Skin of Color Representation in Biologic Advertisements for Psoriasis and Psoriatic Arthritis

Skin of color (SoC) patients with psoriasis experience more severe disease, lower quality of life, and increased psoriasis-related hospitalizations compared to non-SoC counterparts (1-2). SoC patients with psoriasis demonstrate decreased familiarity with biologic medications (3-4) , which could lead to undertreatment and greater disease burden. In light of previous findings indicating inadequate SoC representation in dermatologic direct-to-consumer (DTC) advertising, we compared skin tone representation in patient-facing materials for 13 biologics FDA-approved for psoriasis and psoriatic arthritis (PsA) on pharmaceutical DTC advertising websites from July 20, 2023 to August 20, 2023. Images of 331 people, excluding videos, were analyzed via Fitzpatrick skin scale (I-IV) by five separate investigators. A greater frequency of non-SoC skin tones across all biologic websites was noted, with an average of 85.4% (SD: 1.9) within the I-III Fitzpatrick scale. Of the 13 websites, five had over 90% representation of skin types I-III, with one website solely containing images of individuals with skin types I-III. This lack of representation may be a barrier for SoC patients when starting therapy, delaying treatment and prolonging disease burden for patients.