Dermatological disease patterns during active conflict: a teledermatology registry of 12,638 patient visits in Gaza, 2025–2026

Abstract Armed conflict can create conditions that favor skin disease through population displacement, overcrowding, damaged water and sanitation systems, disrupted supply chains, and reduced access to routine care. Systematic dermatology data from active-conflict settings remain limited. We aimed to characterize recorded dermatological presentations and to describe the operational teledermatology service model, demographic patterns, service contacts, and prescribing during the Gaza conflict that began in October 2023. This retrospective registry-based observational study analyzed 12,638 routine-care encounters representing 12,628 unique patients, prospectively recorded through an asynchronous tele-expertise service across a cumulative network of 14 Palestine Red Crescent Society (PRCS) medical points from February 2025 to January 2026. Descriptive analyses used all encounters, whereas adjusted logistic regression used each patient’s earliest eligible encounter. Observed-to-expected service-contact ratios (SCRs) were calculated as observed contacts divided by expected contacts based on pre-conflict governorate population shares. Females accounted for 55.2% of encounters; median age was 19 years (IQR: 8–36), and 46.0% involved patients aged 0–17 years. Scabies was the leading recorded diagnosis (14.1%), followed by urticaria/allergies (7.3%), impetigo (6.9%), and dermatitis (general/contact) (6.8%). Ectoparasitic infestations represented 18.5% of encounters and bacterial infections 17.1%. Eight diagnoses showed associations with sex after adjustment for age and governorate and Bonferroni correction. Encounter volume peaked in May and October 2025; Deir Al-Balah had the highest SCR (2.59, 95% CI 2.52–2.67). Antibiotics, corticosteroids, antihistamines, and antiparasitic agents were the most frequently recorded medication classes. Among recorded encounters in this active-conflict registry, ectoparasitic and bacterial diagnoses were frequently recorded, with pediatric involvement and geographic variation consistent with displacement, service availability, and disrupted access. The observed patterns reflect the combined effects of healthcare demand, access barriers, and disease pressure, not population burden. They support conflict-adapted dermatology protocols, water, sanitation, and hygiene (WASH)-linked scabies control, antimicrobial stewardship, and teledermatology-supported surveillance where feasible, with population-based confirmation when security permits.