Immune-mediated inflammatory diseases (IMIDs) of the skin can significantly affect individuals' work functioning and pose societal challenges. This systematic review examined the burden of common skin IMIDs (alopecia areata, atopic dermatitis, hidradenitis suppurativa, psoriasis, vitiligo) on work outcomes. Eight databases (PubMed, Web of Science Core Collection, Embase, SciELO, KCI Korean Journal Database, Global Index Medicus, Informit, and Google Scholar) were searched through June 2024. Eligible studies included adults with 1 of these IMIDs and quantitative designs (trials, cohorts, case-control, or cross-sectional studies) reporting work outcomes. From 8176 records, 196 studies were included. Sample sizes ranged from small (n = 28) to nationwide (n = 2,638,681) datasets. Psoriasis (56.12%) and atopic dermatitis (31.12%) dominated, mainly from Europe (54.08%). Most studies (92.35%) assessed productivity and predominantly used validated tools. The evidence shows that skin IMIDs affect multiple work domains, extending beyond productivity loss to psychosocial factors, such as burnout or employment status. Heterogeneity in measurement methods limits external validity. Research gaps persist for rarer IMIDs and low- to middle-income settings, particularly sub-Saharan Africa (only 0.51%). The evidence indicates a substantial effect of skin IMIDs on work, yet consensus on work-related outcomes is lacking. Greater conceptual clarity is needed to understand their impact on employment and support sustainable work participation.

Background Acquired epidermodysplasia verruciformis (aEV) is a skin condition caused by increased vulnerability to cutaneous human papillomaviruses. aEV disproportionately affects people who acquire HIV perinatally. There are no accepted diagnostic criteria for aEV. The lack of routine diagnosis has limited research into this condition. There are no community prevalence estimates, no evidence-based treatments and no cohort studies to understand the risk of skin malignancy. Most people with perinatally-acquired HIV, live in low-resource settings without access to specialist skin doctors or skin biopsies. There is therefore a need to develop diagnostic criteria that can be used by non-specialists and are applicable globally. Aim This Delphi study aims reach consensus on screening and diagnostic criteria for HIV-associated aEV which are applicable in both high and low resource settings. Methods Modified Delphi methodology will be used to achieve expert consensus. A panel of 20–30 experts with at least 5 years’ experience in HIV or dermatology and experience with aEV will be asked to complete a series of surveys. Firstly, they will contribute all possible features of aEV. They will then rate these features in terms of importance. This will be used to guide the creation of draft diagnostic criteria. Panellists will rate their agreement with each criterion and adoption of the criteria as a whole. This will continue until consensus is reached. Consensus is defined a priori as when more than >60% of the panel either agree or strongly agree with each criterion and ≥ 80% of the panel with the adoption of criteria as a whole. Expected Outcomes A screening tool to identify people with possible aEV who warrant further examination. A set of diagnostic criteria that can be applied in real world settings to diagnose aEV. Ethical Approval This study has been approved by the LSHTM Research Ethics Committee (Reference: 33189.)

Neglected tropical diseases (NTDs) affect over one billion people worldwide. More than half of these NTDs primarily affect the skin and are known as 'skin NTDs'. Several recent initiatives have aimed to teach frontline healthcare workers to identify and manage these conditions. However, the content and quality of existing training materials have not been analysed, leaving gaps unclear. This scoping review evaluates skin NTD training materials to identify priorities for resource development. Training materials for frontline healthcare workers available via the InfoNTD, OpenWHO and Centers for Disease Control and Prevention platforms were reviewed for content, year, target audience, region of focus, languages, format and quality. A grey literature search was also conducted to include resources not indexed in these platforms. Of 372 available resources, 114 met study criteria. These included online courses, manuals, web pages, videos, mobile apps, podcasts, articles, booklets, games, slides and databases. Most resources (81.6%, 93/114) discussed 1 NTD rather than multiple diseases. Diagnosis, treatment, complications and follow-up care were included in 78.1% (89/114), 90.4% (103/114), 57.0% (65/114) and 29.8% (34/114) of the resources, respectively. Discussions of complications and follow-up were frequently limited. No materials addressed follow-up of tungiasis. Almost one-third of materials (31.6%, 36/114) did not include images, and 75.4% (86/114) did not include interactive features. Most resources (71.1%, 81/114) were exclusively available in English. In summary, substantial gaps in skin NTD training materials were identified. Enhancing resources with comprehensive information on complications and follow-up, high-quality images, interactive elements and translation for distribution in NTD-endemic areas is needed to strengthen training efforts and improve patient outcomes.

Importance:There are 4.7 to 4.9 billion cases of skin disease a year, contributing to disability, stigma, and reduced quality of life. Data on dermatologic care access and workforce distribution remain limited. Objective:To assess key metrics of access to dermatologic care globally. Design, Setting, and Participants:This cross-sectional study surveyed dermatological care across 194 World Health Organization (WHO) member states and 3 additional geographic areas. A 47-question Delphi-derived instrument was distributed to dermatology leaders in each country from August 2024 to October 2025. Exposure:World Bank Income (WBI) levels (low-income countries [LICs], lower-middle-income countries, upper-middle-income countries, and high-income countries [HICs]) and WHO regions. Main Outcomes and Measures:Primary outcomes were the estimated density of dermatologists per 100 000 globally and number of dermatologists worldwide. Secondary outcomes included training program density, workforce distribution, perceived access to care, and role of nondermatologist practitioners. Outcomes were compared across WBI levels and WHO regions. Response certainty and data source were assessed. Results:Responses were obtained from 158 countries (>80% response rate), representing 97% of the global population (21 of 27 respondents from LICs [78%]; 45 of 52 respondents from lower-middle-income countries [87%]; 40 of 53 respondents from upper-middle-income countries [75%]; 52 of 65 respondents from HICs [80%]). Mean (SD) dermatologist density was 2.66 (2.92) per 100 000 population, ranging from 0.37 (0.80) in LICs to 5.05 (3.00) per 100 000 population in HICs. There were an estimated 175 633 (95% prediction interval, 173 598-177 668) dermatologists globally. Based on countries reporting adequate access to dermatologic care, the estimated threshold for sufficient workforce density was 5.63 dermatologists per 100 000; only 17% of countries (27 countries) met this threshold. Of all responding countries, 21% (31 countries) lacked dermatology training programs, with training availability varying by WBI level. Dermatologists were primarily based in urban centers (mean [SD], 79% [23%]), with increasing maldistribution in lower-income settings. Overall, 42% of countries (57 countries) reported inadequate or extremely poor access to dermatological care. There was significant variation in access to subspecialty care (pediatric, surgical, and dermatopathology) across WBI levels, with worse access in LICs. Primary care physicians were cited as frequently as dermatologists as the main providers of care for skin disease. Other nondermatologist health care workers, including nurses, pharmacists, and traditional healers, also bore substantial responsibility. Overall, 85% of countries (115 of 136 countries) indicated they were certain or very certain of their responses, with 64% of responses (91 of 143 countries) informed by data. Conclusion and Relevance:This study found that significant global disparities exist in access to dermatological care, particularly in lower-resource settings. Achieving skin health equity will require global commitment to expanding and funding training programs, incentivizing decentralization of dermatology practice, and optimizing alternative care delivery including upskilling front-line health care workers.

BACKGROUND:Skin-related neglected tropical diseases (skin NTDs) remain a major source of morbidity in resource-limited settings. These conditions include Buruli ulcer, chromoblastomycosis and other deep mycoses, cutaneous leishmaniasis, post-kala-azar dermal leishmaniasis, leprosy, lymphatic filariasis, mycetoma, noma, onchocerciasis, scabies, tungiasis, and yaws. Recent efforts have focused on developing training materials to help frontline health workers diagnose and treat skin NTDs. However, little is known about how these materials are perceived and utilized in endemic regions. We performed a global online survey to identify gaps and establish priorities for future training resource development. METHODS:We conducted a cross-sectional, anonymous online survey to assess training needs for skin NTDs. The survey was disseminated by the World Health Organization's Global Neglected Tropical Diseases Programme via the WHO website, targeted email distribution to NTD professionals, and outreach on LinkedIn. Respondents identified skin NTDs most urgently requiring improved training resources in their settings and reported on priority topics, target audiences, languages, formats, and barriers to access. RESULTS:A total of 308 participants from 48 countries completed the survey during the one-month response period. The three most frequently reported skin NTDs in need of additional training resources were leprosy (64.6%), scabies (60.7%), and lymphatic filariasis (55.6%). Early detection and diagnosis were the most prioritized training topics (86.0%). Most respondents preferred English-language resources (62.7%), with printed manuals and guidelines identified as the most useful format (70.1%). The most commonly reported barrier was limited availability of up-to-date materials (75.3%). CONCLUSIONS:We highlight persistent gaps in the accessibility of training materials for skin NTDs. While many high-quality resources exist, their dissemination, adaptation, and translation remain limited. Respondent-identified priorities provide a framework to enhance training resources, strengthen the capacity of frontline healthcare workers, and ultimately advance global skin NTD control, elimination, and eradication goals.

Background Acquired epidermodysplasia verruciformis (aEV) is a skin condition caused by increased vulnerability to cutaneous human papillomaviruses. aEV disproportionately affects people who acquire HIV perinatally. There are no accepted diagnostic criteria for aEV. The lack of routine diagnosis has limited research into this condition. There are no community prevalence estimates, no evidence-based treatments and no cohort studies to understand the risk of skin malignancy. Most people with perinatally-acquired HIV, live in low-resource settings without access to specialist skin doctors or skin biopsies. There is therefore a need to develop diagnostic criteria that can be used by non-specialists and are applicable globally. Aim This Delphi study aims reach consensus on screening and diagnostic criteria for HIV-associated aEV which are applicable in both high and low resource settings. Methods Modified Delphi methodology will be used to achieve expert consensus. A panel of 20–30 experts with at least 5 years’ experience in HIV or dermatology and experience with aEV will be asked to complete a series of surveys. Firstly, they will contribute all possible features of aEV. They will then rate these features in terms of importance. This will be used to guide the creation of draft diagnostic criteria. Panellists will rate their agreement with each criterion and adoption of the criteria as a whole. This will continue until consensus is reached. Consensus is defined a priori as when more than >60% of the panel either agree or strongly agree with each criterion and ≥ 80% of the panel with the adoption of criteria as a whole. Expected Outcomes A screening tool to identify people with possible aEV who warrant further examination. A set of diagnostic criteria that can be applied in real world settings to diagnose aEV. Ethical Approval This study has been approved by the LSHTM Research Ethics Committee (Reference: 33189.)

BACKGROUND:Postgraduate medical education is vital for addressing global health disparities, particularly in low- and middle-income countries (LMICs). Dermatology residency training programmes in Ethiopia commenced in 2006 to address a critical shortage of specialists and improve access to care for skin-related conditions, including neglected tropical diseases. This study explores the progress, achievements and challenges of Ethiopia's dermatology residency programmes. OBJECTIVES:To evaluate the development, outcomes and lessons learnt from dermatology residency training in Ethiopia, offering insights for scaling specialist training programmes in LMICs. METHODS:A mixed-methods approach was employed, combining quantitative analysis of training outputs and regional distribution of dermatologists with qualitative key informant interviews. Data were collected through an online survey involving members from the Ethiopian Dermatovenerology Society. Semi-structured interviews were also conducted with senior dermatologists involved in programme development initiation. Thematic content analysis was performed to identify barriers, facilitators and recommendations for programme sustainability. RESULTS:Between 2008 and 2023, Ethiopia graduated 194 dermatologists across five institutions. The annual output increased from 6 to 31 specialists trained each year. Overall, 78 of 108 (72%) dermatologist respondents worked full time in the public sector. There were 51 of the 108 (47%) respondents who were involved in academic institutions. However, 66 of 110 (60%) of dermatologists are concentrated in urban areas. Key facilitators of the residency programme included the Addis Ababa University commitment to expanding postgraduate education, partnerships with the All Africa Leprosy Rehabilitation and Training Center Hospital and full government sponsorship. Challenges included limited infrastructure, shortages in subspecialty training and an urban-centric workforce distribution. Interviewees highlighted the importance of thorough nationally coordinated planning and commitment to address these barriers. CONCLUSIONS:Ethiopia's dermatology training programmes have significantly strengthened the specialist workforce, but inequities in service distribution and gaps in training capacity remain. Strategies to enhance rural service incentives, expand subspecialty training and integrate telemedicine are critical for improving healthcare equity. Lessons from Ethiopia's experience underscore the value of Ministry of Health local leadership and ownership in postgraduate programme expansion.

BACKGROUND:Patients with immune-mediated inflammatory diseases (IMIDs) of the skin face challenges beyond visible signs. Despite their significant psychosocial burden, the global impact of skin IMIDs on work productivity has not been systematically reviewed. OBJECTIVE:To evaluate the global burden of skin IMIDs on work productivity. METHODS:We conducted a systematic review and meta-analysis. Eight electronic databases (PubMed, Web of Science Core Collection, Embase, SciELO, KCI Korean Journal Database, Global Index Medicus, Informit and Google Scholar) were searched from inception to June 2024. We included quantitative studies reporting work-related outcomes in adults (≥18 years) with alopecia areata, atopic dermatitis, hidradenitis suppurativa, psoriasis or vitiligo. For the meta-analysis, studies had to report Work Productivity and Activity Impairment (WPAI), Work Limitations Questionnaire (WLQ) or sick leave duration. Two reviewers independently screened and extracted data. Risk of bias was assessed using validated tools. Data were pooled using frequentist and Bayesian approaches to ensure estimations robustness across heterogeneous designs and sample sizes. RESULTS:Across 100 studies with a cumulative sample of 306,619 participants worldwide, skin IMIDs were consistently associated with impaired work functioning. Notably, the mean WPAI overall work impairment was 28.96 (95% CI 25.61; 32.31), and participants averaged 16.74 days of sick leave per year (95% CI 7.39; 26.1). Findings suggest that occupational impairment was influenced by psychosocial factors, thereby highlighting broader societal and economic consequences. CONCLUSION:Skin IMIDs substantially reduce work functioning and productivity worldwide, representing an underrecognized burden on individuals, employers and health systems. Better multidisciplinary strategies are needed to prevent occupational disadvantage and mitigate the economic and social impact of these chronic conditions.

Background Acquired epidermodysplasia verruciformis (aEV) is a skin condition caused by increased vulnerability to cutaneous human papillomaviruses. aEV disproportionately affects people who acquire HIV perinatally. There are no accepted diagnostic criteria for aEV. The lack of routine diagnosis has limited research into this condition. There are no community prevalence estimates, no evidence-based treatments and no cohort studies to understand the risk of skin malignancy. Most people with perinatally-acquired HIV, live in low-resource settings without access to specialist skin doctors or skin biopsies. There is therefore a need to develop diagnostic criteria that can be used by non-specialists and are applicable in low-resource settings. Aim This Delphi study aims reach consensus on screening and diagnostic criteria for HIV-associated aEV which are applicable in both high and low resource settings. Methods Modified Delphi methodology will be used to achieve expert consensus. A panel of 20–30 experts with at least 5 years’ experience in HIV or dermatology and experience with aEV will be asked to complete a series of surveys. Firstly, they will contribute all possible features of aEV. They will then rate these features in terms of importance. This will be used to guide the creation of draft diagnostic criteria. Panellists will rate their agreement with each criterion and adoption of the criteria as a whole. This will continue until consensus is reached. Consensus is defined a priori as when more than >60% of the panel either agree or strongly agree with each criterion and ≥ 80% of the panel with the adoption of criteria as a whole. Expected Outcomes A screening tool to identify people with possible aEV who warrant further examination. A set of diagnostic criteria that can be applied in real world settings to diagnose aEV. Ethical Approval This study has been approved by the LSHTM Research Ethics Committee (Reference: 33189.)

Skin diseases are among the most common health conditions in low-resource-limited settings (RLS), yet dermatology remains an underserved specialty. The Global Burden of Disease Study 2021 ranked skin diseases among the top ten causes of non-fatal disease burden worldwide, but many RLS still face a severe shortage of dermatologists and dermatology training, alongside underdeveloped health infrastructure, and restricted access to diagnostics, treatments, and medications. In recognition of the impact of skin conditions on overall health and wellbeing, the World Health Assembly (WHA) passed a resolution prioritizing skin health as a global health priority earlier this year. The resolution aims to advance universal health coverage and strengthen primary care systems, recognizing that access to basic skin care is essential for achieving health equity. The WHO Neglected Tropical Diseases (NTD) Working Group on Capacity Strengthening and Training has developed a framework to guide the dissemination of dermatology resources. This framework emphasizes identifying the correct target audiences, including healthcare professionals, health ministry staff, community members, and people affected by skin conditions, with tailored tools and techniques for each group. Tools include hybrid models (both online and in-person) that are contextually appropriate, while techniques focus on sustainability, certification incentives, and ensuring resources are free, accessible, and maintain trust and quality through a grassroots approach. This article highlights key dermatological resources available to healthcare workers in RLS, with a focus on the Community Skin Health Journal. The journal's reach, usage, and effectiveness are evaluated, along with its recent challenges. Finally, we propose strategies to improve access and dissemination, ensuring that dermatology education and capacity strengthening efforts in RLS are impactful, scalable, and sustainable, with the goal of improving skin health for all.

This study analysed authorship trends in high-impact dermatology journals and dermatological content in journals based in low- and middle-income countries (LMIC) from 2018 to 2023. It found that only 12.2% of publications in high-impact dermatology journals were affiliated with LMIC authors, who were less likely to be first or senior authors. The study emphasizes the need for greater global representation to enhance the capacity of LMIC researchers and the visibility of issues important to their communities.

Background:Due to the economic and political instability and the influx of refugees, Lebanon has experienced an increased burden of skin diseases among vulnerable populations. Aim:To assess the demographic characteristics and skin disease profile, with a view to improving dermatological care for Syrian refugees and underserved Lebanese communities in the Bekaa Valley. Methods:We conducted a dermatological needs assessment and interventions as part of a skin and sexually transmitted infections knowledge, attitude and practice project among Syrian refugees and vulnerable populations in Bekaa Valley and northern Lebanon. We collected and analysed demographic and dermatologic data during a medical mission in May 2023. Results:Of the 417 patients, 65% were Syrians and 68% were female. The most common diagnoses were inflammatory dermatoses (28.4%), skin infections (21.3%) and disorders of the skin and appendages (37.3%). During the follow-up activities, 40% of additional 204 individuals consulted had infectious skin conditions. Conclusion:We found a high burden of skin infections among the study participants, most probably due to the high burden of displacement. Urgent interventions are needed to increase dermatological care among the population, including fostering a peaceful and enabling environment for the provision of sustainable health care solutions.