Ncoza C. Dlova Olufolakemi M. Cole-Adeife Esther E. Freeman Fatimata Ly Dermatology is influenced by geographic, genetic, socio-economic and cultural factors, reflecting global variation in skin colour, climate, cultural practices and access to care.1, 2 In Africa, these factors converge to create distinct challenges that make existing dermatology guidelines difficult to apply.3 Africa has over 1.5 billion people across 55 countries (mostly low- or middle-income countries) and over 1500 ethnic groups, with all skin tones represented, though darker skin is predominant.4, 5 Dermatology guidelines used across Africa are adapted from high-income countries and thus overlook the African context.2, 6-8 Darker skin presentations, cultural practices, limited specialist resources and the dual burden of communicable and non-communicable skin diseases are often unaddressed.2, 3, 6, 7 Hence, regionally tailored dermatology guidelines are urgently needed. Dermatoses such as acne, psoriasis, seborrhoeic dermatitis and atopic dermatitis often present with less visible erythema and with hypo- or hyperpigmentation in darker skin types.2, 5-7 These features are not captured by standard severity scores, leading to underestimation of disease severity.2, 5-7 Dyspigmentation significantly impacts quality of life but is rarely addressed in current protocols.2, 5, 6 Skin infections, HIV-associated dermatoses and neglected tropical diseases such as scabies, leprosy, Buruli ulcer and cutaneous leishmaniasis are prevalent in Africa.3 At the same time, non-infectious dermatoses such as atopic dermatitis, acne and seborrhoeic dermatitis are on the rise, due to urbanization changing diets, lifestyles and climate.3, 5-7 Hypertrophic scarring and keloids, pseudofolliculitis barbae and dermatosis papulosa nigra are common in people of African ancestry but are inadequately covered in global guidelines.2, 5, 8 Cultural norms and climate strongly shape skin and hair care practices.3, 5, 9 The hot, humid weather in most of Africa drives frequent bathing, often with alkaline or antiseptic soaps and abrasive sponges.9 These practices can aggravate xerosis and pruritus, disrupt the skin microbiome and worsen inflammatory conditions and hyperpigmentation.9 Hair grooming practices, such as infrequent hair washing, can worsen scalp seborrhoeic dermatitis and psoriasis, and high-tension hairstyles, glued wigs and hair straighteners contribute to traction alopecia and central centrifugal cicatricial alopecia and also pose systemic health risks.2, 5 Some traditional remedies for skin conditions cause adverse cutaneous reactions.2, 5 Skin lightening or bleaching remains widespread across Africa, with 30%–77% of women in Sub-Saharan African countries such as Nigeria, Ghana, Senegal, Mali and South Africa using skin lightening products regularly due to perceived socio-economic benefits.10 The widespread misuse of topical corticosteroids and hydroquinone for skin bleaching results in chronic irritant dermatitis, exogenous ochronosis, steroid-induced acne, skin atrophy, atypical skin infections and even skin cancer, which international guidelines do not address.10 Most African countries have fewer than three dermatologists per million people.3, 4 The majority of dermatological care is thus delivered by non-specialists with little dermatology training.3, 4 Health insurance coverage remains sparse, and out-of-pocket payments are the primary mode of healthcare financing.3, 4 Access to diagnostics such as histopathology and immunofluorescence, and to advanced therapies such as biologics and JAK inhibitors, is sparse due to infrastructure and cost constraints.3, 6, 7 Furthermore, high prevalence of tuberculosis and Hepatitis B necessitate rigorous screening before initiating immunosuppressive treatments, increasing care costs.3, 6 These systemic barriers hinder the use of international guidelines, especially in rural or low-resource settings.3, 6, 7 In May 2025, the World Health Assembly adopted a resolution recognizing skin diseases as a global public health priority.11 This milestone acknowledges the burden of skin conditions worldwide, particularly in LMIC settings, and the need for culturally sensitive, equitable and feasible solutions for the prevention, diagnosis and care of skin diseases.11 Developing evidence-based regional dermatology guidelines tailored to the African context is a timely and essential response to the resolution. Such guidelines would prioritize common conditions among Africans, unique clinical presentations in darker skin tones, promote safe yet culturally acceptable skin and hair care practices and provide diagnostic and therapeutic options aligned with local realities and available resources.2, 4, 6 Regional guidelines should acknowledge the coexistence of infectious and non-infectious conditions and should be formulated to have a cross-cutting, inclusive approach.3, 4, 7 They could also assist task-sharing and guide the development of simplified care algorithms for frontline healthcare workers.3, 4, 6, 7 Developing African dermatology guidelines requires the collaborative effort of dermatologists, researchers, patient associations, policymakers and funders.2, 6 Table 1 summarizes potential action points. Guideline methodology must also be carefully considered (e.g. GRADE methodology versus expert consensus), as this carries important cost and feasibility implications.8 Form regional expert panels under the African Society for Dermatology and Venereology (ASDV) and Société de Dermatologie d'Afrique Francophone (SODAF) to draft condition-specific guidelines, or where full guidelines are not feasible, consensus statements.4, 8 Push for the review of disease severity scoring systems to include presentations in darker skin tones.2, 6, 7 Integrate guidance on gentle cleansing, appropriate, accessible and culturally acceptable emollients and on the prevention of cosmetic skin bleaching, especially with corticosteroids and hydroquinone.2, 4, 8 Emphasize how appropriate care can reduce the social and economic burden of skin, hair and nail disease.2, 5 Engage national dermatological societies in Africa to build consensus and ensure sustainability and effective implementation.2 Engage international dermatology organizations, associations and dermatology industry partners for technical support and funding for both guideline development and increasing access to advanced therapeutics (e.g. biologics for AD and psoriasis—recently added to the WHO Essential Medicines List) across Africa. The lack of regionally relevant dermatology guidelines in Africa reinforces disparities in care, compelling the need for change. The continent requires evidence-informed, resource-sensitive and culturally aligned dermatologic guidance for improved care. Through regional collaboration, research investment, leadership from African dermatologists and guidance from the international dermatology community, regional African dermatology guidelines and consensus statements can help bridge the care gap across the continent. They are a critical step towards global dermatological care that truly leaves no one behind. No funding was received for this article. None to declare. Not applicable. Not applicable. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
Dlova et al. (Sat,) studied this question.