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Pseudofolliculitis barbae (PFB), also known as razor bumps, is a common inflammatory condition characterized by papules and pustules that typically appear in the beard and cheek regions. It occurs when shaved hair regrows and penetrates the skin, leading to irritation and inflammation. While anyone who shaves can develop PFB, it is more prevalent and severe in individuals with naturally tightly coiled, coarse-textured hair.^1,2 Pseudofolliculitis barbae is common in individuals who shave frequently due to personal choice or profession, such as members of the US military^3,4 and firefighters, who are required to remain clean shaven for safety (eg, ensuring proper fit of a respirator mask).⁵ Early diagnosis and treatment of PFB are essential to prevent long-term complications such as scarring or hyperpigmentation, which may be more severe in those with darker skin tones.

Epidemiology

Pseudofolliculitis barbae is most common in Black men, affecting 45% to 83% of men of African ancestry.^1,2 This condition also can affect individuals of various ethnicities with coarse or curly hair. The spiral shape of the hair increases the likelihood that it will regrow into the skin after shaving.⁶ Women with hirsutism who shave also can develop PFB.

Key Clinical Features

The papules and pustules seen in PFB may be flesh colored, erythematous, hyperpigmented, brown, or violaceous. Erythema may be less pronounced in darker vs lighter skin tones. Persistent and severe postinflammatory hyperpigmentation may occur, and hypertrophic or keloidal scars may develop in affected areas. Dermoscopy may reveal extrafollicular hair penetration as well as follicular or perifollicular pustules accompanied by hyperkeratosis.

Worth Noting

The most effective management for PFB is to discontinue shaving.¹ If shaving is desired or necessary, it is recommended that patients apply lukewarm water to the affected area followed by a generous amount of shaving foam or gel to create a protective antifriction layer that allows the razor to glide more smoothly over the skin and reduces subsequent irritation.² Using the right razor technology also may help alleviate symptoms. Research has shown that multiblade razors used in conjunction with preshave hair hydration and postshave moisturization do not worsen PFB.² A recent study found that multiblade razor technology paired with use of a shave foam or gel actually improved skin appearance in patients with PFB.⁷

It is important to direct patients to shave in the direction of hair growth; however, this may not be possible for individuals with curly or coarse hair, as the hair may grow in many directions.^8,9 Patients also should avoid pulling the skin taut while shaving, as doing so allows the hair to be clipped below the surface, where it can repenetrate the skin and cause further irritation. As an alternative to shaving with a razor, patients can use hair clippers to trim beard hair, which leaves behind stubble and interrupts the cycle of retracted hairs under the skin. Nd:YAG laser therapy has demonstrated efficacy in reduction of PFB papules and pustules.^9-12 Greater mean improvement in inflammatory papules and reduction in hair density was noted in participants who received Nd:YAG laser plus eflornithine compared with those who received the laser or eflornithine alone.¹¹ Patients should not pluck or dig into the skin to remove any ingrown hairs. If a tweezer is used, the patient should gently lift the tip of the ingrown hair with the tweezer to dislodge it from the skin and prevent plucking out the hair completely.

To help manage inflammation after shaving, topical treatments such as benzoyl peroxide 5%/clindamycin 1% gel can be used.^3,13 A low-potency steroid such as topical hydrocortisone 2.5% applied once or twice daily for up to 2 to 3 days may be helpful.^1,14 Adjunctive treatments including keratolytics (eg, topical retinoids, hydroxy acids) reduce perifollicular hyperkeratosis.^14,15 Agents containing alpha hydroxy acids (eg, glycolic acid) also can decrease the curvature of the hair itself by reducing the sulfhydryl bonds.⁶ If secondary bacterial infections occur, oral antibiotics (eg, doxycycline) may be necessary.

Health Disparity Highlight

Individuals with darker skin tones are at higher risk for PFB and associated complications. Limited access to dermatology services may further exacerbate these challenges. Individuals with PFB may not seek medical treatment until the condition becomes severe. Clinicians also may underestimate the severity of PFB—particularly in those with darker skin tones—based on erythema alone because it may be less pronounced in darker vs lighter skin tones.¹⁶

While permanent hair reduction with laser therapy is a treatment option for PFB, it may be inaccessible to some patients because it can be expensive and is coded as a cosmetic procedure. Additionally, patients may not have access to specialists who are experienced in performing the procedure in those with darker skin tones.⁹ Some patients also may not want to permanently reduce the amount of hair that grows in the beard area for personal or religious reasons.¹⁷

Pseudofolliculitis barbae also has been linked to professional disparities. One study found that members of the US Air Force who had medical shaving waivers experienced longer times to promotion than those with no waiver.¹⁸ Delays in promotion may be linked to perceptions of unprofessionalism, exclusion from high-profile duties, and concerns about career progression. While this delay was similar for individuals of all races, the majority of those in the waiver group were Black/African American. In 2021, 4 Black firefighters with PFB were unsuccessful in their bid to get a medical accommodation regarding a New York City Fire Department policy requiring them to be clean shaven where the oxygen mask seals against the skin.⁵ More research is needed on mask safety and efficiency relative to the length of facial hair. Accommodations or tailored masks for facial hair conditions also are necessary so individuals with PFB can meet job requirements while managing their condition.

Pseudofolliculitis barbae (PFB), also known as razor bumps, is a common inflammatory condition characterized by papules and pustules that typically appear in the beard and cheek regions. It occurs when shaved hair regrows and penetrates the skin, leading to irritation and inflammation. While anyone who shaves can develop PFB, it is more prevalent and severe in individuals with naturally tightly coiled, coarse-textured hair.^1,2 Pseudofolliculitis barbae is common in individuals who shave frequently due to personal choice or profession, such as members of the US military^3,4 and firefighters, who are required to remain clean shaven for safety (eg, ensuring proper fit of a respirator mask).⁵ Early diagnosis and treatment of PFB are essential to prevent long-term complications such as scarring or hyperpigmentation, which may be more severe in those with darker skin tones.

Epidemiology

Pseudofolliculitis barbae is most common in Black men, affecting 45% to 83% of men of African ancestry.^1,2 This condition also can affect individuals of various ethnicities with coarse or curly hair. The spiral shape of the hair increases the likelihood that it will regrow into the skin after shaving.⁶ Women with hirsutism who shave also can develop PFB.

Key Clinical Features

The papules and pustules seen in PFB may be flesh colored, erythematous, hyperpigmented, brown, or violaceous. Erythema may be less pronounced in darker vs lighter skin tones. Persistent and severe postinflammatory hyperpigmentation may occur, and hypertrophic or keloidal scars may develop in affected areas. Dermoscopy may reveal extrafollicular hair penetration as well as follicular or perifollicular pustules accompanied by hyperkeratosis.

Worth Noting

The most effective management for PFB is to discontinue shaving.¹ If shaving is desired or necessary, it is recommended that patients apply lukewarm water to the affected area followed by a generous amount of shaving foam or gel to create a protective antifriction layer that allows the razor to glide more smoothly over the skin and reduces subsequent irritation.² Using the right razor technology also may help alleviate symptoms. Research has shown that multiblade razors used in conjunction with preshave hair hydration and postshave moisturization do not worsen PFB.² A recent study found that multiblade razor technology paired with use of a shave foam or gel actually improved skin appearance in patients with PFB.⁷

It is important to direct patients to shave in the direction of hair growth; however, this may not be possible for individuals with curly or coarse hair, as the hair may grow in many directions.^8,9 Patients also should avoid pulling the skin taut while shaving, as doing so allows the hair to be clipped below the surface, where it can repenetrate the skin and cause further irritation. As an alternative to shaving with a razor, patients can use hair clippers to trim beard hair, which leaves behind stubble and interrupts the cycle of retracted hairs under the skin. Nd:YAG laser therapy has demonstrated efficacy in reduction of PFB papules and pustules.^9-12 Greater mean improvement in inflammatory papules and reduction in hair density was noted in participants who received Nd:YAG laser plus eflornithine compared with those who received the laser or eflornithine alone.¹¹ Patients should not pluck or dig into the skin to remove any ingrown hairs. If a tweezer is used, the patient should gently lift the tip of the ingrown hair with the tweezer to dislodge it from the skin and prevent plucking out the hair completely.

To help manage inflammation after shaving, topical treatments such as benzoyl peroxide 5%/clindamycin 1% gel can be used.^3,13 A low-potency steroid such as topical hydrocortisone 2.5% applied once or twice daily for up to 2 to 3 days may be helpful.^1,14 Adjunctive treatments including keratolytics (eg, topical retinoids, hydroxy acids) reduce perifollicular hyperkeratosis.^14,15 Agents containing alpha hydroxy acids (eg, glycolic acid) also can decrease the curvature of the hair itself by reducing the sulfhydryl bonds.⁶ If secondary bacterial infections occur, oral antibiotics (eg, doxycycline) may be necessary.

Health Disparity Highlight

Individuals with darker skin tones are at higher risk for PFB and associated complications. Limited access to dermatology services may further exacerbate these challenges. Individuals with PFB may not seek medical treatment until the condition becomes severe. Clinicians also may underestimate the severity of PFB—particularly in those with darker skin tones—based on erythema alone because it may be less pronounced in darker vs lighter skin tones.¹⁶

While permanent hair reduction with laser therapy is a treatment option for PFB, it may be inaccessible to some patients because it can be expensive and is coded as a cosmetic procedure. Additionally, patients may not have access to specialists who are experienced in performing the procedure in those with darker skin tones.⁹ Some patients also may not want to permanently reduce the amount of hair that grows in the beard area for personal or religious reasons.¹⁷

Pseudofolliculitis barbae also has been linked to professional disparities. One study found that members of the US Air Force who had medical shaving waivers experienced longer times to promotion than those with no waiver.¹⁸ Delays in promotion may be linked to perceptions of unprofessionalism, exclusion from high-profile duties, and concerns about career progression. While this delay was similar for individuals of all races, the majority of those in the waiver group were Black/African American. In 2021, 4 Black firefighters with PFB were unsuccessful in their bid to get a medical accommodation regarding a New York City Fire Department policy requiring them to be clean shaven where the oxygen mask seals against the skin.⁵ More research is needed on mask safety and efficiency relative to the length of facial hair. Accommodations or tailored masks for facial hair conditions also are necessary so individuals with PFB can meet job requirements while managing their condition.

Pseudofolliculitis barbae (PFB), also known as razor bumps, is a common inflammatory condition characterized by papules and pustules that typically appear in the beard and cheek regions. It occurs when shaved hair regrows and penetrates the skin, leading to irritation and inflammation. While anyone who shaves can develop PFB, it is more prevalent and severe in individuals with naturally tightly coiled, coarse-textured hair.^1,2 Pseudofolliculitis barbae is common in individuals who shave frequently due to personal choice or profession, such as members of the US military^3,4 and firefighters, who are required to remain clean shaven for safety (eg, ensuring proper fit of a respirator mask).⁵ Early diagnosis and treatment of PFB are essential to prevent long-term complications such as scarring or hyperpigmentation, which may be more severe in those with darker skin tones.

Epidemiology

Pseudofolliculitis barbae is most common in Black men, affecting 45% to 83% of men of African ancestry.^1,2 This condition also can affect individuals of various ethnicities with coarse or curly hair. The spiral shape of the hair increases the likelihood that it will regrow into the skin after shaving.⁶ Women with hirsutism who shave also can develop PFB.

Key Clinical Features

The papules and pustules seen in PFB may be flesh colored, erythematous, hyperpigmented, brown, or violaceous. Erythema may be less pronounced in darker vs lighter skin tones. Persistent and severe postinflammatory hyperpigmentation may occur, and hypertrophic or keloidal scars may develop in affected areas. Dermoscopy may reveal extrafollicular hair penetration as well as follicular or perifollicular pustules accompanied by hyperkeratosis.

Worth Noting

The most effective management for PFB is to discontinue shaving.¹ If shaving is desired or necessary, it is recommended that patients apply lukewarm water to the affected area followed by a generous amount of shaving foam or gel to create a protective antifriction layer that allows the razor to glide more smoothly over the skin and reduces subsequent irritation.² Using the right razor technology also may help alleviate symptoms. Research has shown that multiblade razors used in conjunction with preshave hair hydration and postshave moisturization do not worsen PFB.² A recent study found that multiblade razor technology paired with use of a shave foam or gel actually improved skin appearance in patients with PFB.⁷

It is important to direct patients to shave in the direction of hair growth; however, this may not be possible for individuals with curly or coarse hair, as the hair may grow in many directions.^8,9 Patients also should avoid pulling the skin taut while shaving, as doing so allows the hair to be clipped below the surface, where it can repenetrate the skin and cause further irritation. As an alternative to shaving with a razor, patients can use hair clippers to trim beard hair, which leaves behind stubble and interrupts the cycle of retracted hairs under the skin. Nd:YAG laser therapy has demonstrated efficacy in reduction of PFB papules and pustules.^9-12 Greater mean improvement in inflammatory papules and reduction in hair density was noted in participants who received Nd:YAG laser plus eflornithine compared with those who received the laser or eflornithine alone.¹¹ Patients should not pluck or dig into the skin to remove any ingrown hairs. If a tweezer is used, the patient should gently lift the tip of the ingrown hair with the tweezer to dislodge it from the skin and prevent plucking out the hair completely.

To help manage inflammation after shaving, topical treatments such as benzoyl peroxide 5%/clindamycin 1% gel can be used.^3,13 A low-potency steroid such as topical hydrocortisone 2.5% applied once or twice daily for up to 2 to 3 days may be helpful.^1,14 Adjunctive treatments including keratolytics (eg, topical retinoids, hydroxy acids) reduce perifollicular hyperkeratosis.^14,15 Agents containing alpha hydroxy acids (eg, glycolic acid) also can decrease the curvature of the hair itself by reducing the sulfhydryl bonds.⁶ If secondary bacterial infections occur, oral antibiotics (eg, doxycycline) may be necessary.

Health Disparity Highlight

Individuals with darker skin tones are at higher risk for PFB and associated complications. Limited access to dermatology services may further exacerbate these challenges. Individuals with PFB may not seek medical treatment until the condition becomes severe. Clinicians also may underestimate the severity of PFB—particularly in those with darker skin tones—based on erythema alone because it may be less pronounced in darker vs lighter skin tones.¹⁶

While permanent hair reduction with laser therapy is a treatment option for PFB, it may be inaccessible to some patients because it can be expensive and is coded as a cosmetic procedure. Additionally, patients may not have access to specialists who are experienced in performing the procedure in those with darker skin tones.⁹ Some patients also may not want to permanently reduce the amount of hair that grows in the beard area for personal or religious reasons.¹⁷

Pseudofolliculitis barbae also has been linked to professional disparities. One study found that members of the US Air Force who had medical shaving waivers experienced longer times to promotion than those with no waiver.¹⁸ Delays in promotion may be linked to perceptions of unprofessionalism, exclusion from high-profile duties, and concerns about career progression. While this delay was similar for individuals of all races, the majority of those in the waiver group were Black/African American. In 2021, 4 Black firefighters with PFB were unsuccessful in their bid to get a medical accommodation regarding a New York City Fire Department policy requiring them to be clean shaven where the oxygen mask seals against the skin.⁵ More research is needed on mask safety and efficiency relative to the length of facial hair. Accommodations or tailored masks for facial hair conditions also are necessary so individuals with PFB can meet job requirements while managing their condition.

To the Editor:

Alopecia areata (AA), an autoimmune disease characterized by inflammatory and nonscarring hair loss, can have a considerable impact on quality of life.¹ Baricitinib is a Janus kinase inhibitor that recently was approved by the US Food and Drug Administration for treatment of severe AA in adult patients, becoming the only on-label treatment available.² So far, the most common adverse effects reported in phase 3 trials have been acne, upper respiratory tract infections, headaches, urinary tract infections, and elevated creatine kinase levels.³

At our trichology unit in the dermatology department of a Spanish tertiary-care hospital in Seville, we have successfully used baricitinib to treat 18 patients with severe, therapy-resistant AA. Herein, we present a case of trichilemmal cyst reactivation in one of our patients following successful treatment with baricitinib.

A 53-year-old woman with a history of trichilemmal cysts presented to the dermatology department with total body hair loss of 5 years' duration that was diagnosed as AA universalis (Figure, A). The patient reported that the trichilemmal cysts had shrunk drastically 1 month after complete loss of body hair (Severity of Alopecia Tool [SALT] score, 100)(Figure, B). The largest cyst was surgically removed, and the diagnosis was histologically confirmed by a pathologist. Her mother and sister also had a history of multiple trichilemmal cysts.

The patient previously had failed treatment with oral prednisone 50 mg/d, oral cyclosporine 4 mg/kg/d, oral dexamethasone 4 mg twice weekly, and oral azathioprine 300 mg/wk. Due to the new indication of baricitinib for AA, we opted to start the patient on oral baricitinib 4 mg/d. By week 8 of treatment, she had achieved total hair regrowth (SALT score, 0). This rapid response might indicate a quick-responder phenotype, referring to a subset of patients who exhibit a fast and robust response to treatment (SALT90), generally before week 16, although more evidence is needed.

Notably, we observed the reactivation of 4 trichilemmal cysts on the scalp 6 weeks after starting baricitinib. To our knowledge, this side effect has not previously been reported. We hypothesize that reactivation of the cysts may have been due to the inhibition of the Janus kinase/signal transducer and activator of transcription pathway, which reduces the effects of cytokines and leads to reactivation of hair follicles that were inactive because of inflammation.⁴ As a result, the outer root sheath of the hair follicle can once again be filled with keratin, thereby reactivating the trichilemmal cysts. Based on our experience with this case, it may be relevant to consider personal and family history of trichilemmal cysts before starting treatment with baricitinib for AA and advise the patient about the possibility of this adverse effect.

To the Editor:

Alopecia areata (AA), an autoimmune disease characterized by inflammatory and nonscarring hair loss, can have a considerable impact on quality of life.¹ Baricitinib is a Janus kinase inhibitor that recently was approved by the US Food and Drug Administration for treatment of severe AA in adult patients, becoming the only on-label treatment available.² So far, the most common adverse effects reported in phase 3 trials have been acne, upper respiratory tract infections, headaches, urinary tract infections, and elevated creatine kinase levels.³

At our trichology unit in the dermatology department of a Spanish tertiary-care hospital in Seville, we have successfully used baricitinib to treat 18 patients with severe, therapy-resistant AA. Herein, we present a case of trichilemmal cyst reactivation in one of our patients following successful treatment with baricitinib.

A 53-year-old woman with a history of trichilemmal cysts presented to the dermatology department with total body hair loss of 5 years' duration that was diagnosed as AA universalis (Figure, A). The patient reported that the trichilemmal cysts had shrunk drastically 1 month after complete loss of body hair (Severity of Alopecia Tool [SALT] score, 100)(Figure, B). The largest cyst was surgically removed, and the diagnosis was histologically confirmed by a pathologist. Her mother and sister also had a history of multiple trichilemmal cysts.

The patient previously had failed treatment with oral prednisone 50 mg/d, oral cyclosporine 4 mg/kg/d, oral dexamethasone 4 mg twice weekly, and oral azathioprine 300 mg/wk. Due to the new indication of baricitinib for AA, we opted to start the patient on oral baricitinib 4 mg/d. By week 8 of treatment, she had achieved total hair regrowth (SALT score, 0). This rapid response might indicate a quick-responder phenotype, referring to a subset of patients who exhibit a fast and robust response to treatment (SALT90), generally before week 16, although more evidence is needed.

Notably, we observed the reactivation of 4 trichilemmal cysts on the scalp 6 weeks after starting baricitinib. To our knowledge, this side effect has not previously been reported. We hypothesize that reactivation of the cysts may have been due to the inhibition of the Janus kinase/signal transducer and activator of transcription pathway, which reduces the effects of cytokines and leads to reactivation of hair follicles that were inactive because of inflammation.⁴ As a result, the outer root sheath of the hair follicle can once again be filled with keratin, thereby reactivating the trichilemmal cysts. Based on our experience with this case, it may be relevant to consider personal and family history of trichilemmal cysts before starting treatment with baricitinib for AA and advise the patient about the possibility of this adverse effect.

To the Editor:

Alopecia areata (AA), an autoimmune disease characterized by inflammatory and nonscarring hair loss, can have a considerable impact on quality of life.¹ Baricitinib is a Janus kinase inhibitor that recently was approved by the US Food and Drug Administration for treatment of severe AA in adult patients, becoming the only on-label treatment available.² So far, the most common adverse effects reported in phase 3 trials have been acne, upper respiratory tract infections, headaches, urinary tract infections, and elevated creatine kinase levels.³

At our trichology unit in the dermatology department of a Spanish tertiary-care hospital in Seville, we have successfully used baricitinib to treat 18 patients with severe, therapy-resistant AA. Herein, we present a case of trichilemmal cyst reactivation in one of our patients following successful treatment with baricitinib.

A 53-year-old woman with a history of trichilemmal cysts presented to the dermatology department with total body hair loss of 5 years' duration that was diagnosed as AA universalis (Figure, A). The patient reported that the trichilemmal cysts had shrunk drastically 1 month after complete loss of body hair (Severity of Alopecia Tool [SALT] score, 100)(Figure, B). The largest cyst was surgically removed, and the diagnosis was histologically confirmed by a pathologist. Her mother and sister also had a history of multiple trichilemmal cysts.

The patient previously had failed treatment with oral prednisone 50 mg/d, oral cyclosporine 4 mg/kg/d, oral dexamethasone 4 mg twice weekly, and oral azathioprine 300 mg/wk. Due to the new indication of baricitinib for AA, we opted to start the patient on oral baricitinib 4 mg/d. By week 8 of treatment, she had achieved total hair regrowth (SALT score, 0). This rapid response might indicate a quick-responder phenotype, referring to a subset of patients who exhibit a fast and robust response to treatment (SALT90), generally before week 16, although more evidence is needed.

Notably, we observed the reactivation of 4 trichilemmal cysts on the scalp 6 weeks after starting baricitinib. To our knowledge, this side effect has not previously been reported. We hypothesize that reactivation of the cysts may have been due to the inhibition of the Janus kinase/signal transducer and activator of transcription pathway, which reduces the effects of cytokines and leads to reactivation of hair follicles that were inactive because of inflammation.⁴ As a result, the outer root sheath of the hair follicle can once again be filled with keratin, thereby reactivating the trichilemmal cysts. Based on our experience with this case, it may be relevant to consider personal and family history of trichilemmal cysts before starting treatment with baricitinib for AA and advise the patient about the possibility of this adverse effect.

Most medical students applying to dermatology residency programs in the United States will participate in an away rotation at an outside institution. Prior to COVID-19–related restrictions, 86.7% of dermatology applicants from the class of 2020 reported completing one or more away rotations for their application cycle.^1,2 This requirement can be considerably costly, especially since most programs do not offer financial support for travel, living expenses, or housing during these visiting experiences.³ Underrepresented in medicine (URiM) students may be particularly disadvantaged with regard to the financial obligations that come with away rotations.^4,5 Visiting scholarships for URiM students can mitigate these challenges, creating opportunities for increasing diversity in dermatology. When medical students begin the residency application process, the Visiting Student Learning Opportunities (VSLO) program of the Association of American Medical Colleges (AAMC) is the most widely used third-party service for submitting applications. For many URiM students, an unforeseen challenge when applying to dermatology residency programs is the lack of an easily accessible and up-to-date search tool to find programs that offer funding, resulting in more time spent searching and thereby complicating the application process. The VSLO released the Visiting Scholars Resources Database, a search tool that aims to compile opportunities for additional support—academic professional, and/or financial—to address this issue. Additionally, the Funded Away Rotations for Minority Medical Students (FARMS) database is an independent directory of programs that offer stipends to URiM students. In this study, we evaluated the efficacy of the VLSO’s Visiting Scholars Resources Database search tool and the FARMS database in identifying funded dermatology rotations for URiM students.

Overview of Online Search Tools

We used the AAMC’s Electronic Residency Application Service Directory to identify 141 programs offering dermatology residency positions. We then conducted a Google search using each program name with the phrase underrepresented in medicine dermatology away rotation to identify any opportunities noted in the Google results offering scholarship funding for URiM students. If there were no Google results for a webpage discussing URiM away rotation opportunities for a certain program, the individual program’s website search box was queried using the terms URiM, scholarship, and funding. If there were no relevant results, the webpages associated with the dermatology department, away rotations, and diversity and inclusion on the respective institution’s website were reviewed to confirm no indication of funded URiM opportunities. Of the 141 dermatology programs we evaluated, we identified 56 (39.7%) that offered funded away rotations for URiM students.

For comparison, we conducted a search of the VSLO’s Visiting Scholars Resources Database to identify programs that listed dermatology, all (specialties), or any (specialties) under the Specialty column that also had a financial resource for URiM students. Our search of the VSLO database yielded only 12 (21.4%) of the 56 funded away rotations we identified via our initial Google and program website search. Program listings tagged for dermatology also were retrieved from the FARMS database, of which only 17 (30.4%) of the 56 funded away rotations we previously identified were included. All queries were performed from October 24 to October 26, 2024 (Figure).

Comment

The 2023-2024 AAMC Report on Residents indicated that 54.9% (800/1455) of active US dermatology medical residents identified as White, 27.5% (400/1455) identified as Asian, 8.9% (129/1455) identified as Hispanic, and 8.7% (126/1455) identified as Black or African American.⁶ By comparison, 19.5% of the general US population identifies as Hispanic and 13.7% identifies as Black.⁷ Within the field of dermatology, the proportion of Black dermatology academic faculty in the US is estimated to comprise only 18.7% of all active Black dermatologists.^8,9 With a growing population of minority US citizens, the dermatology workforce is lagging in representation across all minority populations, especially when it comes to Hispanic and Black individuals. To increase the diversity of the US dermatology workforce, residency programs must prioritize recruitment of URiM students and support their retention as future faculty.

Reports in the literature suggest that clinical grades, US Medical Licensing Examination scores, letters of recommendation/ networking, and the risk of not matching are among the primary concerns that URiM students face as potential barriers to applying for dermatology residency.⁴ Meanwhile, dermatology program directors ranked diversity characteristics, perceived interest in the program, personal prior knowledge of an applicant, and audition rotation in their department as important considerations for interviewing applicants.¹⁰ As a result, URiM students may have the diverse characteristics that program directors are looking for, but obtaining away rotations and establishing mentors at other institutions may be challenging due to the burden of accruing additional costs for visiting rotations.^2,10,11 Other reports have indicated that expanding funded dermatology visiting rotations and promoting national programs such as the American Academy of Dermatology Diversity Mentorship Program (https://www.aad.org/member/career/awards/diversity) or the Skin of Color Society Observership Grant (https://skinofcolorsociety.org/what-we-do/mentorship/observership-grant) can be alternative routes for mentorship and networking.³

Our review demonstrated that, of the 141 dermatology residency programs we identified, only around 40% offer funded rotations for URiM students; however, the current databases that applicants use to find these opportunities do not adequately present the number of available options. A search of the VSLO database—the most widely used third-party database for applying to dermatology away rotations—yielded only 12 (21.4%) of the rotations that we identified in our initial Google search. Similarly, a search of the FARMS database yielded only 17 (30.4%) of the dermatology rotations we previously identified. Aside from missing more than half of the available funded dermatology away rotations, the search process was further complicated by the reliance of the 2 databases on user input rather than presenting all programs offering funded opportunities for dermatology applicants without the need to enter additional information. As of October 26, 2024, there were only 22 inputs for Visiting Scholars Resources across all specialties and programs in the VLSO system.

Our findings indicate a clear need for a reliable and accurate database that captures all funded dermatology rotations for prospective URiM applicants because of the strong emphasis on visiting rotations for application success. Our team created a Google spreadsheet compiling dermatology visiting student health equity and inclusion scholarships from inputs we found in our search. We shared this resource via the Association of Professors of Dermatology listserve so program members could verify the opportunities we compiled to create an accurate and updated resource for finding funded dermatology rotations. The program verification process was conducted by having residency program directors or their respective program coordinators mark “yes” on the spreadsheet to confirm the funded rotation is being offered by their program. Our spreadsheet will continue to be updated yearly through cooperation with participating programs to verify their funded electives and through partnership with the AAMC to include our database in their Visiting Students Resources Database that will be released each year within VLSO as applications open for the following season.

The main limitation of our review is that we presume the information provided in the VSLO and FARMS databases has not changed or been updated to include more programs since our initial search period. Additionally, the information available on dermatology residency program websites limits the data on the total programs obtained, as some website links may not be updated or may be invalid for online web user access. The benefit to creating and continually updating our Dermatology Visiting Student Health Equity and Inclusion Scholarship Database spreadsheet will be to ensure that programs regularly verify their offered funded electives and capture the true total of funded rotations offered for URiM students across the country. We also acknowledge that we did not investigate how URiM student attendance at funded rotations affected their outcomes in matching dermatology programs for residency; however, given the importance of away rotations, which positively influence the ability of URiM students to receive interviews, it is understood that these opportunities are viewed as widely beneficial.

Final Thoughts

The current online search tools that URiM students can use to find funded away rotations in dermatology exclude many of the available opportunities. We aimed to provide an updated and centralized resource for students via the shared spreadsheet we created for residency program directors, but further measures to centralize the most up-to-date information on visiting programs offering scholarships to URiM students would be beneficial.

Most medical students applying to dermatology residency programs in the United States will participate in an away rotation at an outside institution. Prior to COVID-19–related restrictions, 86.7% of dermatology applicants from the class of 2020 reported completing one or more away rotations for their application cycle.^1,2 This requirement can be considerably costly, especially since most programs do not offer financial support for travel, living expenses, or housing during these visiting experiences.³ Underrepresented in medicine (URiM) students may be particularly disadvantaged with regard to the financial obligations that come with away rotations.^4,5 Visiting scholarships for URiM students can mitigate these challenges, creating opportunities for increasing diversity in dermatology. When medical students begin the residency application process, the Visiting Student Learning Opportunities (VSLO) program of the Association of American Medical Colleges (AAMC) is the most widely used third-party service for submitting applications. For many URiM students, an unforeseen challenge when applying to dermatology residency programs is the lack of an easily accessible and up-to-date search tool to find programs that offer funding, resulting in more time spent searching and thereby complicating the application process. The VSLO released the Visiting Scholars Resources Database, a search tool that aims to compile opportunities for additional support—academic professional, and/or financial—to address this issue. Additionally, the Funded Away Rotations for Minority Medical Students (FARMS) database is an independent directory of programs that offer stipends to URiM students. In this study, we evaluated the efficacy of the VLSO’s Visiting Scholars Resources Database search tool and the FARMS database in identifying funded dermatology rotations for URiM students.

Overview of Online Search Tools

We used the AAMC’s Electronic Residency Application Service Directory to identify 141 programs offering dermatology residency positions. We then conducted a Google search using each program name with the phrase underrepresented in medicine dermatology away rotation to identify any opportunities noted in the Google results offering scholarship funding for URiM students. If there were no Google results for a webpage discussing URiM away rotation opportunities for a certain program, the individual program’s website search box was queried using the terms URiM, scholarship, and funding. If there were no relevant results, the webpages associated with the dermatology department, away rotations, and diversity and inclusion on the respective institution’s website were reviewed to confirm no indication of funded URiM opportunities. Of the 141 dermatology programs we evaluated, we identified 56 (39.7%) that offered funded away rotations for URiM students.

For comparison, we conducted a search of the VSLO’s Visiting Scholars Resources Database to identify programs that listed dermatology, all (specialties), or any (specialties) under the Specialty column that also had a financial resource for URiM students. Our search of the VSLO database yielded only 12 (21.4%) of the 56 funded away rotations we identified via our initial Google and program website search. Program listings tagged for dermatology also were retrieved from the FARMS database, of which only 17 (30.4%) of the 56 funded away rotations we previously identified were included. All queries were performed from October 24 to October 26, 2024 (Figure).

Comment

The 2023-2024 AAMC Report on Residents indicated that 54.9% (800/1455) of active US dermatology medical residents identified as White, 27.5% (400/1455) identified as Asian, 8.9% (129/1455) identified as Hispanic, and 8.7% (126/1455) identified as Black or African American.⁶ By comparison, 19.5% of the general US population identifies as Hispanic and 13.7% identifies as Black.⁷ Within the field of dermatology, the proportion of Black dermatology academic faculty in the US is estimated to comprise only 18.7% of all active Black dermatologists.^8,9 With a growing population of minority US citizens, the dermatology workforce is lagging in representation across all minority populations, especially when it comes to Hispanic and Black individuals. To increase the diversity of the US dermatology workforce, residency programs must prioritize recruitment of URiM students and support their retention as future faculty.

Reports in the literature suggest that clinical grades, US Medical Licensing Examination scores, letters of recommendation/ networking, and the risk of not matching are among the primary concerns that URiM students face as potential barriers to applying for dermatology residency.⁴ Meanwhile, dermatology program directors ranked diversity characteristics, perceived interest in the program, personal prior knowledge of an applicant, and audition rotation in their department as important considerations for interviewing applicants.¹⁰ As a result, URiM students may have the diverse characteristics that program directors are looking for, but obtaining away rotations and establishing mentors at other institutions may be challenging due to the burden of accruing additional costs for visiting rotations.^2,10,11 Other reports have indicated that expanding funded dermatology visiting rotations and promoting national programs such as the American Academy of Dermatology Diversity Mentorship Program (https://www.aad.org/member/career/awards/diversity) or the Skin of Color Society Observership Grant (https://skinofcolorsociety.org/what-we-do/mentorship/observership-grant) can be alternative routes for mentorship and networking.³

Our review demonstrated that, of the 141 dermatology residency programs we identified, only around 40% offer funded rotations for URiM students; however, the current databases that applicants use to find these opportunities do not adequately present the number of available options. A search of the VSLO database—the most widely used third-party database for applying to dermatology away rotations—yielded only 12 (21.4%) of the rotations that we identified in our initial Google search. Similarly, a search of the FARMS database yielded only 17 (30.4%) of the dermatology rotations we previously identified. Aside from missing more than half of the available funded dermatology away rotations, the search process was further complicated by the reliance of the 2 databases on user input rather than presenting all programs offering funded opportunities for dermatology applicants without the need to enter additional information. As of October 26, 2024, there were only 22 inputs for Visiting Scholars Resources across all specialties and programs in the VLSO system.

Our findings indicate a clear need for a reliable and accurate database that captures all funded dermatology rotations for prospective URiM applicants because of the strong emphasis on visiting rotations for application success. Our team created a Google spreadsheet compiling dermatology visiting student health equity and inclusion scholarships from inputs we found in our search. We shared this resource via the Association of Professors of Dermatology listserve so program members could verify the opportunities we compiled to create an accurate and updated resource for finding funded dermatology rotations. The program verification process was conducted by having residency program directors or their respective program coordinators mark “yes” on the spreadsheet to confirm the funded rotation is being offered by their program. Our spreadsheet will continue to be updated yearly through cooperation with participating programs to verify their funded electives and through partnership with the AAMC to include our database in their Visiting Students Resources Database that will be released each year within VLSO as applications open for the following season.

The main limitation of our review is that we presume the information provided in the VSLO and FARMS databases has not changed or been updated to include more programs since our initial search period. Additionally, the information available on dermatology residency program websites limits the data on the total programs obtained, as some website links may not be updated or may be invalid for online web user access. The benefit to creating and continually updating our Dermatology Visiting Student Health Equity and Inclusion Scholarship Database spreadsheet will be to ensure that programs regularly verify their offered funded electives and capture the true total of funded rotations offered for URiM students across the country. We also acknowledge that we did not investigate how URiM student attendance at funded rotations affected their outcomes in matching dermatology programs for residency; however, given the importance of away rotations, which positively influence the ability of URiM students to receive interviews, it is understood that these opportunities are viewed as widely beneficial.

Final Thoughts

The current online search tools that URiM students can use to find funded away rotations in dermatology exclude many of the available opportunities. We aimed to provide an updated and centralized resource for students via the shared spreadsheet we created for residency program directors, but further measures to centralize the most up-to-date information on visiting programs offering scholarships to URiM students would be beneficial.

Most medical students applying to dermatology residency programs in the United States will participate in an away rotation at an outside institution. Prior to COVID-19–related restrictions, 86.7% of dermatology applicants from the class of 2020 reported completing one or more away rotations for their application cycle.^1,2 This requirement can be considerably costly, especially since most programs do not offer financial support for travel, living expenses, or housing during these visiting experiences.³ Underrepresented in medicine (URiM) students may be particularly disadvantaged with regard to the financial obligations that come with away rotations.^4,5 Visiting scholarships for URiM students can mitigate these challenges, creating opportunities for increasing diversity in dermatology. When medical students begin the residency application process, the Visiting Student Learning Opportunities (VSLO) program of the Association of American Medical Colleges (AAMC) is the most widely used third-party service for submitting applications. For many URiM students, an unforeseen challenge when applying to dermatology residency programs is the lack of an easily accessible and up-to-date search tool to find programs that offer funding, resulting in more time spent searching and thereby complicating the application process. The VSLO released the Visiting Scholars Resources Database, a search tool that aims to compile opportunities for additional support—academic professional, and/or financial—to address this issue. Additionally, the Funded Away Rotations for Minority Medical Students (FARMS) database is an independent directory of programs that offer stipends to URiM students. In this study, we evaluated the efficacy of the VLSO’s Visiting Scholars Resources Database search tool and the FARMS database in identifying funded dermatology rotations for URiM students.

Overview of Online Search Tools

We used the AAMC’s Electronic Residency Application Service Directory to identify 141 programs offering dermatology residency positions. We then conducted a Google search using each program name with the phrase underrepresented in medicine dermatology away rotation to identify any opportunities noted in the Google results offering scholarship funding for URiM students. If there were no Google results for a webpage discussing URiM away rotation opportunities for a certain program, the individual program’s website search box was queried using the terms URiM, scholarship, and funding. If there were no relevant results, the webpages associated with the dermatology department, away rotations, and diversity and inclusion on the respective institution’s website were reviewed to confirm no indication of funded URiM opportunities. Of the 141 dermatology programs we evaluated, we identified 56 (39.7%) that offered funded away rotations for URiM students.

For comparison, we conducted a search of the VSLO’s Visiting Scholars Resources Database to identify programs that listed dermatology, all (specialties), or any (specialties) under the Specialty column that also had a financial resource for URiM students. Our search of the VSLO database yielded only 12 (21.4%) of the 56 funded away rotations we identified via our initial Google and program website search. Program listings tagged for dermatology also were retrieved from the FARMS database, of which only 17 (30.4%) of the 56 funded away rotations we previously identified were included. All queries were performed from October 24 to October 26, 2024 (Figure).

Comment

The 2023-2024 AAMC Report on Residents indicated that 54.9% (800/1455) of active US dermatology medical residents identified as White, 27.5% (400/1455) identified as Asian, 8.9% (129/1455) identified as Hispanic, and 8.7% (126/1455) identified as Black or African American.⁶ By comparison, 19.5% of the general US population identifies as Hispanic and 13.7% identifies as Black.⁷ Within the field of dermatology, the proportion of Black dermatology academic faculty in the US is estimated to comprise only 18.7% of all active Black dermatologists.^8,9 With a growing population of minority US citizens, the dermatology workforce is lagging in representation across all minority populations, especially when it comes to Hispanic and Black individuals. To increase the diversity of the US dermatology workforce, residency programs must prioritize recruitment of URiM students and support their retention as future faculty.

Reports in the literature suggest that clinical grades, US Medical Licensing Examination scores, letters of recommendation/ networking, and the risk of not matching are among the primary concerns that URiM students face as potential barriers to applying for dermatology residency.⁴ Meanwhile, dermatology program directors ranked diversity characteristics, perceived interest in the program, personal prior knowledge of an applicant, and audition rotation in their department as important considerations for interviewing applicants.¹⁰ As a result, URiM students may have the diverse characteristics that program directors are looking for, but obtaining away rotations and establishing mentors at other institutions may be challenging due to the burden of accruing additional costs for visiting rotations.^2,10,11 Other reports have indicated that expanding funded dermatology visiting rotations and promoting national programs such as the American Academy of Dermatology Diversity Mentorship Program (https://www.aad.org/member/career/awards/diversity) or the Skin of Color Society Observership Grant (https://skinofcolorsociety.org/what-we-do/mentorship/observership-grant) can be alternative routes for mentorship and networking.³

Our review demonstrated that, of the 141 dermatology residency programs we identified, only around 40% offer funded rotations for URiM students; however, the current databases that applicants use to find these opportunities do not adequately present the number of available options. A search of the VSLO database—the most widely used third-party database for applying to dermatology away rotations—yielded only 12 (21.4%) of the rotations that we identified in our initial Google search. Similarly, a search of the FARMS database yielded only 17 (30.4%) of the dermatology rotations we previously identified. Aside from missing more than half of the available funded dermatology away rotations, the search process was further complicated by the reliance of the 2 databases on user input rather than presenting all programs offering funded opportunities for dermatology applicants without the need to enter additional information. As of October 26, 2024, there were only 22 inputs for Visiting Scholars Resources across all specialties and programs in the VLSO system.

Our findings indicate a clear need for a reliable and accurate database that captures all funded dermatology rotations for prospective URiM applicants because of the strong emphasis on visiting rotations for application success. Our team created a Google spreadsheet compiling dermatology visiting student health equity and inclusion scholarships from inputs we found in our search. We shared this resource via the Association of Professors of Dermatology listserve so program members could verify the opportunities we compiled to create an accurate and updated resource for finding funded dermatology rotations. The program verification process was conducted by having residency program directors or their respective program coordinators mark “yes” on the spreadsheet to confirm the funded rotation is being offered by their program. Our spreadsheet will continue to be updated yearly through cooperation with participating programs to verify their funded electives and through partnership with the AAMC to include our database in their Visiting Students Resources Database that will be released each year within VLSO as applications open for the following season.

The main limitation of our review is that we presume the information provided in the VSLO and FARMS databases has not changed or been updated to include more programs since our initial search period. Additionally, the information available on dermatology residency program websites limits the data on the total programs obtained, as some website links may not be updated or may be invalid for online web user access. The benefit to creating and continually updating our Dermatology Visiting Student Health Equity and Inclusion Scholarship Database spreadsheet will be to ensure that programs regularly verify their offered funded electives and capture the true total of funded rotations offered for URiM students across the country. We also acknowledge that we did not investigate how URiM student attendance at funded rotations affected their outcomes in matching dermatology programs for residency; however, given the importance of away rotations, which positively influence the ability of URiM students to receive interviews, it is understood that these opportunities are viewed as widely beneficial.

Final Thoughts

The current online search tools that URiM students can use to find funded away rotations in dermatology exclude many of the available opportunities. We aimed to provide an updated and centralized resource for students via the shared spreadsheet we created for residency program directors, but further measures to centralize the most up-to-date information on visiting programs offering scholarships to URiM students would be beneficial.