Dermatology in India

Demographics and Economics

• India is a populous country with close to 1.3 billion individuals. But contrarily to China it is still growing.
• Nevertheless, the Gross Domestic Product (GDP) is only US5 trillion (United States US16 trillion) and only 3.9% of GDP expenditure is for healthcare (United States: 17.9%)

Enough dermatologists ?

• In absolute terms there are 7500 dermatologists
• However this is for 1.2 billion people, that is one dermatologist for 165000 people (United States: 1 for 40000)
• But the problem gets even worse when comparing urban and rural settings

Training in Dermatology

• Like in any country medical and specialty training is very competitive and includes dermatopathology, dermatological surgery, venereal diseases, leprosy and cosmetic dermatology
• …But in the end, too many embrace a career in cosmetics which reduces even further the availability of medical dermatology.

Skin conditions unique to India

• India also offers the dermatologist to see a unique set of conditions:
  • Hansen’s disease (leprosy)
  • subcutaneous and deep fungal granulomas
  • ….sometimes culturally influenced:
    • air borne contact dermatitis to Parthenium or Congress grass and mudichood as a reaction to a hair-grooming technique
    • bindi dermatitis: a reaction to adhesives to fix the bindi to the forehead
    • mehendi dermatitis: reaction to the dye used in decorative designs on the skin
    • chemical leucoderma as reactions to plastic products
    • neonatal rashes in reaction to massage oils.

City vs Countryside…the long road ahead

• In the cities, the result, is that despite being free, public dermatology wards are overcrowded and chaotic as you can’t make an appointment – you simply walk-in
• In the countryside, the lack of dermatologists means that primary care physicians, gynecologist, pediatricians and non-doctors treat skin conditions. Other than medical treatments, naturopathy, homeopathy and Aurveda are also used.
• Nothing stops other doctors from doing dermatology as there is a lack of regulation and there is also a Bachelor of Science in Community Health (3 years) for non-doctors.
• Teledermatology has  been tried. 150 dermatologists use teledermatology (Virtual Skin Clinic) and 1000 patients have been helped using this service. However, the service requires an internet  connection and has to be paid by the patient “out of his pocket”

Incentives to Innovate ?

• Innovative advances in dermatology are very poor. biologics and “high tech”. Lack of availability and affordability are some reasons.
• But when it comes to drugs, the problem is clearly the lack of patent protection laws for a drug maker who would like to introduce a drug. A number is compelling, out of the 184 drugs approved in the US between 2001 and 2009, only half have made it to the Indian market 5 years later.

This other article talks about the lack of dermatologists in India and the consequences and steroid abuse: CLICK HERE

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of information: Houghton V. Dermatology in India. Dermatology World-December 2014