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Global Burden of Skin Disease: Inequities and Innovations

  • Epidemiology (R Dellavalle, Section Editor)
  • Published:
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Abstract

Purpose of Review

We review the current understanding of the burden of dermatological disease through the lens of the Global Burden of Disease project, evaluate the impact of skin disease on quality of life in a global context, explore socioeconomic implications, and finally summarize interventions towards improving quality of dermatologic care in resource-poor settings.

Recent Findings

The Global Burden of Disease project has shown that skin diseases continue to be the 4th leading cause of non-fatal disease burden worldwide. However, research efforts and funding do not match with the relative disability of skin diseases. International and national efforts, such as the WHO List of Essential Medicines, are critical towards reducing the socioeconomic burden of skin diseases and increasing access to care. Recent innovations such as teledermatology, point-of-care diagnostic tools, and task shifting help to provide dermatological care to underserved regions in a cost-effective manner.

Summary

Skin diseases cause significant non-fatal disability worldwide, especially in resource-poor regions. Greater impetus to study the burden of skin disease in low-resource settings and policy efforts towards delivering high-quality care are essential in improving the burden of skin diseases.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Freeman EE. A seat at the big table: expanding the role of dermatology at the World Health Organization and beyond. J Invest Dermatol. 2014;134(11):2663–5.

    Article  CAS  PubMed  Google Scholar 

  2. Engelman D, Fuller LC, Solomon AW, McCarthy JS, Hay RJ, Lammie PJ, et al. Opportunities for integrated control of neglected tropical diseases that affect the skin. Trends Parasitol. 2016;32(11):843–54.

    Article  PubMed  Google Scholar 

  3. Tschachler E, Bergstresser PR, Stingl G. HIV-related skin diseases. Lancet. 1996;348(9028):659–63.

    Article  CAS  PubMed  Google Scholar 

  4. • Hay RJ, Johns NE, Williams HC, Bolliger IW, Dellavalle RP, Margolis DJ, et al. The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134(6):1527–34. Epidemiological study based on the 2010 Global Burden of Disease project that measures the burden of skin diseases worldwide, with burden of individual skin diseases measured in DALYs.

    Article  CAS  PubMed  Google Scholar 

  5. WHO | Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults [Internet]. WHO. [cited 2017 Mar 14] Available from: http://www.who.int/maternal_child_adolescent/documents/skin-mucosal-and-hiv/en/.

  6. •• Karimkhani C, Dellavalle RP, Coffeng LE, Flohr C, Hay RJ, Langan SM, et al. Global skin disease morbidity and mortality: An Update From the Global Burden of Disease Study 2013. JAMA Dermatol [Internet]. 2017 Mar 1. Epidemiological study based on the 2013 Global Burden of Disease project that measures the burden of skin diseases worldwide, with burden of individual skin diseases measured in DALYs.

  7. Boyers LN, Karimkhani C, Naghavi M, Sherwood D, Margolis DJ, Hay RJ, et al. Global mortality from conditions with skin manifestations. J Am Acad Dermatol. 2014;71(6):1137–43.e17.

    Article  PubMed  Google Scholar 

  8. Organization WH. Global report on psoriasis [Internet]. World Health Organization; 2016 [cited 2017 Mar 9] Available from: http://www.who.int/iris/handle/10665/204417.

  9. Jobanputra R, Bachmann M. The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town. South Africa Int J Dermatol. 2000;39(11):826–31.

    Article  CAS  PubMed  Google Scholar 

  10. Basra M, Fenech R, Gatt R, Salek M, Finlay A. The Dermatology Life Quality Index 1994–2007: a comprehensive review of validation data and clinical results. Br J Dermatol. 2008;159(5):997–1035.

    CAS  PubMed  Google Scholar 

  11. Chren M-M, Lasek RJ, Quinn LM, Mostow EN, Zyzanski SJ. Skindex, a quality-of-life measure for patients with skin disease: reliability, validity, and responsiveness. J Invest Dermatol. 1996;107(5):707–13.

    Article  CAS  PubMed  Google Scholar 

  12. Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155(1):145–51.

    Article  CAS  PubMed  Google Scholar 

  13. Weisshaar E, Apfelbacher C, Jäger G, Zimmermann E, Bruckner T, Diepgen TL, et al. Pruritus as a leading symptom: clinical characteristics and quality of life in German and Ugandan patients. Br J Dermatol. 2006;155(5):957–64.

    Article  CAS  PubMed  Google Scholar 

  14. Worth C, Heukelbach J, Fengler G, Walter B, Liesenfeld O, Feldmeier H. Impaired quality of life in adults and children with scabies from an impoverished community in Brazil. Int J Dermatol. 2012;51(3):275–82.

    Article  PubMed  Google Scholar 

  15. McCabe RE, Antony MM, Summerfeldt LJ, Liss A, Swinson RP. Preliminary examination of the relationship between anxiety disorders in adults and self-reported history of teasing or bullying experiences. Cogn Behav Ther. 2003;32(4):187–93.

    Article  PubMed  Google Scholar 

  16. Mosam A, Vawda NB, Gordhan AH, Nkwanyana N, Aboobaker J. Quality of life issues for South Africans with acne vulgaris. Clin Exp Dermatol. 2005;30(1):6–9.

    Article  CAS  PubMed  Google Scholar 

  17. Hariram P, Mosam A, Aboobaker J, Esterhuizen T. Quality of life in psoriasis patients in KwaZulu Natal, South Africa. Indian J Dermatol Venereol Leprol. 2011;77(3):333–4.

    Article  PubMed  Google Scholar 

  18. Aghaei S, Moradi A, Ardekani G. Impact of psoriasis on quality of life in Iran. Indian J Dermatol Venereol Leprol. 2009;75(2):220.

    Article  PubMed  Google Scholar 

  19. Gibbs SAM. Skin disease and socioeconomic conditions in rural Africa: Tanzania. Int J Dermatol. 1996;35(9):633–9.

    Article  CAS  PubMed  Google Scholar 

  20. Harrison LH, Dwyer DM, Maples CT, Billmann L. Risk of meningococcal infection in college students. JAMA. 1999;281(20):1906–10.

    Article  CAS  PubMed  Google Scholar 

  21. Raoult D, Foucault C, Brouqui P. Infections in the homeless. Lancet Infect Dis. 1(2):77–84.

  22. Lim HW, Collins SAB, Resneck Jr JS, Bolognia JL, Hodge JA, Rohrer TA, et al. The burden of skin disease in the United States. J Am Acad Dermatol [Internet]. Available from: http://www.sciencedirect.com/science/article/pii/S0190962217300166.

  23. Dror DM, van Putten-Rademaker O, Koren R. Cost of illness: evidence from a study in five resource-poor locations in India. 2008.

  24. Hay RJ, Fuller LC. The assessment of dermatological needs in resource-poor regions. Int J Dermatol. 2011;50(5):552–7.

    Article  PubMed  Google Scholar 

  25. Laing R, Waning B, Gray A, Ford N, t Hoen E. 25 years of the WHO essential medicines lists: progress and challenges. Lancet. 5;361(9370):1723–9.

  26. Narwane S, Patel T, Shetty Y, Chikhalkar S. Drug utilization and cost analysis for common skin diseases in dermatology OPD of an Indian tertiary care hospital-a prescription survey. 2011.

  27. Molyneux DH, Hotez PJ, Fenwick A. “Rapid-impact interventions”: how a policy of integrated control for Africa’s neglected tropical diseases could benefit the poor. PLoS Med. 2005;2(11):e336.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Guthmann J-P, Arlt D, Garcia LML, Rosales M, de Jesus SJ, Alvarez E, et al. Control of mucocutaneous leishmaniasis, a neglected disease: results of a control programme in Satipo Province, Peru. Trop Med Int Health. 2005;10(9):856–62.

    Article  PubMed  Google Scholar 

  29. • Karimkhani C, Boyers LN, Margolis DJ, Naghavi M, Hay RJ, Williams HC, et al. Comparing cutaneous research Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases with 2010 Global Burden of Disease results. PLOS ONE. 2014;9(7):e102122. Study examines relationship of NIAMS grant funding with relative skin disease burden for 15 skin diseases included in the Global Burden of Disease 2010.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Karimkhani C, Boyers LN, Prescott L, Welch V, Delamere FM, Nasser M, et al. Global burden of skin disease as reflected in Cochrane Database of Systematic Reviews. JAMA Dermatol. 2014;150(9):945–51.

    Article  PubMed  Google Scholar 

  31. Paul S, Evans R, Maurer T, Muhe LM, Freeman EE. Treatment of dermatological conditions associated with HIV/AIDS: the scarcity of guidance on a global scale. AIDS Res Treat. 2016;2016:e3272483.

    Google Scholar 

  32. Oxman AD, Lavis JN, Fretheim A. Use of evidence in WHO recommendations. Lancet. 2007;369(9576):1883–9.

    Article  PubMed  Google Scholar 

  33. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Aneja S, Aneja S, Bordeaux JS. Association of increased dermatologist density with lower melanoma mortality. Arch Dermatol. 2012;148(2):174–8.

    Article  PubMed  Google Scholar 

  35. Wootton R. Telehealth in the developing world. IDRC; 2009. 336 p.

  36. Osei-tutu A, Shih T, Rosen A, Amanquah N, Chowdhury M, Nijhawan RI, et al. Mobile teledermatology in Ghana: sending and answering consults via mobile platform. J Am Acad Dermatol. 2013;69(2):e90–1.

    Article  PubMed  Google Scholar 

  37. Azfar RS, Lee RA, Castelo-Soccio L, Greenberg MS, Bilker WB, Gelfand JM, et al. Reliability and validity of mobile Teledermatology in human immunodeficiency virus-positive patients in Botswana: a pilot study. JAMA Dermatol. 2014;150(6):601–7.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Tran K, Ayad M, Weinberg J, Cherng A, Chowdhury M, Monir S, et al. Mobile teledermatology in the developing world: implications of a feasibility study on 30 Egyptian patients with common skin diseases. J Am Acad Dermatol. 2011;64(2):302–9.

    Article  PubMed  Google Scholar 

  39. Lamel SA, Haldeman KM, Ely H, Kovarik CL, Pak H, Armstrong AW. Application of mobile teledermatology for skin cancer screening. J Am Acad Dermatol. 2012;67(4):576–81.

    Article  PubMed  Google Scholar 

  40. Armstrong AW, Johnson MA, Lin S, Maverakis E, Fazel N, Liu F-T. Patient-centered, direct-access online care for management of atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2015;151(2):154–60.

    Article  PubMed  Google Scholar 

  41. Azfar RS, Weinberg JL, Cavric G, Lee-Keltner IA, Bilker WB, Gelfand JM, et al. HIV-positive patients in Botswana state that mobile teledermatology is an acceptable method for receiving dermatology care. J Telemed Telecare. 2011;17(6):338–40.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Peeling RW, Mabey D. Point-of-care tests for diagnosing infections in the developing world. Clin Microbiol Infect. 2010;16(8):1062–9.

    Article  CAS  PubMed  Google Scholar 

  43. Mabey D, Peeling RW, Ustianowski A, Perkins MD. Tropical infectious diseases: diagnostics for the developing world. Nat Rev Microbiol. 2004;2(3):231–40.

    Article  CAS  PubMed  Google Scholar 

  44. Ridley RG. Evaluating diagnostics: VL. Nat Rev Microbiol. 2007;5:S1.

    Article  CAS  Google Scholar 

  45. Yager P, Domingo GJ, Gerdes J. Point-of-care diagnostics for global health. Annu Rev Biomed Eng. 2008;10:107–44.

    Article  CAS  PubMed  Google Scholar 

  46. Pattabhi S, Whittle J, Mohamath R, El-Safi S, Moulton GG, Guderian JA, et al. Design, development and evaluation of rK28-based point-of-care tests for improving rapid diagnosis of visceral leishmaniasis. PLoS Negl Trop Dis. 2010;4(9):e822.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Amerson E, Woodruff CM, Forrestel A, Wenger M, McCalmont T, LeBoit T, Maurer T. Accuracy of clinical suspicion and pathologic diagnosis of Kaposi Sarcoma in East Africa. J Acquir Immune Defic Syndr. 1999;71(3):295–301. doi: 10.1097/QAI.0000000000000862.

  48. Patel V. Global mental health: from science to action. Harv Rev Psychiatry. 2012;20(1):6–12.

    Article  PubMed  PubMed Central  Google Scholar 

  49. WHO | Task shifting: global recommendations and guidelines [Internet]. WHO. [cited 2017 Apr 5] Available from: http://www.who.int/workforcealliance/knowledge/resources/taskshifting_guidelines/en/.

  50. Eholié S-P, Aoussi FE, Ouattara IS, Bissagnéné E, Anglaret X. HIV treatment and care in resource-constrained environments: challenges for the next decade. J Int AIDS Soc [Internet]. 2012 Aug 22 [cited 2017 Apr 5];15(2) Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3494167/.

  51. Sanne I, Orrell C, Fox MP, Conradie F, Ive P, Zeinecker J, et al. Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial. Lancet Lond Engl. 2010;376(9734):33–40.

    Article  Google Scholar 

  52. Tsang MW, Kovarik CL. The role of dermatopathology in conjunction with teledermatology in resource-limited settings: lessons from the African Teledermatology Project. Int J Dermatol. 2011;50(2):150–6.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Chu K, Rosseel P, Gielis P, Ford N. Surgical task shifting in Sub-Saharan Africa. PLoS Med. 2009;6(5):e1000078.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Fairall L, Bachmann MO, Lombard C, Timmerman V, Uebel K, Zwarenstein M, et al. Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial. Lancet. 2012;380(9845):889–98.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Morris MB, Chapula BT, Chi BH, Mwango A, Chi HF, Mwanza J, et al. Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia. BMC Health Serv Res. 2009;9:5.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Shumbusho F, van Griensven J, Lowrance D, Turate I, Weaver MA, Price J, et al. Task shifting for scale-up of HIV care: evaluation of nurse-centered antiretroviral treatment at rural health centers in Rwanda. PLoS Med. 2009;6(10):e1000163.

    Article  PubMed  PubMed Central  Google Scholar 

  57. • Laker-Oketta M, Wenger M, Semeere A, Castelnuovo B, Kambugu A, Lukande R, et al. Task shifting and skin punch for the histologic diagnosis of Kaposi’s sarcoma in Sub-Saharan Africa: a public health solution to a public health problem. Oncology. 2015;89(1):60–5. Study that examined task-shifting biopsies for Kaposi's Sarcoma diagnosis in East Africa from physicians to non-physicians, finding that task-shifting led to significant increase in healthcare access.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Trends-United Nations Population Division | Department of Economic and Social Affairs [Internet]. [cited 2017 Apr 11]. Available from: http://www.un.org/en/development/desa/population/theme/trends/index.shtml.

  59. The Nigeria Association of Dermatologists | African Society of Dermatology and Venereology (ASDV) [Internet]. African Society of Dermatology and Venereology (ASDV). 2016 [cited 2017 Apr 11] Available from: https://www.asdvafrica.org/about-asdv/the-nigerian-association-of-dermatologists/.

  60. Hu J, McKoy K, Papier A, Klaus S, Ryan T, Grossman H, et al. Dermatology and HIV/AIDS in Africa. J Glob Infect Dis. 2011;3(3):275–80.

    Article  PubMed  PubMed Central  Google Scholar 

  61. • Scott KW, Jha AK. Putting quality on the global health agenda. N Engl J Med. 2014;371(1):3–5. Perspective that emphasizes that access to high-quality care is an important goal when addressing global health need.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Divya Seth

  2. Weill Cornell Medical College, New York, NY, USA

    Khatiya Cheldize

  3. Massachusetts General Hospital Department of Dermatology, 50 Staniford Street, Boston, MA, 02114, USA

    Khatiya Cheldize & Esther E. Freeman

  4. Massachusetts General Hospital Department of Pediatrics, Boston, MA, USA

    Danielle Brown

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  1. Divya Seth
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  2. Khatiya Cheldize
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  3. Danielle Brown
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  4. Esther E. Freeman
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Correspondence to Esther E. Freeman.

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Seth, D., Cheldize, K., Brown, D. et al. Global Burden of Skin Disease: Inequities and Innovations. Curr Derm Rep 6, 204–210 (2017). https://doi.org/10.1007/s13671-017-0192-7

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