5.11.4. Societal impact

Disability due to loss of function

Public sympathy and charity for people with skin disease is limited. This is surprising considering skin disease is so common and that it can affect people in so many ways. Scleroderma, both systemic and localised, directly restricts mobility and functioning of the limbs, while leg ulcers produce chronic pain and limit the ability to walk. Some inflammatory skin diseases such as occupational hand dermatitis or hand psoriasis confer a direct disability by affecting one’s ability to use his/her hands. Atopic eczema and scabies are intensely itchy disorders, leading to loss of sleep for those who suffer from it and for their families. Moreover, on the next day they also cause lack of concentration due to drowsiness.

Mortality and Morbidity

Chronic suffering rather than mortality is characteristic for most skin diseases. Nevertheless, there are exceptions, e.g. once melanoma has spread beyond the regional lymph nodes or into the bloodstream, the outlook is very poor. Melanoma kills a disproportionate number of young economically active people when compared to other cancers (melanoma comprises 1-2% of all cancer-related fatalities). Several other less common skin cancers such as Merkel cell tumours, malignant fibrous histiocytomas, mycosis fungoides, other lymphomas, angiosarcomas and Kaposi sarcoma are similarly aggressive or particularly difficult to treat. A wide range of multisystem dermatological diseases are associated with reduced life expectancy: collagen vascular diseases, acquired blistering diseases and genetic diseases such as xeroderma pigmentosum, epidermolysis bullosa and many others. Rare skin diseases such as blistering drug reactions can result in a person losing almost their entire skin - as in a severe burn. In the absence of a correctly functioning skin, temperature regulation, salt and water balance and defense against infections are largely impaired.

These types of skin conditions are associated to a mortality of around 30%.

Profound psychological effects

In addition to physical symptoms, perhaps the most significant way in which skin disease affects people is the effect it has on personal psychological well-being (Ryan, 1991). Disfiguring skin disease on visible sites such as the face (e.g. acne) can result in loss of self-esteem, depression and poorer job prospects. Indeed, the quality of life scores for people with skin disease are often worse than those of people with more traditional “medical” disorders such as angina and hypertension.

High economic costs

Although skin disease is rarely life threatening, the moderate morbidity and its high prevalence place skin disease among the top four chronic diseases when entire communities are considered. Various studies have assessed the economic impact of specific skin diseases and these have shown that direct costs are as high as for many other diseases, with much of that cost being borne by patients as well as society. Small changes in the way this balance functions can have a profound effect on a country’s health care budget because skin disease affects so many people (Verboom et al, 2002; Williams, 1997). Other costs such as unemployment and losing an economically viable sector of the country’s workforce are also important. Indirect costs e.g. the adverse effects on the quality of life and the opportunity costs due to time lost for daily topical therapy and skin care in many skin diseases also need to be considered within the framework of economic evaluations.