A skin problem can begin with something familiar. An itch that persists. A rash that returns. A patch that looks different from the rest of the skin. What happens next often depends on where a person lives and whether appropriate care is within reach.
The Global Access to Skin Health Observatory is a landmark global study led by Esther Freeman in collaboration with the International League of Dermatological Societies (ILDS) and L’Oréal Dermatological Beauty. For India, the findings raise questions about where specialists practise, how patients reach them and what happens when treatment is delayed. This, however, is a reference point, rather than a universal staffing prescription. Dr. What surprises Prof Bhat is that shortages persist despite the number of postgraduate dermatology training seats. He points to the urban-rural divide, with a concentration of specialists in urban areas, and in many cities in southern India, while rural communities face a different reality, where access even to a doctor may be limited.
Because their health systems differ, ramesh Bhat, the Indian co-author of the study and professor at Father Muller Medical College and head of research at Father Muller Research Centre, Mangalore, cautions against directly comparing India with Europe or the Americas,. National averages can therefore conceal substantial local gaps. Published in JAMA Dermatology , it brings together data from 158 countries representing 97% of the world’s population. The study proposes a benchmark of 5.63 per lakh, derived from countries reporting adequate access to dermatological care. Freeman, who is associate professor of dermatology at Harvard Medical School and director of global health dermatology at Massachusetts General Hospital, places India’s dermatologist density well below the benchmark at around 0.5 to 1 per lakh people. The study reports that, globally, 79% of dermatologists practise in urban areas.
“Dermatologist density gives us an important starting point, but it does not tell us whether a patient can actually receive care,” Dr. Freeman says.
For Prof Bhat, the consequences are visible in clinical practice. He singles out leprosy as a condition where delayed diagnosis has implications beyond the individual patient. His concern brings the discussion back to what happens before someone reaches a specialist and whether the treatment they receive along the way is appropriate. But he cautions that training healthcare workers must not result in unqualified practice or drug misuse. Expanding access requires clarity about who can manage a condition and when specialist assessment is necessary.
He identifies “delay in diagnosis, wrong treatment, steroid abuse” among the problems arising when appropriate care is unavailable. “Teledermatology can be implemented,” Prof Bhat says.
For India, that would mean earlier recognition, appropriate treatment and dependable referral, with fewer patients left to navigate the gaps themselves.
