A Framework for Pharmacist-Led Dermatology Clinics

One of the recurring points on this site is that dermatology, unlike most other clinical specialties, doesn't yet have a credentialing body or a Board of Pharmacy Specialties certification for the pharmacists working in it. A 2025 brief report in the Journal of the American Pharmacists Association Practice Innovations tackles that gap directly, not by waiting for a certification to appear, but by building a homegrown training framework and testing it in a real clinic.

Ruki Wijesinghe, Principal Clinical Pharmacist at the National Skin Centre in Singapore, led a team of dermatologists, clinical pharmacists, and health professions education scholars to design a competency framework using entrustable professional activities, or EPAs: discrete units of clinical work that a supervisor can, at some defined point, trust a pharmacist to perform without direct oversight. The concept isn't new to medicine broadly, but it hadn't been applied to dermatology pharmacy before this.

The Six Core EPAs

The team identified six workplace-based EPAs, each broken down into specific tasks and mapped to competency domains (medical knowledge, pharmacologic knowledge, professionalism, communication, patient care, and technical skill):

• Assessment of the patient, including history-taking, skin examination, working toward a diagnosis or differential, and reviewing the current treatment plan for adherence, safety, and efficacy.
• Consideration of treatment options, applying both pharmacologic and nonpharmacologic knowledge and selecting an approach based on safety, efficacy, cost, and the specific patient.
• Shared decision-making, building rapport, explaining risks and benefits in accessible terms, and respecting patient preference in the final decision.
• Prescribing, safely and with full knowledge of mechanism, dosing, interactions, and adverse effects, including accurate documentation.
• Patient education, ensuring the patient and caregiver understand and are committed to the plan, and supporting self-management going forward.
• Monitoring and reviewing, maintaining a follow-up plan, tracking effectiveness and adverse effects, and escalating red flags back to the supervising dermatologist when needed.

Mastery across all six was required before a pharmacist could run a clinic independently. Two pharmacists already working in the outpatient dermatology setting were selected to pilot the framework, with a four-month timeline to reach entrustment.

How Pharmacists Were Assessed and Credentialed

Rather than relying on a single exam, entrustment decisions were built from multiple workplace-based assessment sources: direct observation, case write-ups, training videos, clinical audits, and multisource feedback from both colleagues and patients. Supervising dermatologists made the final call on readiness, and the framework included a defined path for pharmacists who weren't progressing as expected: additional mentorship, more focused case exposure, or adjustments to the pace of training. Importantly, entrustment wasn't a one-time credential; periodic reassessment was built in to maintain standards over time.

The Pilot's Results

The first pharmacist-led clinic focused on eczema. It performed well enough that institutional leadership expanded the model to psoriasis, acne, urticaria, and androgenetic alopecia. Over three years, the program sustained operation and received 107 direct referrals from dermatologists, freeing up dermatologist appointment slots for complex and new cases. Patients seen in the pharmacist-led clinic saved 45% on consultation costs compared to a dermatologist visit.

Advantages and Limitations, Honestly Stated

The paper doesn't oversell the model. Its stated advantages: EPAs mirror real clinical activity rather than testing knowledge in the abstract, they're tailored to the specific specialty rather than applied as a generic pharmacy credential, and they build in continuous reassessment rather than a one-and-done exam.

Its stated limitations are just as direct: building and running an EPA-based credentialing system takes real investment in time and expertise; entrustment decisions still rely on the subjective judgment of individual supervisors, which can introduce variability; the model focuses on observable tasks and may underweight theoretical knowledge; and the pilot took place inside a large tertiary institution with many dermatologists available for supervision, a setup that may not translate to smaller practices with less physician availability.

Why This Matters for the Society

This is precisely the kind of groundwork a future credentialing body for dermatology pharmacists would draw on. A locally built, tested, and honestly evaluated EPA framework is a real answer to a question the specialty hasn't had one for: what should a pharmacist actually be trusted to do independently in a dermatology setting, and how do you know when they're ready? The author's own conclusion is worth taking at face value: this framework was built for dermatology, but the approach is portable to any specialized pharmacy setting still waiting on formal certification.

This article summarizes and comments on a third-party publication. Full credit for the original research belongs to the author. Read the original open-access article at the link above for complete methodology, tables, and references. This summary is for educational purposes and does not constitute medical or pharmaceutical advice.