Regional contributions to historical and future trends of global fungal skin disease burden: A comprehensive analysis of the Global Burden of Disease 2023 study

Fungal skin diseases are common and contribute substantially to nonfatal disease burden. Despite their prevalence, these conditions are often overlooked because they are rarely life-threatening. However, the rising prevalence of obesity and diabetes, environmental changes associated with climate change, and the emergence of antifungal-resistant dermatophytes may contribute to increasing future burden. In this study, we analyzed Global Burden of Disease (GBD) 2023 estimates to evaluate fungal skin disease burden, using disability-adjusted life years (DALYs) as the metric for burden across 21 GBD regions. Joinpoint regression was used to characterize temporal trends. Decomposition analyses partitioned changes in DALYs into contributions from population growth, population aging, and epidemiologic change. Future DALYs and age-standardized DALY rates (ASDRs) were projected from 2024-2050 using Bayesian age-period-cohort modeling. Global fungal skin disease DALYs increased from 1.5 million (95% UI, 0.6-3.2 million) in 1990 to 2.0 million (95% UI, 0.8-4.2 million) in 2023 and are projected to reach approximately 2.6 million (95% UI, 1.4-4.4 million) by 2050. Global ASDRs are projected to increase from 26 (95% UI, 10-54) in 2023 to 29 (95% UI, 16-53) per 100,000 population by 2050. We identified regions predicted to contribute to worsening burden, most notably South Asia, which was projected to contribute 45.2% (95% UI, -10.7 to 155.0) of future global DALY increases. Global fungal skin disease burden is projected to increase through 2050, accompanied by worsening ASDRs. Projected regional variation in future burden highlights the need for region-specific prevention, surveillance, and control strategies.