recruited via online methods to complete a cross-sectional survey. Based on responses, participants with skin of colour were purposively sampled to take part in an online, one-to-one, semistructured interview. NVivo qualitative data analysis software was used to code and organize the data. Thematic analysis was used to generate themes using a reflexive, iterative approach. Emerging themes were discussed between investigators to reach a consensus regarding final themes. In total, 135 individuals responded to the survey. From 73 eligible individuals, 20 took part in an online interview. Participants were most commonly female (65%, 13) and of Asian or Asian British ethnicity (45%, 9) and had eczema (55%, 11). Ages ranged from 22 to 66 years. We identified eight themes: (i) delayed or missed diagnosis, (ii) preferences regarding healthcare professionals, (iii) lack of online information and social media use, (iv) misunderstanding in cultural communities, (v) concerns about treatment and lack of research in skin of colour, (vi) complementary and alternative medicine use, (vii) experiences and impact of dyspigmentation and (viii) challenges with structural racism. The concepts generated highlight the unique experiences and challenges faced by adults with eczema, acne and psoriasis in the UK. Based on these findings, we highlight actions clinicians can take to recognize and address barriers to effective clinical care for people with skin of colour. Further research is needed in this under-represented group.