The World Health Organization (WHO) has published a strategic framework for skin-related neglected tropical diseases (skin NTDs) that identifies opportunities to integrate approaches for control and management, including common learning platforms, capacity-building for case detection and delivery of treatment.1 The framework, a companion document to the road map, was formally launched during a WHO-hosted webinar on 8 June 2022.
“We urge countries to adapt integrated approaches, as outlined in the framework, to accelerate progress towards control, elimination and eradication of skin NTDs to achieve the 2030 road map targets,” said Dr Kingsley Asiedu, who leads WHO’s global programme for skin NTDs. “The operationalization of cross-cutting approaches for integrating activities and data-reporting will improve the monitoring and evaluation of all skin NTDs,” he added.
Skin NTDs2 afflict hundreds of millions of people. They cause immense discomfort, suffering, stigmatization and mental distress and affect the quality of life of mostly marginalized populations in remote rural areas.
“This framework is designed to support endemic countries in establishing a strong health-care system to deliver holistic services not only for skin NTDs but also for other skin diseases,” said Dr Rie Yotsu, Tulane School of Public Health and Tropical Medicine, the co-author of the framework and a webinar panellist.
At least 10 of the 20 NTDs prioritized by WHO present with changes on the skin before other changes occur in the internal organs or physical disabilities develop. According to Professor Roderick Hay, King’s College London, a contributor to the framework and a webinar panellist “Many of the skin NTDs can be addressed with the right approach … Detected early, they can be effectively treated and cured, many with inexpensive medicines, to overcome the stigma and mental suffering as well as ensure skin health.”
An integrated approach provides opportunities and solutions for addressing skin NTDs in the field using measures ranging from education, awareness-raising and seeking medical care at the onset of symptoms to building capacity by developing appropriate diagnostics and tools.
In his welcoming remarks, Dr Ren Minghui, WHO Assistant Director-General for Universal Health Coverage/Communicable and Noncommunicable Diseases, said that by working with other disease and public health programmes and by integrating our efforts, we can support our Member States in promoting skin health for all as part of universal health coverage.
“We also need greater population awareness of skin diseases and their seriousness. Therefore, building the community health workforce to detect and report skin problems to health workers is vital. This system has been used successfully for dracunculiasis (Guinea-worm disease), leprosy, yaws and other diseases,” he said.
Capacity building is critical to implementing integrated approaches. Online tools for front-line health workers include a training guide and a multilingual mobile App.3 Accurate, reliable tools are also essential to guide diagnosis and integrated management given the co-endemicity and common differential diagnosis for many skin NTDs.
“WHO has been working to identify target product profiles to achieve the road map targets,” said Dr Israel Cruz, Chair, Skin NTD subgroup, WHO Diagnostic Technical Advisory Group for Neglected Tropical Diseases. “These include case detection at the point of care for Buruli ulcer, dermal leishmaniasis and mycetoma.”
For mycetoma, the only effective approach is early case detection and management, involving long periods of antifungal treatment combined with surgery. An integrated approach provides opportunities to share available resources, improve case detection, reduce treatment costs and improve programme efficiency. A promising new medicine for eumycetoma (fosravuconazole) is in clinical trials and will potentially shorten the duration of treatment.
During the webinar, panellists shared country experiences and challenges in implementing skin NTD programmes. In the Brazilian Amazon, a multidisciplinary team provides comprehensive care to patients with dermatological diseases, especially for skin NTDs. Ghana has achieved positive results following the integrated control of Buruli ulcer, leprosy and yaws. Liberia has “fruitful” experience in integrating services, which has improved case detection of NTDs. In Pakistan, leprosy management is integrated with general dermatology and physical rehabilitation and, latterly, with treatment of tuberculosis and cutaneous leishmaniasis, achieving positive outcomes. In Timor-Leste, integrated treatment is provided for scabies, lymphatic filariasis and yaws; and in Vanuatu for scabies, yaws and soil-transmitted helminthiases.
Partners and support
Various partner organizations, including donors, have contributed to supporting national skin NTD programmes. Anesvad supports integration of NTD programmes in West Africa, contributing to the improvement of health systems. The International Federation of Anti-Leprosy Associations deploys joint approaches to tackle several diseases, yielding significant benefits; integrated approaches are essential to achieve zero leprosy. FAIRMED manages a project that integrates Buruli ulcer, leprosy, leishmaniasis, lymphatic filariasis and yaws in Cameroon, the Central African Republic and Congo. The Skin NTDs Cross Cutting Group of the Neglected Tropical Diseases NGO Network has shifted from managing single diseases towards broader integration of skin diseases and has developed training tools to support WHO’s work. NLR (Until No Leprosy Remains) treats patients in India and Nepal who are affected by leprosy and lymphatic filariasis, with positive management of disability that has enabled the mental health problems of patients to be addressed and encouraged their social involvement. For the Global Action for Fungal Infections more work is needed to improve diagnostic capability to address deep fungal conditions that are prevalent worldwide. Affordable access to medicines such as itraconazole is critical and an alternative strategy for NTD antifungal therapy funding is needed.
Dr Gautam Biswas, Director a.i., WHO/NTD, concluded by urging countries and partners to use the framework within the primary health care system and direct resources to addressing the huge unmet needs of skin NTDs.
Watch the full webinar by accessing the recording.
1 Ending the neglect to attain the Sustainable Development Goals: a strategic framework for integrated control and management of neglected tropical diseases. Geneva: World Health Organization; 2022 (https://apps.who.int/iris/handle/10665/355448, accessed 13 June 2022).
2 Buruli ulcer; cutaneous leishmaniasis; mycetoma, chromoblastomycosis and other deep mycoses (including sporotrichosis); leprosy (Hansen’s disease); lymphatic filariasis; onchocerciasis; post-kala-azar dermal leishmaniasis; scabies and other ectoparasitoses (including tungiasis); and yaws.
3The mobile app is available in Android https://play.google.com/store/apps/details?id=com.universaldoctor.skin_ntds&hl=en_US and IOS https://apps.apple.com/us/app/skin-ntds-app/id1499080526