The International Society of Dermatology’s Task Force for Skin Care for All : Community Dermatology

Conceived in Ethiopia (Verma 2007) and launched by the International Society of Dermatology (ISD) in Berlin (2008) The Task Force for Skin Care for All: Community Dermatology is ambitious but, unlike Healthy Skin for All, it is not utopian and should be possible to achieve. The targets are the commonest skin conditions that affect millions, many of which are disabling or have the potential to disable. For instance, with impetigo or streptococcal pyoderma secondary to scabies, which are very common infective skin conditions, it is a concern that glomerular nephritis and rheumatic heart disease are sometime consequences. However, even common conditions are misdiagnosed and ineffective remedies are frequently prescribed for them. Pilot Community Dermatology schemes have proven their capacity to manage this problem. The Task Force is up against, and can record that our profession often overcomes, the ill effects of strife and man’s inhumanity to man, the hazards of climate change, bureaucracy, the mobility of populations, corruption, and several other potential impediments to its achievement. However, the main background factor it must assuage is poverty. Community Dermatology was a term used by Gurmohan Singh 40 years ago when taking skin care to tribal people in Bihar. When Rod Hay used it in an article in The Lancet in 1991, he was articulating a simple principle, in that health workers should consider illness in the wider community as well as in the individual patient. Furthermore, such a concept is not confined to disadvantaged communities but as with the challenges of tanning, skin lightening, and solar damage it applies to resource-rich communities as well. Rod Hay has pointed out that the control of tinea capitis in the early to mid 20th century was organized from dermatology departments. Ma Haide in China created the dermatology department in Nanjing, China, in part to reduce the stigma of diseases such as syphilis, tinea capitis, and leprosy in the massive elimination programs ordered by the communist regime. It has been more recently used by Paul Buxton when launching The Community Dermatology Journal, which has now become an organ of the International Foundation for Dermatology (IFD) that is distributed free to all who request it but focuses on those such as the graduates of the Regional Dermatology Training Centre of Tanzania, who benefit from twice yearly updating. Thus, Community Dermatology is not new. However, in Ethiopia its terminology was adopted to emphasize a developing branch of dermatology in which people such as Aldo Morrone in Rome focus on mobile populations and in Australia projects such as the scabies control programs among the Aborigines are given greater advocacy. The discussions in Ethiopia were reported in the International Journal of Dermatology by Shyam Verma, by whom like many in India, the concept was adopted with enthusiasm. It was previously clearly described in Tropical Doctor by Estrada and Andersson. Community dermatology embraces common skin diseases. It is inclusive of wounds and lymphedema and has long had neglected tropical diseases such as leprosy as a major interest. It concerns populations of individuals rather than individuals in a one-to-one relationship. It requires data on prevalence and manpower. It trains community based workers to manage common problems of the skin. Its interventions are low cost and address the needs of those with few resources; though not exclusively. These may be isolated, peri-urban or mobile communities, often against a threatening background such as strife or climate change. In the context of Community Dermatology, one must not forget that sexually transmitted infections are important in dermatology and in countries with huge populations such as India, China, Indonesia, and Brazil these infections are professionally supervised by dermatologists.