Operationalising One Health for epidermal parasitic skin diseases: threshold-triggered mass drug administration and a minimal indicator set.

Epidermal parasitic skin diseases (EPSDs)-including scabies, pediculosis, cutaneous leishmaniasis, tungiasis and cutaneous larva migrans-affect millions worldwide yet remain neglected within global health programmes. Control is hindered by delayed diagnosis, fragmented service delivery, weak surveillance and limited integration of human, animal and environmental interventions. This review operationalises a One Health approach for EPSDs by proposing a pragmatic, threshold-triggered control pathway supported by a minimal indicator set suitable for district-level implementation. Evidence published between 2020 and 2025 from clinical studies, implementation research, programme evaluations and international policy guidance was synthesised to develop an operational framework linking frontline detection with confirmation, treatment and programme action. The pathway includes three components. First, triage standardises dermoscopic assessment using brief checklists and structured image capture, with optional artificial intelligence decision support where feasible. Second, confirmation prioritises accessible diagnostics, including swab- or tape-based PCR and emerging isothermal assays supported by external quality assurance. Third, predefined epidemiological thresholds guide escalation from targeted case management with household treatment to community-wide mass drug administration when warranted. A minimum indicator set-diagnostic yield, time to treatment, antimicrobial days avoided, household delivery units and micro-costs-is proposed to support programme monitoring and integration into primary care.