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The global challenge for skin health

The human skin is the largest of the body’s organs, with functions that encompass sensation, heat regulation, water conservation and immunological surveillance. It is also the single most important determinant of human appearance and identity, and the interface for much of our physical and social contact with our environment. It is not difficult, therefore, to understand how events that compromise its integrity and health have a profound, and potentially devastating, impact on general well-being and self-respect. Furthermore, illness that directly affects the skin is the fourth most frequent cause of all human disease, affecting some 1 9 billion people at any time, almost one-third of the world’s population. It is therefore a leading reason for seeking medical help in all societies. Skin diseases may be infectious, congenital, degenerative, inflammatory and cancerous, and they affect all ages from cradle to grave, but a disproportionate burden falls on the elderly and young children. One of the more common popular fallacies in the perception of human illness is that, because a disease is very common, it may be of little consequence. Yet intolerable itching and disfigurement are severe consequences of damage to the skin. Furthermore, many of these conditions have long-standing, serious repercussions that impair internal organs from the joints to the kidneys, as well as posing a real threat of mental illness leading to severe depression and even suicide. In much of the world there is a gross mismatch between the burden of human ill health and the skills necessary to manage it, through lack of trained individuals, research and medicines, leading to a huge reservoir of untreated, or poorly treated, disease – a major concern for those addressing global inequalities in health. The major neglected tropical diseases such as leprosy, leishmaniasis, onchocerciasis, lymphatic filariasis and yaws, which affect millions, present with abnormalities of the skin. In many countries their control remains an unfulfilled dream, with a lack of skill in their recognition leading inexorably to a failure to control their spread among vulnerable populations, compromising the hopes for the longterm success of the most comprehensive mass treatment programmes that the world has seen.