Global Disparities in Access to Dermatological Care: the Skin Health Observatory
Freeman, E. E.; Yardman-Frank, J. M.; Kilmer, J.; Pacheco, A.; Su, K.; McMahon, D. E.; Li, C.; Anwar, S.; Barger, K.; Qian, Y.; Strahan, A.; Westby, S.; Bhat, R.; El Sayed, M.; Enbiale, W.; Galvan-Casas, C.; Gao, X.; Gondokaryono, S. P.; Kibbi, A. G.; Lee, A.; Ly, F.; Ocampo-Candiani, J.; Richard, M.-A.; Romiti, R.; Lim, H. W.; Takeshita, J.; Kerob, D.; Chuberre, B.; de Lambert, G.; Fuller, L. C.; Griffiths, C. E. M.; Dlova, N. C.
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BackgroundSkin disease affects 4.7-4.9 billion individuals globally; however, little is known about access to dermatological care. MethodsWe conducted a multinational, cross-sectional survey of dermatological care across 194 WHO member states and three additional geographic areas in 2024-2025. Primary outcomes included dermatologist density per 100,000 population and number of dermatologists globally. Secondary outcomes included training programme density, workforce distribution, perceived access to care, and health system characteristics. Descriptive statistics and nonparametric tests compared outcomes across World Bank Income (WBI) levels and WHO regions. FindingsResponses were obtained from 158 countries. Mean dermatologist density was 2.66 per 100,000, ranging from 0.37 in low-income (LICs) to 5.05 in high-income countries (HICs). There are estimated 175,633 dermatologists globally (95% CI: 173,598-177,668). Forty-two percent of countries reported inadequate or extremely poor access to dermatological care. There was significant variation (p < 0.001) in access to all types of subspecialty care (paediatric, surgical, dermatopathology) across WBI levels, with consistently worse access in lower-income countries. Dermatologists are primarily based in urban centres (79%). Twenty-one percent of countries lack dermatology training programs, with training varying by WBI level (p < 0.001). Non-dermatologist healthcare workers bear a substantial responsibility for management of skin disease. InterpretationSignificant global disparities exist in access to dermatological care, particularly in lower resource settings. Achieving skin health equity will require global commitment to expanding/funding training programmes, incentivizing decentralization of dermatology practice, and optimizing alternative care delivery including upskilling front-line healthcare workers. FundingInternational League of Dermatological Societies and LOreal Dermatological Beauty.
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