If You “Don’t See Color,” You’re Doing It All Wrong
The landscape of dermatologic care is undergoing a crucial transformation, demanding a deeper understanding of diverse skin types. While sun safety and skin health are universal concerns, their nuances, particularly in skin of color, are often profoundly overlooked. This oversight contributes to significant health disparities, leading to delayed diagnoses of serious conditions like melanoma, misidentification of common dermatoses, and a pervasive lack of tailored education and culturally appropriate care. For nurses, nurse practitioners, and visionary entrepreneurs in the medical and beauty space, this presents not just a challenge but a profound opportunity. This article will illuminate these critical gaps, offering a roadmap for transforming your practice, enhancing patient trust, and pioneering innovative solutions.
Background and Significance
The imperative to address dermatologic care in skin of color is underscored by compelling epidemiological data. While skin cancer incidence rates are lower in individuals with richly pigmented skin compared to Caucasians, diagnoses often occur at later, more advanced stages, leading to poorer prognoses and higher mortality rates. For instance, melanoma in Black patients is frequently diagnosed at a later stage (III or IV) and carries a five-year survival rate significantly lower than that for white patients. Beyond malignancy, common dermatoses such as post-inflammatory hyperpigmentation, keloids, central centrifugal cicatricial alopecia (CCCA), and pseudofolliculitis barbae are highly prevalent in skin of color, yet are often mismanaged or overlooked due to inadequate training and a lack of visual representation in educational materials.
Biologically, melanin, the pigment responsible for skin color, does offer some photoprotective benefits, acting as a natural sunscreen. However, this inherent protection is often misunderstood, leading to the dangerous misconception that individuals with skin of color are immune to sun damage or skin cancer. This misperception, coupled with a historical lack of research and education focused on diverse skin types, contributes significantly to diagnostic delays and a lower index of suspicion among healthcare providers.
Systemic and clinical gaps further exacerbate these disparities. The underrepresentation of dermatologists and dermatology nurse practitioners of color means many patients lack providers who share their lived experiences or fully understand their cultural hair and skin care practices. Moreover, traditional nursing and medical curricula frequently lack comprehensive, mandated education on skin of color, resulting in a workforce ill-equipped to confidently assess and treat these populations. This leads to diagnostic challenges, suboptimal treatment plans, and, critically, a breakdown in patient trust. Addressing these issues is paramount not only for improving individual patient outcomes and quality of life but also for advancing health equity. For nurses and nurse practitioners, who are often on the front lines of patient care and community engagement, understanding these nuances is not just a professional responsibility but a moral imperative to ensure safe, timely, effective, efficient, and affordable healthcare services for all.
James Caleb Runyon, MSN, NP-C
A white dermatology NP reflects on what his training missed, and what a Black patient taught him about seeing skin, and people, more clearly.
This article explores the moment I, a white dermatology provider, first recognized the importance of adapting my approach to better serve patients with melanated skin. By sharing this experience, I hope to offer insight into both the provider’s learning journey and the lived realities of patients of color, opening the door for more informed, empathetic, and effective care.
What’s This Post About?
During a routine dermatology visit, I encountered a patient with melanated skin presenting with hyperpigmented, maculopapular lesions that initially resembled nevi. At first glance, the presentation seemed benign, but subtle changes in depth and the patient’s report of pruritus challenged that assumption. As a provider trained primarily with lighter skin tones, I found myself second-guessing my differential. Recognizing the limits of my visual assessment, my plan of action was to biopsy and excise two of the lesions for dermatopathologic analysis. It was important to me that the patient felt included in this decision-making process and understood why we were taking this approach. This moment sparked a deeper awareness of the nuances involved in diagnosing and treating skin of color, and how easily key clinical signs can be overlooked when one isn’t trained to recognize them.
Why It Matters: Education & Research
That clinical encounter forced me to confront two major gaps: education and research. Despite my training, I realized how little exposure I’d had to dermatologic conditions on richly pigmented skin. I went home determined to study and find answers, but I was struck by how limited the literature was. Resources were sparse, and the visuals available didn’t reflect what I had seen on my patient. I was upfront with her and said, “I’m not very experienced in skin of color, I have a goal to be more educated, and we will find out what these are”. It was a vulnerable moment, but one that solidified the urgent need for broader, more inclusive education and more robust research around skin of color.
Patient Testimonial
“Caleb is an overall amazing provider! Most notably, he was up front and honest about his current knowledge of melanated skin and his willingness to educate himself. This made me feel safe as a patient that he wanted to provide me an accurate diagnosis and an effective treatment plan. We ended up deciding to remove and biopsy two of the sites and he put my mind at ease during the procedure. As an African-American woman, it is paramount that I am seen and heard by my providers to feel safe especially while being treated. Caleb exemplified exactly how a provider should approach patient care and continuing education”.
Takeaways
Despite my training, I wasn’t equipped to confidently diagnose certain conditions in melanated skin. That experience taught me something deeper than medicine, it taught me that vulnerability is a strength. As India Arie says, “I am not my hair, I am not this skin”. People of color are not defined by these features, but their skin is seen, felt, judged, and treated every day. It carries clinical significance and cultural weight. As providers, we have a responsibility not just to see it, but to understand it, respect it, and treat it with the skill and empathy it deserves. I want other providers to know this: you can be fully genuine and transparent with your patients, regardless of their race, language, or background. Many will appreciate your honesty more than you realize. In fact, that candor often becomes the foundation for a meaningful, long-term rapport. When we lead with humility, we make space for trust, and trust is where true healing begins.
Call to Action
Do you have a personal story, a question, or something you wish white providers better understood about caring for patients of color? I want to hear from you. Your experiences matter, and they help us all grow. Email me at Calebrunyon123@gmail.com and share your insights, frustrations, or ideas for how we can show up better. Educate us. Challenge us. Let’s build a more inclusive and honest future in dermatology, together.
About the Author
James Caleb Runyon, MSN, NP-C (he/him) is a dermatology nurse practitioner committed to advancing equitable, evidence-based care for patients of all skin types. With a background in surgical technology, emergency medicine, and dermatology, he is passionate about improving outcomes for patients with skin of color and helping fellow clinicians recognize gaps in training and awareness. As a contributor to the Mahogany Dermatology Nursing | Education | Research™ platform, Caleb brings a unique perspective on inclusive dermatologic practice and shares insights grounded in both humility and hands-on clinical experience. Outside of writing, he mentors nurse practitioners and advocates for better education on skin of color in clinical settings. Follow Caleb on Facebook, Instagram, or TikTok to learn more about his work in dermatology and nursing education.
Caleb's profound reflection is not just an act of vulnerability; it's a critical spotlight on the systemic gaps in dermatologic education and practice. His honest admission, that despite his training, he wasn't equipped to confidently diagnose certain conditions in melanated skin due to limited exposure and sparse literature, is a reality far too many providers face. What he so eloquently highlights, and his patient's powerful testimonial affirming the need to feel "seen and heard", directly encapsulates
The first two articles published on this blog over two years ago, marked the beginning of our public mission. Caleb embodies what we envision: a future where all providers have access to crucial information so we can confidently and accurately assess, diagnose, treat, and evaluate skin of color patients safely. This enables us to build trust and rapport with our patients, ensuring they receive the care they deserve when they need it.
-Should You Dedicate Your Career to Diversity, Equity, and Inclusion? Part 2, The Assumption
At Mahogany Dermatology, our mission is clear: to increase access to dermatology nursing education with a specific emphasis on skin of color, business acumen, and digital fluency. We believe true healing and equitable care begin when we lead with humility and foster trust. This requires dedicated efforts to bridge existing knowledge gaps, provide cultural sensitivity training, and build comprehensive resources that truly empower practitioners to serve all patients.
Improving Diversity in Dermatology Nursing Education
The field of dermatology has seen significant advancements, but the real challenge lies in understanding why nursing and medical schools and healthcare entities do not mandate skin of color education. I have written extensively on the Mahogany Dermatology Blog about the lack of diversity in dermatology, including medical education, decision aids, and hands-on training. While some progress has been made, more work is needed.
I Founded Mahogany Dermatology Nursing | Education | Research™ to address gaps in dermatology education and research for nurses and nurse practitioners. Nurses—including RNs, LPNs, and LVNs—gain experience in settings where dermatologic diseases are not prioritized. Many employers require NPs to have two or more years of dermatology experience before hiring (experience that could be obtained while working as a RN). There is a percentage of NPs who receive a job offer despite their lack of experience, but the learning curve remains steep, and the lack of mentorship and professional development remain insufficient.
Addressing the Physician Shortage in Dermatology: The Role of Nurse Practitioners
The American Academy of Dermatology president, Dr. Susan Taylor, founded the Skin of Color Society over 20 years ago. Several dermatology organizations provide education for nurse practitioners, but none focus on nurses when it comes to skin of color. Despite efforts by dermatology organizations and researchers, only 5% of dermatologists are Black or Hispanic, and less than 1% are American Indian, Alaska Native, Native Hawaiian, or Pacific Islander. Many patients face long wait times for dermatology care, up to 35 days in urban areas and over 75 days in rural regions (Benlagha & Nguyen, 2021 ). It takes an average of 12 years to become a dermatologist. According to the 2021 Physician Workforce Data report, there were only 286 physicians per 100,000 people, and physicians of color made up just 30% of the workforce (Association of American Medical Colleges, n.d. ). Nurse practitioners can help bridge these gaps, as we have done in primary care (American Association of Nurse Practitioners, n.d. ).
Welcome to Mahogany Dermatology Nursing | Education | Research
In response to the demand for NPs to have 2+ years of experience to get a dermatology NP job, I have dedicated my time to creating strategies and resources to help nurses and NPs transition into dermatology (Madison, 2024a ). I've published over 100 articles on the blog and through the Mahogany Dermatology Shop, I’ve written resources to help aspiring and practicing clinicians develop a strategy for professional growth:
• New! Nursing Aesthetics: An Introductory Guide for Nurse Practitioners and Entrepreneurs. This latest guide offers essential insights for navigating the exciting intersection of nursing, aesthetics, and entrepreneurship.
• From Bedside to Dermatology: A Step-by-Step Guide for Nurses
• Dermatology Nurse Practitioner Starter-Kit
• How to Become a Nurse: A Workbook for Career Exploration
• Nurse and Nurse Practitioner Mentorship Workbook
• Dermatology DNP Project Ideas – coming 2025
Looking Ahead: Join the Alliance of Cosmetic Nurse Practitioners™ and Shape the Future
As we look to the future, I’m excited about entering the marketplace and integrating artificial intelligence and augmented reality in dermatology nursing education. Our initiatives have the potential to improve diversity in dermatology nursing education and access to care in provider shortage areas and globally where we have a specific interest in partnering with our colleagues and students in Africa.
To truly accelerate this vision and amplify our collective impact, we are building something unprecedented: the Alliance of Cosmetic Nurse Practitioners™. This is not just a membership; it's an exclusive strategic partnership for Nurse Practitioners who specialize in Cosmetics and Entrepreneurship who desire to have a business on the side or build an empire.
The Alliance of Cosmetic Nurse Practitioners is designed to empower leaders like you to:
• Forge Unrivaled Visibility & Credibility: Break through industry silos and transform your insights into industry-wide discourse that shapes the future of aesthetic medicine and solidifies nursing's leadership.
• Accelerate Growth & Strategic Advantage: Leverage our collective intellectual capital and resources to drive innovation with unprecedented efficiency, gaining actionable strategies for business scaling and identifying market gaps in skin of color.
• Pioneer the Future of Dermatology Nursing: Engage with fellow visionaries in research, science, and tech to champion culturally sensitive practices, forge strategic partnerships, and build a new standard of practice in education, research, and innovation.
This is your moment to activate unparalleled influence. Don't miss this opportunity to be part of a force poised to redefine the landscape of nursing aesthetics.
Ready to lead the advancement of aesthetic nursing? Sign up by Sunday, July 13, 2025, at 11:59 PM CST.
We're delighted to invite you to join the Alliance of Cosmetic Nurse Practitioners HERE
About the Author
Dr. Kimberly Madison, DNP, AGPCNP-BC, WCC, is 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™, she expands access to dermatology research, business acumen, and innovation while also leading professional groups and mentoring clinicians. Through her engaging and informative social media content and peer-reviewed research, Dr. Madison empowers nurses and healthcare professionals to excel in dermatology and improve patient care.
• Benlagha, I., & Nguyen, B. M. (2021). Changes in dermatology practice characteristics in the United States from 2012 to 2017. JAAD International, 3, 92–101.
• Madison, K. (2024a). From bedside to dermatology: A step-by-step guide for nurses. Mahogany Dermatology.
• Madison, K. (2024b). Derm NPs & PAs of Atlanta. Mahogany Dermatology.
• Madison, K. (2024c). Project ECHO® on racism in nursing. Mahogany Dermatology.
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