Teledermatology-Supported Care for Skin Neglected Tropical Diseases and Common Skin Diseases in Cote dIvoire: a Mixed Methods Evaluation

Background: Skin-related neglected tropical diseases (skin NTDs) continue to affect people living in remote communities of endemic countries, particularly in regions with limited access to dermatological care. This operational research evaluated the impact of the eSkinHealth app, a digital health tool designed to enhance case management of skin NTDs and other skin diseases in Cote d'Ivoire. The eSkinHealth app functions as a portable electronic medical record and a platform for teledermatology, connecting frontline healthcare workers to remote specialists. Methodology/Principal Findings: The study was conducted across sixteen primary health centers (PHCs) in the Sinfra and Bouafle districts, regions endemic for skin NTDs. Using a before-and-after implementation design, baseline data were collected from paper registries and compared with data captured through the app. The primary objective was to assess changes in skin disease detection and diagnosis, while also evaluating usability, acceptability, and feasibility of the tool among healthcare workers. A total of 1,766 patients were included in the analysis (mean age 22.8 years; 55% male). During the intervention period, skin NTD registrations increased significantly from 30 to 91 cases (p < 0.01). Buruli ulcer cases rose from 6 to 14 (p = 0.05), scabies from 24 to 70 (p = 0.13), and other NTDs such as leprosy, lymphatic filariasis, and yaws were newly detected and documented. In contrast, registrations of non-NTD skin diseases decreased from 662 to 472 cases (p < 0.01); however, the proportion of non-NTD cases which received diagnostic confirmation increased markedly, from 0% at baseline to 94% during the intervention period (p < 0.01). Qualitative interviews with nurses and community health workers highlighted improvements in diagnostic accuracy, patient engagement, and confidence in daily practice, while also noting persistent challenges such as stigma, transportation barriers, technical difficulties, and patient concerns about privacy. Conclusions/Significance: The integration of the eSkinHealth app into routine PHC services proved effective in enhancing diagnostic capacity for skin NTDs in resource-limited settings. However, capturing other skin diseases proved more difficult given their high prevalence. While the app demonstrated clear benefits in improving diagnostic rates and healthcare worker confidence, persistent challenges such as technical issues and patient concerns about privacy need to be addressed for future scalability. As with many digital tools, further refinement will be an ongoing process, and the lessons learnt from this study may provide valuable guidance for similar initiatives in comparable settings.