Evaluating skin colour diversity in the validation of scar assessment tools

Garg, S. P., Williams, T., Taritsa, I. C., Wan, R., Goel, C., Harris, R., Huffman, K., & Galiano, R. D. (2023). Evaluating skin colour diversity in the validation of scar assessment tools. Wound Repair and Regeneration, 31(6), 731–737. https://doi.org/10.1111/wrr.13120

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Background:

Everyone gets scars after an injury, but they look and feel different for everyone. People with dark skin are more likely to get thick, itchy scars called keloids. Doctors use "scar scales" to measure how well these scars are healing. However, most of these scales were originally tested only on people with light skin. This is a problem because dark skin has more active cells that create thicker scars.

Methods: How the Research Was Done

Researchers searched through medical databases from 1981 to 2022. They looked for "validation studies," which are tests that prove a scar scale actually works. Out of 1,253 papers, they found 15 specific scar scales to analyze. They checked each one to see if the scientists included people of different races and skin types.

Results: The Diversity Gap

The systematic review found that 11 out of 15 scar scale validation studies failed to include or report on patients with dark skin tones. Nine of these studies did not mention race, ethnicity, or skin type at all. Only four specific scales—the modified VSS, modified POSAS, acne QOL, and SCAR-Q—included non-White or dark-skinned patients in their testing. Even in these inclusive studies, the representation of individuals with the darkest skin types (Fitzpatrick V and VI) was very low, ranging from only 4.5% to 17%.

A majority of studies did not mention the race or skin type of the people they were tested on.

Only 4 scales included patients with dark skin. For example, in the SCAR-Q scale, only 4.5% of the participants had the darkest skin types.

Conclusion and Future Directions