Global Psoriasis Atlas Field Study in South Africa – December 2023

In December 2023, the GPA conducted a house-to-house survey in two rural, neighbouring villages (Mtyholo Dlova and Mdolomba) in the Eastern Cape, South Africa, resulting in the publication of the first comprehensive community-based point prevalence study of skin disease in the province. This study was completed in collaboration with Professor Ncoza Dlova, GPA Regional Coordinator, alongside a multidisciplinary team of international and local dermatologists, researchers, local community workers and industry volunteers. This work provided population-level data for the first time in the region, generating evidence which may help inform local service planning and future healthcare interventions.

Why the Eastern Cape?

For many skin diseases, inequalities in care are a result of a lack of knowledge, understanding of the disease prevalence, and delays in diagnosis and treatment. Across Africa, data on the burden of skin disease are sparse, limiting the ability to target resources effectively and improve access to care.

The Eastern Cape is one of South Africa’s most under-resourced provinces and the poorest nationally, with high levels of poverty, illiteracy, and unemployment. Many rural residents face substantial barriers to healthcare services and treatment, in part due to limited transportation and financial constraints. Very little is known about the spectrum, distribution, and burden of skin disease in this region.

Since 2019, the GPA have worked and collaborated with Professor Ncoza Dlova (GPA South Africa Regional Co-Ordinator) to improve research capacity and access to sustainable health in Sub-Saharan Africa. This collaboration, alongside colleagues at the Regional Dermatology Training Centre in Moshi (Tanzania), led to the completion of a pilot survey of skin disease in Maasai people in Tanzania (Kahn et al. BJD 2023; https://doi.org/10.1093/bjd/ljac065). This groundwork laid the foundation for the GPA to complete the first-ever cross-sectional, community-based point-prevalence study of skin disease in South Africa’s Eastern Cape, documenting in greater detail the prevalence of all skin diseases.

Where?

In December 2023, the GPA team, comprised of dermatologists (UK, Israel, SA) and researchers, South African dermatologists, and industry partner volunteers (UK & France), travelled to King William’s Town (Qonce). The survey was conducted across 6 days in two rural villages; Mtyholo Dlova and Mdolomba.

What?

The aim was to collect demographic data on all available residents (99% of whom were Xhosa people) and to identify any skin, nail or hair diseases. The team examined 698 residents across 309 households.

Results

In total, 439 people were identified as having at least one skin disease, with 100 different dermatological conditions identified diagnosed in this population by the dermatologists. The prevalence of skin diseases was broadly similar across the two villages. The overall point prevalence of any skin disease was 62.9% (95% CI 59.3-66.5%). Psoriasis was rare in this population with a prevalence of only 0.3% (95% CI 0.0%–0.7%).

Gender differences in skin disease prevalence, and types of skin disease, were observed. Skin disease in general was more common in women than men (point prevalence of any skin disease 65.8% vs. 59.2%). Alopecia and melasma were more prevalent in women whereas pseudofolliculitis barbae and tinea capitis were more prevalent in men.

There was also variation by age, with younger individuals more prone to infections and inflammatory conditions and older adults more prone to dyspigmentation, follicular disorders and degenerative dermatoses.

The most prevalent skin diseases were:

Children (<18 years):

• Tinea capitis (16.4%)

• Acne vulgaris (13.0%)

• Pityriasis alba (10.6%)

• Prurigo, post-inflammatory hyperpigmentation (PIH), xerosis, atopic dermatitis, and scabies also common

Adults:

• Xerosis (7.8%)

• Acne vulgaris (7.4%)

• Melasma (6.2%)

• Dermatosis papulosa nigra (DPN) (5.6%)

• Scarring & nonscarring alopecia, tinea pedis

Impact

The collaborative nature of SKINSCAPE fostered a rich exchange of knowledge, insights, and expertise, particularly through the close partnership with the South African team. This international collaboration enabled meaningful cross-cultural learning, with the South African dermatologists contributing invaluable expertise in the presentation and diagnosis of skin diseases on black skin, strengthening the broader understanding of dermatological conditions in different populations.

The SKINSCAPE team is committed to creating a lasting impact and fostering a legacy of knowledge and support for the communities involved. Local young people from Mtyholo Dlova and Mdolomba volunteered as community workers and received hands-on training in data collection and from dermatologists on recognising skin conditions. By the end the study, the community workers were able to independently identify common skin diseases and the experience inspired several to pursue an education and career in healthcare in the future.

This project also garnered support from various industry partners worldwide, highlighting the importance and value of such collaborative approaches in advancing dermatological research in underserved regions. Unilever generously donated large bags of skin care products and toiletries for every family in both villages. Elsa Taicher (Global Professional Relations Manager, L’Oréal) facilitated the delivery of emollients and sunscreen for distribution by the SKINSCAPE team working in the two community halls and to the local hospital. Dr Zikhona Gxolo, an East London-based dermatologist attached to the Cecilia Makiwane Hospital, expressed her gratitude that so many of the emollients from L’Oréal were donated to the local dermatology clinics during a period of severe shortage in the area.

The GPA team will use the knowledge and insights gained during the visit to refine the survey methodology for future field research and continue to advocate for outreach engagement, particularly in underserved populations and regions, to provide evidence for better access to care for people with skin disease, wherever they may live.

The GPA extends sincere thanks to Professor Ncoza Dlova, GPA colleagues, and the Eastern Cape communities for their support and collaboration, and in particular to Professor Dlova for her leadership, partnership, and longstanding commitment to her community.

Read the full study here: https://doi.org/10.1093/bjd/ljaf386

Following the publication of the SKINSCAPE field study in the British Journal of Dermatology, the GPA team, together with Professor Ncoza Dlova, produced a short video summarising the study and sharing a selection of photos and footage from the 2023 field visit.

The video includes:

• Background and aims of the SKINSCAPE study

• Main findings and impact of the study

• Visual highlights from Mtyholo Dlova & Mdolomba villages

• Footage of time spent in the community during the study

This video serves as a helpful visual companion to the publication, providing additional context to the work carried out in rural South Africa.

Watch the video below.