Dr. Neal Walker: Addressing the white space in dermatologic medicine and improving patient access to care

When I treated patients in my dermatology practice, I saw people struggle with skin conditions that were not life-threatening, yet took an emotional toll. These people included patients with psoriasis who refrained from intimate relationships because of their skin plaques; patients with rosacea who worried that their colleagues would think they had been drinking; patients with alopecia areata who felt compelled to wear hats or wigs; and patients with vitiligo who minimized their time in public places to avoid strangers’ questions and stares.

Dermatologists know these stories are common. Take alopecia areata and vitiligo, for instance. Alopecia areata is an autoimmune skin disease that results in partial or complete loss of hair on the scalp and body, and about 6.8 million Americans have or will develop alopecia areata during their lifetimes.[i] Vitiligo is an autoimmune disease in which the skin loses its pigment; it is the most common pigment disorder worldwide.[ii],[iii] Despite this prevalence and patients’ need for treatment, there is a gap – or white space – in the availability of safe and effective medications.

What can be done to improve patient access to treatments? Earlier this year, I was invited to address this issue of innovation and access at the Winter Clinical Dermatology Conference, a continuing medical education conference for dermatologists.

In my opinion, the first step to overcoming barriers to patient access is bringing new safe and effective medications to market. In response to the low priority that the pharmaceutical industry has placed on developing treatments for skin conditions, Aclaris focuses on discovering and developing compounds that could become therapies for conditions that fall into the white space of dermatology and immunodermatology. We have expertise in identifying promising work from research labs – like the early scientific work on Janus kinase (JAK) inhibitors conducted at Columbia University – and then translating this work into the clinic. Right now, we are conducting clinical trials with multiple JAK inhibitor compounds for the treatment of alopecia areata and vitiligo – with the hope that one day we may have new medicines that will benefit millions of patients worldwide.

Unfortunately, even when treatments are available, too many interests interfere with the physician-patient relationship and limit patients’ access to care. My perspective is that the issue is three-fold, involving third-party payers, chain drug stores and patients.

Third-party payers have extraordinary power to limit coverage for branded medicines and shift a large percentage of the cost of treatment to patients and their employers. Payers often do provide better coverage and reimbursement for the first FDA-approved medication for a disease, so our strategy of focusing on the white spaces may help avoid reimbursement headwinds. Additionally, the business practices of chain drug stores sometimes add to the cost burden for patients, even for generic drugs. In some cases, generics are priced at 80 percent of the brand. And with increasing consolidation in that industry, patients have been left with very few alternatives. It will be interesting to see how the entry of Amazon as a new competitor affects the landscape.

That brings me to patients. I believe that some of the responsibility for access to treatment falls on patients themselves. Patients don’t always realize that when they prioritize convenience – say by seeking care for a skin condition at an urgent care facility or a clinic in a pharmacy – they may be sacrificing a good outcome that would have been accessible through the expertise of a board-certified dermatologist. Also, patients who see dermatologists should understand that not every treatment can be submitted to their insurance. They must keep in mind that they have to pay out-of-pocket for treatments whose sole purpose is to improve appearance, such as the removal of asymptomatic benign lesions like seborrheic keratoses (SKs).

Scientific innovation and openness to change are fundamental to the culture of Aclaris. We are committed to identifying, developing and commercializing therapies to address the white spaces in aesthetic and medical dermatology and immunodermatology. I’m confident we can do our part to increase patient access to transformative medicines.

[i] National Alopecia Areata Foundation. FAQ's. Available at: Retrieved May 30, 2017.

[ii] Boniface K, et al. New Insights Into Immune Mechanisms of Vitiligo. G Ital Dermatol Venereol. 2016 Feb;151(1):44-54. Epub 2015 Oct 29. Available at:

[iii] American Vitiligo Research Foundation. Fitzpatrick T., et al. Vitiligo Facts. Available at: