Clinical Topics & News

Most Common Dermatologic Conditions Encountered by Dermatologists and Nondermatologists

Cutis. 2014 December;94(6):285-292

References

Thorpe KE, Florence CS, Joski P. Which medical conditions account for the rise in health care spending? Health Aff (Millwood). 2004;(suppl web exclusives):W4-437-445.
Johnson ML. Defining the burden of skin disease in the United States—a historical perspective. J Investig Dermatol Symp Proc. 2004;9:108-110.
Agency for Healthcare Research and Quality. Medical expenditure panel survey. US Department of Health & Human Services Web site. http://meps.ahrq.gov. Accessed November 17, 2014.
Bickers DR, Lim HW, Margolis D, 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.
Johnson ML. On teaching dermatology to nondermatologists. Arch Dermatol. 1994;130:850-852.
Ramsay DL, Weary PE. Primary care in dermatology: whose role should it be? J Am Acad Dermatol. 1996;35:1005-1008.
Kimball AB, Resneck JS Jr. The US dermatology workforce: a specialty remains in shortage. J Am Acad Dermatol. 2008;59:741-745.
Resneck JS Jr, Kimball AB. Who else is providing care in dermatology practices? trends in the use of nonphysician clinicians. J Am Acad Dermatol. 2008;58:211-216.
Feldman SR, Fleischer AB Jr, McConnell RC. Most common dermatologic problems identified by internists, 1990-1994. Arch Intern Med. 1998;158:726-730.
Ahn CS, Davis SA, Debade TS, et al. Noncosmetic skin-related procedures performed in the United States: an analysis of national ambulatory medical care survey data from 1995 to 2010. Dermatol Surg. 2013;39:1912-1921.
Antic M, Conen D, Itin PH. Teaching effects of dermatological consultations on nondermatologists in the field of internal medicine. a study of 1290 inpatients. Dermatology. 2004;208:32-37.
Federman DG, Concato J, Kirsner RS. Comparison of dermatologic diagnoses by primary care practitioners and dermatologists. a review of the literature. Arch Fam Med. 1999;8:170-172.
Fleischer AB Jr, Herbert CR, Feldman SR, et al. Diagnosis of skin disease by nondermatologists. Am J Manag Care. 2000;6:1149-1156.
Kirsner RS, Federman DG. Lack of correlation between internists’ ability in dermatology and their patterns of treating patients with skin disease. Arch Dermatol. 1996;132:1043-1046.
McCarthy GM, Lamb GC, Russell TJ, et al. Primary care-based dermatology practice: internists need more training. J Gen Intern Med. 1991;6:52-56.
Sellheyer K, Bergfeld WF. A retrospective biopsy study of the clinical diagnostic accuracy of common skin diseases by different specialties compared with dermatology. J Am Acad Dermatol. 2005;52:823-830.
Medical specialties. Accreditation Council for Graduate Medical Education Web site. http://www.acgme.org/acgmeweb/tabid/368ProgramandInstitutionalGuidelines/MedicalAccreditation.aspx. Accessed November 17, 2014.
McCleskey PE, Gilson RT, DeVillez RL. Medical student core curriculum in dermatology survey. J Am Acad Dermatol. 2009;61:30-35.
Hansra NK, O’Sullivan P, Chen CL, et al. Medical school dermatology curriculum: are we adequately preparing primary care physicians? J Am Acad Dermatol. 2009;61:23-29.

Results

From 2001 to 2010, more than 700 million outpatient visits for skin-related problems were identified, with 676.3 million visits to dermatologists, emergency medicine physicians, family practitioners, general surgeons, internists, otolaryngologists, and pediatricians. More than half (52.9%) of all skin-related visits were addressed by nondermatologists during this time. Among nondermatologists, family practitioners encountered the greatest number of skin diseases (20.5%), followed by pediatricians (11.3%), internists (9.2%), general surgeons (3.4%), otolaryngologists (1.0%), and emergency medicine physicians (0.2%)(Table 1).

Benign tumors and acne were the most common cutaneous conditions referred to dermatologists by nondermatologists (10.6% and 10.1% of all dermatology referrals, respectively), followed by nonmelanoma skin cancers (9.7%), contact dermatitis (8.8%), and actinic keratosis (7.8%)(Table 2). The top 20 conditions referred to dermatologists accounted for 83.7% of all outpatient referrals to dermatologists.

Among the diseases most frequently reported by nondermatologists, contact dermatitis was the most common (12.0%), with twice the number of visits to nondermatologists for contact dermatitis than to dermatologists (51.6 million vs 25.3 million). In terms of disease categories, infectious skin diseases (ie, bacterial [cellulitis/abscess], viral [warts, herpesvirus], fungal [tinea] and yeast [candida] etiologies) were the most common dermatologic conditions reported by nondermatologists (Table 2).

The top 20 dermatologic conditions reported by dermatologists accounted for 85.4% of all diagnoses made by dermatologists. Diseases that were among the top 20 conditions encountered by dermatologists but were not among the top 20 for nondermatologists included actinic keratosis, seborrheic keratosis, atopic dermatitis, psoriasis, alopecia, rosacea, dyschromia, seborrheic dermatitis, follicular disease, and neoplasm of uncertain behavior of skin. Additionally, 5 of the top 20 conditions encountered by dermatologists also were among the top 20 for only 1 individual nondermatologic specialty; these included atopic dermatitis (pediatrics), seborrheic dermatitis (pediatrics), psoriasis (internal medicine), rosacea (otolaryngology), and keratoderma (general surgery). Seborrheic dermatitis, psoriasis, and rosacea also were among the top 20 conditions most commonly referred to dermatologists for treatment by nondermatologists. Table 3 shows the top 20 dermatologic conditions encountered by nondermatologists by comparison.

References

Thorpe KE, Florence CS, Joski P. Which medical conditions account for the rise in health care spending? Health Aff (Millwood). 2004;(suppl web exclusives):W4-437-445.
Johnson ML. Defining the burden of skin disease in the United States—a historical perspective. J Investig Dermatol Symp Proc. 2004;9:108-110.
Agency for Healthcare Research and Quality. Medical expenditure panel survey. US Department of Health & Human Services Web site. http://meps.ahrq.gov. Accessed November 17, 2014.
Bickers DR, Lim HW, Margolis D, 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.
Johnson ML. On teaching dermatology to nondermatologists. Arch Dermatol. 1994;130:850-852.
Ramsay DL, Weary PE. Primary care in dermatology: whose role should it be? J Am Acad Dermatol. 1996;35:1005-1008.
Kimball AB, Resneck JS Jr. The US dermatology workforce: a specialty remains in shortage. J Am Acad Dermatol. 2008;59:741-745.
Resneck JS Jr, Kimball AB. Who else is providing care in dermatology practices? trends in the use of nonphysician clinicians. J Am Acad Dermatol. 2008;58:211-216.
Feldman SR, Fleischer AB Jr, McConnell RC. Most common dermatologic problems identified by internists, 1990-1994. Arch Intern Med. 1998;158:726-730.
Ahn CS, Davis SA, Debade TS, et al. Noncosmetic skin-related procedures performed in the United States: an analysis of national ambulatory medical care survey data from 1995 to 2010. Dermatol Surg. 2013;39:1912-1921.
Antic M, Conen D, Itin PH. Teaching effects of dermatological consultations on nondermatologists in the field of internal medicine. a study of 1290 inpatients. Dermatology. 2004;208:32-37.
Federman DG, Concato J, Kirsner RS. Comparison of dermatologic diagnoses by primary care practitioners and dermatologists. a review of the literature. Arch Fam Med. 1999;8:170-172.
Fleischer AB Jr, Herbert CR, Feldman SR, et al. Diagnosis of skin disease by nondermatologists. Am J Manag Care. 2000;6:1149-1156.
Kirsner RS, Federman DG. Lack of correlation between internists’ ability in dermatology and their patterns of treating patients with skin disease. Arch Dermatol. 1996;132:1043-1046.
McCarthy GM, Lamb GC, Russell TJ, et al. Primary care-based dermatology practice: internists need more training. J Gen Intern Med. 1991;6:52-56.
Sellheyer K, Bergfeld WF. A retrospective biopsy study of the clinical diagnostic accuracy of common skin diseases by different specialties compared with dermatology. J Am Acad Dermatol. 2005;52:823-830.
Medical specialties. Accreditation Council for Graduate Medical Education Web site. http://www.acgme.org/acgmeweb/tabid/368ProgramandInstitutionalGuidelines/MedicalAccreditation.aspx. Accessed November 17, 2014.
McCleskey PE, Gilson RT, DeVillez RL. Medical student core curriculum in dermatology survey. J Am Acad Dermatol. 2009;61:30-35.
Hansra NK, O’Sullivan P, Chen CL, et al. Medical school dermatology curriculum: are we adequately preparing primary care physicians? J Am Acad Dermatol. 2009;61:23-29.

Most Common Dermatologic Conditions Encountered by Dermatologists and Nondermatologists

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