Latest news with #EstherFreeman
The Hindu
08-07-2025
- Health
- The Hindu
No health without skin health: a global call to end skin bleaching and prioritise dermatological equity
Every July 8, World Skin Health Day asks the world to reconsider what we see and what we choose not to see. Skin, the body's largest organ, is also its most visible and most vulnerable. It is both a physical barrier and a mirror of health, dignity and social belonging. Yet, despite its profound role in our well-being, skin health is routinely side-lined in global health agendas. In 2025, the message of World Skin Health Day is clear and urgent: #NoHealthWithoutSkinHealth. This year's campaign builds on a historic achievement: the 78th World Health Assembly passed a landmark resolution officially recognising skin diseases as a public health priority. 'The resolution is the result of years of work by ministries of health and the dermatological community,' says Esther Freeman, director of global health dermatology at Harvard Medical School. 'Skin disease touches so many areas, infectious diseases, neglected tropical diseases, even cancer. Its inclusion signals long-overdue recognition.' 'What this means for patients is greater visibility, better funding, and stronger policy support,' she adds. 'It opens the door to cross-sectoral partnerships and the integration of dermatology into broader health systems.' But recognition is just the beginning. One of the most urgent and visible challenges facing dermatologists today is the global crisis of skin bleaching and this year, International League of Dermatological Societies (ILDS) has taken a bold next step. The International League of Dermatological Societies (ILDS) represents over 200 dermatological societies across the globe. The World Skin Health Day is a join initiative by the ILDS and the International Society of Dermatology (ISD). These societies collectively include more than 2,00,000 dermatologists, serving an estimated 4–5 billion people worldwide - particularly when accounting for both direct clinical care and public health outreach. Together, they work to elevate skin health on the international stage, advocate for underserved populations, and influence policy at institutions like the World Health Organization. The campaign is more than symbolic - it aims to unite clinicians, researchers, public health professionals, patients and policymakers in recognising that healthy skin is not a luxury, but a fundamental part of human health. A crisis hidden in plain sight Globally, more than 1.8 billion people live with at least one skin disease, making skin conditions one of the most common human health problems. Conditions such as eczema, psoriasis, acne, infections, leprosy, pigmentary disorders, and skin cancers cut across age, geography, and social status. But their visibility often brings stigma, especially when access to treatment is limited. 'Skin diseases are among the most visible and stigmatised conditions worldwide, yet they continue to be sidelined in the global health agenda,' says Rashmi Sarkar, director and professor of dermatology, Lady Hardinge Medical College, Delhi and Regional Director of ILDS (Asia, Middle East and Africa). 'You cannot speak of health equity while ignoring the skin. Skin health is not cosmetic- it is central to mental wellbeing, quality of life, and social inclusion.' Building on the World Health Assembly resolution, the ILDS, in a new resolution, is calling for urgent global action against skin bleaching - a dangerous and deeply-rooted practice affecting communities across Africa, Asia, South America and the Caribbean. The dangers of skin bleaching 'Skin bleaching is not about beauty. It is a symptom of something much deeper,' says Prof. Sarkar. 'It stems from systemic colourism, colonial histories, and socio-cultural messaging that equate lighter skin with success, desirability, and access. These narratives are reinforced every day - on screens, in advertisements and even, at times, in clinical spaces.' People often use bleaching products in an attempt to lighten or 'brighten' their skin tone, unaware of the serious risks involved. Many of these products contain potent steroids, hydroquinone, mercury and other heavy metals. These substances can severely compromise the skin barrier, leading to conditions like exogenous ochronosis,steroid-induced acne, skin thinning, and even systemic toxicity. 'The creams may seem harmless, even helpful at first glance,' explains Prof. Sarkar, 'but they can cause irreversible damage—both physically and psychologically. And because many are self-compounded or sold through informal channels, their safety is not regulated at all.' This isn't just a women's issue. 'We are now seeing increasing numbers of young men using skin-lightening products,' she adds. 'Social media pressures, dating preferences, and workplace discrimination are pushing men toward the same harmful practices. Skin bleaching cuts across gender, age, geography, and economic background. It is a full-blown public health crisis.' Prof. Sarkar has worked with partners across Asia, Africa, and the Middle East to bring global attention to this issue. The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL) has also played a pivotal role, making awareness about steroid misuse, skin bleaching and its consequences a national campaign priority. 'This year's World Skin Health Dayis not just about telling people to stop using creams. It's about rewriting the story,' she says. 'We must educate people that the skin they have is the skin they're meant to have. Darker skin is not a flaw - it is functional, protective and beautiful. We need to challenge the very idea that lighter is better.' Cross-sectoral action The new ILDS resolution is a call for cross-sectoral action. Dermatologists cannot fight this alone. 'We need public health leaders, media influencers, government regulators, educators, and people from all walks of life to join us,' she urges. 'Because it's not enough to just treat the damage - we must prevent it, by shifting both culture and policy.' Prof. Sarkar emphasises that skin health is often a window into systemic health. 'The skin is where we first see signs ofmalnutrition, HIV, diabetes, autoimmune disease - especially in low-resource settings. If we ignore the skin, we miss crucial opportunities for early diagnosis and care.' In her work across countries, she has seen first-hand how lack of dermatological training and access creates wide inequities in care. 'We need dermatology included in national health programmes, greater investment in training, research and especially in regulation of harmful products. But more than anything, we need compassion,' she says. 'Every person deserves care, regardless of the colour of their skin.' More than a medical campaign As the world marks World Skin Health Day 2025, Prof. Sarkar reminds us that this is more than a medical campaign, it is a movement. Clinics around the world will host free skin health consultations, school programmes, and community awareness drives. Social media will share stories of real people who've lived with the stigma, damage and courage to reclaim their skin. Later this year, the ILDS will convene the 4th World Skin Summit in Cape Town, where leaders from over 80 countries will gather to discuss how to make skin care more inclusive, accessible, and sustainable. 'Our message is clear,' says Prof. Sarkar. 'We cannot keep skin health at the margins. If we truly want universal health coverage, dignity in care and equity in public health - then skin must be part of the conversation.' She concludes:'What is visible is not always seen. Until we see the skin and the people who live in it, there can be no health for all.' (Dr. Monisha Madhumita is a consultant dermatologist at Saveetha Medical College, Chennai.
Medscape
09-06-2025
- Health
- Medscape
WHO Resolution Aims to Bridge Global Gap in Skin Care
A medical resident in the South Pacific will soon make history. After he graduates in 2026, he's slated to become the first dermatologist to serve the Solomon Islands, a nation of 800,000 people. His training is both a breakthrough and the product of an international effort to improve access to skin care. As they gathered in Fiji in late May to support the resident's regional training program, visiting dermatologists got thrilling news: In Geneva, the World Health Organization (WHO) unanimously passed a landmark resolution to support global skin health. Dermatology trainee Joseph Sangatu, slated to become the first dermatologist in the Solomon Islands, and American dermatologist Esther Freeman, MD, PhD, in the patient ward at the Pacific Dermatology Trainin Cengter in Suva, Fiji. 'We're here 2 days after the resolution passed, already implementing it,' said Claire Fuller, a London-based consultant dermatologist and chair of the International League of Dermatological Societies (ILDS) in an interview. 'The timing is fantastic.' Addressing a Global Care Crisis The resolution aims to tackle stark disparities in global dermatological care. Africa and the Pacific islands have only zero to three dermatologists per million people, Esther Freeman, MD, PhD, associate professor of dermatology at Harvard Medical School and director of Global Health Dermatology at Massachusetts General Hospital, Boston, said in an interview from Fiji. 'Many countries have zero dermatologists. There are two dermatologists in Papua New Guinea for 10 million people,' she said. In May, at the annual meeting of the Society for Investigative Dermatology in San Diego, Freeman told colleagues about other gaps in care: In parts of Africa, people with albinism can't find sunscreen, and moisturizer for atopic dermatitis costs double the typical monthly salary. In Australia, only six dermatologists serve rural areas. At least a billion patients with skin disease have no access to dermatologic care, she said, and many more can't afford it. The WHO's 'Skin Diseases as a Global Public Health Priority' resolution, proposed by the Ivory Coast and backed by Nigeria, Togo, Micronesia, and China, aims to implement a coordinated global strategy through initiatives like Fiji's regional training program. The resolution, which passed without the support of the absent US delegation, doesn't come with funding. But José Ruiz Postigo, MD, PhD, a Neglected Tropical Diseases medical officer with WHO, told Medscape Medical News from Fiji that the vote is still transformative. A resolution comes with a high level of mandate, he said. 'When you approach someone at a ministry of health and they ask why you are doing this, to what extent is this a priority, you show them the resolution.' What Will the Resolution Do? One goal of the resolution is to boost the training of dermatologists around the world through programs such as the Fiji's Pacific Dermatology Training Center . It's the first dermatology training program ever established in the Pacific islands, and three Fijians are graduating as the region's inaugural dermatologists. The center, supported by a 5-year ILDS agreement, is similar to programs that have been implemented in other parts of the world. A regional center in Tanzania, for example, serves 16 countries across Africa. Fuller emphasized that training isn't just a matter of producing dermatologists: '80% of dermatology burden is caused by about 10 diseases. We've got an achievable curriculum, and we can train community frontline workers on these 10 diseases.' Freeman agreed, noting that a focus on 10 diseases is 'much more manageable . ' 'We definitely need dermatologists to train the trainers, but they're not the only key players. We'll never have enough dermatologists,' she said. 'Using Papua New Guinea as an example, we need to acknowledge who's on the ground. It could be nurses, medical officers, pharmacists. There's a lot of different cadres of health workers, and this gives us an opportunity to think about the big picture of how we treat people on the front line.' Funding Isn't Allocated — But It's Encouraged Even though it doesn't allocate funding, the resolution specifically recommends that member states increase investment and financing for skin health. 'We in the dermatology community can go to WHO members and say, 'You signed up for this resolution, how can we help you deliver it?'' Fuller said. 'We're not waiting for governments to just act on this; we're going to help them do it.' In addition, the resolution 'opens the door' toward nongovernmental funding, she said. 'Everyone can go to a donor, a university, and say 'Look, in view of this resolution, we want to do this, but we need money.' It's something concrete to point to.' The resolution also mandates WHO to develop internal dermatological resources. 'There's no dermatology department,' Fuller added. 'An obvious solution is to develop a dermatological resource within WHO.' As for the ultimate goal, she said, 'we'd like to be able to say that access to dermatological care is a standard: Any person with a common skin disease would be able to go to their frontline healthcare provider and get it addressed, and there would be specialist services available to refer to when needed.'
Medscape
21-05-2025
- Health
- Medscape
New Project Aims to Document Worldwide Skin Care Crisis
SAN DIEGO — In Burundi, East Africa, desperate patients protect their skin from the sun with petroleum jelly because they can't find sunscreen. In the Democratic Republic of the Congo, Central Africa, patients with atopic dermatitis face an impossible choice: Pay double their monthly salary for a basic moisturizer or go without. And in a wealthy nation — Australia — only six dermatologists are available to treat patients in remote rural areas, while 44 cluster in a single urban shopping mall. Across the world, at least a billion patients with skin disorders have no access to dermatologists, and many can't find — or afford — even the most basic skin treatments. 'Less than half of patients will have access to healthcare for their skin disease, which means that right now, access to healthcare is functioning much more like a privilege than the human right that we know it to be,' said Esther Freeman, MD, PhD, director of Global Health Dermatology at Massachusetts General Hospital and associate professor at Harvard Medical School, Boston, in a presentation here at the annual meeting of the Society for Investigative Dermatology. Esther Freeman, MD, PhD Now, Freeman told colleagues, the groundbreaking Skin Observatory Study aimed to document the world's skin health disparities and light the path toward a better future. 'The most important half of any problem is beginning to understand it in order to start thinking about solutions,' said Freeman, who's leading the project. 'Right now, there is no comprehensive assessment that characterizes access to care and delivery of dermatological care across different regions in the world. The overall goal of the study is to look at defining access to care on a truly global level.' The project, funded by the International League of Dermatological Societies and L'Oreal Dermatological Beauty, was launched last year and is already transforming understanding of global skin health. It was previously known that while Europe had about 50 dermatologists per million residents and the United States had approximately 34 per million, Sub-Saharan Africa had 0-3 per million. Several small nations had no dermatologists at all. Now, the project is producing new statistics. It's already collected numbers from 147 countries representing 95% of the world's population, Freeman said, and preliminary data highlighted the lack of dermatologic resources in many countries. To date, the findings reveal that while nations typically offer antibiotics and steroids to patients, access to biologics is much rarer. Sunscreen access is severely limited in some countries because there's no local manufacturing, and this can be fatal. In Tanzania, East Africa, Freeman noted, 90% of patients with albinism 'will die a premature death before the age of 30 if they don't have access to sun protection.' What's being done in terms of solutions? Freeman highlighted GLODERM (International Alliance for Global Health Dermatology), which now operates in 60 countries with 2000 members, with a mission statement that includes providing health care providers access to training, support, and resources needed 'to offer appropriate care of skin diseases for patients and communities' with limited resources, according to its website. 'I firmly believe that the people closest to the problems are those closest to the solutions,' Freeman explained. 'My job is to think about how we can train and empower people closest to the problems to come up with their own solutions.' Unlike traditional clinical mentorship programs, GLODERM focuses on leadership development. 'What we are teaching is: How do you negotiate with your government if you are trying to establish a department? If you're going to build a residency program for the first time in your country, how do you talk to the Ministry of Health? How do you talk to donors?' Freeman urged dermatologists at all career stages to contribute to global skin health equity through mentoring, ensuring representation in research, and joining existing organizations dedicated to the cause. She ended on a hopeful note, noting that the World Health Assembly, the decision-making body of the World Health Organization, will soon vote on a resolution declaring skin diseases a global public health priority. Freeman said this is a major milestone after 20 years of advocacy. 'I hope I've convinced you today that together, all of us in this room can be part of changing the landscape of access to dermatologic care on a truly global level, even if that means starting right exactly where you are, all the way from student to very senior PI [principal investigator],' Freeman said.
