Global Dermatology

In the world we know, the dermatology field is filled with fancy lasers and devices, Botox and fillers, and plastic surgery to create the most aesthetically pleasing outcomes. In other worlds, these approaches are light years away, and an aesthetically pleasing outcome is correlated more with treating and managing infections and medical conditions that have skin manifestations. Throughout my career, I have traveled internationally with several medical and dermatology groups to set up clinics in underserved areas of Mexico and East Africa. One similarity was evident across the board during these trips—a scarcity of medical specialists in dermatology.

Reducing Stigma

In Mexico, the number of patients presenting with warts seemed overwhelming, and liquid nitrogen was not easy to come by. We also saw a higher incidence of ochronosis, likely the result of using bleaching creams sold over the counter in pharmacies to treat melasma, another common condition causing significant emotional distress for the women and men affected by it. Treating patients with melasma was a challenge for us because medications were frequently scarce and the treatment options we often employ in the United States, such as lasers and chemical peels, were not available options. In addition, patients may not have had access to creams and retinoids after the free medications we distributed ran out. For many people with melasma in Mexico, long-term management of the condition is difficult. Patients may not be able to afford sunscreen to use regularly for prevention, and sun avoidance is hard because many people spend most of their days in the sun.

In East Africa, we saw a variety of skin conditions. Because the prevalence of HIV was so high in the community, there was a multitude of cases involving bacterial, fungal, and parasitic infections. When visiting schools and screening the children, tinea capitis Global Dermatology Common dermatologic conditions in Mexico and East Africa are associated with stigma and decreased quality of life. Angie Koriakos, DO, MPH was present in around half of the students. In adults, there was a high prevalence of tinea corporis and bacterial skin infections. Patients with HIV were often stigmatized by the skin manifestations of the infection. Lipoatrophy was significant in many of these patients, who do not have access to the injectable dermal fillers available in the United States.

One of the most striking conditions seen in East Africa was oculocutaneous albinism type 2 (OCA-2), an autosomal recessive disorder that presents with hypopigmentation of the skin, hair, and eyes. A common form of albinism, OCA-2 is associated with greatly diminished visual acuity; nystagmus; and increased rates of skin cancer, primarily squamous cell carcinoma and basal cell carcinoma. OCA-2 is present at a significantly higher rate in sub-Saharan Africa; 1 in 1400 in Tanzania compared with 1 in 36 000 in the United States. Albinism has long been associated with stigma and superstitions in East Africa, such as the belief that the mother of a child with OCA-2 was impregnated by a White man or that the child is the ghost of a European colonist. There have also been notions that the body parts of those affected are good-luck charms or possess magical powers. Since 2000, more than 100 people with OCA-2 in Tanzania and other African countries have been murdered for their body parts, which can be sold on the black market for as much as $75 000.1,2 Witch doctors in Tanzania use these body parts to create potions to bring good luck and wealth. As a result, those with OCA-2 not only face the risk of numerous skin cancers, but they must also contend with safety concerns due to threats on their lives.

Improving Quality of Life

Patient goals for dermatologic treatment in these countries are far less about reversing aging or looking younger and far more about managing skin diseases to remove the physical manifestation of infections and underlying conditions. Many of these skin conditions cause significant stigma and decrease quality of life, and obtaining treatment is often a luxury due to a lack of dermatology specialists. Programs such as the Regional Dermatology Training Centre in Tanzania are working to educate medical specialists in dermatology to provide more access to treatment.

Disclosure: The author reports no relevant financial relationships.

1. Cruz-Inigo AE, Ladizinski B, Sethi A. Albinism in Africa: stigma, slaughter, and awareness campaigns. Dermatol Clin. 2011;29:79-87. doi:10.1016/j.det.2010.08.015

2. Velton R. The ‘silent killer’ of Africa’s albinos. BBC Future. April 25, 2017. Accessed August 11, 2022. https://www.bbc.com/future/article/20170425-the-silentkiller- of-africas-albinos