In the Mississippi Delta, one of the poorest regions in the United States (open in new tab), residents do not head to a specialist's office to check moles or lighten blemishes, but instead line up once a month at Roaring Fork High School. A single medical professional is stationed there just 12 days a year to test every local adult and child for any of the nearly 3,000 skin conditions that can be diagnosed. If that seems like a problem, it is: the Delta is just one of many dermatology "deserts" in the United States.

Most of these problem areas are located in the Midwest, rural South, and central North. Says sociologist Dr. Shannon Monnat, associate professor at Syracuse University and co-director of the university's Policy, Place, and Population Health Lab. These residents have few options. They travel long distances to get the treatment they need or try to find ways to treat their skin problems on their own, which can be costly and ineffective.

The closest dermatologist to Roaring Fork, in the heart of the Delta, is about 90 miles away in Jackson, Mississippi, where it can take up to three months to get an appointment. Can you imagine what percentage of people in the poorest parts of Mississippi actually come in for that appointment 90 miles away?" asks Robert Broedel, M.D., chief of dermatology at the University of Mississippi Medical Center, who staffs the clinic at Roaring Fork High School. Broedel, M.D., chief of dermatology at the University of Mississippi Medical Center, who is on staff at the Roaring Fork High School clinic, asks. No kidding, the answer is: "Percentages. 'No transportation, no gas money, no day care. Or lack of transportation, or lack of gasoline, or lack of day care.

With tests postponed for months, patients can live their lives undiagnosed, and their conditions can deteriorate rapidly. And we are not just talking about rashes and infections. Cancer, especially in the most aggressive melanomas, can grow and metastasize without treatment. In fact, according to a Cleveland Clinic study published in the Journal of the American Academy of Dermatology (open in new tab), delaying treatment of stage I melanoma for just four weeks increases the likelihood that the patient will die.

In addition, skin cancer is more common than many people think: Every day, about 9,500 Americans are diagnosed (open in new tab) and nearly 20 people die from the disease. University of Missouri professor of dermatology Karen Edison, M.D., tracks the incidence of these cancers in her home state of Missouri. We know that the darker the melanoma, the greater the chance of dying from the cancer," Edison said. We see this trend in Missouri. There is a definite higher rate of this happening in areas far from where dermatologists practice."

In 2017, there were approximately 9,600 dermatologists practicing in the United States, according to a study published in the Journal of the American Academy of Dermatology (opens in new tab), the most recent data available (opens in new tab) The number of specialists in the United States is only about 1.5 million, which is only enough to adequately serve 50 percent of the country's population. In addition, because most specialists work in urban areas, states with large rural populations, such as Mississippi and Missouri, have fewer dermatologists per capita than other states. Ninety-four percent of Americans with private insurance do not see a dermatologist annually as recommended. In other words, primary care physicians bear the burden of care.

While general practitioners can treat basic skin conditions, many of them are not trained in dermatology or other specialties. 'Primary care physicians have a difficult problem. They try to do dermatology, cardiology, pulmonology, and other specialties all at once. Without the opportunity to consult with a specialist, there is a great deal of pressure to do what is best. A patient may say, "You're my doctor, so I'll stick with you." But that can have a devastating impact, especially when it comes to chronic conditions that require immediate attention, such as painful cystic acne, lupus-related lesions, and psoriasis.

Because the shortage of dermatologists in rural areas is a systemic problem, the solution is not simple. In an attempt to shrink the dermatology dead zone, some universities offer grants and other incentives to graduates who agree to work in rural areas. And many universities in medically underserved states have made it their mission to encourage doctors to go where they are needed most. Says Dr. Edison, "At the University of Missouri, we have a track record of training people to go to underserved areas." The University of Missouri has a track record of training people to go to disadvantaged areas," Dr. Edison said. [That's] why it's important for us to make more training and services available to general practitioners." Says Dr. Edison, "It is incumbent upon us to teach dermatology during primary care training." And we can provide access to continuity of care through the use of technology such as teledermatology (open in new tab) services."

Live two-way teledermatology uses videoconferencing to connect patients and primary care physicians with dermatologists and specialists across the country or around the world. Its flexibility is appealing," Dr. Brodell says. Many dermatologists are beginning to offer remote dermatology appointments, similar in function to Skype, for patients who cannot come in person. This can be arranged by phone through the dermatologist's office, and the attending physician can recommend a trusted doctor. This technology also helps physicians manage their time: they can go to their laptops at home after hours and help several patients a day, especially in urgent cases.

Another variation of this service is in a store-and-forward format: health care providers in free clinics or offices in underserved areas can take photos and notes while seeing patients and forward these materials to trained dermatologists for feedback. Many of these programs are free of charge, with specialist physicians volunteering their services. (If your local practice or primary care practice says it does not offer such services, you can help change that: the American Academy of Dermatology can add a new practice in as little as two weeks to the Let them know they can be added to the AccessDerm program. For more information, click here (opens in a new tab).)

There are also telemedicine providers that allow patients to connect directly with a dermatologist and send digital photos for consultation. Dr. Brodell warns, however, that these services are not so reliable. He says, "But some of these various programs don't even ask you to report back to your primary care physician. Many of them lack two-way communication," he explains. In other words, the consultant does not contact the attending physician to discuss the diagnosis (and vice versa), which can hinder communication and treatment.

There is another problem that plagues Internet-based medicine: not knowing who you are connecting with. Patients may pay $50 for an opinion, but they may be dealing with a doctor who is licensed in another country or not licensed at all. And they will only make their best guess based on the initial images provided," he says. If a dermatologist's direct service is the only option, Brodell recommends asking where the doctor practices, where he or she is licensed, and whether he or she can provide diagnostic records to your doctor. These are simple ways to tell if a dealer is trustworthy.

Seeing a dermatologist may seem like a luxury to many Americans. Not only because dermatologists detect and treat skin cancer. Acne, eczema, psoriasis, and other conditions that dermatologists treat affect the overall health of their patients. Many skin conditions can be embarrassing and lead to social isolation and depression." The ability to confidently interact with others affects all aspects of one's life. Dermatology should not be viewed as a secondary or optional medical service."