Marcia Frellick

March 08, 2017

ORLANDO — The prevalence and cost of skin disease in the United States are increasing and will continue to do so as the population ages, according to an analysis of claims data presented here at the American Academy of Dermatology (AAD) Annual Meeting.

"The impact of skin disease in this country is staggering, affecting one in every four Americans each year and taking a toll on lives, livelihood, and our economy," study author Henry Lim, MD, incoming president of the AAD and chair of its Burden of Skin Disease Work Group, said in a news release.

Dr Lim, from Henry Ford Hospital in Detroit, and his colleagues analyzed 2013 claims data for 24 skin diseases, updating 2004 data on the burden of skin diseases (J Am Acad Dermatol. 2006;55:490-500). First results were published online February 27 in the Journal of the American Academy of Dermatology.

Claims varied widely by disease, and were highest for noncancerous skin growths (benign neoplasms, keloids, scars, cysts), at 7.81%, cutaneous infections (5.75%), and viral and fungal diseases (5.75%). Claims were lowest for bullous diseases (0.05%), vitiligo (0.05%), and cutaneous lymphoma (0.02%).

The most surprising finding for me was that half of these skin disease categories in some patients resulted in mortality.

Americans older than 65 years were more likely to make a claim for skin disease than those 18 to 44 years (49.4% vs 34.0%). And, on average, people in the older age group had 2.2 skin diseases.

Although it is difficult to make direct comparisons between 2004 and 2013 data because of differences in methodologies, there was a clear increase in the incidence of skin disease, said Karen Edison, MD, chair of the AAD access to dermatology committee, and one of the authors of a commentary accompanying the published report.

"We're expecting that to get worse with the aging population — 20% of us will be 65 and older by 2030," she said.

"The most surprising finding for me was that half of these skin disease categories in some patients resulted in mortality," Dr Edison told Medscape Medical News. "People don't think of skin disease as serious, but it certainly can be."

Our old medicines that we have used forever have just gone through the roof. It's a national scandal. Ask any dermatologist.

Healthcare costs related to skin disease rose 170% from 2004 to 2013, owing to new treatments, rising costs, and regulatory changes. In 2013, direct healthcare costs were $75 billion, with another $11 billion attributed to lost opportunity costs.

Spending on over-the-counter products saw the biggest increase — at 308%. But spending on prescription medicine has also soared.

"Our old medicines that we have used forever have just gone through the roof. It's a national scandal. Ask any dermatologist," Dr Edison said.

In response to the report, the AAD is launching SkinSerious, a campaign to raise awareness of skin disease that will focus on prevention.

"Our most deadly disease is melanoma, and it can be prevented in a large number of cases," Dr Edison explained.

AAD Launches SkinSerious

Part of the campaign is designed to increase partnerships with primary care physicians and expand access to dermatologists, who now treat only one-third of patients with skin diseases, she said.

For example, the campaign will encourage primary care physicians to ask patients to remove shirts before exams, "at least for the one of five Caucasian patients who are at high risk," she noted. This step is especially important for men who live alone.

Most melanoma patients have seen their primary care physicians in the previous year, but their skin wasn't always exposed, she pointed out.

Dr Edison and her multispecialty team conduct weekly videoconference sessions to train primary care physicians in dermatologic procedures as part of the Extension for Community Healthcare Outcomes (ECHO) program at the University of Missouri in Columbia.

The links between primary care and dermatology are increasingly important. "For instance, we now know that people with severe psoriasis are at high risk for metabolic syndrome," she explained.

Clarifying the role of dermatologists and making sure they are practicing to the top of their license is important because, as Dr Lim and his colleagues note in their report, 20,000 dermatologists are needed but currently there are only 10,000 dermatologists in practice.

"We need to find more creative ways of getting patients access to dermatologists," Dr Lim said.

This is the first of three reports that will be published on the burden of skin disease. Parts 2 and 3 will be published in the April and May issues, respectively, of the Journal of the American Academy of Dermatology.

Dr Edison has disclosed no relevant financial relationships. Dr Lim reports that his university has received support from Allergan, Estée Lauder, and Ferndale Laboratories.

American Academy of Dermatology (AAD) Annual Meeting. Presented March 5, 2017.


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