Nail Discoloration during the COVID-19 Pandemic.

A 45-year-old woman presented to the outpatient dermatology clinic during the COVID-19 pandemic with a painless green discoloration of several fingernails present for 1 week (Figure 1). The patient had no significant past medical history and was not taking any medication. No other findings were noted. There was no history of nail trauma or past fungal infection of the nail. The patient admitted that she had frequent hand washing, given the current pandemic, and never used protective gloves in everyday activities.

The global, regional, and national burden of atopic dermatitis in 195 countries and territories: An ecological study from the Global Burden of Disease Study 2017.

INTRODUCTION: Numerous population-based studies have focused on the global prevalence of atopic dermatitis (AD), but there are few studies on the global trends of the burden associated with AD. METHODS: We analyzed the global AD trends in 2017 in 195 countries worldwide using the Global Burden of Disease (GBD) Study database, including prevalence rates, age and sex patterns, and AD burden, using disability-adjusted life years (DALYs). Age-standardized DALYs were also compared to the sociodemographic index values of all the countries in 2017. RESULTS: The age-specific DALYs in 2017 showed a right-skewed distribution, with the highest DALYs between 1 and 5 years of age. Females had a higher burden of AD throughout all age groups and geographic regions. The GBD super region with the greatest burden of DALYs caused by AD was high income (178.63 DALYs per 100,000 males, 231.8 for females), and the country with the highest DALYs was Sweden (326.91). The GBD super region with the lowest age-standardized DALY burden caused by AD was south Asia (84.51 DALYs per 100,000 males, 100.54 for females). CONCLUSION: There is a large GBD caused by AD. The observed burden is the greatest in resource-rich countries, females, and young children.

The global, regional, and national burden of fungal skin diseases in 195 countries and territories: A cross-sectional analysis from the Global Burden of Disease Study 2017.

INTRODUCTION: Fungal skin diseases are highly prevalent worldwide, but few existing studies focus on the burden of dermatomycoses. METHODS: An analysis of fungal skin disease trends in 2017 in 195 countries worldwide was conducted using the Global Burden of Disease Study database, including prevalence rates, age and sex patterns, and fungal burden, using disability-adjusted life years (DALYs). Age-standardized DALYs were also compared to the sociodemographic index values of all the countries in 2017. RESULTS: The age-specific fungal skin disease DALYs in 2017 showed a right-skewed distribution, with a peak between 1 and 5 years of age. The world region with the greatest burden of fungal skin disease was sub-Saharan Africa (DALY rate 89.3 per 100,000 males, 78.42 for females), and the individual country with the greatest DALY rate was Mali (122). The Global Burden of Disease super region with the lowest fungal skin disease burden had high incomes (DALY rate 33.12 per 100,000 males, 30.16 for females), which includes southern Latin America, western Europe, high-income North America, Australasia, and high-income southern Pacific. CONCLUSION: Skin mycoses place a substantial burden on patients worldwide. This burden is the greatest in resource-poor countries, tropical regions, and children between 1 and 5 years of age. DALYs can potentially serve as a purposeful measure for directing health policy resources to improve the global impact of fungal skin disease.

Burden of skin disease and associated socioeconomic status in Asia: A cross-sectional analysis from the Global Burden of Disease Study 1990-2017.

INTRODUCTION: Skin diseases have a significant global impact on quality of life, mental health, and loss of income. The burden of dermatologic conditions and its relationship with socioeconomic status in Asia is currently not well understood. METHODS: We selected Global Burden of Disease Study datasets to analyze disability-adjusted life years (DALYs) in 50 Asian countries, including Central Asia, northern Asia, eastern Asia, western Asia, southeastern Asia, and southern Asia, between 1990 and 2017. We compared DALYs to the socioeconomic status using the sociodemographic index and gross domestic product per capita of a country. Statistical analysis was performed using Pearson's correlation. RESULTS: Some countries had higher or lower than expected age-standardized DALY rates of skin diseases. Asian countries, especially high-income countries, had a high burden of inflammatory dermatoses, including acne, alopecia areata, atopic dermatitis, contact dermatitis, decubitus ulcers, psoriasis, pruritus, and seborrheic dermatitis. The burden of infectious dermatoses was greater in low-income Asian countries. The burden of skin cancer in Asia was relatively low. CONCLUSION: There is a high burden of skin disease, especially inflammatory conditions, in Asian countries, but the burden of individual dermatoses in Asia varies by country and socioeconomic status. DALYs can potentially serve as a purposeful measure for directing resources to improve the burden of skin disease in Asia.

The global burden of skin cancer: A longitudinal analysis from the Global Burden of Disease Study, 1990-2017.

BACKGROUND: Despite efforts toward the earlier detection and prevention of skin cancer, the prevalence of skin cancers continues to increase. Identifying trends in skin cancer burdens among populations can lead to impactful and sustainable interventions. METHODS: We assessed the global trends in skin cancer from 1990 to 2017 in 195 countries worldwide through the Global Burden of Disease Study (GBD) 2017 database. RESULTS: The rate of change in skin cancers between 1990 to 2017 varied among countries. Squamous cell carcinomas increased by 310% during this time, the highest among any neoplasm tracked by the GBD. Men experienced greater age-specific prevalence rates of keratinocyte carcinoma across all ages (P < .05). Women had a greater prevalence of melanoma until approximately age 50 years, after which the trend reversed until age 85 years. Men experienced greater age-specific death rates across all ages. The disability-adjusted life years (DALYs) of melanoma and keratinocyte carcinoma increased exponentially with age (P < .05). CONCLUSION: The incidence, prevalence, and DALYs of skin cancers are increasing disproportionately among different demographic groups. As a worldwide epidemiological assessment, the GBD 2017 provides frequently updated measures of the skin cancer burden, which may help to direct resources and allocate funding to close the gap in global skin cancer disparities.

The global, regional, and national burden of psoriasis in 195 countries and territories, 1990 to 2017: A systematic analysis from the Global Burden of Disease Study 2017.

BACKGROUND: Few existing studies on the global incidence, prevalence, and burden of disease from psoriasis are of high quality, making reliable data and comparisons difficult to find. METHODS: We analyzed global psoriasis trends from 1990 to 2017 in 195 countries worldwide through the Global Burden of Disease Study database, including age-standardized prevalence rates, percent change in age-standardized prevalence rates, age and sex patterns, and psoriasis burden using disability-adjusted life years. RESULTS: The age-specific prevalence rate in 2017 showed a left-skewed distribution with a peak between 60 and 70 years of age and a roughly equal male-to-female ratio across all ages. Psoriasis burden was greatest in countries with high income and high sociodemographic index. A positive linear relationship between psoriasis prevalence and comorbidities is seen with cardiovascular disease (R = .67), mental health (R = .63), type 2 diabetes mellitus (R = .55), stroke (R = .51), non-Hodgkin lymphoma (R = .84), Hodgkin lymphoma (R = .77), nonmelanoma skin cancer (R = .68), and inflammatory bowel disease (R = .55) across all countries in 2017. CONCLUSION: There is increasing prevalence, burden, and associated comorbidities of psoriasis on a global scale and the need for support to reduce this important global health disparity.

Dermatoses of the Caribbean: Burden of skin disease and associated socioeconomic status in the Caribbean.

INTRODUCTION: Dermatologic disease represents a significant burden worldwide, but the regional effect of skin disease in the Caribbean and how it relates to socioeconomic status remain unknown. OBJECTIVE: This study aims to measure the burden of skin disease in the Caribbean from epidemiologic and socioeconomic standpoints. METHODS: We selected Global Burden of Disease Study data sets to analyze disability-adjusted life-years (DALYs) and the annual rate of change of dermatoses between 1990 and 2017 in 18 Caribbean countries and the United States. The principal country-level economic factor used was gross domestic product per capita from the World Bank. RESULTS: Countries with lower gross domestic product per capita had higher DALYs for dermatology-related infectious diseases, urticaria, asthma, and atopic dermatitis. Countries with higher gross domestic product per capita had higher DALYs of cutaneous neoplasms, contact dermatitis, psoriasis, and pruritus. Several Caribbean countries were among the top worldwide for annual increase in DALYs for melanoma, nonmelanoma skin cancers, bacterial skin disease, and total skin and subcutaneous diseases. CONCLUSION: Despite promising ongoing interventions in skin disease, better support is needed in both resource-rich and -poor areas of the Caribbean. DALYs can serve as a purposeful measure for directing resources and care to improve the burden of skin disease in the Caribbean.

Burden of skin disease and associated socioeconomic status in Europe: An ecologic study from the Global Burden of Disease Study 2017.

INTRODUCTION: Dermatoses contribute to a large burden of global disease, but the relationship between socioeconomic status and the effect of dermatologic conditions in Europe is not well understood. METHODS: We selected Global Burden of Disease Study data sets to analyze disability-adjusted life-years (DALYs) and the annual rate of change of dermatoses between 1990 and 2017 in 43 European countries. The principal country-level economic factor used was gross domestic product per capita from the World Bank. Statistical analysis was performed with Spearman ρ correlation. RESULTS: Wealthier European countries had higher DALYs for melanoma, basal cell carcinoma, psoriasis, atopic dermatitis, acne, seborrheic dermatitis, alopecia, asthma, contact dermatitis, and viral skin disease. Poorer countries had higher DALYs of squamous cell carcinoma, urticaria, decubitus ulcers, pruritus, scabies, tuberculosis, and syphilis. Thirteen European countries were in the top 10th percentile globally for annual increase in skin and subcutaneous disease burden. CONCLUSION: The majority of European countries have experienced an increase in skin and subcutaneous diseases in recent decades relative to the rest of the world, but the burden of individual dermatoses in Europe varies by country and socioeconomic status. DALYs can potentially serve as a purposeful measure for directing resources to improve the burden of skin disease in Europe.

Safety and Efficacy of Mohs Micrographic Surgery in Children and Adolescents: A Systematic Review.

BACKGROUND: Although there is a large body of evidence demonstrating the safety and efficacy of Mohs micrographic surgery (MMS) in adults, little is known regarding the safety and efficacy of MMS in children and adolescents. METHODS: The authors searched all publications from 1993 to 2018 reporting on the use of MMS for the treatment of cutaneous neoplasms in patients aged 0 to 18 years. Patient demographics, surgical characteristics, outcomes, and complications were extracted from each report. RESULTS: Forty-one publications describing 58 patients were included in the final analysis. The mean age was 8.3 years, and the most commonly treated tumor was dermatofibrosarcoma protuberans. There were no recurrences noted at a mean follow-up of 2 years. Two (3.4%) patients experienced complications after MMS. CONCLUSION: In this systematic review, the authors present aggregate data demonstrating high safety and efficacy of MMS in children and adolescents. Further research is necessary to develop guidelines for the use of MMS in children and adolescents.