Global Disparities in Access to Dermatological Care

Abstract

Importance: There are 4.7 to 4.9 billion cases of skin disease a year, contributing to disability, stigma, and reduced quality of life. Data on dermatologic care access and workforce distribution remain limited. Objective: To assess key metrics of access to dermatologic care globally. Design, Setting, and Participants: This cross-sectional study surveyed dermatological care across 194 World Health Organization (WHO) member states and 3 additional geographic areas. A 47-question Delphi-derived instrument was distributed to dermatology leaders in each country from August 2024 to October 2025. Exposure: World Bank Income (WBI) levels (low-income countries [LICs], lower-middle-income countries, upper-middle-income countries, and high-income countries [HICs]) and WHO regions. Main Outcomes and Measures: Primary outcomes were the estimated density of dermatologists per 100 000 globally and number of dermatologists worldwide. Secondary outcomes included training program density, workforce distribution, perceived access to care, and role of nondermatologist practitioners. Outcomes were compared across WBI levels and WHO regions. Response certainty and data source were assessed. Results: Responses were obtained from 158 countries (>80% response rate), representing 97% of the global population (21 of 27 respondents from LICs [78%]; 45 of 52 respondents from lower-middle-income countries [87%]; 40 of 53 respondents from upper-middle-income countries [75%]; 52 of 65 respondents from HICs [80%]). Mean (SD) dermatologist density was 2.66 (2.92) per 100 000 population, ranging from 0.37 (0.80) in LICs to 5.05 (3.00) per 100 000 population in HICs. There were an estimated 175 633 (95% prediction interval, 173 598-177 668) dermatologists globally. Based on countries reporting adequate access to dermatologic care, the estimated threshold for sufficient workforce density was 5.63 dermatologists per 100 000; only 17% of countries (27 countries) met this threshold. Of all responding countries, 21% (31 countries) lacked dermatology training programs, with training availability varying by WBI level. Dermatologists were primarily based in urban centers (mean [SD], 79% [23%]), with increasing maldistribution in lower-income settings. Overall, 42% of countries (57 countries) reported inadequate or extremely poor access to dermatological care. There was significant variation in access to subspecialty care (pediatric, surgical, and dermatopathology) across WBI levels, with worse access in LICs. Primary care physicians were cited as frequently as dermatologists as the main providers of care for skin disease. Other nondermatologist health care workers, including nurses, pharmacists, and traditional healers, also bore substantial responsibility. Overall, 85% of countries (115 of 136 countries) indicated they were certain or very certain of their responses, with 64% of responses (91 of 143 countries) informed by data. Conclusion and Relevance: This study found that significant global disparities exist in access to dermatological care, particularly in lower-resource settings. Achieving skin health equity will require global commitment to expanding and funding training programs, incentivizing decentralization of dermatology practice, and optimizing alternative care delivery including upskilling front-line health care workers.