A cross-sectional study on adults from 27 European countries showed that, among other findings, chronic skin disease, mole checks, and skin infections were the main reasons for consultations with dermatologists.¹

These findings and many more were highlighted in this study that examined data from a large representative sample of the general population in Europe, mapping out the medical journeys of dermatology patients to allow for greater insight into the importance of healthcare services.

The study’s investigators noted the value of their research, given the high worldwide prevalence of skin diseases and the potentially long and delayed journey from diagnosis to treatment for many patients with skin diseases (as is the case with hidradenitis suppurativa).^2,3

To examine the journey for patients with skin disease, this research was conducted and it was led by Marie Aleth Richard, Md, PhD, from the Research Center in Health Services and Quality of Life Aix Marseille University’s Dermatology Department at the University Hospital Timone in Marseille, France.

“In the framework of the large (European Academy of Dermatology and Venereology) burden of skin diseases study on a representative sample of the European general population, the aim of the present evaluation was to describe the medical journey of people with skin diseases from the first consultation to the diagnosis,” Richard and colleagues wrote.

Background and Findings

The investigators used a multinational, cross-sectional study design and their work was carried out with the EADV population-based study on the 'Burden of skin diseases in Europe.' The layout of this research was detailed and its methodology was previously provided.⁴

The study took place from November 2020 - August 2021, and the research involved a representative sample of adult subjects in the age range of 18 or older who were from 27 European countries. These countries were 24 European Union (EU) nations and the United Kingdom, Switzerland, and Norway, with only 3 EU nations—Cyprus, Luxembourg, and Malta—being excluded.

The main goal of the investigators was to find those who had reported experiencing a minimum of 1 skin ailment or unpleasant skin-related sensation during the course of the preceding year. The team used questionnaires consisting of 2 distinct modules, with Module A being filled out by all participants and gathering information on skin phototype, socio-demographic factors, medical consultations in the year prior, comorbidities, and overall status of health and life quality.

Module B was filled out entirely by subjects reporting a skin disease or reporting skin-related discomfort within the prior year, and the questionnaire asked about clinical data and measures of the disease's overall impact. The module was also designed to gather information related to the subject’s healthcare journey, the involvement with healthcare professionals, care demand, and rationale for not consulting with clinicians.

In situations in which multiple different skin diseases were found to be present, the investigators instructed the subjects to respond with respect to the most bothersome of their reported conditions. The team also summarized qualitative and ordinal variables by count and frequency, and their analyses were done on the entire sample and separately for those with specific skin conditions.

Additionally, the investigators excluded skin cancer patients who were shown not to have consulted a physician to ensure a diagnosis confirmation.

Overall, the research team ended up with data on 44,689 individuals, reporting that 30.3% had sought a consultation with a dermatologist within the preceding 2 years. They also found that the main reasons for these individuals' actions were mole monitoring or skin cancer screenings for 22.3% of them, and chronic skin conditions for 16.2%.

The team added that dermatologists most frequently diagnosed eczema, acne, psoriasis, and rosacea, but general practitioners were more commonly diagnosing fungal skin infections. They added that other specialists were often consulted for sexually transmitted diseases (STDs), but that initial diagnoses, especially for STDs, were shown not to always be conclusive.

Notably, the investigators found that a major portion of the subjects were found not to have consulted any healthcare professionals for specific skin conditions, with notable percentages observed for alopecia (for 44.7%), acne (for 36.4%), and fungal infections (for 30.0%). They added that 17.7% of those with psoriasis were also shown not to have looked for a medical consultation.

The research team found a substantial number of individuals with alopecia believed their issue was not a cause for concern, and the team noted that many with psoriasis reported believing they could manage their disease because they had previously seen a clinician. The team also found that 41.1% of those with acne and 48.2% with fungal infections reported believing they could self-manage their skin conditions.

“Based on patients' experiences, providers can address the needs of the patient with targeted interventions,” they wrote. “Streamlining the patient journey by providing guidelines for primary and secondary care across specialisms can improve patients' outcomes, and reduce diagnostic delay and health care expenses.”

References

1. ^{Richard, MA, Paul, C, Nijsten, T, Gisondi, P, Salavastru, C, Taieb, C, et al. The journey of patients with skin diseases from the first consultation to the diagnosis in a representative sample of the European general population from the EADV burden of skin diseases study. J Eur Acad Dermatol Venereol. 2023; 37(Suppl. 7): 17–24. https://doi.org/10.1111/jdv.18916.}
2. ^{Bickers DR, Lim HW, Margolis D, Weinstock MA, Goodman C, Faulkner E, et al. The burden of skin diseases: 2004. A joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol. 2006; 55: 490–500.}
3. ^{Bettoli V, Pasquinucci S, Caracciolo S, Piccolo D, Cazzaniga S, Fantini F, et al. The Hidradenitis suppurativa patient journey in Italy: current status, unmet needs and opportunities. J Eur Acad Dermatology Venereol. 2016; 30: 1965–70.}
4. ^{Richard M, Paul C, Nijsten T, Gisondi P, Salavastru C, Taieb C, et al. Prevalence of most common skin diseases in Europe: a population-based study. J Eur Acad Dermatol Venereol. 2022; 36: 1088–96.}