Sky-High Prevalence of Skin Conditions Found in Ordinary Germans

Skin conditions were highly prevalent among a nearly random selection of Germans in the general population, most of them previously undiagnosed.

In some 2,700 attendees at an agricultural festival associated with Munich’s Oktoberfest in 2016 who volunteered for public health screenings, 64.5% were found to have at least one skin abnormality on a dermatologist’s exam, according to Alexander Zink, MD, MPH, PhD, of Technical University of Munich in Germany, and colleagues. In contrast, they noted, a previous study of German workers found a prevalence of about 27%.

The most common conditions in the Oktoberfest cohort were: eczema (11.7%), actinic keratosis (26.6%), and rosacea (25.5%), the group reported in the Journal of the European Academy of Dermatology and Venereology. Just over half of participants were women, and mean age in the cohort was 52.

Diagnosed conditions were less common in women (58.0%) than in men (72.3%), and they increased with age, as expected.

About 66% of the affected participants were unaware of their skin abnormality, the researchers found.

“Information and awareness campaigns are needed to improve public knowledge and increase the utilization of health services, especially since early detection and treatment can reduce the global burden of skin diseases,” Zink’s group wrote.

Skin conditions are the fourth most common human illness, leading to a large non-fatal burden. Many of the people with a skin condition do not consult a doctor, so the actual burden may be even greater than reported since this data is based on secondary information that excludes individuals who do not seek medical care, the researchers noted.

The American Academy of Dermatology’s (AAD) Burden of Skin Disease study showed that, in any given year, many Americans seek treatment for a skin condition, noted Bruce Brod, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia.

“Skin disease may even be slightly underrepresented due to health disparities and sometimes limited access to care. Although there is a skin cancer epidemic there are many other debilitating skin diseases that are prevalent and don’t get on the radar as much such as hidradenitis,” Brod told MedPage Today.

The prevalence of skin diseases further emphasizes the dermatology workforce shortage, he said. “Access to care for skin conditions needs to improve,” Brod said, noting that the AAD offers “innovative” programs to bring dermatologist care to more people.

He cautioned, though, that while the Oktoberfest study “sends an important message,” it might not be fully generalizable to the U.S. “In other populations, other skin conditions might be more prevalent,” he said.

Robert Brodell, MD, of the University of Mississippi Medical Center in Jackson, also highlighted access to care as a problem for many Americans. He noted that outside of big cities, wait times to see a dermatologist can be very long.

“So that leaves primary care with an even greater burden caring for skin disease because some patients may not be able to get into the dermatologist that they call. So access problems in dermatology are real,” Brodell told MedPage Today.

Zink and colleagues noted some methodological issues with the study. Selection bias was possible because participants were attending Oktoberfest. “Another limitation is that people who were categorized as indoor workers according to their stated professions, reported that in fact they spent many hours outside during a typical working day,” they wrote.