- Yemsrach Abawaji, MD
- Comorbidities, Diagnosis, IPC Fellows, Psoriasis Around the World, Treatment
In Ethiopia, a country of approximately 130 million people, there are roughly 200 dermatologists. That ratio alone shapes nearly every aspect of care for patients with psoriasis and other inflammatory skin diseases. As a Consultant Dermatologist at Menelik II Comprehensive Specialized Hospital and a 2026 IPC Fellow, I see daily how that gap between need and capacity plays out in delayed diagnoses, unavailable therapies, and patients who arrive after years of inadequate treatment.
A System Not Built for Complexity
More than 80% of Ethiopia’s population lives in rural areas, far from specialist care. Most patients with inflammatory skin conditions first present to primary health facilities, where psoriasis, atopic dermatitis, and lichen planus are frequently misidentified as fungal infections and treated accordingly, sometimes for years. By the time patients reach a dermatology clinic, many have extensive disease that has affected their quality of life, social functioning, and ability to work.
The diagnostic complexity runs deeper than just specialist access. In resource-limited settings, inflammatory and infectious skin diseases coexist, and the differential diagnosis is not always straightforward. I recently saw a patient who had visited several clinics over months for joint pain, fever, and hand swelling, receiving various nonsteroidal anti-inflammatory drugs without improvement. When he came to our outpatient clinic, he presented with hand swelling, limited range of motion, and a reddish annular plaque on his forehead. Further examination revealed similar lesions on his back and gluteal area. He was ultimately diagnosed with borderline leprosy with a type 1 lepra reaction.
This patient did not have psoriasis; his case illustrates how inflammatory skin conditions, in general, can be misdiagnosed, and how delays can occur in resource-limited settings where infectious and inflammatory diseases often present similarly.
Earlier recognition and timely referral could meaningfully improve outcomes for many of these patients. Bridging that gap starts at the primary care level.
Treatment Decisions Driven by Availability, Not Evidence
Access to treatment is a parallel and equally significant challenge. Conventional therapies for psoriasis are not consistently available in Ethiopia, and affordability creates an additional barrier for many of the patients we see in public hospital settings, a significant proportion of whom live below the poverty line. Disease progression and complications become more likely when adherence is interrupted by cost.
Biologic therapies have transformed the management of moderate to severe psoriasis globally. In Ethiopia, they are not available. Treatment decisions are therefore shaped not by what a patient needs clinically, but by what can actually be obtained and sustained. Of the conventional systemic therapies, methotrexate and cyclosporine are available, though cyclosporine remains difficult to access for most patients and carries a significant cost burden.
Understanding Psoriasis Beyond the Skin
Awareness of the systemic associations of psoriasis remains limited among patients and, in many cases, among non-specialist providers as well. Cultural context compounds the clinical picture. Misconceptions about psoriasis are common in our communities; many patients believe their disease carries a moral or spiritual meaning and seek care from traditional healers rather than medical providers, often delaying diagnosis further and, at times, complicating disease presentation.
Addressing these beliefs requires more than information. It requires consistent, respectful patient education integrated into clinical encounters at every level of the health system.
Building Toward Better Care
Despite the challenges, there are meaningful opportunities to strengthen psoriasis care in Ethiopia, and groundwork is already being laid. A decade ago, dermatology residency training in Ethiopia was available only at Tikur Anbessa Specialized Hospital; today, five teaching hospitals offer residency programs, increasing the number of dermatologists trained each year. Coverage has expanded in the capital as well: whereas only a limited number of facilities in Addis Ababa had practicing dermatologists, virtually all federal hospitals and hospitals under the Addis Ababa City Administration now have specialist care on site.
Primary care training is the most immediate lever. Primary health care providers are the first point of contact for most patients, and even focused dermatology training can reduce diagnostic delays and improve referral pathways, particularly for rural and underserved populations. I recently began volunteering at a local health center one day per week, specifically to support primary care providers in diagnosing, managing, and referring patients with skin disease, including psoriasis, a small-scale model of what broader workforce development could achieve.
Teledermatology offers another pathway. While a large-scale program has not yet been implemented, we have used a practical model to extend specialist support to remote providers. The Ministry of Health launched a two-week basic dermatology training course for general practitioners working in underserved areas. After the training, participants and dermatologists from our center join a shared messaging group where providers can submit clinical information and images from challenging cases and receive guidance in near real time. It is a modest but meaningful use of existing technology to bridge the distance between patients and specialist knowledge. By connecting primary care workers with specialists remotely, teledermatology can accelerate diagnosis and reduce the travel burden for patients in remote areas.
Perhaps the most important long-term need is data. Epidemiological information on psoriasis prevalence, comorbidity patterns, and treatment outcomes in sub-Saharan Africa remains sparse. Without that foundation, it is difficult to plan services, secure resources, or make the case to policymakers for improved access to care. Collaborative research with international partners, including through organizations such as the International Psoriasis Council (IPC), offers a practical path toward generating that evidence and building local capacity alongside it.
The future of dermatology care in Ethiopia depends on closing the distance between patients and diagnosis, between diagnosis and treatment, and between available and possible care.
