New Project Aims to Document Worldwide Skin Care Crisis

SAN DIEGO — In Burundi, East Africa, desperate patients protect their skin from the sun with petroleum jelly because they can’t find sunscreen. In the Democratic Republic of the Congo, Central Africa, patients with atopic dermatitis face an impossible choice: Pay double their monthly salary for a basic moisturizer or go without. And in a wealthy nation — Australia — only six dermatologists are available to treat patients in remote rural areas, while 44 cluster in a single urban shopping mall.

Across the world, at least a billion patients with skin disorders have no access to dermatologists, and many can’t find — or afford — even the most basic skin treatments. “Less than half of patients will have access to healthcare for their skin disease, which means that right now, access to healthcare is functioning much more like a privilege than the human right that we know it to be,” said Esther Freeman, MD, PhD, director of Global Health Dermatology at Massachusetts General Hospital and associate professor at Harvard Medical School, Boston, in a presentation here at the annual meeting of the Society for Investigative Dermatology.

Now, Freeman told colleagues, the groundbreaking Skin Observatory Study aimed to document the world’s skin health disparities and light the path toward a better future. 

“The most important half of any problem is beginning to understand it in order to start thinking about solutions,” said Freeman, who’s leading the project. “Right now, there is no comprehensive assessment that characterizes access to care and delivery of dermatological care across different regions in the world. The overall goal of the study is to look at defining access to care on a truly global level.”

The project, funded by the International League of Dermatological Societies and L’Oreal Dermatological Beauty, was launched last year and is already transforming understanding of global skin health.

It was previously known that while Europe had about 50 dermatologists per million residents and the United States had approximately 34 per million, Sub-Saharan Africa had 0-3 per million. Several small nations had no dermatologists at all.

Now, the project is producing new statistics. It’s already collected numbers from 147 countries representing 95% of the world’s population, Freeman said, and preliminary data highlighted the lack of dermatologic resources in many countries.

To date, the findings reveal that while nations typically offer antibiotics and steroids to patients, access to biologics is much rarer. Sunscreen access is severely limited in some countries because there’s no local manufacturing, and this can be fatal. In Tanzania, East Africa, Freeman noted, 90% of patients with albinism “will die a premature death before the age of 30 if they don’t have access to sun protection.”

What’s being done in terms of solutions? Freeman highlighted GLODERM (International Alliance for Global Health Dermatology), which now operates in 60 countries with 2000 members, with a mission statement that includes providing health care providers access to training, support, and resources needed “to offer appropriate care of skin diseases for patients and communities” with limited resources, according to its website.

“I firmly believe that the people closest to the problems are those closest to the solutions,” Freeman explained. “My job is to think about how we can train and empower people closest to the problems to come up with their own solutions.”

Unlike traditional clinical mentorship programs, GLODERM focuses on leadership development. “What we are teaching is: How do you negotiate with your government if you are trying to establish a department? If you’re going to build a residency program for the first time in your country, how do you talk to the Ministry of Health? How do you talk to donors?”

Freeman urged dermatologists at all career stages to contribute to global skin health equity through mentoring, ensuring representation in research, and joining existing organizations dedicated to the cause.

She ended on a hopeful note, noting that the World Health Assembly, the decision-making body of the World Health Organization, will soon vote on a resolution declaring skin diseases a global public health priority. Freeman said this is a major milestone after 20 years of advocacy.

“I hope I’ve convinced you today that together, all of us in this room can be part of changing the landscape of access to dermatologic care on a truly global level, even if that means starting right exactly where you are, all the way from student to very senior PI [principal investigator],” Freeman said.

Freeman leads the Skin Observatory Study, which is funded by the International League of Dermatological Societies and L’Oreal Dermatological Beauty.