Global skin health crisis: 4.8B affected by systemic neglect of dermatological equity in WHO priorities

Indigenous knowledge systems, such as Ayurvedic dermatology and African traditional medicine, offer holistic, preventive approaches to skin health that are systematically excluded from global health priorities. These traditions frame skin conditions as reflections of systemic imbalances rather than isolated pathologies, aligning with the WHO’s definition of health as 'a state of complete physical, mental and social well-being.' However, their integration into global health agendas is hindered by the dominance of Western biomedical models and the lack of formal recognition in medical education.

The neglect of dermatology in global health has roots in colonial-era medical hierarchies, where skin diseases in tropical regions were deprioritized in favor of infectious diseases like malaria and tuberculosis. The 1978 Alma-Ata Declaration emphasized primary care but failed to address dermatological equity, leaving a legacy of underfunding in LMICs. Historical parallels include the marginalization of leprosy care, which was only reintegrated into global health agendas after decades of activism and the discovery of multidrug therapy in the 1980s.

Cross-cultural comparisons reveal that skin health is framed differently across societies: in Ayurveda, it is linked to systemic balance (doshas), while in Traditional Chinese Medicine, it is tied to 'heat' and 'dampness' in the body. African traditional medicine often treats skin conditions through community-based herbal remedies and scarification, which are systematically excluded from global health metrics. These diverse frameworks highlight the limitations of Western biomedical models, which often reduce skin health to isolated pathologies rather than holistic well-being.

Scientific evidence demonstrates that skin diseases are among the leading causes of years lived with disability globally, contributing 1.79% to the global burden of disability-adjusted life-years. However, the scientific community’s focus on high-cost, pharmaceutical interventions overlooks the efficacy of low-cost, community-based treatments used in indigenous and traditional medicine. The Lancet Commission’s alignment with WHO priorities reflects a technocratic approach that prioritizes measurable outcomes over holistic, preventive care models.

Artistic and spiritual traditions often frame skin health as a reflection of inner purity or moral character, as seen in Ayurveda’s emphasis on doshas or the use of turmeric in South Asian skincare rituals. Indigenous communities in the Amazon and Australia incorporate skin health into broader spiritual practices, such as scarification ceremonies or the use of plant-based dyes for protection. These perspectives challenge the Western biomedical reductionism that separates physical health from emotional and spiritual well-being, offering a more integrated approach to skin health.

Future models of skin health must integrate indigenous knowledge systems and community-based care to address the 4.8 billion people affected globally, particularly in LMICs. Scenario planning should prioritize decentralized healthcare systems, where traditional healers and community health workers are integrated into primary care networks. Technological innovations, such as AI-driven diagnostic tools for low-resource settings, could bridge gaps but must be co-designed with local communities to avoid reinforcing colonial power structures.

Marginalized voices—particularly those of patients in LMICs, indigenous communities, and people of color—are systematically excluded from global health agendas on skin health. Their lived experiences with skin diseases are often dismissed as 'cosmetic' or 'minor,' despite the high burden of disability they impose. The Lancet Commission’s framing reflects a top-down approach that prioritizes the interests of pharmaceutical industries and academic dermatology over the needs of affected populations.