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.
The framework, a companion document to the road map, was formally launched during a WHO-hosted webinar on June 8, 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 program 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 NTDs 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 panelist.
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 panelist “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 programs 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. 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 program efficiency. A promising new medicine for eumycetoma (fosravuconazole) is in clinical trials and will potentially shorten the duration of treatment.
