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People with debilitating skin conditions face a global “crisis” in access to treatment due to a shortage of specialist doctors, a major new study has found.
While in Europe there were six dermatologists for every 100,000 people, the figure in Africa was 0.26, leaving many patients reliant instead on nurses, medical assistants or traditional healers.
“We expected to find disparities, but really the scale and the severity were much greater than we anticipated,” said Dr Esther Freeman, the study’s principal investigator and associate professor of dermatology at Harvard Medical School. “Skin disease is everywhere, but healthcare for skin disease is not.”
Skin diseases, including acne, scabies and skin cancers, affect around one in three people worldwide. There are over 3,000 distinct conditions and in 2021 there were 4.69bn new cases, according to the World Health Organization (WHO).
The study, published in the journal JAMA Dermatology, uses data collected from members of the International League of Dermatological Societies (ILDS) and other experts in 158 countries.
Comparing countries by income level, the researchers found 5.05 dermatologists per 100,000 people in the richest group of countries and just 0.37 per 100,000 in the poorest.
Australia and Niger both have a population of around 27m - but Australia has more than 600 dermatologists to Niger’s 18.
Overall 42 per cent of respondents said there was inadequate or extremely poor access to care in their countries.
Noel Mudibo, an patient advocate in Nairobi, Kenya, has the rare skin condition pemphigus vulgaris, which began as blisters in his mouth and on his legs when he was a student in 2017.
The blisters were so severe that he could not brush his teeth. Friends thought he must be on drugs, because of his deteriorating hygiene, or that he had HIV. Many started avoiding him.
A university doctor prescribed antibiotics, but there was no improvement.
Over the next few years he looked up his symptoms online, tried traditional medicine, and took “high voltage painkillers” to control the pain. He could only manage to eat very soft and bland foods, such as plain spaghetti.
He received the correct diagnosis and treatment only in 2021, “I saw some relief,” he said.
Patients in Kenya with rare skin diseases must contend with stigma, including the suggestion their symptoms are caused by witchcraft, Mr Mudibo said, as well as high treatment costs and a shortage of laboratories to carry out tests.
More dermatologists alone would not remove all the barriers, he said. But it would improve the chances of a swift and accurate diagnosis, and boost awareness.
Governments faced with limited health budgets tend to deprioritise skin health because it is “perceived as cosmetic or not essential”, Dr Freeman said. This situation is only expected to get worse as countries like the US and UK cut aid budgets, with countries across Africa disproportionately impacted.
“The reality is skin conditions are one of the top 10 causes of disability worldwide and incredibly prevalent,”. Dr Freeman said. “When we see our patients who are incredibly ill with metastatic cancer, with severe drug reactions, with severe autoimmune conditions [...] you know it's not a luxury.”
Only one in six countries met the study’s benchmark of 5.63 for the minimum number of dermatologists per 100,000 people. None were in Africa or Southeast Asia, where Dr Freeman said the lack of dermatologists was coupled with higher levels of skin disease in “a double hit”.
Specialised dermatology, such as surgery to remove skin cancers, and paediatric services, was even less likely to be available, she said.
In 2025, countries agreed at the WHO’s annual assembly that skin diseases should be a global health priority. The ILDS said the new evidence should inform that work, including training GPs, nurses and traditional healers to provide better care.
Myriam Cohen-Welgryn, president of L’Oreal Dermatologic Beauty, which funded the study, said it intended to work on further research and fund training, education, and scientific journal access for health workers in poorer countries.
This article has been produced as part of The Independent’s Rethinking Global Aid project
