What's the Likelihood of Skin Disease Creating Disability?


A study published in JAMA Dermatology has combined the occurrence of skin diseases worldwide with the likelihood of creating disability across a lifespan to define 10 of the most challenging conditions.

These conditions are listed in order of decreasing “disability-adjusted life years:” dermatitis, acne, hives, psoriasis, viral skin diseases, fungal skin diseases, scabies, melanoma, pyoderma, cellulitis, non-melanoma skin cancer, decubitus ulcer and alopecia areata.

Atopic Dermatitis or Atopic Eczema

According to Peter Pugliese, M.D., an estimated 84% of children and adolescents have trouble falling asleep, which is a potential issue with atopic dermatitis. Additionally, atopic eczema affects as many as 10-20% of children in Western civilization, said Pugliese.1

While diseases such as dermatitis are expensive to take care of and causes suffering, there is not enough information or research to help benefit individuals who are affected, as opposed to more fatal diseases such as skin cancer.

“We do not know the total impact of these diseases in terms of decrease in the quality of life, lost productivity untold amount of both physical and psychological pain.” —Peter Pugliese, M.D.

“Many of these chronic skin diseases continue to remain a mystery to medical science, though a considerable amount of research sheds light on both the cause, which is to improve treatment,” said Pugliese. “We do not know the total impact of these diseases in terms of decrease in the quality of life, lost productivity untold amount of both physical and psychological pain.”

Terri A. Wojak, business development/education director of True U Esthetics, explained that while the cause of eczema is mainly unknown, it is assumed to be a combination of environmental and hereditary factors. 

“Eczema is prevalent worldwide, and though there are several theories as to environmental factors, there doesn’t seem to be one that stands out for any type of inflammation that can trigger a breakout,” added Wojak.

Inflammatory Diseases Rise Globally

Paper author, Robert Dellavalle, M.D., Ph.D., MSPH, investigator at the University of Colorado Cancer Center and professor of dermatology at the University of Colorado School of Medicine, explained how one specific type of disease seems to stand out above the rest.

"I was surprised at how much more disabling are the inflammatory skin diseases—rashes, acne and hives—around the world," he said.

Skin cancers in countries like China and India are rarer than in the United States, which rates non-cancer skin conditions higher, worldwide, explained Dellavalle.

“Also, some of these rashes and acne can start young and be irritating throughout your life, whereas cancers tend to surface much later in life, meaning that if we calculate burden across the lifespan—which we do with our measure of disability-adjusted life years—the effects of these longer-lasting conditions enlarge,” added Dellavalle.

According to Mark Lees, Ph.D., CIDESCO Dipl., protecting skin barrier is significant, as its function is to block potential irritants from penetrating the skin surface.

“When the barrier is damaged, irritants find their way through the epidermis much more easily, causing redness and subject symptoms such as stinging and burning,” Lees explained. “This irritation can result in increased redness and visible inflammation. It also can worsen the appearance of rosacea flares and acne, as well as make telangiectasias more prominent.”

Eczema, psoriasis, seborrheic dermatitis, rosacea and other inflammatory skin conditions are negatively impacted from damaged barriers, added Lees.

Examining Data

The study utilized data from the Institute for Health Metrics and Evaluation, kept at the University of Washington and funded by the Bill and Melinda Gates Foundation. Moving forward, the institute plans to gather and store global health information, accessible to the public.

Over 4,000 sources contributed to the study, which Dellavalle and colleagues gathered from the U.S., U.K., Australia and the Netherlands.

Lead author, Chante Karimkhani, M.D., University of Colorado dermatology research fellow dives into the significance of the study.

“Not only do skin diseases cause substantial pain, disfigurement, and both psychological and financial morbidity, but dermatologic findings are often the initial manifestation of systemic disease,” explained Karimkhani. “Global Burden of Disease metrics and patterns have the potential to affect public health and research priorities on a global scale. As a comprehensive and transparent measure of large-scale population health, the Global Burden of Disease Study is a rich and valuable resource.”


1. Beasley R, von Keil, U, Mutius E, Pearce N, worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic dermatitis: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) steering committee. Lancet 351, 1225 – 1232 (1998)

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