Key Takeaways:

• Only 1 in 6 countries have enough dermatologists to meet their population’s healthcare needs.
• 42% of countries report poor or inadequate access to dermatological care. 
• Almost 80% of dermatologists work in urban areas, creating an access gap for those in rural and underserved areas.

Every year, more than 4.7 billion cases of skin disease are reported, which contribute to disability, reduced quality of life, discrimination, and even reduced educational and economic opportunities. Often an overlooked cause of death, skin diseases disproportionately affect children and individuals in low- and middle-income countries, where access to dermatological care remains limited.

The Global Access to Skin Health Observatory Study, published by the International League of Dermatological Societies and L’Oréal Dermatological Beauty, surveyed dermatological care across World Health Organization member states and additional geographic regions. The study received responses from 158 countries, representing 97% of the global population, and provided a systematic assessment of access to dermatological care through evaluations of workforce shortages, training capacity, and infrastructure. Here are the study’s key findings:

Non-Dermatologist Providing Dermatologic Care 

Many health providers, and traditional healers, who are not certified dermatologists end up providing dermatological services due to limited access, including nurses and pharmacists: In 89% of countries, dermatologists must attend medical school followed by a formal dermatology residency; 82% of responding countries have professional or government organizations that oversee this training.

• 92% of low-income and lower-middle-income countries allow doctors to complete their training in another country.
• Although 78% of low-income countries reported having at least one dermatology training program, there were only 0.004 training programs per 100,000 people, compared to 0.044 programs per 100,000 in high-income countries.
• The African region is particularly limited in training opportunities, with 0.003 programs per 100,000 people. 
• About 21% of countries reported having no dermatology training program.

Infrastructure and Provider Shortages

Low-income countries reported greater shortages of dermatologists (89% vs. 57%), but there were also regional disparities, including differences in healthcare infrastructure.

• 94% of countries in the African region reported shortages, compared with 47% in the Eastern Mediterranean region.
• 61% of low-income countries reported that their healthcare infrastructure, specifically for dermatologic care, was inadequate or extremely poor. Only 20% of high-income countries reported this.
• On average, 79% of dermatologists work in urban areas, and in low-income countries, 91% work in cities, leaving little to no access for those who live elsewhere.
• 46% of responding countries said that access to care was affected by many dermatologists practicing in cosmetic dermatology rather than medical. 
• Dermatologists in high-income countries are more likely to work exclusively in private practice. An average of 48% of dermatologists in these countries work only in private settings, compared to 35% in low-income countries.
• In low and middle-income countries, some dermatologists may also need to work in private practice to supplement relatively low public-sector salaries while also working in public settings, known as dual practice.

Access to dermatologists may also come down to how governments prioritize dermatological needs. Interestingly, only 26% of countries considered dermatological care a national priority, yet only 6% of low-income countries reported that skin disease was a government priority, compared to 30% of high-income countries.

Dermatologist Numbers Needed

Thirty countries reported having at least adequate access to all types of dermatologic care examined in the study. It is estimated that a country needs approximately 5.63 dermatologists per 100,000 people to provide sufficient dermatologic care, yet only 17% of countries in the study reached this threshold. African and Southeast Asian regions had the lowest levels of access, with countries reporting inadequate or extremely poor access to dermatologic care.

• Of the 27 countries with adequate dermatologic care, 19 (70%) were in Europe.
• No countries in Africa met the threshold.
• No countries in Southeast Asia met the threshold.
• 51% of European countries met the threshold.

Unequal access to dermatological care is a global health equity issue, largely driven by differences in funding, healthcare infrastructure, training, and national priorities. The study argues that improving skin health equity will require more investment in training programs, expanding care beyond centralized practices (specialized clinics, hospitals, and urban medical centers), and equipping front-line healthcare workers with the tools they need in order to provide care.