Top Skin-of-Color Publications in Dermatology


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Introduction
Tools such as the Altmetric Attention Score (AAS) and Web of Science (WoS) allow researchers to qualify their work's impact. WoS uses publication citation counts and is often utilized in academia, while the AAS analyzes online media attention to determine the impact of research [1].

Methods
Using Altmetric Explorer to obtain an article's AAS and WoS to measure an article's citation count, the top 50 papers from each search engine were collected using the keywords "skin of color" and "dermatology." An article's mention in news outlets and on blogs and Twitter were recorded from Altmetric Explorer as well as whether these mentions came from members of the public or practitioners; this we defined as metrics indicative of online media "attention." The mean (SD), 95% CI, and P values were determined by comparing the metrics provided by the top 50 papers from Altmetric and WoS. Table 1 presents a comparison of the top 10 cited articles on WoS and the top 10 articles with the highest AAS.

Results
The mean AAS for the top 50 papers from Altmetric and WoS were 39.1 and 24.2, respectively (P=.02). The P values were statistically significant in several of the categories compared, including the AAS (P=.02), news outlet mentions (P=.008), and Twitter mentions (P=.02) ( Table 2). Recurring themes in the top AAS skin-of-color (SoC) papers included skin cancer; cosmetic dermatology, notably pigmentation disorders; and inadequate knowledge among health care practitioners in identifying dermatologic conditions in SoC patients. By contrast, the top-cited SoC papers from WoS involved basic science research of dermatologic conditions and recommendations for assessment tools for clinicians and patients.

Principal Findings
While highly cited publications often guide clinical recommendations and carry substantial influence on practitioners, they may fail to highlight the discussions taking place outside of the scientific community [21]. For SoC patients, their interests and concerns regarding dermatologic conditions must be understood by health care providers as disease processes often manifest differently in this population compared to the general public [13]. With over 70% of the US population using social media, these platforms will allow increased sharing of research topics, supporting the utility of Altmetric scoring compared to citation count alone [22]. Within our study, the difference in recurrent themes between top AAS versus top-cited publications indicated that the clinical mindset and patient-centered topics may not align.

Limitations and Future Work
Limitations to our study include a small sample size, narrow inclusion criteria, and a lack of time constraints. Future studies comparing AAS and WoS should be confined to a short time period to mitigate temporal confounding factors due to the differing accrual rates of citation count and AAS [23]. Medical societies and health care providers can use insights from this study to shape the practice of dermatology to better understand the interests and expectations of SoC patients.

Conclusion
AAS and WoS provide different metrics on the influence of academic research. Factors that may generate greater social media attention include papers with more pictures and an author's social media presence. Elements that may produce greater citation counts include a journal's impact factor and an author's academic reputation and home institution. Altmetric uniquely represents the attention of the general public, which can facilitate patient-centered decision-making.

Conflicts of Interest
RPD is editor-in-chief of JMIR Dermatology, a joint coordinating editor for Cochrane Skin, a dermatology section editor for UpToDate, a social media editor for the Journal of the American Academy of Dermatology, and a podcast editor for the Journal of Investigative Dermatology (JID). He is a coordinating editor representative on Cochrane Council. RPD receives editorial stipends (JID, JMIR Dermatology), royalties (UpToDate), and expense reimbursement from Cochrane Skin.