Bridging the Gap: Why Dermatology Nursing Education Must Include Skin of Color
Unless you specialize in dermatology, you likely did not receive adequate dermatology education in nursing, medical, or physician associate school. This lack of education becomes even more significant when we talk about skin of color. In nursing, this includes a paucity of course competencies, required/recommended textbooks, and licensure or certification requirements from the boards of nursing and certification bodies (American Association of Nurse Practitioners and the American Nurses Credentialing Center). In this article, I share the insights gleaned from a student-led public education project on dermatology skin of color in the United Kingdom as one solution that academic entities, clinicians, researchers, or entrepreneurs can implement. I also link to my recommendations for Essential Textbooks in Dermatology for Skin of Color and my article on the Skin of Color Training UK Edition.
~12 minute read
Trends in Dermatology
The Skin of Color Society was started by the incoming President of the American Academy of Dermatology, Dr. Susan Taylor, MD, over 20 years ago. Since that time, there have been several initiatives, research projects, professional organizations, and annual meetings held to improve the lack of diversity in dermatology education and training. Despite these initiatives, less than 5% of dermatologists are Black or Hispanic. On average, it takes about 12 years to become a dermatologist. Studies show a trend for dermatologists to live in wealthier zip codes in metropolitan areas. There are less than four dermatologists for every 100,000 people in densely populated areas where wait times average 35 days. In some major cities like Philadelphia and rural communities, wait times have been reported to be as long as 75 days (Benlagha, 2021; Greater Access for Patients Partnership, n.d).
There is a paucity of peer-reviewed data on similar demographics when it comes to aesthetic and dermatology nurse practitioners. This presents an opportunity for nurse researchers, faculty, and doctoral students to disseminate a nation-wide survey to better understand the gaps in dermatology nursing workforce, compensation, racial and ethnic composition, and sexual orientation and gender identity (SOGI).
"We can all agree that when it comes to life-threatening diagnoses like melanoma or physically and psychologically distressing disorders like acne, atopic dermatitis, keloids, and psoriasis, we must act to improve outcomes and quality of life."
The shortage of dermatology services includes a 67.10% gap in dedicated medical dermatology patient care time. With skin cancer rates rising, wait times lengthening, and demand for dermatologic care increasing, the limited availability of practicing dermatologists has become a pressing public health concern (Greater Access for Patients Partnership, n.d). This challenge is further intensified by barriers that disproportionately affect underserved communities. To address these issues, practicing and aspiring dermatology nurse practitioners must identify innovative strategies to expand patient access to dermatologic care.
Skin of Color
At the time of this writing, I just finished publishing a 3-part series on skin of color in aesthetics, where I went into detail about what we mean when we say skin of color and the inappropriate application of the Fitzpatrick skin phototype system. Briefly, in dermatology, skin of color (SOC) refers to individuals from diverse racial and ethnic backgrounds who share common skin characteristics, conditions, and response patterns. These include higher levels of melanin, a tendency for pigmentary changes, hypertrophic scarring, and keloid formation (Madison, 2025). While skin phototypes vary within racial groups, SOC generally includes individuals identified in U.S. Census categories as American Indian or Alaska Native, Asian, Black, and Native Hawaiian or Pacific Islander (Narla et al., 2023).
Historically, SOC populations have been underrepresented in dermatologic education, research, and the professional workforce. Many dermatologic conditions that disproportionately affect our communities lack sufficient treatment guidelines, leaving gaps in care. By 2044, racial and ethnic minority groups—many of whom have SOC—will make up the majority of the U.S. population, underscoring the urgent need for more inclusive dermatologic practices in nursing (Narla et al., 2023).
The racial and social injustices highlighted in 2020, along with the disproportionate impact of COVID-19 on communities of color, brought renewed attention to these disparities. In response, the American Academy of Dermatology (AAD) launched a three-year diversity, equity, and inclusion (DEI) plan in 2021. This initiative focuses on:
- Increasing diversity within the dermatology workforce
- Expanding education and research on SOC and health disparities
- Advocating for policies that address healthcare inequities
Members of organizations like the Skin of Color Society and the National Medical Association have implemented skin of color education into residency programs for all students, regardless of their race or ethnicity, and implemented new protocols for inclusive clinical research (Narla et al., 2023). Given the aforementioned percentage of Black and Hispanic dermatologists, they recognize that everyone must have access to skin of color education and understand the importance of culturally sensitive care.
-Read my article about My Meeting with HUED to learn about initiatives by VisualDx, Vaseline, HUED, and See My Skin.
Gaps in Dermatology Nursing Education
Similar initiatives have not been initiated in nursing schools or the majority of dermatology nurse practitioner fellowship programs. There are no programs in existence for nurses specifically to obtain dermatology education; this is a problem considering most employers require NPs to have an average of two years of experience at that time of hire. Even when NPs are hired without experience or education, they report a significant stress, a need for mentorship, and trouble keeping pace in clinic given the steep learning curve. I see this as a need for undergraduate level dermatology nursing education that parallels current nursing education where we have undergraduate course work followed by advanced curricula which will better prepare NPs for the programs in existence at this time. These gaps are prime opportunities for faculty, DNP projects, PhD nurse-led research, authors, clinicians, professional organizations, and entrepreneurs. To be clear, these gaps in SOC education include medical and aesthetic dermatology, pediatrics, wound care, technology, medical images, decision-support tools at the point-of-care, and hands-on training modules.
"See my interview with the Lahey Dermatology Nurse Practitioner Training program to see what they're doing to increase access to SOC education and training for their NP Fellows."
For the remainder of this article, I will discuss a student-led public education project on dermatology skin of color in the United Kingdom as one starting point.
Skin of Color in the United Kingdom
In the UK, when it comes to SOC, there is also a lack of diversity in dermatology education, poor health outcomes, decreased access to healthcare, low rates of health literacy, misdiagnosis and underdiagnosis, medical distrust in researchers, and unrecognized bias amongst clinicians (Loginovic et al., 2022).
When it comes to the student-led program, it wasn’t the first of its kind. Don’t Forget the Bubbleswas started by a research team and the Royal London Hospital. Malone Mukwende, a medical student, started theMind the Gapclinical handbook of signs and symptoms of diseases in SOC patients. These programs received a significant amount of media attention with the assistance of the British Association of Dermatologists (BAD), which helped publish the relevant resources. I was excited to read that the BAD brought attention to the critical role of journal editors and publishers when it comes to improving health outcomes, diversity, racial equity, and inclusion (Loginovic et al., 2022). This recognition helps to support my argument about why dermatology nurse practitioners must write.
While these projects made great strides in bringing awareness to the lack of diversity in dermatology, there were still gaps in medical faculty, medical curricula, and “diversity within medical faculties, and institutional mindset, which led to passive and tokenistic contributions to the curriculum” (Loginovic et al., 2022, p. 4). The authors report that for health outcomes to improve, initiatives should include clinicians and patients. I couldn’t agree more.
Outcomes of student-led public education project on dermatology skin of color in the United Kingdom:
-Saw over 500 participants over 2 days
-Costs associated with printed materials, poster boards, and incentives for participation funded by a university grant
-Students improved their public speaking skills, improved their delivery of complex health information at the appropriate health literacy level, and gained early exposure to how race and ethnicity influence healthcare delivery, a key factor in the patient experience and overall health outcomes.
-Promotion of the event created an opportunity for medical students to advocate for more diversity and racial equality at their school
-Increased rapport between the public and future healthcare providers in a safe environment when it comes to discussing socially pertinent topics
If you structure your nurse-led program based on the UK version, consider the following key features.
Patient Education Objectives:
-Disease prevention
-Health promotion
-Skin of color presentations
When:
-During nursing school before the start of clinical rotations via textbooks, modules, lab, and simulation training
-Ensure exposure to diverse skin tones (in clinic and/or simulation) during the first two semesters of clinical rotations
-Incorporate increased awareness about current biases in dermatology to increase clinical confidence, diagnostic accuracy, and holistic care
How:
-DNP Projects
-PhD translational research
-Host public events (per semester, bi-annually, or annually)
-Nursing students educate the public on disease prevention, health promotion, how to recognize and manage common conditions, diversity in dermatology, and overall skin health
-Utilize posters or digital screens/tablets displaying common skin conditions on diverse skin tones using language at a 5th or 6th grade level explaining the pathophysiology, preventative measures, and common treatment recommendations (Agency for Healthcare Research and Quality, n.d.).
-Nursing students should encourage the public to share their experiences receiving dermatologic care, ask questions, and address misconceptions
I invite you to read my previous articles:
Essential Textbooks for Dermatology in Skin of Color. Click here.
Introducing the Skin of Colour Training UK Edition. Click here.
References
Agency for Healthcare Research and Quality. (n.d.). Health literacy universal precautions toolkit, 2nd edition: Tool 11 – Assess, select, and create easy-to-understand materials. U.S. Department of Health and Human Services.
Benlagha, I., & Nguyen, B. M. (2021). Changes in dermatology practice characteristics in the United States from 2012 to 2017. JAAD international, 3, 92–101.
Greater Access for Patients Partnership. (n.d.). Patients are waiting: America's dermatology appointment wait times crisis. Society of Dermatology Physician Assistants.
I am a Board-Certified Nurse Practitioner, educator, and author dedicated to advancing dermatology nursing education and research with an emphasis on skin of color. As the founder of Mahogany Dermatology Nursing | Education | Research, I aim to expand access to dermatology research, business acumen, and innovation using artificial intelligence and augmented reality while also leading professional groups and mentoring clinicians. Through engaging and informative social media content and peer-reviewed research, I empower nurses and healthcare professionals to excel in dermatology and improve patient care.
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