Only one in six countries has enough dermatologists to meet population needs, with Africa facing some of the widest gaps
Only one in six countries worldwide has enough dermatologists to meet the healthcare needs of its population, with high-income countries almost nine times more likely to have an adequate dermatology workforce than low-income countries, according to a new global study.
The Global Access to Skin Health Observatory Study, published in JAMA Dermatology, assessed access to skin health services, the distribution of dermatologists, training and specialist care across 158 countries representing 97% of the world’s population.
More than 2 billion people globally live with skin diseases, which are among the most common health conditions and rank among the top ten causes of disability worldwide. Yet 74% of countries surveyed reported that skin health is not a national government priority.
The findings come as countries begin implementing the World Health Assembly’s 2025 resolution recognising skin diseases as a global public health priority.
Africa faces a severe shortage
The study estimates that the world needs about 5.63 dermatologists per 100,000 people to provide adequate care. The current global average is only 2.66 per 100,000, leaving more than 80% of countries below the proposed benchmark.
The gap is particularly pronounced between wealthy and poorer countries. Dermatologist density ranges from 0.37 per 100,000 people in low-income countries to 5.05 per 100,000 in high-income countries.
No country in Africa or South-East Asia currently reaches the study’s benchmark.
The differences become stark when countries with similar population sizes are compared. Australia and Niger each have populations of about 27 million, but Australia has more than 600 dermatologists compared with just 18 in Niger. Japan and Ethiopia each have populations of around 130 million, yet Japan has more than 7,000 dermatologists while Ethiopia has about 200.
Dr Esther Freeman, the study’s principal investigator, vice-chair of the International Foundation for Dermatology and associate professor of dermatology at Harvard Medical School, said the study provides data that can be used to identify and address these inequalities.
“Where you live should not determine your access to skin health – but today, it does,” Freeman said.
The study also found that specialised dermatological services are severely limited in poorer countries. About 90% of economically disadvantaged countries reported inadequate access to subspecialties such as paediatric dermatology, dermatological surgery and dermatopathology.
Rural communities face an additional gap
The shortage of specialists is compounded by where dermatologists work. Globally, 79% of dermatologists are based in urban areas, rising to 91% in low-income countries. This leaves rural and remote communities with particularly limited access to specialist skin care.
The study describes these areas as “dermatological deserts”, where people may have little or no access to specialist services.
Overall, 42% of countries reported poor or extremely inadequate access to dermatological care. The proportion rises to about two-thirds among the world’s lowest-income countries.
This creates a major mismatch between disease burden and access to care, with some of the populations most affected by skin disease having the fewest specialists available to diagnose and treat them.
Primary care workers filling the gap
In countries with few or no dermatologists, skin conditions are often managed by primary care doctors, nurses, pharmacists and community health workers.
However, many non-specialist health workers receive limited formal training in dermatology.
The workforce gap is particularly severe in Africa, where 94% of countries reported insufficient provider capacity. Across low-income countries, the figure was 89%.
The study also found that approximately 46% of African countries have no dermatology training programme.
Despite these differences in workforce availability, professional requirements for dermatologists are broadly similar. In 89% of countries, becoming a dermatologist requires both a medical degree and formal dermatology residency training.
The researchers suggest that this points to systemic barriers to expanding the workforce rather than major differences in professional standards.
What could close the gap?
The study identifies several potential approaches, including expanding regional dermatology training programmes, increasing the dermatology skills of frontline health workers and using telemedicine and artificial intelligence to extend access to specialist expertise.
For countries with few specialists, these approaches could help primary health-care workers identify and manage common skin conditions while improving referral of patients who need specialist care.
The study’s data are available through the Skin Observatory Data Explorer, an online platform that allows health ministries, researchers and other stakeholders to examine data by country and region.
Professor Henry W. Lim, president of the International League of Dermatological Societies, said the findings could help countries track progress following the World Health Assembly resolution.
“The Study will continue to grow, with data added over time, helping us track progress and support long-term change,” Lim said.
Myriam Cohen-Welgryn, president of L’Oréal Dermatological Beauty, said the company would support efforts to expand access to skin health through its Act For Dermatology programme.
The Global Access to Skin Health Observatory is a collaboration between the International League of Dermatological Societies and L’Oréal Dermatological Beauty through the L’Oréal Act For Dermatology programme.
