Industry-sponsored clinical trials in dermatology generate substantial institutional revenue; yet, participant compensation is frequently calibrated to minimum regulatory thresholds rather than to the actual costs of participation. Existing frameworks including institutional review board review under 21 Code of Federal Regulations 50.20 and European Health Union Regulation 536/2014 provide essential protections against coercive payment practices, but approval does not guarantee that stipends adequately offset lost wages, transportation costs, or structural participation barriers. Drawing on the Belmont Report's principles of justice and respect for persons, we argue that regulatory compliance is a floor, not the full measure of ethical practice. We propose that dermatology research programs adopt tiered, burden-reflective compensation models and integrate participant advisory perspectives into compensation design, not to circumvent existing oversight but to exceed it in the service of research equity.
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