The comprehensive literature review yielded 18 dermatological care gaps, which were further grouped by the authors into four distinct root causes: cultural diversity, socioeconomic disadvantage, racial and ethnic biases, and underrepresentation in medical research and training (Fig. 1) [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65].

Root causes extracted from identified care gaps for individuals with SOC in the USA. HCP healthcare professional, SOC skin of color

Next, publications were analyzed to extract the field (i.e., education, research, or healthcare/access) responsible for addressing the identified care gaps and the associated stakeholders (i.e., dermatologists, patients, residents, researchers, and/or caregivers) (Fig. 2). These details were either derived explicitly from the publications or implied on the basis of the proposed solutions and future directions.

Overview of 18 distinct care gaps identified for patients with SOC across dermatology education, research, and clinical care. AI artificial intelligence, HCP healthcare professional, SOC skin of color

Cultural diversity contributed to gaps in dermatology education, including lack of materials for non-English speakers, absence of culturally sensitive channels for disease awareness, and limited HCP adaptation to health literacy levels of patients [9,10,11,12,13,14,15,16,17]. Additionally, certain populations with SOC may have existing mistrust in the healthcare system, further contributing to their reluctance to seek treatment and understand their condition and exacerbating their fear of side effects. Even if individuals with SOC were trusting of the healthcare system, communication about dermatologic diseases could be hindered by HCPs’ limited familiarity with the disproportionate effects of dermatologic diseases on these patient populations.

Socioeconomic disadvantages exacerbate dermatological healthcare gaps, such as insufficient insurance coverage and restricted access to care in socioeconomically disadvantaged areas, compounded with work constraints and transportation costs [7, 18,19,20,21,22,23,24,25,26]. Populations with SOC may reside in low-income communities with limited healthcare facilities and specialists, resulting in reduced access to advanced technologies. Even when such services are available, costs may be prohibitive, requiring patients to pay high out-of-pocket fees for consultations and treatments and take time off from their jobs to attend medical appointments.

Racial and ethnic biases led to gaps in both dermatology education and healthcare, including a lack of awareness about disease-specific inequities and a shortage of SOC-specialized clinicians, respectively [1, 8, 27,28,29]. Patient trust and satisfaction are closely linked to dermatologists’ awareness of racial and ethnic considerations, as well as cultural sensitivity during patient interactions. Indeed, HCP knowledge and experience with managing patients with SOC have been reported as crucial factors for delivery of culturally competent care [1, 5].

Lastly, gaps arising from underrepresentation in medical and research settings included scarcity of images in dermatology textbooks, insufficient diversity education in medical school, and lack of comprehensive SOC scale to classify diverse patient skin tones. Additionally, numerous limitations have been identified in research, such as lack of nuanced understand of disease burden and clinical presentation across diverse populations, poor representation of individuals with SOC in clinical trials, and low accuracy of artificial intelligence (AI)-based diagnostic tools due to the underrepresentation of patients with SOC in image databases [1, 2, 4, 6, 7, 13, 14, 25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51].

Following the identification of care gaps, an initiative scan was conducted to evaluate the breadth and focus of activities aimed at mitigating the disparities in dermatological care of individuals with SOC. Thorough review of the landscape of dermatology-specific efforts on the basis of results from the literature review revealed hundreds of initiatives spanning national and international organizations, including medical societies, the pharmaceutical industry, patient advocacy organizations, and nonprofit organizations (Fig. 3).