Global Psoriasis Atlas in Action
2 September 2019
The remit of the Global Psoriasis Atlas (GPA) is to be the leading epidemiological resource on psoriasis globally. As a joint project of the International League of Dermatological Societies (ILDS), International Federation of Psoriasis Associations (IFPA) and International Psoriasis Council (IPC) the GPA documents and uses global and regional healthcare data for psoriasis in order to identify the global burden of psoriasis. The project aims to provide the common benchmark on the complete burden of psoriasis in all countries and regions throughout the world.
As part of a systematic review, led by Professor Darren Ashcroft, the GPA has identified a shortage of epidemiological information on psoriasis in Sub-Saharan Africa. The GPA team secured a grant from the Global Challenges Research Fund (GCRF) of almost £40,000 to run a workshop and undertake a pilot survey on psoriasis epidemiology in Tanzania.
The workshop and survey were based at the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania. The RDTC is a supra-regional training, research and clinical centre. It provides care to dermatological patients and training to Medical Assistants and Clinical Officers. The GPA team, led by GPA Director Professor Griffiths and Programme Manager Rebekah Swan, were based at the RDTC from 7-12 July 2019. The team included Professor Darren Ashcroft (Manchester University), Professor Ncoza Dlova (GPA Regional Coordinator, South Africa), and Manchester University dermatology trainees Dr Sidra Khan and Dr Tina Tian. In addition to the Manchester team, Nirohshah Trialonis Suthakharan (Researcher, GPA Work Stream 2) and Kathryn Hampton from Janssen participated in the trip. Dr Daudi Mavura, RDTC Director and Co-PI on the GCRF grant, worked with Rune Philemon and supported the team throughout their visit.
The purpose of the trip was to work with RDTC staff and dermatology specialists from across the Sub-Saharan region to conduct a workshop, two pilot field surveys and to learn more about access to care for patients with psoriasis in Tanzania.
Dr Mavura arranged for the team to review 21 psoriasis patients invited to attend a follow-up appointment for their psoriasis management. Many of the patients had travelled long distances, some up to 1,200km, for their review in the clinic in Moshi. The GPA team were able to gain an understanding of the case presentation, medical history, diagnosis, comorbidities and treatments available to the patients. With a population of 57 million but only 31 dermatologists, access to specialist care in Tanzania is limited. Treatments for psoriasis in Tanzania are prohibitively expensive and so patients tend to opt for cheaper, over-the-counter, products. Patients often receive their diagnosis and treatment from non-specialist healthcare workers, who in many cases misdiagnose psoriasis as a fungal infection. Topical therapies are mainly coal tar, salicylic acid preparations and betamethasone valerate. The only systemic therapy in use is methotrexate. Treatment is invariably intermittent because of the difficulties in travelling which limits follow up and continuity of care. It was the team’s impression, on this admittedly small subset of patients, that psoriasis was less severe in Tanzania than in the UK, with fewer co-morbidities.
The team conducted a training workshop for the dermatology specialists, staff and students from the region. This included presentations on the GPA and case studies on psoriasis management from the UK, South Africa and Tanzania. Professor Darren Ashcroft presented on the epidemiology of psoriasis, including the GPA systematic review of psoriasis prevalence and incidence. He also led group work to discuss the development of research methods for future epidemiological studies of psoriasis in the region.
The trip culminated with the team conducting a pilot survey of skin disease, with a particular emphasis on psoriasis, to gather information on the prevalence of the condition in two different locations. On 10 July, the team travelled to a church at Sanya Station, in Maasai Land and on 11 July to a school at Usa River. They saw more than 200 people with a variety of skin diseases but not one of them had psoriasis. Common dermatoses seen included tinea capitis, pityriasis versicolor, late onset eczema and skin trauma. It was concluded that the prevalence of psoriasis may well be close to the estimate for the country of less than 1%.
It is anticipated that the GPA team will utilise the methodological knowledge and networking gained during the trip to design future research studies not just in Tanzania but in other countries in the region. This kind of engagement and outreach work is a clear part of the strategy and future direction of the GPA. Professor Griffiths said ‘This work with the team at the RDTC has laid solid foundations for future collaboration’. The planned studies in countries where data on the epidemiology of psoriasis are scarce will help to understand the burden of psoriasis in the region. Ultimately, this will ensure that all psoriasis patients in those countries will have access to the best available care, which is a key goal of the World Health Organization (WHO).
 The GCRF comprises of £1.5 billion set aside by the UK Government to support a breadth of scientific projects in the developing world.
Rebekah SwanGPA Programme Manager