KVA
8th November 2024
Charntaé Farrell, Senior Medical Writer

It's more than skin deep: calling for improvement in dermatology care

We naturally think of dermatological conditions as only affecting the surface of our skin. However, there is more to them than meets the eye, with them more often than not being much more than skin deep. For millions globally, conditions like psoriasis and eczema can be a dark cloud of struggle affecting their daily lives. The journey from symptom onset through diagnosis and effective treatment can be long and complex, creating a substantial burden on patients and healthcare systems alike.

There are many challenges facing patients with dermatological conditions in the UK. Here, we will explore a few of them and the need for systemic change in dermatology care.

A growing backlog in dermatology care

As of February 2024, more than 450,000 individuals are awaiting dermatological care in the UK and Ireland, with some hospitals experiencing delays of up to two years.1,2 This extended wait for diagnosis and treatment initiation may impact the psychosocial well-being of patients, reducing their quality of life.3

Challenges in achieving accurate diagnoses

Delays in dermatology treatment are exacerbated by challenges in diagnosis. Symptoms of different skin conditions often overlap, requiring specialist input to make a differential diagnosis. This is further compounded by the fact that there is limited availability of specialised dermatologists to meet the patient demand. Additionally, for healthcare professionals (HCPs), insufficient access to advanced diagnostic tools and training sessions can contribute to these diagnostic challenges​ and add to the healthcare burden.4 Therefore, there is a need for streamlined diagnostics in dermatology to achieve accurate diagnoses.

The impact on patients as a result of training gaps in diagnostic accuracy

Lack of HCP education in diagnostics for dermatological conditions creates a far bigger ripple in the challenges of dermatology care than we would probably expect. In a recent MIT study, doctors have shown to experience more difficulty diagnosing skin conditions when looking at images of darker skin tones. The study, made up of over 1,000 dermatologists and general practitioners (GPs), found that dermatologists accurately diagnosed around 38% of the images that they were shown, but only 34% of those images showed darker skin. GPs were less accurate overall, with the same reduction in accuracy with darker skin.5 While this is a US study, these gaps in HCP education for dermatological diagnostics is also reflective of the UK. These are not just numbers, they are impacting real lives. Addressing the educational shortfall in diagnostics is imperative to ensure that patients are receiving equitable, accurate care and will help to reduce disparities and build trust in the dermatology space for everyone. 

The role of AI in improving dermatological diagnosis

Addressing diagnostic issues calls for a multi-faceted approach. One promising avenue is the integration of artificial intelligence (AI) into dermatology. In the same MIT study, AI-assisted programmes have demonstrated the potential to enhance diagnostic accuracy across various skin tones, helping specialists and GPs alike to identify conditions more effectively. Furthermore, raising awareness and incorporating more diverse case studies in medical training could improve diagnostic outcomes over time.5

Barriers to timely treatment access

Beyond diagnosis, timely access to appropriate treatments is important. For many, the pathway to therapies that are right for them is often littered with hurdles. Even when alternative therapies exist, accessing them isn't the walk in the park that you think it is.

Long waiting times for specialist consultations often mean patients experience significant delays in starting alternative, more appropriate therapies – potentially leading to disease progression and decreasing the effectiveness of therapies by the time a patient receives the appropriate level of care.6

For chronic conditions such as psoriasis and eczema, the wait for systemic treatments can mean months of unmanaged symptoms, impacting both quality of life and long-term health outcomes.7–10 Additionally, inadequate or delayed intervention can translate to a higher burden on healthcare resources as more intensive treatments or hospital admissions become necessary. We therefore need to ensure that patients are able to get the treatment that they need, at the time in which they need it, to ensure that they receive maximum efficacy from therapies.

The need for systemic change in dermatology services

A shift in how dermatology services are delivered is essential for the improvement in care. Improving access to innovative diagnostic tools and therapies earlier in the patient journey can play a pivotal role in transforming patient outcomes and reducing the strain on specialist services and secondary care.

Ultimately, embracing advancements in technology, improving educational resources for HCPs, and addressing systemic inefficiencies will be key to reducing the burden of dermatological diseases on patients, HCPs and the wider healthcare system. For patients, these steps represent more than just improvements in skin health; they are a step towards better quality of life and holistic well-being.

References: 

  1. NHS. Statistical Press Notice NHS referral to treatment (RTT) waiting times data February 2024. Available at: https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2024/04/Feb24-RTT-SPN-Publication-PDF-only-445KB-08666.pdf (Accessed November 2024).
  2. The National Treatment Purchase Fund (NTPF). Outpatient / Waiting list – hospitals. Available at: https://www.ntpf.ie/home/outpatient_group.htm (Accessed November 2024).  
  3. Barankin B, DeKoven J. Can Fam Physician. 2002;48:712–716.
  4. NHS England. Transforming elective care services dermatology. Available at: https://www.england.nhs.uk/wp-content/uploads/2019/01/dermatology-elective-care-handbook-v1.pdf (Accessed November 2024).
  5. MIT News. Doctors have more difficulty diagnosing disease when looking at images of darker skin. Available at: https://news.mit.edu/2024/doctors-more-difficulty-diagnosing-diseases-images-darker-skin-0205 (Accessed November 2024).
  6. NHS Health Research Authority. Disease progression and wait times in dermatological patients. Available at: https://www.hra.nhs.uk/planning-and-improving-research/application-summaries/research-summaries/disease-progression-and-wait-times-in-dermatological-patients-v1/#:~:text=Research%20summary,progressed%20to%20warrant%20specialist%20input. (Accessed November 2024).
  7. Yeung H, et al. JAMA Dermatol. 2013;149:1173–1179.
  8. Fleming P, et al. J Eur Acad Dermatol Venereol. 2017;31(5):798–807.
  9. Kurd SK, et al. Arch Dermatol. 2010;146(8):891–895.
  10. Gupta MA, et al. Int J Dermatol. 1993;32(3):188–190.