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Prevalence of Skin Disorders in Patients Seeking Health Care

      To the Editor:
      In their article published in the January 2013 issue of Mayo Clinic Proceedings, St. Sauver et al
      • St. Sauver J.L.
      • Warner D.O.
      • Yawn B.P.
      • et al.
      Why patients visit their doctors: assessing the most prevalent conditions in a defined American population.
      reported the prevalence of skin disorders in patients seeking health care, noting that almost half of the observed population (42.7%) had at least one International Classification of Diseases, Ninth Revision code for skin conditions within 5 years. The authors stated that “skin disorders are not typically major drivers of disability” and that perhaps teledermatology should be investigated as a way to increase health care efficiency and reduce health care expenditures.
      We believe, and the evidence supports, that skin disease is indeed a major driver of disability.
      • Bickers D.R.
      • Lim H.W.
      • Margolis D.
      • et al.
      American Academy of Dermatology Association
      Society for Investigative Dermatology. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology.
      In fact, one could infer that the finding that so many patients are willing to navigate the medical system, schedule appointments, and make co-payments, is testament to the fact that their skin ailments are important concerns and not just trivial distractions. Inflammatory skin disease adversely affects not only quality of life but also sleep, work productivity, social functioning, and pain and discomfort levels. Inflammatory skin disease is also associated with other medical and psychiatric disabilities.
      • Kimball A.B.
      • Gieler U.
      • Linder D.
      • Sampogna F.
      • Warren R.B.
      • Augustin M.
      Psoriasis: is the impairment to a patient's life cumulative?.
      Neoplastic dermatologic disease, especially nonmelanoma skin cancer, is an epidemic, with 1 in 5 Americans expected to experience a tumor in their lifetime. If left untreated, neoplastic dermatologic disease is potentially deforming and in some cases life threatening.
      • Stern R.S.
      Prevalence of a history of skin cancer in 2007: results of an incidence based model.
      Although it is true that teledermatology has some real benefits in solving geographic access issues, it has yet to be shown to increase the productivity of dermatologists, which is where cost savings could be realized. Moreover, a recent review of the literature evaluated 78 teledermatology studies and reported that approximately two-thirds of the studies found better diagnostic accuracy in clinic dermatology.
      • Warshaw E.M.
      • Hillman Y.J.
      • Greer N.L.
      • et al.
      Teledermatology for diagnosis and management of skin conditions: a systematic review.
      Importantly, it was also determined that teledermatology and teledermatoscopy were inferior to clinic dermatology in diagnosing malignant lesions, a factor that should be seriously considered given the potential adverse outcomes of delayed diagnosis and treatment and the fact that this application is likely to be a common desired use of this technology.
      We believe that it is critical to acknowledge the prevalence of skin disease and its potential impact on patients’ physical and psychological well-being. We also note that dermatology training in medical school is minimal, especially compared with the demand presented by US patients.
      • Moore M.M.
      • Geller A.C.
      • Zhang Z.
      • et al.
      Skin cancer examination teaching in US medical education.
      A call for action is needed to improve the dermatologic capabilities of many physicians, as well as the appropriateness of referrals and follow-up visits to dermatologists.

      References

        • St. Sauver J.L.
        • Warner D.O.
        • Yawn B.P.
        • et al.
        Why patients visit their doctors: assessing the most prevalent conditions in a defined American population.
        Mayo Clin Proc. 2013; 88: 56-67
        • Bickers D.R.
        • Lim H.W.
        • Margolis D.
        • et al.
        • American Academy of Dermatology Association
        Society for Investigative Dermatology. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology.
        J Am Acad Dermatol. 2006; 55: 490-500
        • Kimball A.B.
        • Gieler U.
        • Linder D.
        • Sampogna F.
        • Warren R.B.
        • Augustin M.
        Psoriasis: is the impairment to a patient's life cumulative?.
        J Eur Acad Dermatol Venereol. 2010; 24: 989-1004
        • Stern R.S.
        Prevalence of a history of skin cancer in 2007: results of an incidence based model.
        Arch Dermatol. 2010; 146: 279-282
        • Warshaw E.M.
        • Hillman Y.J.
        • Greer N.L.
        • et al.
        Teledermatology for diagnosis and management of skin conditions: a systematic review.
        J Am Acad Dermatol. 2011; 64: 759-772
        • Moore M.M.
        • Geller A.C.
        • Zhang Z.
        • et al.
        Skin cancer examination teaching in US medical education.
        Arch Dermatol. 2006; 142: 439-444

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