Unequal access, unequal outcomes: A perspective on dermatological healthcare worldwide

Julia-Tatjana Maul Johannes A. Didaskalu Farah Novoa Mia-Louise Nielsen While psoriasis and its impact have been extensively studied in high-income countries, most regions—especially low- and middle-income countries—lack reliable, standardized data on how psoriasis affects individuals, how it is managed and what outcomes patients experience. Currently, over 80% of the countries in the world have no comprehensive epidemiological or treatment data on psoriasis.1 This creates major gaps in understanding the true global burden of disease, including differences in prevalence, severity, comorbidities such as psoriatic arthritis and cardiometabolic disease, and impact on mental health.2, 3 While data collection in many countries provides country-specific insights, this fragmented approach lacks standardization in methodology, variables and definitions, limiting the generalizability of results and complicating the comparisons across populations. Consequently, it is challenging to make informed decisions about health policy, resource allocation and research priorities. Moreover, access to care varies dramatically across regions. In some countries, patients have access to a full range of therapies—including biologics and small-molecule treatments—while in others, modern treatments are scarce or unavailable. This inequality contributes to widespread undertreatment and poor disease control.4 These disparities and challenges are not confined to the management of psoriasis but represent a broader issue across many inflammatory skin conditions and in dermatology in general.5 This includes hidradenitis suppurativa where there is evidence for delayed diagnosis and higher disease burden in racial and ethnic minority groups in real-world clinical settings.6 Additionally, a reduced utilization of biologics is observed in the treatment of both psoriasis and atopic dermatitis among racial and ethnic minority groups, which has been attributed to differences in access, culture, language barriers and socio-economic factors.7 Also, the treatment guidelines of atopic dermatitis acknowledge the importance of considering diverse skin tones and health disparities in the management of atopic dermatitis and in related research, promoting equity and inclusiveness.8 In response to the World Health Organization's call in 2016 to close these evidence gaps and improve access to care, the Global Healthcare Study on Psoriasis (GHSP) was established and initiated data collection in 2020. Its purpose is to create a standardized, global evidence framework to harmonize the data collection across borders, facilitating a unified approach to dermatological research. This allows for better quantification of the true burden of psoriasis and associated comorbidities worldwide as well as documentation of variations in treatment access and quality of care. Finally, this provides policymakers, clinicians and researchers with actionable information to improve outcomes and reduce inequalities. By generating robust, comparable data across diverse health systems, the GHSP aspires to empower countries to improve care pathways and advocate for equitable access to effective treatments. The GHSP is an investigator-initiated academic project that was designed as a standardized, multilevel data collection platform integrating country-, centre- and patient-level information to ensure comprehensive representation. Its methodology includes a country level with annual collection of country-specific information on psoriasis on treatment availability, reimbursement policies, insurance situations, regulatory frameworks and prevalence of psoriasis as well as other major skin conditions and comorbidities. In addition, centre-level data collection contains details of participating study centres' characteristics, including catchment area, number of patients treated, specific treatments offered and available and other most common skin diseases treated. Furthermore, at patient level, data are a cross-sectional collection of standardized patient information at the point of care, including demographics, socio-economic background, disease characteristics, comorbidities, treatment history, disease severity, quality of life impairment and access to treatment, recorded at the time of the visit regardless of disease stage.9 This approach ensures that data from participating sites are comparable across regions and can be integrated with established registries such as the Swiss Dermatology Network for Targeted Therapies. Other efforts, such as the Global Psoriasis Atlas, are mapping the worldwide prevalence and epidemiological patterns of psoriasis, while the GHSP complements these data by providing detailed, patient-level information on clinical characteristics, management and real-world outcomes across diverse healthcare settings.10 By September 2025, the GHSP had collected data from more than 5000 patients across 100 centres in 24 countries spanning six continents (Figure 1). In January 2025, the GHSP had evolved into the Global Healthcare Registry of Skin Diseases, extending its scope to include atopic dermatitis and hidradenitis suppurativa. The registry is transitioning from cross-sectional snapshots to longitudinal follow-up, creating a real-world registry to track disease progression, treatment outcomes and drug survival globally. By systematically documenting disease characteristics, treatment patterns and health system contexts across the world, the GHSP aims to fill long-standing evidence gaps, inform clinical guidelines and advance global dermatology research to improve the lives of patients living with inflammatory skin diseases. No funding relevant to this manuscript. The Global Healthcare Study on Psoriasis is an investigator-initiated academic project that receives non-restrictive support from multiple pharmaceutical companies (bristol meyer squibb, Eli Lilly and Company, Union Chimique Belge, AbbVie, Johnson & Johnson, Almirall ApS, Amgen Inc. and Boehringer Ingelheim). These supporters have no role in the study design, data collection, data analysis, interpretation of results or manuscript preparation. With no relation to the present manuscript, Dr. Nielsen has received consultancy honoraria from LEO Pharma. Mr. Didaskalu has nothing to declare. With no relation to the present manuscript, Prof. Julia-Tatjana Maul has served as advisor and/or received speaking fees and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, BMS, Celgene, Eli Lilly, LEO Pharma, Incyte, Janssen-Cilag, MSD, Novartis, Pfizer, Pierre Fabre, Roche, Sanofi and UCB. Dr. Farah Novoa has received honoraria from SunPharma, with no relation to the present manuscript. The study was approved by the local ethics committee (EK2020–00002) and was conducted in compliance with the Declaration of Helsinki and Good Clinical Practice rules.Swiss Ethics Committee of Zurich approval was obtained (BASEC, approval ID: 2020-00002). No identifiable patient information is available in the article. Patients have given informed consent to have their data collected and stored for the Global Healthcare Study on Psoriasis. Data sharing is not applicable to this article as no new data were created or analyzed in this study.