Addressing health disparities for people of color in dermatology with Nicole Williams

In her role, she is responsible for leading strategic partnerships between the UCB Portfolio Innovation Team and influential external executive stakeholders by creating innovative collaborations focused on health equity, shared decision-making models, and holistic care approaches within integrative health systems.

Theo and Nicole discuss the role telehealth has played in addressing disparities in dermatology for patients who have skin of color. 

Theo Harvey: I know you have a background in healthcare, but specifically around skincare. I would love to understand your thoughts around treating skin remotely with technology and telehealth. The first question I have for you is – again, COVID is the big equalizer changer for everything healthcare related and we did see the rise of teledermatology – what are your opinions on the benefits of this technology and what are you seeing? What are the benefits for the patient and maybe even for the doctor?

Nicole Williams: Sure. I would definitely say that telehealth has increased during COVID. It was something that really wasn’t expected, to now it’s transformed to like patients are almost demanding it like we want on-demand  everything: TV, Amazon service, and our medical care now. 

I think  one of the benefits is that a lot of these patients were not able to travel to see providers because maybe they live an hour away and they’re being referred to a medical center and it’s kind of hard to get into a lot of these different specialists. So it was taking four to six months to see a provider live. 

With the option of doing telehealth, it could be offered at some alternative times, maybe even before clinic or having late night clinic hours. That’s something that I’ve seen that has been done for a lot of different academic centers, but a lot of those patients have trouble getting a ride to these institutions that might be an hour from their house. They have to take off work. And so when a lot of these patients that have social determinants of health or health disparities, if they’re not working, then they’re probably not making money. And so that’s not really great for them, but if they could have a telehealth appointment, it might be easier. 

And then I think also if they’re able to get in a lot sooner, they could catch maybe their issues sooner than later and have it progress. Being diagnosed early is great. One innovative way that I’ve heard of institutions in the Northeast using TELEM during COVID was that they were using a satellite clinic in these rural areas and they would have the provider on the telehealth visit. And then they would have a medical assistant in the satellite clinic, in these rural areas, actually taking photos of the skin disease issues that the patient was facing so that they could have really clear pictures. The medical assistant or the nurse knew exactly what to take the picture of. They could actually touch and feel the skin as well and relay that back to the provider. That pilot program actually did really well. 

Theo Harvey: Great example. I mean, the themes of meeting people where they are, I love that having these satellite locations to treat patients. This is the beginning of it, right? So where do you see this technology going? 

Nicole Williams: I mean, I think adherence rates increase as well. I see a lot of patients wanting to do services at home. So for instance, within psoriasis, you have phototherapy or light therapy boxes that can be delivered to patients’ homes. Some of the technology that goes along with that, now providers can actually see when they turn that lightbox on. 

They’ll know when the patient is actually doing their therapy. That’s one way to kind of track and have a complete circle back to the provider on if the patient is actually getting their treatment. I also see more and more telehealth in regards to therapy, which is, I think it’s really great for skin of color pain patients, or even to skin disease patients, because they deal with so many psychosocial issues. They’re needing the therapy sessions to kind of talk through their depression and anxiety.

When you look at me, you actually can’t tell that I have high cholesterol, but with the patient that has psoriasis or maybe atopic dermatitis, it’s out front, it might be on their face, their hands, their neck, their arms. That brings a lot of psychosocial issues for those kinds of patients. 

I really feel that telehealth with therapy really increased. And I think that is going to be increasingly going forward, especially helping patients with skin disease. I think that’s the direction we’re going. 

Shared decision-making tools or digital health tools that help aid the discussion with the patient is something else that’s going to be being pushed out from telehealth or digital health options. That’s because patients want to be heard, they want to go to the doctor and actually talk about some of their psychosocial issues with a person. If the patient can have their voice heard and then the provider have certain aided tools, whether they like to have an injection or do they like pills, do they like creams, they can show them pictures.

And that also helps with patients that may have language barriers as well. I think also with the air decision making, they feel like they were part of the treatment plan, and it’s not just the provider, like pushing some information on the patient saying, well, this is what you’re going to do and this is what you’re going to take. Of course, they are the ones practicing medicine, but it’s really important to incorporate the patient’s perspective and some of their concerns. I think those kind of tools are definitely being used. And I feel like that’s where telehealth is going.

Theo Harvey: You talked about the clinical aspect and understanding are they even using it? That’s what telehealth can help with, but also the ancillary things that go along with that, right? Like the mental aspect, cause you’re right, there’s a lot of stigma associated with these types of conditions and there could be some mental conditions that people deal with. And then finally just the support that they could use with, like the connections and research that can be delivered to them in the format that’s digitally. 

We really do a lot with my company with a lot of underserved communities dealing with patients, deal with hypertension. They’re alone at home, how do we engage them? Given your knowledge around this area, especially with your work with skin of color patients and the journey of skin diseases, what do you believe are the key issues facing people of color in regards to skincare?

Nicole Williams: Well, this is very timely cause I just conducted a whole workshop on health disparities from key opinion leaders on social determinants of health across the nation. So these are really top of mind for me, but there are so many, but I would like to focus on just a couple. And I think the main one is trust. Trust in the healthcare system. 

Our history includes really heinous things like the Tuskegee experiment and the Henrietta Lacks cells being used without her knowledge. So those types of experiences have happened in our history, definitely lead to the mistrust of the medical profession for a lot of patients with skin of color. I think also the mistrust comes when there’s not a lot of cultural competency from providers, so they might have been misdiagnosed or just passed along to several different providers before they get to one that actually understands their skin disease and their healthcare needs.

I hear this all the time, that there needs to be more diversity in dermatology. There’s not enough minority dermatologists across the nation in regards to the training, as well as getting, out into the community and serving those patients. It doesn’t really match the general population. The percentage is a lot lower than what we actually see in the United States. 

I think some of those issues are also that there’s pictures that are not included in medical textbooks. There’s not pictures that are included on the dermatology boards when you actually go to be a dermatologist, it’s not included it in their curriculum training during their residency program. So all of those things lead to things where you’re not really sure on how to treat patients with skin of color.

And the one that I hear the most is about our hair. So obviously African American women have different hair textures. The way that we wear our hair is different, different hair styles. It might include braids, extensions, cornrows, and with that lack of cultural competency, when you’re going to see a provider that doesn’t necessarily understand African American hair, they might see it as like, okay, well you have this scalp condition and I need you to take this shampoo or use the shampoo every day. I don’t know, a black woman on the face of the planet that would wash their hair every single day. And so that lack of understanding of our needs leads to some of the mistrust as well. So I think that’s like one of the biggest ones. And then I also think from an educational standpoint, and this is how digital tools I think could definitely help this patient population, is just understanding skin disease.

I’ve heard this story recently. A patient had really bad scaly psoriasis and they went to a black dermatologist, and the dermatologist was like, have you ever noticed that your skin was really dry? And she said, well, my whole family just called me ashy skin. I just thought I had dry skin. I didn’t realize it was actually a skin disease. And the same thing goes for screening for skin can cancer. A lot of African American patients or minority patients, skin of color patients, don’t feel like they need to go get annual skin checks because we don’t have, a high prevalence of skin cancer in our populations. But, Bob Marley is like one of the famous stories. He actually died of skin cancer. He played soccer outdoors all the time in Jamaica. He actually got skin cancer in his toil and that actually led to his death. So it’s really important that we do take care of our health and understand and have that education within our communities to promote what skin disease looks like.

Theo Harvey: Oh, that was very comprehensive and I appreciate that. I learned a lot, so thank you, Nicole, for your time today. I really appreciate it.