Growing awareness of skin disease starts flurry of initiatives

Abstract

Skin diseases in developing countries have a serious impact on people's quality of causing lost productivity at work school, discrimination due to disfigurement. Skin changes may also indicate the presence of more serious diseases that need treatment. In the past, such conditions were ignored or given low priority by health authorities because they did not, on the whole, kill people, they often did not present in tertiary care centres. now there is a big push at both national international levels to train health workers in developing countries to improve diagnosis treatment of dermatological conditions. Professor Rod Hay, Head of the School of Medicine Dentistry, Queen's University Belfast, said the change is very welcome. Hay is Chair of the International Foundation for Dermatology, a non-profit organization based in Chicago, the United States, linked to the International League of Dermatological Societies, that aims to improve dermatological care in developing countries. He said: is better recognition of the extent of the problem, helped by the fact that the first signs of certain diseases, including HIV/AIDS, leprosy onchocerciasis, tend to appear as skin problems. Dr Jose Figueroa-Munoz, who is currently a medical officer in WHO's Stop TB Department but was previously a fellow of the St John's Institute of Dermatology in London, United Kingdom, agreed that there is now better acknowledgement of skin diseases the impact they have. Most of these diseases have always been there, in many cases they are so common that they are part of the local culture, Figueroa-Munoz said. But there is now more realization that even though many people do not see these diseases as a problem, they could still be having an important impact on general health. For example, skin diseases that cause severe itching at night can reduce someone's productivity during the day at work, or their ability to pay attention in school. In many communities, people with visible skin disease suffer discrimination when applying for jobs, or, if a woman has a disfiguring skin disease, she may never marry. Factors such as these have an impact on people's quality of life, Figueroa-Munoz said, and for this reason it is important to treat skin diseases educate communities about how to prevent them. There is plenty of evidence that skin diseases are much more common in developing countries than in the developed world. Surveys have shown that up to 60% of people in both rural urban areas in developing countries suffer from skin diseases. By contrast, one study in the United Kingdom estimated that 28% of people had a treatable skin disease. In contrast to the situation in developed countries, malignant melanoma non-melanoma skin cancers are rare in the indigenous populations of most developing countries, among those with pigmented skins in general. The exception is the very high risk of skin cancers in albinos. The last few years have seen a flurry of new initiatives targeted at treatment of skin disorders in developing countries, many of them fostered by the International Foundation for Dermatology. At the international level, recognition of the problem is continuing to grow: Hay points out that the Disease Control Priorities Project of the World Bank/WHO/Fogarty International Center is due to publish its second report this month, which includes a chapter on the priorities relating to skin diseases in developing countries. At a workshop in September 2004 organized by the International Foundation for Dermatology, Hay made the case that it was time to strengthen community dermatology programmes for developing countries. Many skin conditions are due to infections, he concluded, could be treated with simple remedies if these were used in the right way. Poor training is one factor contributing to the huge amount of time resources being poured into treating skin disease badly, he said. …