This article is a follow-up to my previous piece, "How Allergan’s DREAM Initiative is Shaping Skin of Color Care for Aesthetic NPs," where I discussed their efforts to address the lack of diversity in aesthetics. In this article, I highlight the key points from their 2022 groundbreaking report, "Forces of Beauty." Additionally, you’ll find how the findings impact nursing practice and education, as well as how we can address the problems identified in the report via detailed ideas for a DNP Project and PhD nurse-led research, and entrepreneurship. If you are a doctoral student or mentor, consider how this report can inspire actionable, data-driven interventions. Lastly, I reveal the cover of my newest publication, Nursing Aesthetics: An Introductory Guide for Nurse Practitioners and Entrepreneurs.
*The winning cover for my newest publication: Nursing Aesthetics: An Introductory Guide for Nurse Practitioners & Entrepreneurs. A huge thank you to all who voted! You will all receive a special gift once the book is available for purchase! Join the email list so you can be one of the first to be notified.
Introduction
The aesthetics industry has long celebrated a narrow, Eurocentric standard of beauty. For nurses and nurse practitioners working at the intersection of skin health and aesthetics, understanding and addressing this systemic exclusion is not just a moral imperative—it is a professional and economic opportunity. The DREAM Initiative’s Forces of Beauty® report provides critical qualitative and quantitative data on how beauty standards continue to marginalize women of color, and what our role as nurse leaders must be in dismantling those systems.
With insights from nearly 4,000 women and 21 focus groups, this report doesn’t just critique the industry—it provides a blueprint for action. Aesthetic and dermatology NPs can use these findings to design DNP projects, drive nurse-led research, and build businesses that improve the lack of diversity in dermatology and aesthetics when it comes to creating goods and services.
Key Findings from the Forces of Beauty Report
• 96% of women say feeling beautiful impacts how they feel about themselves.
• 1 in 4 Black, Hispanic, and Multiracial women believe society’s beauty standards are racist.
• Only 31% of women agree that beauty standards are achievable.
• Black women are more likely than other groups to want their racial beauty celebrated and respected without exploitation.
The implications? We are not just talking about self-esteem. These beauty standards affect clinical encounters, consumer behavior, and access to care. Women of color have had to create our own products, businesses, and standards—not out of trend, but out of necessity.
Recently, I was listening to a popular dermatology podcast where the host and the guest were laughing at patients who make products in their kitchen. The guest’s immediate response to finding out her patient made products at home was laughter and disbelief over the patient’s preference, stating that the big brands have large research and development departments to support their usage over homemade products for self-care and sale. My recommendation? Ask the patient why they felt the need to make products at home. Black and Brown communities often struggle to find products in the market that meet our needs as it relates to our values, beliefs, needs, and budget. This should not be surprising given the lack of diversity in dermatology when it comes to nursing education, faculty, medical images, textbooks, clinical trials (recruitment, inclusion criteria, efforts to reduce attrition, and accessibility), regulatory policies, medical language, health literacy, social and political determinants of health, algorithm biases, leadership, and capitalism.
Why This Matters for Nursing Practice
Representation Gaps = Clinical Gaps
The report underscores how a lack of representation shows up in product development and even the makeup of aesthetic training programs. These disparities contribute to misdiagnosis, delayed treatment, poor health outcomes, and decreased patient-provider rapport and trust.
As nurses, our training must include:
• Competencies for treating diverse skin tones and hair textures
• Understanding of inherited aesthetic trauma and internalized colorism
• Cultural humility in treatment planning
Nursing Implication: Schools of nursing and entrepreneurs must revise/create curricula and ensure clinical rotations include exposure to skin of color and diverse beauty standards. Aesthetic NPs in practice should pursue continued education and certifications that prioritize diversity in care delivery.
The DREAM Initiative’s Forces of Beauty® 2022 Report by Allergan
PhD Nursing Research Opportunity
Title: AI-Powered Dermatology Education for Skin of Color: Developing and Validating Inclusive Diagnostic Tools
Background and Significance
Dermatology remains one of the most visually dependent specialties, yet it consistently underrepresents skin of color in educational resources, diagnostic training, and clinical decision tools. This gap contributes to diagnostic delays, misdiagnosis, and poorer outcomes for patients with darker skin types. Artificial intelligence (AI) offers new opportunities to enhance diagnostic accuracy and improve training. However, current AI dermatology tools have been found to underperform in non-white populations due to biased training datasets. There is an urgent need for equitable and culturally responsive tools that center skin of color in dermatologic assessment and education.
Purpose of the Study
To design, implement, and evaluate an AI-powered diagnostic support and education tool that features a diverse range of skin tones and conditions. The tool will serve as a clinical and educational resource for nurses, nurse practitioners, and nursing students.
Study Objectives
1. To develop an AI-based dermatology education tool with a curated and diverse image dataset representative of skin of color.
2. To evaluate the usability and acceptability of the tool among nurse practitioners, dermatology nurses, and pre-licensure students.
3. To assess the diagnostic accuracy and decision-making improvement in clinical scenarios when the tool is used.
4. To generate recommendations for AI integration in dermatology education that promotes equity and inclusivity.
Study Design
Design: Multi-phase mixed-methods study
Phase 1 – Tool Development:
• Collaborate with dermatologists, data scientists, and nurse educators to design the AI tool.
• Source and annotate an inclusive image dataset (covering acne, eczema, psoriasis, melasma, folliculitis, CCCA, keloids, etc., across multiple skin tones).
• Use machine learning to train and refine the tool’s recognition algorithm.
Phase 2 – Usability Testing:
• Conduct think-aloud testing and structured usability interviews with target users (NPs, nurses, students).
• Analyze feedback using the System Usability Scale (SUS).
Phase 3 – Pilot Testing and Validation:
• Conduct randomized clinical scenario simulations comparing diagnostic accuracy with and without the tool.
• Use pre- and post-test assessments to measure change in accuracy, confidence, and decision-making quality.
Participants and Setting
• Dermatology Nurse Practitioners
• Registered Nurses working in dermatology, primary care, long-term care, and home health
• Pre-licensure nursing students in a CNA, LVN, LPN, AD, BSN, or MSN program
Setting may include:
• Academic simulation labs
• Teledermatology platform partnerships
• EMR training environments
Instruments and Measures
Quantitative Measures:
• System Usability Scale (SUS)
• Diagnostic Accuracy Scores (comparison against a gold-standard dermatology review panel)
• Pre/post confidence and knowledge assessments
Qualitative Measures:
• Semi-structured interviews guided by the COREQ framework
• Thematic analysis to explore user experiences, cultural relevance, and perceptions of inclusivity
Theoretical Framework
Technology Acceptance Model (TAM) or Unified Theory of Acceptance and Use of Technology (UTAUT)
These models are widely used in health informatics and educational innovation studies and would support exploration of behavioral intention, perceived usefulness, and actual system use.
Expected Outcomes
• A validated, nurse-friendly AI tool for dermatology education that reflects diverse patient populations.
• Enhanced diagnostic confidence and accuracy in skin of color cases among nursing professionals.
• Guidelines for integrating equitable AI tools into nursing curricula and continuing education programs.
• Contribution to nursing science through publications, conference presentations, and dissemination to professional organizations, schools of nursing, and healthcare entities (e.g., DNPs of Color, Dermatology Nurses’ Association, SDNP, Diversity in Dermatology, and state nursing and nurse practitioner associations).
Potential Impact
This research addresses urgent gaps in dermatologic education and contributes to the broader field of health equity in digital health. The tool could become a scalable, replicable solution used in academic nursing programs, fellowships, and telehealth platforms—ultimately improving access to dermatology education for nurses who will be able to confidently and accurately assess, treat, evaluate, and educate patients with skin of color.
The DREAM Initiative’s Forces of Beauty® 2022 Report by Allergan
DNP Project Idea: Aesthetic Trauma and Mental Health
Explore the long-term psychological effects of exclusionary beauty standards on Black and Latina patients, and how this impacts their relationship to self-care, aging, and aesthetic medicine. This project could be structured as a mixed-methods study, using the Dermatology Life Quality Index (DLQI) to collect quantitative data.
For the qualitative component, consider the following validated tools and approaches:
1. Semi-Structured Interview Guide using the COREQ Framework
• Tool: Consolidated Criteria for Reporting Qualitative Research (COREQ)
• Use: A 32-item checklist used to develop and report on qualitative interviews and focus groups.
• Why It Works: COREQ allows you to design structured but open-ended interviews that can capture the lived experiences of participants, particularly around beauty, bias, and healthcare.
Body Image States Scale (BISS) + Narrative Interviewing
• Tool: Body Image States Scale (BISS)
• Use: A 6-item, validated tool that assesses body image in real time.
• Why It Works: When paired with open-ended narrative interviews, BISS offers both emotional insight and deeper thematic understanding related to body image, cultural beauty norms, and psychological effects of exclusion.
Interpretative Phenomenological Analysis (IPA)
• Tool: IPA is a validated qualitative methodology, not a survey instrument.
• Use: Ideal for small sample sizes, IPA explores how participants make sense of their personal and social experiences.
• Why It Works: It’s particularly suited for studies exploring identity, emotional trauma, and beauty-based microaggressions in healthcare.
Suggested Mixed-Methods Structure for Your Project
1. Quantitative: Use DLQI to evaluate life quality related to skin conditions or aesthetic concerns.
2. Qualitative: Conduct semi-structured interviews using COREQ guidelines or analyze data using IPA.
3. Optional: Include BISS before and after specific interventions or consultations to measure shifts in body image perception.
Nurse-Led Entrepreneurial Innovation
The Forces of Beauty report highlights a consistent truth: women of color are beauty industry pioneers, not afterthoughts. As NPs, we can create:
• Inclusive skincare lines informed by patient-centered research
• Digital, interactive education tools that teach cultural humility and skin-of-color assessment
• Incubators for NP-owned aesthetic businesses focused on equity and representation
At Mahogany Dermatology Nursing | Education | Research, we’re leveraging our intellectual property and community to increase access to dermatology and aesthetic education and training for NPs and entrepreneurs, preparing to train nurses using AI and AR, and using social media content and peer-reviewed articles to reshape the narrative around beauty, science, and business.
Recommendations for Aesthetic and Dermatology NPs
1. Educate Yourself: Go beyond CEUs. Read reports like Forces of Beauty and engage with data from your community.
2. Refine Your Offer: Build offers that speak to transformation, not just procedures. Representation is part of your business model.
3. Join Movements: Join local and national organizations or partner with other stakeholders to identify evidence-based, inclusive care standards.
4. Mentor the Next Generation: Representation in faculty, clinical preceptorship, and publishing is essential to shifting standards in education.
Conclusion: Meeting Women Where They Are
As the Forces of Beauty report says, "One of us cannot represent all of us." But together, through innovation, mentorship, research, and entrepreneurship, nurses and nurse practitioners can redesign an aesthetics industry that sees and serves all of us.
Allergan Aesthetics. (2023). Forces of Beauty®: The Science Behind What We See. AbbVie.
Kimberly Madison, DNP, AGPCNP-BC, WCC
I am a Board-Certified Nurse Practitioner, educator, and author dedicated to advancing dermatology nursing education and research with an emphasis on skin of color. As the founder of Mahogany Dermatology Nursing | Education | Research, I aim to expand access to dermatology research, business acumen, and innovation using artificial intelligence and augmented reality while also leading professional groups and mentoring clinicians. Through engaging and informative social media content and peer-reviewed research, I empower nurses and healthcare professionals to excel in dermatology and improve patient care.
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