The Burden of Skin and Subcutaneous Diseases in the United States From 1990 to 2017

IMPORTANCE Skin and subcutaneous diseases affect the health of millions of individuals in the US. Data are needed that highlight the geographic trends and variations of skin disease burden across the country to guide health care decision-making. OBJECTIVE To characterize trends and variations in the burden of skin and subcutaneous tissue diseases across the US from 1990 to 2017. DESIGN, SETTING, AND PARTICIPANTS For this cohort study, data were obtained from the Global Burden of Disease (GBD), a study with an online database that incorporates current and previous epidemiological studies of disease burden, and from GBD 2017, which includes more than 90 000 data sources such as systematic reviews, surveys, population-based disease registries, hospital inpatient and outpatient data, cohort studies, and autopsy data. The GBD separated skin conditions into 15 subcategories according to incidence, prevalence, adequacy of data, and standardized disease definitions. GBD 2017 also estimated the burden from melanoma of the skin and keratinocyte carcinoma. Data analysis for the present study was conducted from September 9, 2019, to March 31, 2020. MAIN OUTCOMES AND MEASURES Primary study outcomes included age-standardized disability-adjusted life-years (DALYs), incidence, and prevalence. The data were stratified by US states with the highest and lowest age-standardized DALY rate per 100 000 people, incidence, and prevalence of each skin condition. The percentage change in DALY rates in each state was calculated from 1990 to 2017. RESULTS Overall, age-standardized DALY rates for skin and subcutaneous diseases increased from 1990 (821.6; 95% uncertainty interval [UI], 570.3-1124.9) to 2017 (884.2; 95% UI, 614.0-1207.9) in all 50 states and the District of Columbia. The degree of increase varied according to geographic location, with the largest percentage change of 0.12% (95% UI, 0.09%-0.15%) in New York and the smallest percentage change of 0.04% (95% UI, 0.02%-0.07%) in Colorado, 0.04% (95% UI, 0.01%-0.06%) in Nevada, 0.04% (95% UI, 0.02%-0.07%) in New Mexico, and 0.04% (95% UI, 0.02%-0.07%) in Utah. The age-standardized DALY rate, incidence, and prevalence of specific skin conditions differed among the states. New York had the highest age-standardized DALY rate for skin and subcutaneous disease in 2017 (1097.0 [95% UI, 764.9-1496.1]), whereas Wyoming had the lowest age-standardized DALY rate (672.9 [95% UI, 465.6-922.3]). In all 50 states and the District of Columbia, women had higher age-standardized DALY rates for overall skin and subcutaneous diseases than men (women: 971.20 [95% UI, 676.76-1334.59] vs men: 799.23 [95% UI, 559.62-1091.50]). However, men had higher DALY rates than women for malignant melanoma (men: 80.82 [95% UI, 51.68-123.18] vs women: 42.74 [95% UI, 34.05-70.66]) and keratinocyte carcinomas (men: 37.56 [95% UI, 29.35-49.52] vs women: 14.42 [95% UI, 10.01-20.66]). CONCLUSIONS AND RELEVANCE Data from the GBD suggest that the burden of skin and subcutaneous disease was large and that DALY rate trends varied across the US; the age-standardized DALY rate for keratinocyte carcinoma appeared greater in men. These findings can be used by states to target interventions and meet the needs of their population

Emerging topical therapies to treat pigmentary disorders: an evidence-based approach

Background Hyperpigmentation disorders are commonly encountered in dermatology clinics. The use of prescription-grade and over-the-counter topical lightening agents has increased in popularity, leading to a substantial growth of research over the past decade. Objective We seek to review clinical studies evaluating the use of different Rx-grade and OTC ingredients in treating hyperpigmentation. Methods and materials A comprehensive search on PubMed was conducted to identify patient-based evidence on the most common ingredients used as topical lightening agents: arbutin, ascorbic acid, cysteamine, hydroquinone, kojic acid, niacinamide, retinoids, and triple-combination therapy. The topicals were classified as either prescription-grade or over-the-counter. Results Varying levels of evidence support the use of topicals in treating hyperpigmentation. There were more clinical trials examining Rx-grade products than OTC products. Mild but tolerated side effects are noted in many of these agents. Conclusion Careful monitoring and adjustment of doses will be needed to maximize skin lightening benefits and minimize side effects

Social Media and Ethical Challenges for the Dermatologist

Purpose of Review: The purpose of review is to provide guidance on the use of social media within the context of dermatology and discuss its ethical, professional, and legal implications in education, mentorship, networking, business, and clinical settings. Recent Findings: Despite its fundamental value as a means of communication and knowledge sharing, social media carries legal, ethical, and professional challenges. Healthcare providers have run into issues such as misinformation, conflicts of interest, and overstepping patient-physician boundaries when using social media. An interesting finding is that dermatologists commonly engage with an online audience through social media marketing or being an influencer to improve business and extend their reach to clients; however, this warrants formal training and the need to monitor their own online presence to prevent legal consequences. Summary: Social media has become integral in everyday life; billions of people now receive information and stay connected with each other through social platforms. Within medicine, social media has enhanced various aspects of healthcare, such as professional networking, patient care, and patient education. In dermatology, social media allows dermatologists to promote their businesses and services through patient testimonials, posting advice on blogs, and networking with a large audience of potential patients. However, having a social media presence must be exercised with care, purpose, and transparency to maximize benefits and minimize harmful consequences. This is especially important when inappropriate social media posts by physicians can be scrutinized for breaching patient confidentiality, violating privacy, financial conflicts of interest, and possibly disseminating incorrect information

The Contact Dermatitis Quality of Life Index (CDQL): Survey Development and Content Validity Assessment

BackgroundThere is limited measurement and reporting of quality of life (QoL) outcomes for patients with contact dermatitis (CD). ObjectiveThe purpose of this study is to develop a standardized Contact Dermatitis Quality of Life index (CDQL) for adult patients. MethodsA list of 81 topics was compiled from a review of QoL measures used previously in CD research. A total of 2 rounds of web-based Delphi surveys were sent to physicians who registered to attend the 2018 American Contact Dermatitis Society meeting, asking that they rank the relevance of topics for measuring QoL in CD using a 4-point scale. Items met consensus for inclusion if at least 78% of respondents ranked them as relevant or very relevant, and their median score was ≥3.25. ResultsOf the 210 physicians contacted, 34 physicians completed the initial survey and 17 completed the follow-up survey. A total of 22 topics met consensus for inclusion in the CDQL, addressing symptoms, emotions, functions of daily living, social and physical functions, work/school functions, and treatment. ConclusionsThis study was limited by the following factors: few open-ended questions in the initial survey, a lack of direct patient feedback, and long survey length, which likely contributed to lower survey participation. The CDQL is a comprehensive, CD-specific QoL measure developed on the basis of expert consensus via a modified Delphi process to be used by physicians and other health care professionals who care for adult patients with contact dermatitis