Skin conditions are frequently cited among the most common health problems in the United States and Canada.

The burden of skin disease has avoided accurate estimation because of many obstacles, including defining skin disease, International Classification of Diseases version 9 codes being unreliable, and lack of epidemiologic data on skin disease as well as difficulty in calculating total costs of skin disease.

Improved collaboration focusing on the burden of skin disease at an international level has allowed for better estimation of the burden of skin disease during the past decade.

The benefits of dermatologists’ expertise include greater cost-effectiveness and more training and experience treating common skin conditions. Patients increasingly recognize the benefits of specialist care, and the demand for dermatologists’ services continues to rise. The supply of dermatologists has not kept up with the demand despite increases in use of nonphysician clinicians.

The role of self-care and primary care in skin disease remains significant. Efficacy of self-care depends on patients’ ability to understand and carry out appropriate self-treatment regimens. Primary care doctors are frequently called on to treat common skin problems, so a solid grounding in basic dermatology topics for all primary care trainees is essential.

Patients enrolled in a health maintenance organization are more likely to see a nondermatologist and less likely to see a dermatologist for a skin complaint than those enrolled in a preferred provider organization.

Dermatologist supply has been shown to positively correlate with improved skin disease outcomes. The increasing wait times and shortage in the dermatology workforce have created the need for physician extenders in dermatology practices.

The Department of Veterans Affairs health care system’s nationwide centralization allows for comprehensive comparative effectiveness research and has recently undertaken a mission to evaluate teledermatology.

Although racial and socioeconomic disparities are evident in diseases, such as melanoma, nonmelanoma skin cancer (NMSC), and atopic dermatitis, a paucity of data exists on the overall impact of health disparities on dermatologic diseases.

The recent passage of health care reform and the impending increased patient load may exacerbate dermatologic health disparities given the dermatology workforce shortage.

Additional investigations exploring disparities in dermatologic education and research are needed.

Health outcomes unique to psoriasis includes major impacts on health-related quality of life due to physical discomfort, impaired emotional functioning, and nega tive body image and self-image as well as limitations in daily activities, social contacts, and work. Furthermore, there is growing literature on the association between psoriasis and cardiovascular, rheumatologic, endocrine, malignancy, and psychiatric comorbidities.

The costs of health care maintenance and medications for the treatment of psoriasis continue to increase. Research in developing novel agents to treat psoriasis remains one of the greatest areas of future need because access and affordability is a main prohibitive treatment factor for the uninsured or underinsured.

Multiple disease-severity and quality-of-life instruments exist to assess atopic dermatitis, but only selected instruments have been validated.

Treatment of atopic dermatitis includes a variety of therapies, from medications to nutritional supplements to psychotherapy. Large randomized controlled trials are needed for the treatment categories of oral antihistamines, probiotics, and psychological counseling.

Contact dermatitis is the most common work-related skin disorder and hands are the most frequently affected site.

Occupation is a key factor in the development of contact dermatitis.

Occupational contact dermatitis is more likely to be allergic than irritant in nature.

Acne is one of the most common dermatologic conditions. The disease burden results in high cost and physician burden in the United States.

Current treatment of acne focuses on the evidence-based recommendations of topical retinoids and avoidance of antibiotic monotherapy. Other treatments oral contraceptive therapy for female patients and systemic treatments such as isotretinoin. Further research is required to establish best practice guidelines.

To better meet the treatment needs of acne, physicians should pursue more innovative technologic means. These include, but are not limited to, more extensive education in medical school for primary care providers, teledermatology, and further education of midlevel providers.

Chronic ulcers are a growing cause of patient morbidity and health care cost in the United States.

Most common causes of chronic ulcers include venous leg ulcers, pressure ulcers, diabetic neuropathic foot ulcers, and leg ulcers of arterial insufficiency.

Chronic wounds account for an estimated $6 billion to $15 billion annually in US health care costs.

Melanoma incidence and mortality have risen in the past few decades. Despite increased surveillance and improvements in screening, these trends emphasize the continued need for better screening tests that assist patients and general practitioners in the early detection of melanoma.

Many factors are associated with an increased risk for melanoma, including personal and family history of melanoma, nevi count, and certain medical conditions. Additionally, risk behaviors, such as indoor tanning, can serve as targets for the melanoma prevention efforts of public health practitioners and health providers.

Although the tumorigenesis of melanoma has not been completely elucidated, genes, such as p16/ARF and BRAF, have been implicated as serving a role. Efforts to understand melanoma pathogenesis have infomred and will continue to inform the discovery of new adjuvant systemic therapies for melanoma.

Without a national tumor registry, epidemiologic studies regarding accurate incidence and mortality rates continue to be challenging. Nonetheless, trend analyses suggest that NMSC incidence in the United States is increasing, which emphasizes the need for continued vigilance and surveillance of the population.

Health outcomes unique to NMSCs include quality-of-life assessments that incorpo rate appearance and emotional domains. Furthermore, treatment modality seems to have effects on all aspects of health outcomes, such as rates of recurrence, quality of life, and costs.

Few long-term randomized controlled trials comparing the efficacies of alternative therapies for primary NMSCs exist. This is, perhaps, one of the greatest areas of research needs because cost, cosmesis, and efficacy are all considerations when determining the type of treatment, particularly for low-risk tumors.

Bacterial, fungal, and viral skin infections represent broad categories of disease that range in severity from benign to life threatening.

Infectious skin diseases are highly prevalent and can be difficult to treat given the emergence of several highly virulent pathogens as well as the limited therapeutic efficacy of available treatments in some cases.

Future research in infectious skin disease may emphasize increased disease surveillance and cost analyses, evaluation of existing therapies, and ongoing development of superior treatment modalities.

There are several effective treatment modalities for actinic keratoses, including cryotherapy and photodynamic therapy, and for small, low-risk, NMSCs, including electrodessication and curettage, and excision.

For invasive skin cancers and other higher-risk skin cancers, surgical excision is the most effective treatment.

Surgical excision with appropriate margins remains the treatment of choice of melanoma.

Serious adverse events resulting from cosmetic dermatologic procedures are rare. Dermatologists safely perform a range of noninvasive and minimally invasive cosmetic procedures in an outpatient, in-office setting under minimal or local anesthesia.

Sequelae after cosmetic dermatology procedures are typically mild transient erythema and edema.

There are few unbiased objective outcome measures for evaluating the effects of cosmetic dermatology procedures.

Utilization rates of Mohs micrographic surgery (MMS) are rapidly increasing with a paucity of data to support its cost-effectiveness compared with other surgical modalities in treating a wide variety of cutaneous malignancies.

Evidence-based guidelines for the use of antibiotic prophylaxis for MMS suggest limited indications.

More adequately powered prospective studies are needed to better quantify the risk of postoperative bleeding and other complications attributable to various anticoagulation therapies to help develop guidelines for their management in the MMS perioperative period.