The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions.

The Global Burden of Disease (GBD) Study 2010 estimated the GBD attributable to 15 categories of skin disease from 1990 to 2010 for 187 countries. For each of the following diseases, we performed systematic literature reviews and analyzed resulting data: eczema, psoriasis, acne vulgaris, pruritus, alopecia areata, decubitus ulcer, urticaria, scabies, fungal skin diseases, impetigo, abscess, and other bacterial skin diseases, cellulitis, viral warts, molluscum contagiosum, and non-melanoma skin cancer. We used disability estimates to determine nonfatal burden. Three skin conditions, fungal skin diseases, other skin and subcutaneous diseases, and acne were in the top 10 most prevalent diseases worldwide in 2010, and eight fell into the top 50; these additional five skin problems were pruritus, eczema, impetigo, scabies, and molluscum contagiosum. Collectively, skin conditions ranged from the 2nd to 11th leading cause of years lived with disability at the country level. At the global level, skin conditions were the fourth leading cause of nonfatal disease burden. Using more data than has been used previously, the burden due to these diseases is enormous in both high- and low-income countries. These results argue strongly to include skin disease prevention and treatment in future global health strategies as a matter of urgency.

Non-melanoma skin cancer in Australia: the 2002 national survey and trends since 1985.

OBJECTIVES: To measure the incidence of treated non-melanoma skin cancer (NMSC) in Australia in 2002 and investigate trends since 1985 by histological type, sex, age group, latitude and skin type. DESIGN: Face-to-face survey between 1 January and 31 December 2002 using stratified sampling of households to identify people treated for skin cancer in the previous 12 months. Self-reported diagnoses were confirmed with treatment providers. Data from similar surveys conducted in 1985, 1990 and 1995 were used to assess trends. SETTING: Whole of Australia (population 19.6 million). PARTICIPANTS: Of 57 215 people interviewed, 4098 said they had been treated for skin cancer in the past year and 3198 gave permission for their diagnoses to be confirmed with their doctor. RESULTS: 817 people were confirmed as having at least one skin cancer treated in the past year. The age-standardised rate per 100 000 population for NMSC was 1170, for basal cell carcinoma (BCC) 884, and for squamous cell carcinoma (SCC) 387. The estimated number of NMSC cases in Australia for 2002 was 374 000. Cumulative risks to age 70 years of having at least one NMSC were 70% for men and 58% for women. Rates of BCC and SCC have increased since 1985, and the increases greatest for people aged 60 years and older; rates for those younger than 60 years have stabilised. CONCLUSIONS: The incidence of treated NMSC in Australia in 2002 was more than five times the incidence of all other cancers combined. Although the overall NMSC rates have risen since 1985, the stabilisation of rates for people younger than 60 years who were exposed to skin cancer prevention programs in their youth highlights the importance of maintaining and strengthening these programs.

Morbidity and cost of atopic eczema in Australia.

The severity, morbidity and financial costs of atopic eczema (AE) were assessed during a 1-year prospective study of a cohort of 85 people aged 14-63 years (mean 36 years) with the disease. A dermatologist examined each participant using the Six Area Six Sign Atopic Dermatitis severity scoring system to classify severity. Participants completed a Dermatology Life Quality Index (DLQI), a Nottingham Eczema Severity Score (NESS) and an ongoing diary of health-care consultations and treatment costs. Follow up by mail to each participant was conducted every 2 months and participants completed a NESS, a DLQI and a diary of costs incurred. The DLQI data revealed that 36% spent over 10 min per day applying treatments, 28% indicated that AE influenced the clothes they wore, 21% felt embarrassed by their skin and 15% reported problems with treatments. There appeared to be a relationship between increased morbidity and increased severity. The average annual out-of-pocket cost for products used for treatment was A$425, ranging from A$13.50 to over A$2000 per individual. The average out-of-pocket cost for medical consultations was A$120, ranging from zero to over A$800 per individual. Although there were concerns about the reproducibility of the severity and morbidity measures, the data showed that AE can have substantial effects both financially and from a personal perspective for those affected.

Campaigning for melanoma prevention: a model for a health education program.

Melanoma incidence and mortality rates are rising in many countries. This has led to the development of a variety of education programs designed for either early detection of melanoma when it can be easily cured, or prevention by taking a long term approach. Australia has been leading in these areas running programs such as Slip! Slop! Slap! for over 20 years. Data now show that attitudes towards sunlight and suntans have changed substantially. Sunburn rates have decreased as photoprotection has increased. Melanoma mortality rates are decreasing in the younger cohorts as a result of earlier detection of tumours that can be easily cured. Finally, incidence rates for melanoma in the younger cohorts are starting to level out and go down. Thus health education programs can be successful if they are well-designed and evaluated. In Australia we are now extending these programs beyond melanoma and into education programs on other common skin diseases such as acne, atopic dermatitis, warts, tinea, and a variety of other common conditions, depending on the level at which the education program is being delivered. This is the first time that coordinated public education programs on skin diseases, apart from skin cancer, have occurred anywhere in the world.

Short-course therapy with imiquimod 5% cream for solar keratoses: a randomized controlled trial.

A dual-centre, randomized, double-blind, vehicle-controlled study was conducted to evaluate the safety and efficacy of short courses of therapy with imiquimod 5% cream in clearing >/=75% of baseline solar keratoses (SK) within a field of treatment. Subjects with 5-15 baseline SK within one treatment area (scalp, forehead and temples, or both cheeks) were randomized to apply imiquimod or vehicle cream to the entire treatment area three times a week for 3 weeks. Subjects were assessed 4 weeks after completing the first course for clearance of lesions. Subjects with <75% clearance were commenced on a second 3-week course of study cream. Subjects with >/=75% clearance were followed up until study completion without further therapy. All subjects were evaluated at the study endpoint of 14 weeks after initiating therapy for assessment of the primary outcome (>/=75% clearance of baseline solar keratoses). Twenty-one out of 29 (72%) imiquimod-treated subjects cleared >/=75% of baseline lesions compared with 3/10 (30%) subjects using the vehicle cream (Fisher's exact test, P = 0.027). Imiquimod was well tolerated. The present study has a short follow-up endpoint, but suggests that imiquimod is a potential therapeutic alternative in patients with SK.

Warts are not merely blemishes on the skin: A study on the morbidity associated with having viral cutaneous warts.

Eighty-five people aged 2-76 years with 250 common and plantar warts were followed prospectively for 9 months. The majority (57; 67%) had one to two warts. Of the 54 subjects who had a past history of warts, 41 (75.9%) had sought treatment for them. Twenty-four (58.5%) said that treatment had been unsuccessful; 22 (53.7%) experienced pain during their treatment; 14 (34.1%) said that treatment had been inconvenient; nine (22%) required multiple treatments; and eight (19.5%) said the treatment resulted in the development of scars. The quality-of-life assessment related to their current warts revealed that 81.2% were moderately to extremely embarrassed by them; 70.5% were moderately to extremely concerned about negative appraisal by others for having them; 24.7% said that it was moderately to extremely difficult to play sport because of their warts. Moderate to severe discomfort from their warts occurred in 51.7% of people and 35.4% said they had moderate to severe pain. During the 9-month study period, 27 (31.8%) of the participants had at least one wart regress spontaneously with 49 (19.6%) of the 254 warts regressing during that time. These data confirm the impression that a wart is not merely a blemish on the skin. Warts have the potential to cause considerable morbidity at times; this should be taken into account when a patient asks for treatment.

Pigmented fungiform papillae on the tongue in an Asian man.

Fungiform papillae of the tongue vary in their appearance. It is not rare for them to be pigmented in black subjects, but this is less common in Asians. We report a case of pigmented fungiform papillae in a 65-year-old Vietnamese man. The patient also had recurrent aphthous ulceration and hepatitis C. Pigmentation affected all fungiform papillae and was asymptomatic. Macrocytosis was noted on full blood examination, while liver function tests were normal. The pigmentation of the fungiform papillae remained stable.

The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap).

OBJECTIVE: To determine the prevalence and severity of seborrheic dermatitis and pityriasis capitis in Australian preschool-aged children. DESIGN: A stratified cross-sectional skin survey using cluster sampling of centers throughout Victoria, Australia. SETTING: The study population included children attending child care centers, preschools, and Maternal and Child Health Centers, with the reference population being Australian children 5 years and younger. PARTICIPANTS: Of the 1,634 children in the original sample, 1.116 children aged 11 days to 5 years 11 months were included in the study. INTERVENTION: Parents completed a questionnaire recording demographic information and personal and family history of skin problems and related diseases. A dermatologist performed a total skin examination, including the diaper area for children younger than 12 months. MAIN OUTCOME MEASURE: The age- and sex-specific prevalence rates and site and severity of seborrheic dermatitis and pityriasis capitis were measured. RESULTS: The overall age- and sex-adjusted prevalence of seborrheic dermatitis was 10.0% (95% confidence interval [CI], 8.2%-11.7%): 10.4% (95% CI, 7.8%-12.9%) in boys and 9.5% (95% CI, 7.0%-12.0%) in girls. This was highest in the first 3 months of life, decreasing rapidly by the age of 1 year, after which it slowly decreased over the next 4 years. Most (71.9%) had disease classified as minimal to mild. Pityriasis capitis occurred in 41.7% (95% CI, 38.8%-44.6%) of the 1,116 children examined, with 85.8% categorized as minimal to mild only. CONCLUSIONS: Seborrheic dermatitis and pityriasis capitis are common in early childhood. Most children have minimal to mild disease that would require little if any treatment. Education programs directed at those caring for preschool-aged children are needed to provide information on simple preventative measures and treatment, if necessary, that could easily reduce the morbidity associated with these very common conditions.