Countries are urged to adapt their strategic framework to meet the huge unmet needs of skin diseases

The World Health Organization (WHO) has released a strategic framework for skin-related neglected tropical diseases (cutaneous NTDs) that identifies opportunities to integrate control and management approaches, including learning platforms communities, capacity building for case detection and treatment delivery.1 The framework, a companion document to the roadmap, was officially launched during a webinar hosted by WHO on June 8, 2022.

“We urge countries to adapt integrated approaches, as outlined in the framework, to accelerate progress towards the control, elimination and eradication of cutaneous NTDs in order to achieve the goals of the 2030 roadmap,” said Dr Kingsley Asiedu, who leads the WHO’s global program for cutaneous NTDs. “The operationalization of cross-cutting approaches to activity integration and data reporting will improve monitoring and evaluation of all cutaneous NTDs.,” he added.

Cutaneous NTDs2 afflict hundreds of millions of people. They cause immense discomfort, suffering, stigma and mental distress and affect the quality of life of mostly marginalized populations in remote rural areas.

This framework is designed to help endemic countries establish a strong health care system to provide holistic services not only for cutaneous NTDs, but also for other skin diseases,” said Dr. Rie Yotsu, of the Tulane School of Public Health and Tropical Medicine, framework co-author and webinar panelist.

At least 10 of the 20 WHO-prioritized NTDs show changes in the skin before other changes occur in internal organs or physical disabilities develop. According to Professor Roderick Hay, King’s College London, framework contributor and webinar panelist “Many cutaneous NTDs can be treated with the right approach… Detected early, they can be effectively treated and cured, often with inexpensive drugs, to overcome stigma and mental suffering as well as ensure healthy skin.

An integrated approach provides opportunities and solutions to tackle cutaneous NTDs on the ground using measures ranging from education, awareness and seeking medical care at the onset of symptoms to building capacity by developing appropriate diagnostics and tools.

WHO/NTD

In his welcoming remarks, Dr Ren Minghui, WHO Assistant Director-General for Universal Health Coverage/Communicable and Non-Communicable Diseases, said that by working with other disease control and health programs public and by working together, we can help our Member States to promote skin health for all as part of universal health coverage.

“We also need more public awareness of skin diseases and their severity. Therefore, it is vital to strengthen community health personnel to detect and report skin problems to health workers. This system has been used successfully for dracunculiasis (guinea worm disease), leprosy, yaws and other diseases,” he said.

Capacity building is essential for the implementation of integrated approaches. Online tools for frontline health workers include a training guide and a multilingual mobile app.3 Accurate and reliable tools are also essential to guide diagnosis and integrated management given the co-endemicity and common differential diagnosis for many cutaneous NTDs.

WHO has worked to identify target product profiles to achieve the roadmap objectives,said Dr. Israel Cruz, chair of the Skin NTD subgroup of the WHO Diagnostic Technical Advisory Group for Neglected Tropical Diseases. “These include point-of-care case detection for Buruli ulcer, cutaneous leishmaniasis and mycetoma.

For mycetoma, the only effective approach is early case detection and management, involving long periods of antifungal therapy combined with surgery. An integrated approach offers opportunities to share available resources, improve case detection, reduce treatment costs, and improve program efficiency. A promising new drug for eumycetoma (fosravuconazole) is in clinical trials and will potentially shorten the duration of treatment.

Country experiences

During the webinar, panelists shared country experiences and challenges in implementing cutaneous NTD programs. In the brazilian amazona multidisciplinary team provides comprehensive care for patients with dermatological pathologies, in particular cutaneous NTDs. Ghana achieved positive results following the integrated control of Buruli ulcer, leprosy and yaws. Liberia has a ‘successful’ experience in integrating services, which has improved case detection of NTDs. In Pakistan, the management of leprosy is integrated with general dermatology and physical rehabilitation and, lately, with the treatment of tuberculosis and cutaneous leishmaniasis, obtaining positive results. In East Timor, integrated treatment is offered for scabies, lymphatic filariasis and yaws; and in Vanuatu for scabies, yaws and soil-transmitted helminthiasis.

Partners and support

Various partner organizations, including donors, have been instrumental in supporting national cutaneous NTD programs. Anesvad supports the integration of NTD programs in West Africa, contributing to the improvement of health systems. The International Federation of Anti-Leprosy Associations deploys joint approaches to tackle multiple diseases, yielding significant benefits; integrated approaches are essential to achieve zero leprosy. FAIRMED runs a project that integrates Buruli ulcer, leprosy, leishmaniasis, lymphatic filariasis and yaws in Cameroon, Central African Republic and Congo. The cross-sectional group on cutaneous NTDs of the Neglected Tropical Diseases NGO Network moved from the management of individual diseases to a broader integration of skin diseases and developed training tools to support the work of WHO. NLR (Until No Leprosy Remains) treats patients in India and Nepal affected by leprosy and lymphatic filariasis, with positive disability management that has addressed patients’ mental health issues and fostered their social involvement. For the Global action against fungal infections further work is needed to improve diagnostic capability to treat deep fungal conditions that are prevalent worldwide. Affordable access to drugs such as itraconazole is critical and an alternative strategy for financing NTD antifungal therapies is needed.

Dr Gautam Biswas, Acting Director of WHO/MTN, concluded by urging countries and partners to use the framework within the primary health care system and direct resources to meet the huge unmet needs of Cutaneous NTDs.

Watch the full webinar by accessing the recording.

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2 Buruli ulcer; cutaneous leishmaniasis; mycetoma, chromoblastomycosis and other deep mycoses (including sporotrichosis); leprosy (Hansen’s disease); lymphatic filariasis; onchocerciasis; post-kala-azar cutaneous leishmaniasis; scabies and other ectoparasitosis (including tungiasis); and yaws.