Systematic Review | Not Peer Reviewed | Dermatoses 

Socioeconomic factors impact the severity of inflammatory skin conditions such as atopic eczema and psoriasis, research being presented at the British Association of Dermatologists’ Annual Meeting suggests. Furthermore, skin cancers, such as melanoma, also have a worse prognosis in those with a lower socioeconomic status (SES). 

Low-income households, a lower level of paternal or maternal education and dilapidated housing were consistently linked to an increase in the severity of five common skin conditions: atopic eczema, psoriasis, melanoma, hidradenitis suppurativa and sarcoidosis.  

This study, presented by researchers from Betsi Cadwaladr University Health Board, examined sources from meta-analysis and reviews to analyse the link between socioeconomic factors and the severity and incidence rate of various dermatological conditions.  

Whilst melanoma incidence was increased in individuals with a higher socioeconomic status, a worsened prognosis was associated with a lower socioeconomic status. The chances of having a more advanced melanoma at diagnosis was significantly higher in groups with lower education level and the risk of mortality was increased for those with a low SES.  

Similarly, a review using the Global Burden of Disease study data found that the incidence of psoriasis is greater in high-income European countries. However, lower household incomes are linked to more clinically severe psoriasis cases. Patients that have a low socioeconomic status also have a higher impairment to their health-related quality of life than those from a high-income household.  

Using a 2018 US survey of 2,137 patients with childhood-onset atopic eczema, education levels were also found to be inversely associated with the severity of a patient’s eczema. What is more, a higher concentration of children suffering with severe eczema lived in unsafe, unsupportive, or underdeveloped neighbourhoods.  

Hidradenitis suppurativa severity was found to be higher in low SES households and a higher proportion of patients with severe-to-very severe sarcoid were from lower-income households (13% compared to 3%). 

Dr Siwaporn Hiranput, Dermatology specialist registrar at Glan Clwyd hospital, North Wales deanery said: 

“The data from this study gives robust evidence that while skin disease can affect all members of society, the burden of diseases do not fall equally. Consistently, the most deprived in society tend to face more severe disease. We want to emphasise the importance of socioeconomic factors in patients with common skin conditions.” 

Harriet Dalwood of the British Association of Dermatologists, said: 

“It is really important to have research which clearly demonstrates health inequalities amongst people with skin disease. We know that melanoma is a disease which disproportionately affects the more advantaged in society, but it is less well recognised that that the severity of the disease tends to be worse amongst those with lower socioeconomic status. Health inequalities such as these are not just a health issue, they require joined-up thinking across government supported by organisations across the country.” 

The researchers have acknowledged that there are limitations to this study, including difficulty determining the sequence of the observed association and reverse causality. For example, the severity of dermatoses may influence SES rather than the other way round.    

Further research is needed to ascertain the potential link between SES and skin diseases. This would include larger studies examining the association of SES with other common skin conditions, and the use of specific study designs to and minimise bias, in particular recall bias. 

This article originally featured on the British Association of Dermatologists ’Patient Hub’
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