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MobileDerm addresses disparities in skin health

As appeared first in New Pittsburgh Courier

Skin is the largest organ in the human body. It helps to regulate body temperature, boosts body immunity and provides sensation. It is our body’s first barrier against disease and infection. As such, it is important to remember to protect skin and keep it healthy. Protecting skin includes keeping it moisturized, seeing a dermatologist for any concerns and using sunscreen.

One of the most basic ways to protect skin is to be aware of sun exposure. Though sunlight can feel good, uplift our mood and provide the body with essential vitamin D, its ultraviolet (UV) radiation is harmful to skin. It can cause wrinkles and other skin damage and is a major risk factor for skin cancer for everyone.

“All skin types and colors have to be protected from the sun using clothing or sunscreen and by not using tanning beds [which use UV rays],” says Alaina J. James, MD, PhD, assistant professor of dermatology, University of Pittsburgh School of Medicine. “People of color who may not burn with sun exposure still need to use sunscreen—at least SPF 30, reapplying every two hours and making sure they are using zinc- or titanium-based sunscreens.”

Dr. James reminds us that, while people of color may have a lower risk of developing skin cancer, their risk of becoming ill and dying from skin cancer is greater than that of other people. This disparity exists partly because people in Black and Brown communities often receive a diagnosis very late in the disease process. She says that access to care, insurance coverage and provider awareness are barriers to health care and contribute to disparities in skin health.

To address some of these disparities in skin health, Dr. James has created a program called MobileDerm.

For a number of years, providers in the field of dermatology have successfully used telemedicine for purposes like looking at a patient-provided photo of a mole (a model of care that has prepared them well for the physical distancing required during the COVID-19 pandemic). But a care model she has developed in the past few years takes telemedicine one step further toward skin health equity.

To improve access to dermatologic services, Dr. James, Pitt medical students and UPMC dermatology residents are doing outreach dermatology clinics in Pittsburgh community health centers. Dr. James developed MobileDerm, a program where dermatology health care providers meet patients where they are—in community-based health centers and clinics where patients have easier access and are often more comfortable.

“There aren’t many dermatologists in general,” says Dr. James. “Many are concentrated in bigger cities, which leaves people in outlying or lower-resource communities without a dermatologist in their community. We’re seeing that people who don’t have easy access to dermatologists have skin problems that go on for a long time and are much worse than they need to be. We want MobileDerm to help reduce that wait time.”

Dr. James thinks that meeting patients in the patients’ communities helps to build and sustain relationships and trust.

“There is something special and empowering about partnering with a community and learning about that community and trying to develop a relationship with patients and local providers,” she says. “Having discussions about things that I may not know or understand about a community is important. Once we build relationships through in-person, face-to-face contact and discussion, from there we can follow up using different tele-visits and video platforms.”

Dr. James sees even international trips she has done to provide dermatological care as influencing MobileDerm’s model of care. During a service trip to Honduras in 2019, she and a dermatology team of Pitt undergrads, medical students and residents would diagnose and treat many patients at a full-service, pop-up dermatology clinic with onsite pharmacy and procedures. Dr. James would like to recreate this traveling dermatology service program in our local Pittsburgh area and neighboring rural communities.

Overall, Dr. James wants people to remember that their role in skin health—gentle hair and nail care, noting concerning skin lesions, rashes or nonhealing wounds, and as well as guarding against UV exposure—is essential. With increased sun protection, people’s vitamin D levels, which are important for a healthy immune system and strong bones, are often lower. It is important to eat nutritious, vitamin D-rich foods and monitor vitamin D levels. Recent studies suggest that very low vitamin D levels may be associated with severe Covid-19 infections. Skin health is not just acne, warts or mole checks (see information on moles elsewhere on the page); skin can sometimes reflect what is going on inside the body. Many systemic diseases can present with changes in the skin. Dermatologists can help coordinate health care with other health care providers to make sure patients are receiving the proper treatment.

Lastly, Dr. James wants people to know that, despite COVID-19 physical distancing, if they are having urgent skin problems, providers are available for in-person patient appointments, as well as video visits and E-Dermatology. She and the UPMC dermatology team are here to help and serve communities.



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