Navigating Challenges in Pediatric Dermatology Access, Addressing Disparities: Elizabeth Garcia Creighton

Elizabeth Garcia Creighton, BA

One of the challenges with getting patients to seek care in pediatric dermatology is that many people don’t know this subspecialty exists, which can create disparities in care for some populations, explained Elizabeth Garcia Creighton, BA, a medical student at the University of Colorado School of Medicine. Other factors that may impact willingness to seek care include language barriers and the lack of awareness of how skin conditions may look different on a variety of skin tones.

In part 1 of our interview, Creighton discussed findings she presented at the Society for Pediatric Dermatology Annual Meeting around the willingness of general dermatologists to see pediatric patients. In part 2 of our interview, she explains the challenges of getting a new patient appointment for pediatric patients and the current shortage of pediatric dermatologists.

These answers have been edited for style and clarity.

The American Journal of Managed Care® (AJMC®): Looking at your work around disparities, how do different backgrounds impact decisions to seek care for dermatologic diseases?

Garcia Creighton: The thing that relates the most to this question is that a lot of people don't know that pediatric subspecialties exist. That's something we found with a lot of our research, too. It's not just Hispanic populations but also rural populations as well. I think it's hard when you're not living in a city and you don't know that there are children's hospitals with a bunch of subspecialists, for example. I think that makes it hard [to seek care].

We've seen with our research that, yeah, a lot of rural communities have no idea that pediatric dermatology exists. There was a recent study that we published called “What Matters Most to Minoritized Families in Pediatric Dermatology Care.”1 We saw that a lot of patients did not know…that pediatric dermatology exists. We saw especially a lot of Hispanic and Latino communities had no idea. They were like, “I didn't even know what pediatric dermatology was.”

One thing we could do is raise awareness of pediatric dermatology as well. It's a little bit hard when every single pediatric dermatologist, pretty much, is located in a major city at a children's hospital, and you're trying to reach communities multiple hours away in more rural settings. But that's something we could try to do as well.

[There are also] language barriers…to try to navigate the system, because usually you have to call a children's hospital, and then they transfer you to a central appointment line or something like that. Then they transfer you to pediatric dermatology. That can be hard as well, especially when it's not a language like Spanish or English. Normally, they have Spanish speakers who can help you translate or help you with the navigation process, but they don't always have other languages beyond Spanish and English. That was one thing that we found, too.

AJMC: What are some of the challenges—and how do we overcome them—when managing skin conditions that present differently based on skin color?

Garcia Creighton: I think one of the biggest things is, historically, that textbooks and exam questions have been on White skin. That's one thing that's been researched quite a lot. And then the other thing is exposure during training—trying to get enough exposure during training to a variety of different skin colors. That [training] plays into whether people of all skin colors can access that dermatology office, for example. Whether you go to a residency that has a large amount of diverse populations around it, and whether they take all types of insurance, for example. I think that's the biggest thing, is making sure that you get enough exposure during training.

There's a lot of work going into changing the textbooks. [They are] working towards change and showing examples of skin conditions and skin of many different skins of color, which is nice, but I think that's one, definitely one area where we can continue to improve. Historically, we see eczema on White skin, and we don't know what it looks like on Black skin or psoriasis or so on. I can tell you that on my board exam [in July], they're making those more diverse. I did see very many different skin tones. I was very happy about that.

Reference

1. Thapar M, Garcia-Creighton E, Garcia-Hernandez S, Tietbohl C, Kohn LL. What matters most to minoritized families in pediatric dermatology care: a qualitative study. Pediatr Dermatol. Published online July 12, 2025. doi:10.1111/pde.16021