Given the paucity or absence of epidemiological data for most skin diseases, small changes in disease incidence are unlikely to be noticed. Clinical impressions of change in incidence are also confounded by the general increase in provision of healthcare in most developed countries over the last century, leading to a reduced threshold for visiting a physician. In addition, there are organizational differences between countries in what disorders fall within dermatology. For instance, in North America perhaps 50% of dermatology workload falls within what in the UK would be classed as cosmetic surgery or medicine.
Despite the absence of systematic data there are important secular and geographical differences in disease burden that (to this author) seem robust. Atopic dermatitis incidence appears to have increased by a factor of two or more in the last three decades in many developed countries (Williams, 1997). Cancers of the skin in many world populations (chiefly those with pale skin) have also increased two to three-fold over a similar time course (Marks, 1995). By contrast psoriasis incidence seems to have stayed constant. For other common conditions such as acne or skin infections there is no suitable data.
The geographical prevalence of skin disease also varies greatly worldwide. Infection and infestations are especially common in many African countries and other third world nations. By contrast, skin cancer rates are low in those with black skin and highest in those of Northern European ancestry who now live in equatorial regions. Rates of the commonest skin cancers are 15-50 times higher in parts of Australia than in parts of the UK, in populations that largely share the same genetic ancestry (Holme et al., 2000; Rees, 1998; Rees, 2002b).
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