Advertisement
Mayo Clinic Proceedings Home

In reply–Prevalence of Skin Disorders in Patients Seeking Health Care

      We thank Drs Sung and Kimball for their interest in our recent article.
      • 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.
      In their letter, they argue that some skin disorders may be major drivers of disability. In particular, they discuss inflammatory skin disease (eg, psoriasis) and nonmelanoma skin cancer. In addition, they argue that teledermatology and teledermatoscopy may not be a strategic alternative to a direct patient interaction with a specialist.
      We agree that some skin conditions may have major physical and psychological consequences; however, our findings in Olmsted County were partly driven by common skin conditions such as acne or sebaceous cysts that are generally not major drivers of disability or death.
      • 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.
      The third major dermatologic condition in Olmsted County was actinic keratosis, a condition considered to be a precursor of nonmelanoma skin cancer. This dermatologic condition may in some cases be life threatening.
      We suggested that new models of dermatologic care delivery, such as teledermatology, should be critically explored within US health care systems to increase care efficiency and reduce health care expenditures.
      • 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.
      • van der Heijden J.P.
      • de Keizer N.F.
      • Bos J.D.
      • Spuls P.I.
      • Witkamp L.
      Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost.
      Drs Sung and Kimball argued that teledermatology is generally inferior to direct examination by a specialist and that malignant lesions may go unrecognized with the former. We acknowledge that melanoma is the fifth most commonly diagnosed new cancer among men and the seventh among women. However, death rates from melanoma have been declining rapidly in whites younger than 50 years of age, suggesting that the recognition of melanoma is improving in the United States.

      American Cancer Society. Cancer Facts & Figures 2013. http://www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2013. Accessed April 23, 2013.

      We certainly agree with Drs Sung and Kimball that primary care physicians could benefit from additional education related to dermatologic conditions in medical school, residency, and continuing medical education programs. Teledermatology supported by primary care physicians who have additional training and experience with dermatologic evaluation may provide better results than those reported in current studies. Until we can provide additional primary care training for the identification of skin diseases, we agree with Warshaw et al,
      • Warshaw E.M.
      • Hillman Y.J.
      • Greer N.L.
      • et al.
      Teledermatology for diagnosis and management of skin conditions: a systematic review.
      who concluded that “teledermatology may still be superior to dermatologic care provided by nondermatologists.”

      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
        • van der Heijden J.P.
        • de Keizer N.F.
        • Bos J.D.
        • Spuls P.I.
        • Witkamp L.
        Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost.
        Br J Dermatol. 2011; 165: 1058-1065
      1. American Cancer Society. Cancer Facts & Figures 2013. http://www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2013. Accessed April 23, 2013.

        • 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

      Linked Article

      • Prevalence of Skin Disorders in Patients Seeking Health Care
        Mayo Clinic ProceedingsVol. 88Issue 7
        • Preview
          In their article published in the January 2013 issue of Mayo Clinic Proceedings, St. Sauver et al1 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.
        • Full-Text
        • PDF