Multidisciplinary Dermatology: A Framework from the Association of Academic Cosmetic Dermatology

J Clin Aesthet Dermatol. 2025;18(6):18–21.

by Alexandra Richmond, MD, MSCR; Lucia Ray, BA; Kevin Truong-Balderas, BS; Neelam Vashi, MD; Travis Blalock, MD; Maria Hordinsky, MD; Arisa Ortiz, MD; Kristen M. Kelly, MD; Elika Hoss, MD; Melissa L. Shive, MD, MPH; Rawaa Almukhtar, MD, MPH; Stephanie R. Jackson Cullison, MD, PhD, MS; Bianca Y. Kang, MD; Yakir Levin, MD, PhD; Saranya P. Wyles, MD, PhD; and Murad Alam, MD, MBA, MSCI

Dr. Richmond is with the Department of Dermatology and Dermatologic Surgery at the Medical University of South Carolina in Charleston, South Carolina. Ms. Ray is with the University of Minnesota Medical School in Minneapolis, Minnesota. Mr. Truong-Balderas is with Rush Medical College at Rush University Medical Center in Chicago, Illinois. Dr. Vashi is with the Boston University School of Medicine in Boston, Massachusetts. Dr. Blalock is with the Department of Dermatology at Emory University School of Medicine in Atlanta, Georgia. Dr. Hordinsky is with the Department of Dermatology and Dermatologic Surgery at the University of Minnesota Medical School in Minneapolis, Minnesota. Dr. Ortiz is with the Department of Dermatology at the University of California San Diego Health in San Diego, California. Drs. Kelly and Shive are with the Department of Dermatology at the University of California Irvine in Irvine, California. Dr. Hoss is with the Department of Dermatology at the Mayo Clinic in Phoenix, Arizona. Dr. Almukhtar is with the Department of Dermatology at the Scripps Clinic in La Jolla, California. Dr. Jackson Cullison is with the Department of Dermatology at the Thomas Jefferson University Sidney Kimmel Medical College in Philadelphia, Pennsylvania. Dr. Kang is with the Department of Dermatology at the Mayo Clinic in Scottsdale, Arizona. Dr. Levin is with the Department of Dermatology and Wellman Center for Photomedicine at the Massachusetts General Hospital at Harvard Medical School in Boston, Massachusetts. Dr. Wyles is with the Department of Dermatology at the Mayo Clinic in Rochester, Minnesota and the Center for Regenerative Biotherapeutics at the Mayo Clinic in Rochester, Minnesota. Dr. Alam is with the Department of Dermatology at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois; the Department of Surgery at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois; the Department of Otolaryngology at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois; and the Department of Medical Social Sciences at the Feinberg School of Medicine at Northwestern University in Chicago, Illinois.

FUNDING: No funding was provided for this article.

DISCLOSURES: Dr. Kelly reports receiving funding for research and equipment from Lutronic and Michaelson Diagnostics; research funding from Biophotas and FDZJ; equipment clinic from Scion, and serving as a consultant to Primus Pharmaceuticals. The remaining authors have no conflicts of interest to disclose.

Abstract: Cross-specialty collaboration can be helpful in the treatment of patients with complex medical conditions involving dermatologic manifestations. This article underscores the utility of multidisciplinary collaboration through discussion of seven hypothetical case scenarios, including patient care in the clinical contexts of hidradenitis suppurativa, venous varicosities, scleroderma, gender-affirming care, sequelae from cancer, solid organ transplantation, and neurocutaneous syndromes. Through these cases, we highlight how a holistic healthcare approach that encompasses multiple specialties can positively contribute to dermatologic patient care. Keywords: Multidisciplinary collaboration, medical dermatology, restorative dermatology, complex patient care, interdisciplinary communication, resident education, holistic healthcare

Introduction

Multidisciplinary collaboration across surgical and medical specialties offers patients a comprehensive and streamlined approach to their healthcare needs, especially in the context of restorative dermatology.^1,2 By leveraging the Association of Academic Cosmetic Dermatology (AACD) mission, which aims to enhance dermatology residents’ education, optimize clinical services, support faculty development, and provide unbiased patient education, we create a clear purpose for this collaborative effort. Through cross-specialty collaboration, patients can receive a holistic assessment and individualized tailored plan with appropriate optimally coordinated follow-up.

A multispecialty clinic for treating complex medical conditions with significant dermatologic manifestations is also beneficial to physicians. Creating relationships between departments allows for improved communication and rapport for referrals, facilitating care management with complex patients.³ Residents also benefit by observing complex patient cases and procedures that they may not otherwise encounter in residency training.⁴ In addition, the collaboration between departments creates opportunities for teaching, research, as well as shared expenses for devices and other consumables, aligning with the AACD’s commitment to advancing the field through innovative practices.

Despite these advantages, certain considerations should be addressed prior to establishing multidisciplinary care teams. Given potential overlap in scope of practice between specialties, clear roles must be defined. This is especially true in procedural subspecialties with shared resources such as light and energy-based devices.⁵ In continuity clinics, reimbursement must also be addressed to ensure departments are appropriately compensated for their time and use of resources. Within larger hospital systems, proximity between departments poses hurdles for multispecialty clinics and shared revenue models. In these situations, virtual conferences or boards can provide a more practical platform to discuss complex patients.

Herein, we highlight the importance of multidisciplinary collaboration through hypothetical case scenarios in dermatology. It is crucial to avoid drawing arbitrary lines that suggest certain specialties cannot perform specific tasks or prescribe medications, as multiple specialties often have overlapping roles. As such, these cases represent a single approach in which multidisciplinary patient care can be implemented; however, they are not limited to the following index patient care scenarios.

Hidradenitis suppurativa

A 15-year-old African-American female presents to an outpatient pediatric dermatology clinic for newly diagnosed Hurley Stage 2 hidradenitis suppurativa (HS). This patient’s condition can be managed using a multidisciplinary approach involving specialists from pediatric dermatology, family medicine, obstetrics and gynecology (OB-GYN), plastic surgery, endocrinology, pain management, and psychiatry. The pediatric dermatology team can offer several interventions, including topical or systemic antibiotics, systemic immunomodulatory medications, intralesional corticosteroid injections, radiofrequency microneedling, and/or carbon dioxide (CO₂) laser therapy for advanced wound and scar management.⁶ Laser hair removal and deroofing procedures can also be utilized to reduce the incidence of new lesions and remove affected tissue, respectively. Neurotoxin injection with botulinum toxin can be considered to reduce hyperhidrosis and subsequent flares.⁷

Colleagues in family medicine and OB-GYN can help to manage lifestyle changes to achieve a healthy weight as well as oral contraceptives for hormonal management. If extensive scarring and sinus tracts are not responsive to conventional treatments, a plastic surgery consultation can be pursued. Endocrinological assessments can aim to identify and manage hormonal imbalances contributing to disease pathogenesis. Pain management specialists may also be engaged to assess the patient’s pain severity with advanced control methods. Lastly, colleagues in behavioral health or psychiatry can help support the patient through the psychosocial impact of HS, such as addressing feelings of low self-esteem, an increased incidence of developing depression and anxiety, and developing coping strategies through therapy sessions.⁸ Coordination of care for patients with HS can occur through interdisciplinary conferences including patient providers from multiple specialties.

Venous varicosities

A 55-year-old female with a history of hypertension and diabetes mellitus presents to dermatology for cosmetic treatment of her spider veins. Through screening questions, she is found to also have symptoms of venous reflux and describes swelling and discomfort while ambulating and a bothersome appearance. Through a multidisciplinary approach, she can be counseled on lifestyle modifications as well as surgical and nonsurgical therapeutic options. Discussions can first focus on symptom control and at-home therapy including compression stockings, leg elevation, and exercise. Vascular surgery, interventional cardiology, and/or interventional radiology can treat this patient’s venous reflux through minimally invasive procedures such as endovenous laser or radiofrequency ablation.^9,10 The dermatologist team can later offer sclerotherapy for aesthetics.¹¹ Having a comprehensive discussion can allow the patient to make the best decision for herself based on her comfort level and concerns. In addition to treatment options, colleagues in the medicine department can optimize the patient’s management of comorbidities. Interdisciplinary care for patients with venous varicosities can be streamlined through the use of integrated electronic medical record order sets including considerations from multiple specialties.

Scleroderma

A 40-year-old female with a history of newly diagnosed scleroderma presents to establish care. Given the complex and heterogeneous nature of this disease, a comprehensive approach involving multiple specialties is necessary. Colleagues in rheumatology can partner with dermatology to oversee her care including monitoring medications, labs, and signs of disease progression. In addition to medical therapy, the dermatology team can offer a variety of procedural therapies including neuromodulators, hyaluronic filler, and/or hyaluronidase for oral incompetence, laser treatment for telangiectasia and dyspigmentation, or excision of calcium deposits.^12,13 Depending on her symptoms and disease progression, the internal medicine subspecialties can assist with evaluation and management. Similarly, physical therapy can work with her to improve overall mobility. Lastly, it is important to offer psychiatry or behavioral health to ensure she is coping with her disease.¹⁴ Dermatologists can play a role in coordinating multidisciplinary care by advocating for joint rheumatology-dermatology comprehensive conferences to present cases of scleroderma.

Gender-affirming care

A 24-year-old transgender male presents to establish gender-affirming-care after moving to the area after college. He had started hormone therapy with his previous provider but would like to consider additional gender-affirming medical treatments at present. Collaboration with experts in various subspecialties can help to deliver comprehensive quality care. Dermatologists can provide treatments to help align gender identity and gender expression, including laser hair removal and soft tissue augmentation.¹⁵ Additionally, the dermatology team can manage a range of skin-related effects of gender-affirming therapies, including acne vulgaris, androgenetic alopecia, and scar management following surgery.¹⁶ Colleagues in plastic surgery and urology can also offer additional surgical procedure options, including gender affirming facial and top surgery and phalloplasty. The patient’s hormone therapy can be continued by family medicine or endocrinology, who may also be consulted along with OB-GYN on fertility preservation and reproductive health counseling, if desired by the patient. Patients may also benefit from consultation with a speech therapist if they seek to alter aspects of their voice to better match their gender identity. Mental health providers should also be an integral part of the multidisciplinary care team for patients undergoing gender-affirming care, as they can help provide counseling and ensure patients have a strong support network. Patients receiving gender-affirming care may benefit from interdisciplinary conferences including providers from multiple specialties to more effectively coordinate their care.

Sequelae from cancer

A 55-year-old female who recently started radiation therapy for breast cancer presents to the dermatology clinic with concerns about the impacts of her treatments on her skin, nails, and hair. While oncology and radiology specialists will primarily manage the patient’s breast cancer treatment plan, many other specialists can help to manage the sequelae of cancer treatments.¹⁷ Dermatologists can advise patients on skin care during chemotherapy and radiation, as well as help to manage cutaneous side effects of medications and radiation therapy.¹⁸ Additionally, dermatologists can offer recommendations for prevention and treatment of hair loss experienced as a side effect of chemotherapy.¹⁹ After completion of breast cancer therapy, dermatologists can offer laser tattoo removal for radiation tattoos or laser or surgical scar revision. Plastic surgeons may also be consulted for surgical treatment and reconstruction. To address additional effects of breast cancer treatment, the collaborative care team may include pain management specialists, nutritionists, and mental health providers. An integrative health expert may also be helpful in providing guidance on diet, appropriate supplements, and encouraging exercise to support the patient’s overall well-being and recovery. Patients with cancer can benefit from providers from multiple specialties participating in their tumor board, helping to create their treatment plan from a more holistic perspective.

Solid organ transplantation

A 55-year-old male presents for the treatment of warts following a recent kidney transplant. A multidisciplinary approach is essential to ensure all aspects of his care are addressed. The transplant medicine team can oversee his immunosuppressive medications and monitor for signs of rejection. Given the immunosuppression, infectious diseases physicians can monitor for signs of infection and ensure he is up-to-date on necessary medications. Additionally, the immunosuppression places him at a higher risk for non-melanoma skin cancer.²⁰ The dermatology team offers support through regular skin surveillance, use of field therapy to deter progression of premalignant lesions, and management of comorbid conditions such as warts and onychomycosis.²¹ Should skin malignancies arise, having a multidisciplinary team will ensure he is properly treated. The transplant team can offer dose adjustments or alternatives to his immunosuppressive regimen to prevent additional malignancies, while dermatology can work alongside medical oncology, radiology, radiation oncology, and surgical specialty colleagues to determine the best treatment plan. Collaborating with integrative health experts will allow for patient assistance with diet, supplements, if appropriate, physical exercise, and stress management techniques, alongside conventional medical treatments. Lastly, during the transplant process, it is important he works with physiatry, behavioral health, and social workers to coordinate his care, create a support network, and learn coping strategies for management. Given the medical complexity of care for patients with a history of solid organ transplantation, these patients can benefit from interdisciplinary care conferences or grand rounds including multiple disciplines.

Neurocutaneous syndromes

A three-month-old presents with a port-wine birthmark determined to be part of the sequelae of Sturge-Weber Syndrome. Given this neurocutaneous syndrome impacts many different body systems, a multidisciplinary approach to treatment is crucial. It is important to involve pediatric neurology in this patient’s care, given the associated neurological abnormalities.²² Patients can also benefit from evaluation by pediatric ophthalmology given the possibility of ocular pathology in Sturge-Weber Syndrome.²² Dermatologists should be consulted to determine the best treatment for port-wine birthmarks and begin early treatment with light-based devices such as pulsed dye laser.²³ Pediatric anesthesia may need to be involved if it is determined that sedation is needed for treatment of port-wine birthmarks.²³ Patients can also benefit from involvement of mental health professionals as they grow older given the psychosocial consequences of Sturge-Weber Syndrome.²³ Dermatologists can facilitate the care of patients with neurocutaneous syndromes such as Sturge-Weber Syndrome by organizing interdisciplinary conferences, allowing for a more comprehensive approach to each patient’s case.

Conclusion

By integrating the expertise of multispecialty care, complex medical patients seen in dermatologic clinics are afforded a holistic healthcare approach that targets specific medical needs and addresses the psychological and lifestyle aspects critical to long-term well-being. Consulting with multiple specialists can feel overwhelming for some patients. To reduce patients’ stress and anxiety, effective communication, and coordination among providers within the multidisciplinary team are essential in simplifying this complexity. Streamlined communication ensures that patient care is comprehensive and cohesive. This collaboration enhances patients’ understanding and comfort with their treatment plans, fostering professional development among healthcare providers through interdepartmental learning and shared research opportunities. While challenges such as logistical care coordination and clear role delineation exist, structured collaborative protocols and virtual platforms can mitigate these obstacles, making multidisciplinary care a feasible and highly beneficial strategy for medical dermatology patients.

In addition to building relationships between departments, it is important to create relationships with institutional leadership to highlight the value of each department. Participation in hospital committees and leadership positions can help to establish standards for your hospital and the broader community by solidifying expertise.

The diverse case scenarios outlined in this article underscore this approach’s adaptability and extensive application, reinforcing its significance in the advancement of modern medicine. By continuing to promote and refine multidisciplinary collaboration, we can significantly improve patient care efficiency and the overall healthcare landscape that starts in our dermatology clinic. The mission of the AACD is to enhance dermatology residents’ education in cosmetic and laser dermatology, optimize clinical cosmetic services in academic settings, support the professional development of cosmetic dermatology faculty, and educate patients with unbiased, scientifically valid information on cosmetic procedures. The AACD perspective, which provides a clear purpose and direction, highlights why this multidisciplinary approach is uniquely effective. Through this lens, we discuss a comprehensive, patient-centered care model that not only addresses complex dermatologic conditions but also advances the field through innovative practices and collaborative care strategies.

References

1. Long V, Choi EC, Tan CL. Supportive oncodermatology—a narrative review of its utility and the way forward. Support Care Cancer. 2021;29(9):4931–4937.
2. Patel A, Jafferany M. Multidisciplinary and holistic models of care for patients with dermatologic disease and psychosocial comorbidity: A systematic review. JAMA Dermatol. 2020;156(6):686–694.
3. Aggarwal S, Sharma A, Sharma R. Seeking better inter-departmental cooperation in healthcare settings. Indian J Med Ethics. 2010; 7(3):180.
4. Teheux L, Wollaars H, Draaisma JMT, et al. Learning for doctor-to-doctor collaboration: a qualitative study exploring the experiences of residents and supervisors with intraprofessional workplace learning in complex tertiary care. BMC Med Educ. 2023;23(1):478.
5. The American Society for Laser Medicine and Surgery, Inc. Specialty laser and energy-based device use. Accessed 7 Jul 2024. https://www.aslms.org/for-the-public/specialty-laser-and-energy-based-device-use.
6. Lyons AB, Townsend SM, Turk D, et al. Laser and light-based treatment modalities for the management of hidradenitis suppurativa. Am J Clin Dermatol. 2020;21(2):237–243.
7. Shih T, Lee K, Seivright JR, et al. Hyperhidrosis treatments in hidradenitis suppurativa: A systematic review. Dermatol Ther. 2022;35(1):e15210.
8. Kouris A, Platsidaki E, Christodoulou C, et al. Quality of life and psychosocial implications in patients with hidradenitis suppurativa. Dermatology. 2016;232(6):687–691.
9. Yao PY, Mukhdomi T. Varicose vein treatment: endovenous laser therapy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Updated 18 May 2023. Accessed 7 Jul 2024. https://www.ncbi.nlm.nih.gov/books/NBK556120/
10. Chokkalingam Mani B, Delgado GA. Varicose vein treatment: radiofrequency ablation therapy. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Updated 26 Sept 2022. Accessed 7 Jul 2024. http://www.ncbi.nlm.nih.gov/books/NBK556120/.
11. de Ávila Oliveira R, Riera R, Vasconcelos V, et al. Injection sclerotherapy for varicose veins. Cochrane Database Syst Rev. 2021;12(12):CD001732.
12. Zhu JL, Black SM, Chen HW, et al. Emerging treatments for scleroderma/systemic sclerosis. Fac Rev. 2021;10:43.
13. Pieretti G, Rafaniello C, Fraenza F, et al. Hyaluronic acid‐based fillers in patients with autoimmune inflammatory diseases. J Cosmet Dermatol. 2023;22(9):2420–2423.
14. Angelopoulos NV, Drosos AA, Moutsopoulos HM. Psychiatric symptoms associated with scleroderma. Psychother Psychosom. 2001;70(3):145–150.
15. Fruechte S, Farah R, Wendland Z, et al. Considerations to best serve transgender patients seeking aesthetic care. Dermatol Times. 2023;44(6):28–29.
16. Huang C, Gold S, Radi R, et al. Managing dermatologic effects of gender-affirming therapy in transgender adolescents. Adolesc Health Med Ther. 2022;13:93–106.
17. Shao J, Rodrigues M, Corter AL, et al. Multidisciplinary care of breast cancer patients: a scoping review of multidisciplinary styles, processes, and outcomes. Curr Oncol. 2019;26(3):e385–e397.
18. Milam EC, Rangel LK, Pomeranz MK. Dermatologic sequelae of breast cancer: from disease, surgery, and radiation. Int J Dermatol. 2021;60(4):394–406.
19. Wikramanayake TC, Haberland NI, Akhundlu A, et al. Prevention and treatment of chemotherapy-induced alopecia: what is available and what is coming? Curr Oncol. 2023;30(4):3609–3626.
20. Gibson JAG, Cordaro A, Dobbs TD, et al. The association between immunosuppression and skin cancer in solid organ transplant recipients: a control-matched cohort study of 2,852 patients. Eur J Dermatol. 2021;31(6):712–721.
21. Miotto IZ, Festa Neto C, De Oliveira WRP. Cutaneous infections from viral sources in solid organ transplant recipients. Transpl Immunol. 2023;78:101838.
22. Sabeti S, Ball KL, Bhattacharya SK, et al. Consensus statement for the management and treatment of Sturge-Weber Syndrome: neurology, neuroimaging, and ophthalmology recommendations. Pediatr Neurol. 2021;121:59–66.
23. Sabeti S, Ball KL, Burkhart C, et al. Consensus statement for the management and treatment of port-wine birthmarks in Sturge-Weber Syndrome. JAMA Dermatol. 2021;157(1):98–104.