Integrated Management of Skin NTDs-Lessons Learned from Existing Practice and Field Research

Abstract

Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. Because a number of these diseases share not only the geographical distribution, but also a common feature which is skin involvement, bringing together a sub-group of 'skin NTDs' is one way forward to promote further integration among NTDs. With these diseases, which include leprosy, Buruli ulcer, yaws, mycetoma, lymphatic filariasis, and leishmaniasis, patients may be left with life-long deformities and disabilities when diagnosis and treatment are delayed. Stigma is another serious consequence of skin NTDs as it places a large barrier on the economic activities and social life of a patient. As a result, this creates a vicious cycle and obstructs a key goal of society, the elimination of poverty. Enhancement in surveillance systems as well as the further development of diagnostic methods, improvement in treatment and management, and identification of preventative measures for skin NTDs are therefore urgently needed. This article summarizes the existing practices and field research on skin NTDs and identifies potential synergies that could be achieved by adopting this integrated approach.

Keywords: case management; integration; mass drug administration; neglected tropical diseases; skin NTDs; skin infections; surveillance; training; tropical skin diseases.

Figure 1

Clinical presentation of skin NTDs. (A) Leprosy (borderline tuberculoid leprosy). Ill-defined, multiple hypo-pigmented patches on the back. (B) Deformities of the feet and ulcer from peripheral neuropathy in leprosy. (C) Lymphatic filariasis. Unilateral lymphedema of the limb. (image: Saravu R. Narahari) (D) Mucocutaneous leishmaniasis. Redness and swelling of the nose. Inside: destruction of the nasal mucosa. Same patient as (A) (co-infection). (E) Cutaneous leishmaniasis. Infiltrated granulomatous lesion with central ulceration on the forehead. (F) Mycetoma. Multiple nodules with openings of draining sinuses discharging pus and blood. (image: Ahmed Fahal) (G) Buruli ulcer. Ulceration on the arm with extensive edema. Black and yellowish necrotic tissue on wound surface with some traditional remedies at first visit. (H) Yaws (primary yaws). Nodule with central ulceration with yellow crust on the forehead. (image: Kingsley Asiedu) (I) Tungiasis. Multiple small nodules with central black dot (body part of the adult flea) on the palm and on the finger tips.

Figure 2

Wound care facility in Côte d’Ivoire for leprosy, Buruli ulcer, and other ulcers.

Figure 3

Education on self-skin care for prevention of disabilities (POD) for people affected by leprosy in a village in India.