In 2008 WHO invited the International League of Dermatological Societies under the presidency of Professor Jean-Hilaire Saurat to form a Dermatology Topic Advisory Group (TAG) to oversee the revision of the skin disease content of ICD. I was asked to be Co-Chair together with Professor Michael Weichenthal of Kiel University in Germany. Both of us have long had an interest in skin disease terminology and classification. The TAG has members from around the world and they have worked hard to design and contribute to the development of a completely redesigned skin disease chapter.

ICD-11 is being designed as a knowledge base for use on electronic platforms, although paper versions will still be produced. By introducing a polyhierarchical structure into ICD, WHO has enabled representation of disease entities in more than one location. It is thus now possible to display relevant neoplasms, infections and complex developmental and inflammatory disorders within the skin disease chapter (fig.1). 

Figure 1:

Furthermore, each disorder must also have an explicit text definition together with a number of defined attributes (synonyms, body system and part involved, genes involved etc.) to create a so-called ontology (fig. 2). 

Figure 2:

The skin disease chapter has been completely redesigned and now includes over five thousand entities arranged in what the TAG hopes will be seen as a logical hierarchical order (fig. 3). A large number of these are from an updated and much expanded classification of genetic and developmental disorders. Indeed, over half of the entities are cross-references from other chapters.

Figure 3:

From this foundation it will be possible to extract smaller subsets for use in different settings such as primary care, internal medicine etc. An important new feature is the inclusion of an anatomy chapter which will allow any disorder to be associated with a code indicating location or distribution (e.g. right ala nasi or palmoplantar).

Many individuals have contributed to the development of the draft which is certainly not yet complete and there are areas with which I and the TAG are still dissatisfied. It is, however, now open for comment and criticism and I would urge you all to look at your areas of interest to see whether they are adequately and accurately represented. This is a once in a generation opportunity to shape the way skin disease is classified in the future. 

An online search for ICD-11 beta will take you to the ICD browser (; fig. 4). Alternatively you can access it from

Figure 4:

The TAG is well aware that there is still much to be done. A large number of definitions have yet to be written. If any individual or group would like to take responsibility for providing definitions for a specific topic area please contact me at Comments and criticisms can be recorded online or sent to me at the same email address.

I look forward to hearing from you.

Robert Chalmers,
Co-Chair and Managing Editor                                                         July 2012

Dermatology Topic Advisory Group
WHO ICD Revision Project
Consultant Dermatologist
Dermatology Centre
University of Manchester
Manchester UK


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