Push to reverse uneven medical skin care access

South Africa has fewer than five dermatologists for every million people, and most of them are in big city hospitals or private rooms.

For everyone else, especially in rural and low-income communities, a simple skin check can mean months of waiting or hours on the road.

Prof Ncoza Dlova, former dean of the University of KwaZulu-Natal’s School of Clinical Medicine, says access to dermatology care in South Africa is “highly uneven”.

Dlova, together with other global leading dermatology experts, set three global priorities to drive equity in skin health at the recent World Skin Summit, organised by the International League of Dermatological Societies (ILDS) in Cape Town.

The priorities are equity and access, which focus on fairness, inclusivity and representation in dermatology so all people can receive timely, affordable care; collaboration and integration — to strengthen partnerships between governments, the World Health Organization and other stakeholders to turn global policy into sustainable national action; and innovation and implementation — using data and technology to close gaps in workforce capacity, diagnosis and treatment across the world.

Dlova, an ILDS board member, told Sunday Times that while there were centres of excellence in major cities, many people, particularly those in rural and low-income communities, faced significant obstacles to receiving timely and effective treatment.

“Barriers to access include the lack of access to dermatological care and diagnostic resources and the cost and affordability of care, as many treatments are not fully covered in the public system or by private insurance.

“Other barriers include an under-recognition of skin diseases in health policy. Skin conditions are often viewed as ‘cosmetic’ rather than as causing major disability, so they receive less priority and funding, despite being among the most common reasons for primary care visits.

South Africa has some of the highest UV levels in the world, comparable to Australia, yet sunscreen use remains much lower than in countries such as Australia, New Zealand and parts of Western Europe.

—  Prof Ncoza Dlova, ILDS board member

“There is also an underrepresentation of darker skin tones in medical training. Fewer than 6% of dermatology images in global medical literature depict dark skin, making diagnosis more challenging for the majority population,” she said.

She said the country’s skin-health habits sit somewhere in the middle globally, but South Africans were not doing enough to protect their skin.

“South Africa has some of the highest UV levels in the world, comparable to Australia, yet sunscreen use remains much lower than in countries such as Australia, New Zealand and parts of Western Europe. Public awareness campaigns are also fewer and less consistent — plus the lack of access to dermatological care already highlighted,” said Dlova.

The most common “bad habits” were a desire for a suntan and skin bleaching.

“This is more prevalent among white South Africans while we also see a desire for ‘skin bleaching’ among those of Indian or African heritage. Both are highly damaging to the skin.”

Social media has had a “profound and double-edged” impact on skin health in South Africa, said Dlova.

“On the one hand, it has opened up access, democratised information and created awareness — but it has also amplified misinformation and risky practices. An example is the rise of so-called ‘skincare influencers’ with no medical training. Many of these influencers promote unregulated products such as harsh at-home chemical peels, those with incorrect combinations of active ingredients and DIY remedies that worsen pigmentation or eczema. Our challenge is to ensure that science rises above this noise,” she said.

The impact of global crises on skin health was also discussed at the summit, with speakers warning that climate change, pandemics and socio-economic instability are driving a rise in preventable skin diseases, making dermatology an essential pillar of global health security.

“Dermatology must speak for underserved regions and advocate for affordability and accessibility,” said Prof Martin Röcken, chair of the organising committee for the ILDS World Skin Summit.

New approaches were proposed, including expanding the use of teledermatology and AI triage tools, local drug manufacturing, fair pricing negotiations, mobile clinics and standardised migrant health toolkits. Improved data collection via ILDS member societies, together with industry engagement, was also recommended to support affordability and sustainable access.

Patients were recognised as co-leaders in global health, as attending patient advocates explained how their lived experience is shaping innovation and crisis response, reframing them not as passive recipients of care but as true partners in healthcare strategy and delivery.

Prof Noufal Raboobee, president of the Dermatology Society of South Africa and summit host, reminded delegates that dermatology extended beyond disease management to advancing human rights, social justice and health equity.

“Let discussions at the World Skin Summit be more than a meeting of minds and become, instead, a catalyst for change.”

ILDS president Prof Henry W Lim said: “We convened this landmark summit to bring our members and partners together to confront the challenges ahead and to define the future of equitable skin health. The priorities agreed here will only become a true legacy if they translate into action. Skin health is a fundamental human right and together, we’re committed to making that right a global reality.”