BACKGROUND:Skin diseases represent a major public health concern, affecting all demographics and imposing significant personal, economic and social burdens. OBJECTIVES:To assess the epidemiology and impact of skin diseases using the Global Burden of Disease (GBD) data, highlighting regional variations, knowledge gaps and areas for improvement. METHODS:GBD data on prevalence, incidence, disability-adjusted life years (DALYs) and years lived with disability (YLDs) for skin conditions from 2000 to 2021 were analysed. RESULTS:According to GBD 2021, the global prevalence of skin and subcutaneous diseases, excluding sexually transmitted infections (STIs) and skin cancers, was 25.7%, ranking sixth among the most prevalent disease categories worldwide. These conditions accounted for a global YLDs rate of 495.1 per 100,000 person-years, placing them eighth in terms of disease burden. Overall, the most prevalent conditions were STIs excluding HIV (16.8%), fungal infections (7.8%), and acne (3.0%). Squamous cell carcinoma, basal cell carcinoma and decubitus ulcers showed increasing prevalence, while atopic dermatitis, scabies and viral infections declined slightly. Acne, scabies and atopic dermatitis predominated in youth, whereas fungal infections, contact dermatitis and skin cancers predominated in older adults. Females showed higher prevalence of STIs, acne and atopic dermatitis. Infectious skin diseases were more common in Sub-Saharan Africa and tropical regions, while chronic inflammatory and neoplastic diseases predominated in high-income regions. CONCLUSIONS:Several limitations were identified. The GBD initiative only includes some dermatological diseases reflecting the difficulties in obtaining data because of the multitude of skin diseases with underreporting and misdiagnosis. There are significant gaps in data from low- and middle-income countries, a lack of reliable trends and inadequate quality-adjusted life year estimates considering cultural and social variations. The GBD initiative provides valuable insights but underestimates the true burden of skin diseases. Improved reporting and inclusion of neglected conditions are urgently needed through global collaboration among stakeholders.

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.

Kaposi's sarcoma (KS) remains common in sub-Saharan Africa and despite persistently high mortality less than 50% of people with advanced-stage KS with an indication for chemotherapy currently receive it in western Kenya. To address this, a tailored multi-component navigation strategy including physical navigation and care coordination, peer mentorship, education, assistance with health insurance, a health insurance stipend, and transportation stipends was implemented within AMPATH healthcare network in western Kenya in 2021. This study evaluates service penetration (engagement), acceptability, appropriateness, and fidelity to the multi-component navigation strategy. We used a convergent mixed methods approach using Proctor et al.'s framework for implementation outcomes. We enrolled all adults with newly diagnosed HIV-associated KS from 2021 to 2024. Quantitative data included structured questionnaires, CD4+ T cell count, and navigation activity logs. Scores for acceptability and appropriateness questionnaires ranged from 4 to 20, with 20 representing high levels. In-depth interviews were also conducted among people with HIV-associated KS, healthcare workers, and navigation team members. Descriptive statistics were used for measures of service penetration (engagement), acceptability, appropriateness, and fidelity. Framework analysis was used for in-depth interviews. Among the 124 Adults with HIV associated KS eligible to participate, service penetration was 74% within 90 days after KS diagnosis. The median acceptability score among people with HIV-associated KS was 20 (Range: 19, 20) and appropriateness was 20 (Range 20, 20). Fidelity to at least one component was 87% (N=80), and no participant experienced all 6 components. Fidelity was 2.2% (N=2) for the transportation stipends (7 total) and 28% (N=26) for the health insurance enrollment stipend. During in-depth interviews, patients and healthcare workers described high levels of acceptability and appropriateness of the navigation strategy. Patients described experiences of variability in navigation strategy components, and healthcare worker and navigation team members described how financial constraints and time constraints contributed to variability in fidelity. A multi-component navigation strategy designed to improve chemotherapy engagement for HIV-associated KS was both acceptable and appropriate. Fidelity was variable with low fidelity to financial components, suggesting areas for future adaptation to ensure sustainability and context appropriateness during integration into the health system and future scale-up. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the National Institute of Allergy and Infectious Diseases (NIAID), the National Cancer Institute (NCI), and the Fogarty International Center in accordance with the regulatory requirements of the National Institutes of Health under Award Numbers U54 CA190153, U54 CA25457, U54 CA254571-02S1, K23 AI136579, K24 AI141036, and D43 TW009345-09S7 awarded to the Northern Pacific Global Health Fellows Program. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Institutional Review Board of the University of California San Francisco gave ethical approval for this work. The Institutional Research and Ethics Committee of Moi University gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.

Neglected tropical diseases (NTD) refer to a group of 21 diseases that disproportionally affect impoverished communities in low- and middle-income countries (LMIC) [1]. NTD collectively impact 1.7 billion people, which is about 20% of the world's population [1]. Each year, NTD account for more than 200,000 deaths, with millions left disabled and disfigured due to insufficient access to care and affordable treatment, often leading to social exclusion, stigmatization and discrimination. Although the term NTD has successfully directed funding and resources towards these conditions and encouraged global partnerships and high-level policy initiatives, the term may also have unintended negative consequences. In this paper, we aim to explore the term NTD and stimulate a dialogue that re-evaluates its meaning into more inclusive and equitable language.

PURPOSESub-Saharan Africa bears a disproportionate share of the global burden of HIV- associated Kaposi's sarcoma (KS), with high morbidity and mortality rates influenced by stigma, delayed diagnosis, and limited access to care. This study examines Peer Navigation, through both personal and clinical perspectives, as a potential intervention to improve outcomes for those living with KS in western Kenya.Patients AND MethodsThis study centers on the lived experience of one KS survivor who became a Peer Navigator in western Kenya. The narrative captures his journey from diagnosis to treatment and the subsequent impact of guiding others through their healthcare journey as a Peer Navigator.RESULTSBetween October 2021 and July 2024, the Peer Navigator provided support to 77 patients. These interactions led to improvements in patient knowledge, reduced feelings of social isolation, renewed hope for recovery, and increased confidence in treatment options.CONCLUSIONPeer Navigation plays a crucial role in improving outcomes for patients living with HIV- associated KS. By integrating the survivor's voice, this model of care delivery provides invaluable emotional and social support, fostering improved patient-reported outcomes and encouraging treatment adherence, thereby offering a transformative model for care delivery.

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.

Primary and booster vaccinations are critical for mitigating COVID-19 transmission, morbidity, and mortality. Future booster vaccine campaigns rely on an increased understanding of vaccine hesitancy.

With increasing numbers of initiatives addressing health inequity in dermatology there is growing interest among funders and nonprofits in defining and measuring two key aspects of global health success: impact and sustainability. The demands to clearly describe and demonstrate impact and sustainability in global health dermatology and health equity programmes from funders are to ensure accountability, proper use of funds and mutually beneficial outcomes. There is no one-size-fits-all method for evaluating health interventions. Instead, we highlight approaches that can be tailored to specific global health efforts to better conceptualize areas to improve operational strategies and their implementation internally and communication with funders externally.

BACKGROUND:Primary and booster vaccinations are critical for mitigating COVID-19 transmission, morbidity, and mortality. Future booster vaccine campaigns rely on an increased understanding of vaccine hesitancy. OBJECTIVE:To evaluate self-reported allergic and skin vaccine reactions as factors potentially associated with vaccine hesitancy in a nationwide vaccine allergy registry. METHODS:Responses to survey questions concerning COVID-19 vaccine perceptions, coded from free text by 2 independent reviewers. Multivariable logistic regression models were used to determine the association between changed negative perception and respondent demographics, vaccination history, and reaction characteristics. RESULTS:A total of 993 individuals (median of 46 years [IQR, 36-59], 88% female, 82% White) self-reported reactions to COVID-19 vaccination. Reactions included the following: delayed large local skin reaction (40%), hives/urticaria (32%), immediate large local skin reaction (3%), swelling (3%), anaphylaxis (2%), and other or unspecified (20%). Most respondents were initially unconcerned about the safety of COVID-19 vaccines (56%). After reactions, 401 of 993 (40%) report negative change in perception of vaccination, with more than half of these respondents (n = 211, 53%) citing their reasoning as a negative experience with adverse effects. Of 102 individuals asked about future vaccination, 79 (77%) indicated that they were unlikely or very unlikely to receive future COVID-19 vaccinations. Increased negative perception after reaction was associated with younger age, later COVID-19 vaccination dose number, and reaction type. CONCLUSION:Our findings reveal that an individual's experience with allergic or cutaneous adverse effects after COVID-19 vaccination affects attitudes and decision-making regarding future vaccination, even in initially non-hesitant individuals. Further investigation of secondary vaccine hesitancy is necessary for adapting public health messaging to this important population.

BackgroundAcne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older.ObjectiveThe objective of this study was to provide evidence-based recommendations for the management of acne.MethodsA work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations.ResultsThis guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements.LimitationsAnalysis is based on the best available evidence at the time of the systematic review.ConclusionsThese guidelines provide evidence-based recommendations for the management of acne vulgaris.

Persons with HIV-associated Kaposi's sarcoma (KS) experience three co-existing stigmatizing health conditions: skin disease, HIV, and cancer, which contribute to a complex experience of stigmatization and to delays in diagnosis and treatment. Despite the importance of stigma among these patients, there are few proven stigma-reduction strategies for HIV-associated malignancies. Using qualitative methods, we explore how people with HIV-associated KS in western Kenya between August 2022 and 2023 describe changes in their stigma experience after participation in a multicomponent navigation strategy, which included 1) physical navigation and care coordination, 2) video-based education with motivational survivor stories, 3) travel stipend, 4) health insurance enrollment assistance, 5) health insurance stipend, and 6) peer mentorship. A purposive sample of persons at different stages of chemotherapy treatment were invited to participate. Participants described how a multicomponent navigation strategy contributed to increased knowledge and awareness, a sense of belonging, hope to survive, encouragement, and social support, which served as stigma mitigators, likely counteracting the major drivers of intersectional stigma in HIV-associated KS.

While the majority of American Academy of Dermatology members have some broad awareness of human trafficking, most are not aware of it in their communities or of the skin signs that could prompt identification of those being exploited, and have requested educational resources to assist patients affected by trafficking. The American Academy of Dermatology Ad Hoc Task Force on Dermatologic Resources for the Intervention and Prevention of Human Trafficking has been working to develop relevant resources, including an online toolkit on the American Academy of Dermatology website: https://www.aad.org/member/clinical-quality/clinical-care/human-trafficking.