Acne Can Be More Distressing Than Melanoma

Laird Harrison

February 18, 2018

SAN DIEGO — Acne can have wider-ranging and longer-term effects than skin cancer, according to the Global Burden of Disease Study, an initiative for quantifying health costs funded by the Bill and Melinda Gates Foundation.

The new system for ranking skin diseases by injury they cause could shift research priorities and change the way dermatologists see their patients, senior author Robert Dellavalle, MD, PhD, from the University of Colorado in Denver, told Medscape Medical News.

"It affects my clinical practice in giving more priority and thought to inflammatory skin disease," said Dellavalle. His student, Parker Hollingsworth from Northeast Ohio Medical University in Rootstown, presented the finding here at the American Academy of Dermatology (AAD) 2018 Annual Meeting.

The analysis fits into a trend in which researchers try to determine what features of their health are most important to patients, explained session moderator Sewon Kang, MD, from Johns Hopkins University in Baltimore, Maryland. The US Food and Drug Administration "is putting more and more emphasis on patient-reported outcomes," he said in an interview. "Perhaps in a similar way, this way of measuring the impact of disease is more meaningful."

The study evaluated 333 diseases and injuries in 195 countries and territories. Using 11,552 data sources from 2016, it divided more than 1000 skin diseases into categories, Hollingsworth explained.

It affects my clinical practice in giving more priority and thought to inflammatory skin disease. Dr Robert Dellavalle

Its primary unit of measurement is the disability-adjusted life-year, which is derived by combining the years of life lost with the number of years lived with disability.

To weigh the relative importance of shortened lifespan with a disability, researchers gather data from surveys of patients. They give the patients hypothetical choices between years of life and years of various kinds of disability to measure how the participants weigh the effects.

They might tell patients who have suffered a stroke to imagine they have 10 years left to live and ask them how many years of life they would give in exchange for never having had the stroke. If the average patient was willing to give up 5 years of life for the cure, the researchers would assign the stroke disability a value of 50% of a year of life.

Disability weights are measured on a scale of 0 to 1, with zero meaning full health and one implying a state equivalent to death. So in this hypothetical example, a stroke would be weighted 0.5.

The years lived with disability are calculated by multiplying the prevalence of a disease by a disability weight.

In the Global Burden of Disease Study, skin conditions accounted for 60 million disability-adjusted life-years, which is about 2.5%. The percentage appears to have held steady at least since the 1990s, Hollingsworth pointed out.

This made skin diseases the 11th most harmful health problem in the categories used by the study, which were ranked:

  1. Ischemic heart disease

  2. Cerebrovascular disease

  3. Lower respiratory infection

  4. Low back and neck pain

  5. Diarrheal diseases

  6. Road injuries

  7. Sense organ diseases

  8. Chronic obstructive pulmonary disease

  9. Neonatal preterm birth

  10. HIV, AIDS

  11. Skin diseases

  12. Diabetes

Grouping skin diseases into categories, the researchers calculated thousands of disability-adjusted life-years. The ranking varied when researchers looked at patients' age. Acne is most harmful in young people aged 10 to 24 years and becomes less important later in life. In contrast, viral skin diseases and cancer become more problematic with age.

Table. Global Burden of Skin Diseases

Skin Disease Disability-Adjusted Life-Years
Acne 15,836
Dermatitis 11,210
Viral infection 5915
Psoriasis 5643
Urticaria 4030
Scabies 3788
Fungal 3509
Other 3027
Pyoderma 1945
Melanoma 1551
Basal and squamous cell carcinoma 1023
Pruritus 709
Decubitus ulcer 670
Cellulitis 608
Alopecia areata 504

The Global Burden of Disease Study has challenged previous systems for comparing the importance of different health problems, said Dellavalle. "Not everybody agrees with this, but it does seem to be disrupting the other sources of data including the World Health Organization and the World Bank because it is the most transparent," he pointed out, with methodology published and data available through the Institute for Health Metrics and Evaluation website and elsewhere.

"It is great for prioritizing which skin diseases should get more research," Dellavalle said. "There is not as much research going into acne as there should be, if you look at the amount of disability it causes."

Although patients do not die from acne, they may suffer social stigma and perhaps lose employment opportunities when the disease becomes disfiguring, he said.

It is too early to say that the Global Burden of Disease Study reports will bring about a shift in the way resources are allocated, but already some researchers are using them to support their requests for funding, Dellavalle explained.

The analysis also helped the researchers rank the burden of skin diseases among countries. They placed the United States number 3 in disability-adjusted life-years per 100,000 people, after New Zealand and Sweden.

For melanoma, the United States ranked number 29, and New Zealand, Australia, and Norway topped the list of countries most affected by this deadly skin cancer.

This study is funded by the Bill and Melinda Gates Foundation. The study authors, Dellavalle and Hollingsworth, and session moderator Kang have disclosed no relevant financial relationships.

American Academy of Dermatology (AAD) 2018 Annual Meeting: Abstract 6589. Presented February 17, 2018.

Follow Medscape Dermatology on Twitter @MedscapeDerm and Laird Harrison @LairdH

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