Skin in the game

By Andrea Niermeier, Contributing Writer, July 1, 2025

Cheryl Burgess, MD, FAAD, medical director of the Center for Dermatology and Dermatologic Surgery and the Professional Aesthetic Image Center, remembers getting ready to go to prom and facing limited options for makeup, often having to search in niche sections of the drug store rather than finding her products alongside mainstream brands. Through medical school and dermatology residency in the late 1980s, she noted the lack of formal training in skin of color with pictures in dermatology atlases mostly portraying lightly pigmented skin. These early experiences helped her develop a passion for product formulation and became a lens through which she saw her patients’ challenges — ultimately inspiring her to co-found Black Opal in 1993, one of the first skin care lines that addressed the needs of patients with skin of color.

A physician’s in-depth knowledge of both their specialty and the people they treat positions them to identify unmet needs in health care. With a growing global dermatology market — driven by an aging population seeking treatments for age-related skin concerns — an increasing prevalence of skin disorders, emerging markets and personalized treatment approaches, and technological innovations, entrepreneurs may find opportunities ranging from teledermatology to biologics to aesthetic treatments. John Harris, MD, PhD, FAAD, founding director of the Vitiligo Clinic and Research Center and the Autoimmune Therapeutics Institute at UMass Chan Medical School, remarked, “I think most physician scientists dream of this concept — that they will make a discovery that will then become a treatment for a patient to make their lives better. But it’s a very difficult thing to do and there are a lot of reasons why.” With the evolving role of physicians beyond the clinical setting, how does a dermatologist take an innovative idea and successfully bring it to market? Turns out, the paths may be as numerous as the products, but all are paved with integrity, collaboration, and hard work.

Peeling back layers

Similar to Dr. Burgess, Lindy Fox, MD, FAAD, co-founder of VETTED Dermlab, highlighted that her idea for a skin care line was born out of personal and professional frustration. This included patients coming in with dermatitis related to products they were putting on their skin, the background noise and misinformation on social media, and her own struggle with contact dermatitis because of allergies to ingredients in her skin products. “We recommend patients use hypoallergenic products, but because patients want a more luxurious self-care experience, they don’t buy those products and then continue to have issues with their skin.”

After discussing these challenges with University of California, San Francisco colleagues Nina Botto, MD, FAAD, and Carina Woodruff, MD, FAAD, they decided to fill this hole in skin products. Dr. Fox and her business partners worked to fully identify the problem they were trying to solve and develop a strong mission to guide them. “A hypoallergenic product packaged sustainably, advertised with integrity, and available to all was important to us.” They also talked to lawyers to set up the business and choose a name that represented their company as well as for trademark and domain purposes. “There are a lot of dynamics to work through when you have three founders. We’ve learned to stay mission driven. If we ever have a new idea, we always hold it up against that. It has kept us grounded on why we are doing it and who we are doing it for. We are aligned in our principles.”

Anar Mikailov, MD, FAAD, founder of KPAway and co-founder of Skintensive, attributed clinical experience discussions with colleagues as a catalyst for entrepreneurship. Dr. Mikailov founded KPAway in 2015 based on his own experiences with keratosis pilaris. Two years later, he partnered with Vladimir Ratushny, MD, PhD, FAAD, to establish Skintensive. Their conversation about the need for improved clinical care for patients with senile/actinic purpura began when they were both residents at Harvard. Dr. Mikailov noted that having a co-founder helps validate a concept or idea and allows for a division of tasks essential for a company’s growth. He remarked, “We have complementary backgrounds and personalities, and having two people to manage different roles and responsibilities facilitates growth to the next level.”

“I think most physician scientists dream of this concept — that they will make a discovery that will then become a treatment for a patient to make their lives better.”

Part of Dr. Mikailov’s background includes working for a few different start-up companies before and during medical school and residency. However, he believes having a certain personality may be more important to entrepreneurship than a business background. “We are in a unique position to observe a problem that is tangible and therefore what you really need is the awareness and open mind to see the problem. It takes a personality type who will take a leap of faith and decide to say ‘no’ to other potential opportunities to really focus on a concept that may or may not work out.” A SWOT analysis can formally assess a project’s strengths, weaknesses, opportunities, and threats, both internally and externally.

Dr. Fox admitted that she and her co-founders had limited knowledge about business when they started. She and her team talked to many people they knew in business and entrepreneurship, including connections of friends and family, and she joked that she listened to nearly every episode of Guy Raz’s podcast “How I Built This” to learn the process, mistakes, and experiences of others. “What I came to understand is that business is all about case studies and very different from medicine. In medicine you learn the basics of chemistry, biology, and anatomy. Then you learn about sick systems, how to identify them, how they present, and how to treat them. You have control over each one of those steps. There’s not one pathway for entrepreneurship, no book to teach you all the things that can happen or how to control the environment of business.”

While many physician entrepreneurs find inspiration in the stories that patients bring into their clinics, others are empowered by their own research. Dr. Harris started his first company in 2018 after a discovery in his lab prompted him to develop a new drug to treat vitiligo. Since then, he has created four other companies focused on the skin, which all merged under Alys Pharmaceuticals in 2024.

The company you keep

How does an entrepreneur like Dr. Harris begin to take his lab discovery to market? He emphasized the value of collaboration and teamwork. “I love to work in teams and leverage others’ expertise. I think there’s a depth of knowledge required that is very hard to get if you do something else. When things go wrong, it could be challenging if you don’t have that knowledge.” When building a team, sometimes entrepreneurs find assistance in unlikely places or at unexpected times. Such was the case for Dr. Harris, who was being consulted as a key opinion leader for a different disease for a fledgling company when the investor expressed interest in his work.

“Relationships are really important. They say that luck favors the prepared mind, but I think reputation is also an important part of starting a company. People need to trust you,” Dr. Harris observed. “They had interest in me as a founder partly because I was humble, admitted what I didn’t know, felt confident in what I did know, and answered their questions well.” That investor helped Dr. Harris, who at first didn’t know much about how to develop a drug, connect with an antibody expert and a CEO to guide the operations process. Not only did these initial connections help Dr. Harris launch later companies. They afforded him the opportunity to mentor others with potential ideas and move them forward.

Dr. Mikalov pointed out that one’s social network can be a source of diverse talent, emphasizing that neighbors, members at one’s church or gym, and colleagues may have needed skills or expertise. He also suggested LinkedIn cold emails or Instagram direct message chats as ways to connect with desired specialists or professionals. Even though Drs. Mikalov and Ratushny handled most tasks when they first began, they brought on a chief scientific officer about a year ago. As they have grown, they have also added an operations director, social media director, web and SEO director, and Amazon and retail sales leads. In addition, they have a contract with a public relations firm.

Another important relationship for many dermatology entrepreneurs with products like skin care lines is the one with their formulation and manufacturing lab. Dr. Burgess reminisced about finding her business partner during her lab search. She described walking downtown to the Cosmetic, Toiletry, and Fragrance Association (now called the Personal Care Products Council) to buy a book that listed cosmetic industry companies, including vertical manufacturing ones. Calling labs to speak to formulators, she connected with Nikos Mouyiaris. “I had a great partner who would listen to what I wanted to innovate and say what we needed to do. We were on the same communication plane and worked successfully together for 25 years.” While searching for a formulation or manufacturing lab today is not flipping through book pages, Dr. Fox stressed that it still can be a grueling process to find one that meets all needs in terms of product integrity as well as workable timelines and minimum order quantity.

Fueled to grow

Dr. Fox, Dr. Burgess, and Dr. Mikailov all self-invested in their ideas to get their businesses running. With their own money and a modest amount from friends and family, Dr. Fox and her colleagues were able to launch VETTED Dermlab and immediately garner sales. “Being more established in dermatology and answering a problem we knew our colleagues shared helped us sustain steady sales from the beginning.” While she acknowledged bigger rounds of funding may be needed in the future to scale, grow, and improve inventory, for now her team is enjoying ownership in the successful business they have created. However, some younger businesses need to seek angel investors, or contributors who help fund the early stages in exchange for equity.

Although some entrepreneurial endeavors begin with self-investment, others related to drug development require venture capital. Dr. Harris commented that while funding from organizations like the National Institutes of Health (NIH) can help study a disease, make a discovery, understand the pathogenesis, and maybe identify a target for a new drug, it is not enough to develop that drug. “That’s usually referred to as the valley of death between basic science and clinical use. You have to be able to get funding that is much bigger,” he added. That number is in the millions.

Some institutions help their physicians connect with this kind of venture capital. For example, the Building Research, Innovation, Development, and Growth Excellence, or BRIDGE, program at the University of Massachusetts (UMass) Chan Medical School strives to support research, protect intellectual property, and facilitate commercialization. Dr. Harris stated that pitching to some investors through this program helped him learn about the process, connect with others, and practice his skills. Although physicians may want to impress investors with their deep science, he emphasized keeping a pitch simple while being prepared to dig deep if necessary. To present effectively, a physician must also keep the audience in mind. Dr. Harris warned that if an investor follows an asset-centricity model, meaning they want to invest in a company that has a single drug for a single disease, then pitching a platform that could make 1,000 drugs for 500 different diseases may not be appealing to that investor.

Staying in bounds

Physician entrepreneurs should consider regulatory and legal requirements early in planning, which may include communicating with their institution about a business idea. Dr. Fox and her co-founders approached UCSF early, learning what titles they could hold and how they should present themselves outside of UCSF, and identifying intellectual property. “They gave us a 100% green light and also have a stake in our company.”

For regulatory considerations, Dr. Harris used the support of UMass, including a committee established for identifying conflicts of interest. He cautions potential entrepreneurs to use the resources available to them to avoid errors that could jeopardize their intellectual property. For example, making a discovery and then presenting an abstract about it at a meeting before filing for a patent could put the request at risk. He urges entrepreneurs to keep thorough documentation of their processes and discoveries in order to establish a paper trail of timing, if necessary.

While skin care products classified as cosmetics may not need the regulatory studies and FDA approval that a prescription drug does, Dr. Mikailov and his team have their own compliance officer, in addition to oversight through their manufacturing company and their own internal testing, to ensure that their products are safe. In addition, carrying well-suited liability insurance and ensuring proper labeling are important.

Even with vertical manufacturing companies, online shopping, and social media, Dr. Mikailov cautions that while concept-to-creation may be faster than a decade ago, journeying from a concept to a successful brand is still a challenging process. However, the reward is great. Dr. Fox agrees. “What is similar about my career as a dermatology hospitalist and as an entrepreneur? I really enjoy looking at a problem and saying I want to fix that. I believe we are doing something good for our patients and colleagues, as well as the field of dermatology. I want people to be healthier. We know how to do that, and we can do that in the beauty space too.”

After years with Black Opal, Dr. Burgess went on to consult for major makeup companies on formulation and patent a technique using dermal fillers. In her office today, she carries a sunblock that she developed with skin of color in mind. Curiosity, innovation, resilience, and collaboration — the very qualities that may inspire someone to pursue medicine — may also ignite the spirit of a visionary entrepreneur.

Additional DermWorld Resources