Dermatology in the Black barbershop: A potential opportunity for expanding access and bridging gaps
Authors: Uchenna K. Okoji, Jules B. Lipoff
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: The barbershop, a place of refuge for Black men, is an archetypal safe Black space, where patrons can be vulnerable, seek counsel, and speak freely while attending to grooming needs. Research has established barbershops, historically common sites for medical practice such as bloodletting and cauterization during the Middle Ages, as culturally appropriate venues for education, training, and screening to address health disparities.1Luque J.S. Ross L. Gwede C.K. Qualitative systematic review of barber-administered health education, promotion, screening and outreach programs in African-American communities.J Community Health. 2014; 39: 181-190Crossref PubMed Scopus (78) Google Scholar While studies have examined cardiovascular health, prostate cancer, and diabetes, few have considered the barbershop for expansion of dermatologic care access (eg, salons as clinical sites for skin cancer screening).2Adotama P. Tinker D. Mitchell K. et al.Barber knowledge and recommendations regarding pseudofolliculitis barbae and acne keloidalis nuchae in an urban setting.JAMA Dermatol. 2017; 153: 1325-1326Crossref PubMed Scopus (9) Google Scholar,3Turrisi R. Gunn H. Hultgren B. et al.The style project: feasibility of collaborating with salons for prevention and early detection of skin cancer.Arch Dermatol. 2012; 148: 1206-1207Crossref PubMed Scopus (7) Google Scholar The limited data on dermatologic health disparities suggest that people of color have worse health outcomes and less outpatient care compared with White patients.4Tripathi R. Knusel K.D. Ezaldein H.H. et al.Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States.JAMA Dermatol. 2018; 154: 1286-1291Crossref PubMed Scopus (86) Google Scholar Certainly, the cause is multifactorial, including access to care. We propose that bringing dermatology to the barbershop could bridge access gaps and open opportunities for better care for this population. Given the recent extra attention and widespread calls for action against racism and social injustice, this moment represents an auspicious time to push for changes toward health equity, at the very least, small incremental ones. Many Black men visit barbershops frequently—weekly or biweekly. This consistency lends itself to longitudinal data collection. Possible interventions include (1) providing educational material to barbers and patrons on conditions disproportionately affecting Black men (eg, pseudofolliculitis barbae and acne keloidalis nuchae), (2) educating barbers to identify common conditions (eg, atopic dermatitis, acne vulgaris, and androgenic alopecia), (3) establishing referral services between barbers and dermatologists specializing in skin of color, and (4) developing "in-house" dermatology services in barbershops during peak times. Barbershop-centered interventions would not only increase awareness of dermatology in this community, but also could improve the comfort and access to medical care by providing services at a familiar location outside of a traditional medical office. Communities of color are well known to have higher levels of health care system distrust,5Armstrong K. McMurphy S. Dean L.T. et al.Differences in the patterns of health care system distrust between blacks and whites.J Gen Intern Med. 2008; 23: 827-833Crossref PubMed Scopus (213) Google Scholar so such community collaboration could be helpful in establishing better connections. Further, this education could dispel myths and inaccuracies about skin conditions and care perpetuated by media and folklore. For instance, Adotama et al2Adotama P. Tinker D. Mitchell K. et al.Barber knowledge and recommendations regarding pseudofolliculitis barbae and acne keloidalis nuchae in an urban setting.JAMA Dermatol. 2017; 153: 1325-1326Crossref PubMed Scopus (9) Google Scholar found that although most barbers could correctly identify pseudofolliculitis barbae, their ideas about treatment varied considerably. Consistent, evidence-based education could close knowledge gaps. With coronavirus disease 2019 (COVID-19), engagement with barbershops must proceed cautiously and when appropriate. Still, bringing dermatology to barbershops could build trust, when done culturally appropriately, and especially if led by dermatologists connected to the communities. It is important that these activities are driven by these physicians with built-in community ties and personal buy-in, but the burden of caring for these underserved populations should not alone rest on dermatologists of color, who constitute a small fraction of the workforce. True systemic change will depend on continued support and commitment from dermatology organizations and the dermatology workforce at large to push for greater awareness and resources to better center care for patients of color. We encourage establishing these forward-thinking interventions as active approaches towards greater patient diversity and inclusivity, making clear that all are welcome.