A pathway for skin NTD diagnostic development

Background Among the more than 20 diseases and disease groups featured in the 2021–2030 neglected tropical diseases (NTDs) road map published by the World Health Organization (WHO), 10 present primarily with cutaneous manifestations: Buruli ulcer, cutaneous leishmaniasis and post-kala-azar dermal leishmaniasis, mycetoma, chromoblastomycosis and other deep mycosis, leprosy, lymphatic filariasis, onchocerciasis, scabies and other ectoparasites, and yaws. These are sometimes referred to as skin NTDs. Skin NTDs hinder individuals’ quality of life through pain, deformity, loss of function, stigma, social discrimination, isolation, and loss of livelihoods. As a result, the 2021–2030 NTD road map identified skin NTDs as a priority area of work. To assist national programmes, in 2022, WHO released a companion document to guide integrated approaches to their detection, diagnosis, management, and control [1]. Skin NTDs pose a significant public health challenge globally, with the highest burden found in sub-Saharan Africa [2]. Despite a 1991 World Health Assembly resolution to eliminate leprosy as a public health problem by 2000, leprosy remains a concern, with current efforts focused on early detection, treatment, disability management, and stigma reduction. Buruli ulcer affects mainly children and requires early detection, antibiotics, wound care, and surgery. Yaws also affects mainly children, with mass drug administration and healthcare access the keys to its eradication. Cutaneous leishmaniasis necessitates early detection, (toxic) anti-parasitic drugs, topical therapies, and vector control. Lymphatic filariasis requires mass drug administration and morbidity management for hydrocele and lymphoedema. For interruption of transmission of onchocerciasis, WHO recommends mass drug administration of ivermectin and vector control in some areas. Scabies is prevalent worldwide, especially in overcrowded settings and requires early diagnosis and treatment. Mycetoma needs early diagnosis, differentiation between bacterial and fungal aetiology to guide medication, and often surgery. Tungiasis requires prevention through improved living conditions and health education, along with early detection, flea extraction, and wound care.