Evaluating Skin Color Diversity in the Validation of Scar Assessment Tools.

Across scar studies, there is a lack of dark-skinned individuals, who have a predisposition for keloid formation, altered pigmentation, and poorer quality-of-life. There is a need for patients-of-color to be included in scar scale development and validation. In this study, we evaluate the racial diversity of patients included in the validation of scar assessment scales. A systematic review was conducted for articles reporting on the validation of a scar assessment tool. Racial, ethnic, and Fitzpatrick skin type(FST) data was extracted. Fifteen scar scale validation studies were included. Nine of the studies did not mention FST, race, or ethnicity of the patients. Two of the studies that reported FST or race information only included White patients or included no FST V/VI patients: MAPS and UNC4P. Only four studies included non-white patients or dark-skinned patients in the validation of their scar scale: the modified Vancouver Scar Scale, Modified POSAS, Acne QOL, and SCAR-Q scales. The patients included in the modified VSS validation were 7 and 13% FST V/VI, 14% African in the modified POSAS, and 4.5% FST V/VI in the SCAR-Q. We highlight the severe lack of diversity in scar scale validation, with only 4 out of 15 studies including dark-skinned patients. Given the susceptibility of darker-skinned individuals to have poorer scarring outcomes, it is critical to include patients-of-color in the very assessment tools that determine their scar prognosis. Inclusion of patients-of-color in scar scale development will improve scar assessment and clinical decision-making. This article is protected by copyright. All rights reserved.