The global burden of skin disease in 2010: an analysis of the prevalence and impact of skin conditions. J Invest Dermatol. 2014;134:1527-1534. [PMID: 24166134 DOI: 10.1038/jid.2013.446]

Blistering time as a parameter for the strength of dermoepidermal adhesion: a systematic review and meta-analysis

Skin ageing is associated with a flattening of the dermoepidermal junction and a less effective anchoring system, predisposing to bulla formation, trauma and shear-type injuries. An artificial and controlled technique for standardized dermoepidermal separation is the suction blister method, whereby the strength of dermoepidermal adhesion is characterized by blistering time. To identify and quantify influencing factors on blistering time in healthy humans. A search in the Medline and Embase databases (1946 to June 2014) and in reference lists was conducted. In total, results of 146 suction blister experiments in 3418 individuals reported in 59 publications were analysed. The median blister diameter was 6 mm (IQR 5-6) and the median suction pressure was -210 mmHg (IQR -200 to -300), resulting in a median blistering time of 75 min (IQR 48-120). In the multivariate model, skin temperature and age were the strongest predictors for suction blistering time (P < 0·001, R(2) adjusted  = 0·707). This strong association between temperature and suction blistering indicates that the dermoepidermal junction loses its strength with increasing skin temperature. This finding supports the practice of skin and tissue cooling to prevent injuries. The increased vulnerability of the skin seems to exist irrespectively of applied mechanical loads. We conclude that blistering time is an important and clinically relevant (outcome) parameter measuring the structural and mechanical integrity of deeper cutaneous layers.

Time to resolution and effect on quality of life of molluscum contagiosum in children in the UK: a prospective community cohort study

BACKGROUND

Molluscum contagiosum is one of the 50 most prevalent diseases worldwide, but scarce epidemiological data exist for childhood molluscum contagiosum. We aimed to describe the time to resolution, transmission to household child contacts, and effect on quality of life of molluscum contagiosum in children in the UK.

METHODS

Between Jan 1, and Oct 31, 2013, we recruited 306 children with molluscum contagiosum aged between 4 and 15 years in the UK either by referral by general practitioner or self-referral (with diagnosis made by parents by use of the validated Molluscum Contagiosum Diagnostic Tool for Parents [MCDTP]). All participants were asked to complete a questionnaire at recruitment about participant characteristics, transmission, and quality of life. We measured quality of life with the Children's Dermatology Life Quality Index (CDLQI). Participants were prospectively followed up every month to check on their recovery from molluscum contagiosum and transmission to other children in the same household, until the child's lesions were no longer visible.

FINDINGS

The mean time to resolution was 13·3 months (SD 8·2). 80 (30%) of 269 cases had not resolved by 18 months; 36 (13%) had not resolved by 24 months. We recorded transmission to other children in the household in 102 (41%) of 250 cases. Molluscum contagiosum had a small effect on quality of life for most participants, although 33 (11%) of 301 participants had a very severe effect on quality of life (CDLQI score >13). A greater number of lesions was associated with a greater effect on quality of life (H=55·8, p<0·0001).

INTERPRETATION

One in ten children with molluscum contagiosum is likely to have a substantial effect on their quality of life and therefore treatment should be considered for some children, especially those with many lesions or who have been identified as having a severe effect on quality of life. Patients with molluscum contagiosum and their parents need to be given accurate information about the expected natural history of the disorder. Our data provide the most reliable estimates of the expected time to resolution so far and can be used to help set realistic expectations.

FUNDING

Wales School of Primary Care Research (WSPCR) and Cardiff University.

Advances in skin grafting and treatment of cutaneous wounds

The ability of the skin to repair itself after injury is vital to human survival and is disrupted in a spectrum of disorders. The process of cutaneous wound healing is complex, requiring a coordinated response by immune cells, hematopoietic cells, and resident cells of the skin. We review the classic paradigms of wound healing and evaluate how recent discoveries have enriched our understanding of this process. We evaluate current and experimental approaches to treating cutaneous wounds, with an emphasis on cell-based therapies and skin transplantation.

The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants––3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67–3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68–2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33–2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.

Global mortality from conditions with skin manifestations

BACKGROUND

Global Burden of Disease Study is a research database containing systematically compiled information from vital statistics and epidemiologic literature to inform research, public policy, and resource allocation.

OBJECTIVE

We sought to compare mortality among conditions with skin manifestations in 50 developed and 137 developing countries from 1990 to 2010.

METHODS

This was a cross-sectional study to calculate mean age-standardized mortality (per 100,000 persons) across countries for 10 disease categories with skin manifestations. We compared differences in mortality from these disorders by time period (year 1990 vs year 2010) and by developing versus developed country status.

RESULTS

Melanoma death rates were 5.6 and 4.7 times greater in developed compared with developing countries in 1990 and 2010, respectively. Measles death rates in 1990 and 2010 were 345 and 197 times greater in developing countries, and corresponding syphilis death rates were 33 and 45 times greater.

LIMITATIONS

Inability to adjust for patient-, provider-, and geographic-level confounders may limit the accuracy and generalizability of these results.

CONCLUSION

The mortality burden from skin-related conditions differs between developing and developed countries, with the greatest differences observed for melanoma, measles, and syphilis. These results may help prioritize and optimize efforts to prevent and treat these disorders.

Parasitic mites of medical and veterinary importance--is there a common research agenda?

There are an estimated 0.5-1 million mite species on earth. Among the many mites that are known to affect humans and animals, only a subset are parasitic but these can cause significant disease. We aim here to provide an overview of the most recent work in this field in order to identify common biological features of these parasites and to inform common strategies for future research. There is a critical need for diagnostic tools to allow for better surveillance and for drugs tailored specifically to the respective parasites. Multi-'omics' approaches represent a logical and timely strategy to identify the appropriate mite molecules. Recent advances in sequencing technology enable us to generate de novo genome sequence data, even from limited DNA resources. Consequently, the field of mite genomics has recently emerged and will now rapidly expand, which is a particular advantage for parasitic mites that cannot be cultured in vitro. Investigations of the microbiota associated with mites will elucidate the link between parasites and pathogens, and define the role of the mite in transmission and pathogenesis. The databases generated will provide the crucial knowledge essential to design novel diagnostic tools, control measures, prophylaxes, drugs and immunotherapies against the mites and associated secondary infections.

An insight into the global burden of skin diseases

The skin conditions expert group of the Global Burden of Disease 2010 study estimated the global burden of skin conditions worldwide. Health loss due to 15 skin diseases between 1990 and 2010 for 187 countries was quantified. All skin conditions combined were the fourth leading cause of non-fatal disease burden at the global level. The burden of skin conditions was high in both high- and low-income countries, indicating that prevention of skin diseases should be prioritized.

Comparing cutaneous research funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases with 2010 Global Burden of Disease results

IMPORTANCE

Disease burden data helps guide research prioritization.

OBJECTIVE

To determine the extent to which grants issued by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) reflect disease burden, measured by disability-adjusted life years (DALYs) from Global Burden of Disease (GBD) 2010 project.

DESIGN

Two investigators independently assessed 15 skin conditions studied by GBD 2010 in the NIAMS database for grants issued in 2013. The 15 skin diseases were matched to their respective DALYs from GBD 2010.

SETTING

The United States NIAMS database and GBD 2010 skin condition disability data.

MAIN OUTCOME(S) AND MEASURE(S)

Relationship of NIAMS grant database topic funding with percent total GBD 2010 DALY and DALY rank for 15 skin conditions.

RESULTS

During fiscal year 2013, 1,443 NIAMS grants were issued at a total value of $424 million. Of these grants, 17.7% covered skin topics. Of the total skin disease funding, 82% (91 grants) were categorized as "general cutaneous research." Psoriasis, leprosy, and "other skin and subcutaneous diseases" (ie; immunobullous disorders, vitiligo, and hidradenitis suppurativa) were over-represented when funding was compared with disability. Conversely, cellulitis, decubitus ulcer, urticaria, acne vulgaris, viral skin diseases, fungal skin diseases, scabies, and melanoma were under-represented. Conditions for which disability and funding appeared well-matched were dermatitis, squamous and basal cell carcinoma, pruritus, bacterial skin diseases, and alopecia areata.

CONCLUSIONS AND RELEVANCE

Degree of representation in NIAMS is partly correlated with DALY metrics. Grant funding was well-matched with disability metrics for five of the 15 studied skin diseases, while two skin diseases were over-represented and seven were under-represented. Global burden estimates provide increasingly transparent and important information for investigating and prioritizing national research funding allocations.

Strategic Plan for the Spanish Academy of Dermatology and Venerology (AEDV): FuturAEDV 2013-2017

BACKGROUND

The Spanish Academy of Dermatology and Venereology (AEDV) has decided that a Strategic Plan is needed to help the association adapt to new circumstances and anticipate future developments.

OBJECTIVES

1) To position the AEDV as a medical association that can exert an influence in everything related to dermatology. 2) To contribute to the development of the specialty, strengthening the prestige and reputation of dermatology and dermatologists. 3) To establish a model for operating and strategic thinking that can be handed on to successive Boards of Directors and will enable the Academy to identify future challenges.

METHODS

The approach used to develop the Strategic Plan was as follows: analysis of trends in the health care system; assessment of the current situation of AEDV and of dermatology in general through an internal analysis based on surveys and interviews with academics; analysis of strengths, weaknesses, opportunities, and threats; preparation of a mission statement; and identification, development, and implementation of a strategy map prioritizing strategic lines of action.

RESULTS

The strategy map set out 16 general goals grouped into 4 main topics (achieving the vision, internal and external customers, internal processes, and innovation) and detailed in an action plan with 19 initiatives, each with specific actions. The plan will be monitored by the Strategic Plan Monitoring Committee, which is made up of the members of the Standing Committee and the chairs of the 9 Technical Committees responsible for implementing the initiatives.

COMMENT

The Functional Plan should guide the management of AEDV until 2017, and its implementation will enable the association to contribute to the development and prestige of the specialty and position itself as a reference in terms of its functional model.