Kritin K. Verma

Dermatology is one of the most interdisciplinary specialties in medicine, yet the pathways through which physicians may enter dermatologic practice are not always clearly defined for trainees. Although dermatology residency remains the primary route to board certification, alternative pathways allow physicians from other specialties to participate in dermatologic care. These include fellowships and training opportunities in dermatopathology, pediatric dermatology, cosmetic dermatologic surgery, micrographic surgery and dermatologic oncology, and community-based dermatology fellowships for physicians trained in family medicine or internal medicine. This review outlines the major residency and fellowship routes that lead to dermatologic practice in the United States and highlights the evolving interdisciplinary structure of the dermatology workforce. The growing role of primary care providers in dermatologic care is also highlighted alongside emerging training opportunities to expand access while maintaining quality. While alternative pathways offer opportunities to expand access to dermatologic care and foster collaboration across specialties, they also present limitations related to variability in training exposure, procedural experience, and standardization of curriculum. Understanding these pathways is important for medical students, residents, and educators seeking to navigate career planning within dermatology and related specialties. A comprehensive overview of these routes may improve transparency in dermatology training and support a more collaborative, multidisciplinary approach to skin health.

Vitiligo is a chronic depigmentary disorder affecting 0.5% to 2% of the population, caused by autoimmune destruction of melanocytes. Nondermatology clinicians, such as physical therapists, occupational therapists, chiropractors, and dentists, frequently observe patients' skin and are well positioned to detect early lesions on the face, extremities, trunk, and back. Early recognition is important due to associations with autoimmune comorbidities (e.g., thyroid disease, type 1 diabetes) and psychosocial impact, including anxiety and psychiatric conditions. With brief training and clear referral pathways, these professionals can facilitate timely dermatologic evaluation, provide reassurance, and prompt assessment for systemic disease. Early detection also supports improved outcomes with emerging therapies. Integrating dermatologic recognition into nondermatology clinical practice offers a practical, interdisciplinary strategy to enhance diagnosis, reduce patient distress, and improve holistic vitiligo care.