Data from the

NATIONAL HEALTH SURVEY

Skin Conditions and Related

Need for Medical Care

Among Persons 1=74 Years

United States, 1971-1974

DHEW Publication No. (PHS) 79-1660

U.S, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Office of the Assistant Secretary for Health

National Center for Health Statistics

Hyattsville, Md. November 1978

Series 11

Number 212
NATIONAL CENTIER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A. ISRAEL, Deputy Director

JACOB J. FELDAMN, Ph.D., Associate Director for Amdy.sis

GAIL F. FISHER, Ph.D., Associate Director for the Cooperative Health Statistics System

ELIJAH L. WHITE, Associate Director for Data Systems

JAMES T. BAIRD, JR., Ph.D., Associate Director for International Statistics

ROBERT C. HUBER, Associate Director for Managewzent

MONROE G. SIRKEN, Ph.D., Associate Director for Mathematical Statistics

PETER L. HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for Program Development

PAUL E. LEAVERTON, Ph.D., Associate Director for Research

ALICE HAYWOOD,, Information Officer

DIVISION OF HEALTH EXAMINATION STATISTICS

MICHAEL A. W. HATTWICK, M.D., Director

JEAN ROEERTS, Chiej, Medical Statistics Branch

ROBERT S. MURPHY, Chiej Survey Planning and Development Branch

DIVISION OF OPERATIONS

HENRY MILLER, ChieJ Health -Examination Field Operations Branch

COOPERATION OF THE U.S. BUREAU OF THE CENSUS

Under the legislation establishing the National Health Survey, the Public Health Service is

authorized to use, insofar as possible, the sesw?icesor facilities of other Federal, State, or private

agencies. In accordance with specifications established by the National Center for Health Statistics, the U.S. Bureau of the Census participated in the design and selection of the sample and

carried out the household interview stage of :the data collection and certain parts of the statistical processing.

Vital and Health Statistics-Series 11-No. 212

DHEW Publication No. (PHS) 79-1660

Library of Congress Catalog Card Number 78-11486
Library of Congress Cataloging h Publication Data

Johnson, Mane-Louise T.

Skin conditions and related need for medicaI care among persons 1-74 years, United

States, 1971-1974.

(Vital and health statistics: Series 11, Data from the National Health Survey; no. 212)

(DHEW publication; no. (PHS) 79-1660)

1. Skin–Diseases–United States–Statistics. 2. Health surveys-United States. I. Roberts,

Jean, joint author. II. Title. III. Series: United States. National Center for Health Statistics.

Vital and health statistics: Series 11, Data from the National Health Survey, Data from the

health examination survey; no. 212. IV. Series: United States. Dept. of Health, Education,

and Welfare. DHEW publication; no. (PHS) 79-1660. [DNLM: 1. Skin diseases—Occurrence—

United States. 2. Skin diseases–Pathology. W2 A N148vk no. 212]

RA407.3.A347 no,, 212 [RL72] 312’.0973s

[312’.35’00973] 78-11486
CONTENTS

Introduction ...........................................................................................................................................

Dermatology Examination .....................................................................................................................

Mycological Studies ..........................................................................................................................

Biopsies .............................................................................................................................................

Photography .....................................................................................................................................

Classification of Disease Conditions ..................................................................................................

Quality Control .................................................................................................................................

Findings .................................................................................................................................................

Prevalence ...................................................................................................................................... ...

Extent of Concern for Skin Pathology ..............................................................................................

Recurrence and Duration of Skin Pathology of Concern ...................................................................

Handicap From Skin Condition ........................................................................................................

Discomfort From Skin Condition .....................................................................................................

Adequacy of Treatment for Skin Condition .....................................................................................

Comparison With Previous Studies ....................................................................................................

summary...............................................................................................................................................

References .............................................................................................................................................

fist of Detailed Tables ...........................................................................................................................

Appendixes

L Statisticrd Notes ............................................................................................................. ..........

IL The Dermatology Examination Form .......................................................................................

III. Skin Pathology Classification and Glossary of Selected Terms ..................................................

LIST OF TEXT FIGURES

1. Prevalence rates for significant skin pathology and significant skin conditions among persons 1-74

years, by age: United States, 1971-1974 ......................................................................................

2. Prevalence rates for significant skin pathology among persons 1-74 years, by age and sex: United

States, 1971-1974 ........................................................................................................................

3. Prevalence rates for significant skin pathology and significant skin conditions among persons 1-74

yea-s, by age and sex: United States, 1971-1974 .........................................................................

4. Prevrdence rates for the 7 most frequently occurring types of skin pathology among persons 1-74

years, by sex: United States, 1971-1974 ......................................................................................

5. Prevalence rates for the 4 most frequently occurring types of skin pathology among persons 1-74

years, by age: United States, 1971-1974 ......................................................................................

6. Prevalence rates for the principaf types of skin pathology within each age group among persons

1-74 years: United States, 1971-1974 ..........................................................................................

7. Prevalence rates for the 4 most frequently occurring types of skin pathology among persons 1-74

years, by age and sex: United States, 1971-1971 .........................................................................

1

3

3

3

4

4

4

4

4

10

14

15

17

20

22

24

26

27

48

60

67

8. Prevalence rates for significant skin pathology with occupationrd exposure among persons 18-74

years, by age and sex: United States, 1971-1974 .........................................................................

...

[11
9. Prevalence rates for skin conditions of concern (complaints), significant skin pathology not of

concern, and nonsignificant skin pathoIogy of concern among persons 1-74 years, by age:

United States, 1971-1974 .......... ...................................................... ...... ......................................

10. Prevalence rates for skin conditions of concern (complaints) among persons 1-74 years, by age

and sex: United States, 1971-1974 .................. ..... .......... ........................................................... ..

11. Prevrdence rates for the major types of skin conditions of concern (complaints) within each age

group among persons 1-74 years: United States, 1971-1974 ........................................................

12. Prevalence rates for the major types of skin conditions of concern (complaints) among persons

1-74 years, by age: United States, 1971-1974 ............ ................................. .................................

13. Percent of persons 1-74 years with selected significant skin pathology who are concerned about

the condition, by sex: United States, 1971-1974 .........................................................................

14. Percent of skin conditions of concern (complaints) considered sociaf or employment-housework

handicap by the individual or to be disfiguring to at least some extent by the examiner, by age:

United States, 1971-1974 ............................................................................................................

15. Percent of males and females 1-74 years with skin conditions of concern (complaints) rated as

disfiguring by examiner or causing some type of handicap to the affected person: United

States, 1971-1974 .......................................................................................................................

16. Percent distribution of persons with skin conditions of concern (complaints), by adequacy of

treatment for condition(s) and age: United States, 1971-1974 ....................................................

LIST OF TEXT TABLES

A. Rank order and rates (greater than 10.0 per 1,000 population) of the most prevalent types of

skin pathology, within each age group: United IStates, 1971-1974 .......................... .....................

B. Prevalence rates for selected significant and nonsignificant types of skin conditions and proportion of each type rated as significant among persons 1-74 years: United States, 1971 -1974 ........

c. Rank order and rates (greater than 3.0 per 1,000 population) of the most prevalent types of skin

conditions of concern (complaints), within each age group: United States, 1971 -1974 ...............

D. Proportion of persons with selected specific types of significant skin pathology who complained

about the condition, within each age group: United States, 1971-1974 .............................. .........

E. Percent of persons 1-74 years with skin conditions of concern (complaints), by the recurrence

and duration of condition, the degree of resultant handicap or disfigurement, part of body

affected, and sex, showing selected standard errors: United States, 1971-1974 .................. .........

F. Percent distribution of persons 1-74 years with skin conditions of concern (complaints) by extent

of discomfort from condition, according to part of body affected and sex, showing selected

standard errors: United States, 1971-1974 ..................................................................................

G. Percent distribution of persons 1-74 years with skin conditions of concern (complaints) reporting

some degree of resultant handicap-employ merit-housework, social, or overall discomfort-by

examiner’s rating of extent of disfigurement, age, and sex: United States, 1971 -1974 ................

H. Percent of persons 1-74 years with skin conditions of concern (complaints), by type of care

sought, adequacy of present treatment, reasons for not seeking care, part of body affected, and

sex, showing selected standard errors: United States, 1971-1974 .............. ..................................

J. Percent of persons with skin conditions of concern (complaints) by reason no care was sought

and adequacy of treatment sought, accordkg to age and sex: United States, 1971 -1974 ............

K. Prevalence of selected skin conditions from the Health Interview Survey (HIS) of 1969 and the

dermatology component of the Health and Nutrition Examination Sumey (HAF’ES) of 1971-

1974: United States .................................... .......................................... .......................................

11

11

13

13

14

16

19

21

7’

10

12

13

15

18

19

20

22

23

iv
SYMBOLS

Data not available---—-–--------———— ---

Category not applicable———————— . . .

Quantity zero-—-———— —————-

Quantity more than Obut less than 0.05— 0.0

Figure does not meet standards of

reliability or precision *
SKIN CONDITIONS AND

MEDICAL CARE AMONG

RELATED NEED FOR

PERSON 1-74 YEARS

Marie-Louise T. Johnson, M.D., Ph.D., New York University School of Medicine;

and Jean Roberts, M.S., Division of Health Examination Statistics

INTRODUCTION

This report contains estimates of the prevalence of the various types of skin pathology

including those derrnatological conditions about

which the individual expresses concern, the extent of handicap or discomfort from such conditions, and the extent of need for related medical

care among the civilian noninstitutionalized population of the United States 1-74 years of age.

These national estimates are based on findings

from the first Health and Nutrition Examination

Survey of 1971-1974. The prevalence data are

analyzed by age and sex.

An Advance Data report “Prevalence of Dermatological Disease Among Persons 1-74 Years

of Age: United States” summarizing some of

these findings has been published. 1

The Health Examination Survey in which

these data were obtained is one of the major

programs of the National Center for Health Statistics authorized under the National Heahh Survey Act of 1956 by the 84th Congress as a continuing Public Health Service activity to determine the hezdth status of the population.

The intent of the National Health Survey2 is

carried out through the programs of the Health

Examination Survey; the Health Interview Survey which collects health information from samples of persons by household interviews focused

primarily on the impact of illness and disability

within various population groups; the Health

Manpower and Facilities surveys which obtain

data on hospitals, nursing homes and other resident institutions, and the entire range of personneI in the health occupations; and the Health

Resources Utilization surveys.

Only in the Health Examination Survey programs are health data collected by direct physical examinations, tests, and measurements performed on samples of the population. Hence, it

provides the best of the survey methods for

obtaining diagnostic data on the prevalence of

medicaI1y defined illness. It is the only one of

the survey programs of the National Center for

Health Statistics that secures information on

previously unrecognized or undiagnosed conditions as well as on a variety of physical, physiological, and psychological measures within the

population. Medical history, demographic, and

socioeconomic data with which the examination

findings may be interrelated are also collected

on the sample population under study in these

examination surveys.

Since it was organized, the Health Examination Survey has been conducted as a series of

separate programs, called “cycles,” each of

which is Iimited to some specific segment of the

U.S. population and to specific aspects of

health. During the first cycle in 1960-1962, the

prewdence of certain chronic diseases, including

heart disease and =thritis, and the distributions

of various physical and physiological measures

were determined among a defined adult population.3 ~4For that program, a national probability

sample of 7,710 adults, of whom 6,672 (86.5

percent) were examined, was selected to represent the 111 million civilian noninstitutionalized

adults age 18-79 years in the U.S. population at

that time.
For the second and third cycles in

1963-1965 and 1966-1970, the target populations were the Nation’s noninstitutionalized children age 6-11 years and youths age 12-17 years,

respectively.5 Y6 In both programs, the examination focused primarily on health factors related

to growth and development. For the second program, a national probability sample of 7,417, of

which 7,119 (96 percent) were examined, was

selected to represent the nearly 24 million U.S.

children age 6-11 years in the noninstitutionalized population. For the third program, a national probability sample of 7,514, of whom

6,768 (90 percent) were examined, was selected

to represent the 22.7 million of that age in the

civilian noninstitutionalized population.

The first Health and Nutrition Examination

Survey (HANES I), from which the findings in

this report were obtained, was designed to measure the nutritional status of the U.S. population

age 1-74 years and to obtain some limited information on the general health status of the entire

age group as well as more detailed information

on the health status and medical care needs of

adults age 25-74 years in the civiIian noninstitutionalized population. A comprehensive description of the specific content and plan of operation of the HANES I program, including sample

design, has been published.7 Data collection

operations were slowed during the survey because of budgetary limitations, making it necessary to extend HANES I through mid-1974 so

that the entire probability sample selected in the

original design for this program could be examined.

As in previous Health Examination Survey

programs, the U.S. Bureau of the Census cooperated in the sample design and in the initial visits

and interviewing at selected eligible households

in the 65 primary sampling units (PSU’S)

throughout the United States. Additional household visiting, interviewing, history taking, and

explaining of the examination portion of the

program were done by members of the field

teams of the mobile examination center. The

selected sample persons for whom an appointment could be made were brought into the

specially constructed mobile examination centers which were moved into a central location in

each of the PSU’S. The teams that traveled to

the various survey locations throughout the

country included medical and dental examiners

as well as technicians, interviewers, and other

staff.

The probability sample design used ifi the

study provided for a sampling ratio of poor persons, preschool children, women of childbearing

ages, and the elderly that was higher than the

ratio among others in the civilian noninstitutionalized population.

Field data collection operations for HANES

I were started in April 1971 and completed in

June 1974. Of the 28,043 persons 1-74 years

selected in the national probability sample to

represent the 194 million of those ages at midsurvey time in the civilian noninstitutionalized

population, 20,749 (74.0 percent) were examined. The response rate decreases with age

from 83.7 percent among those 1-5 years to

64.3 percent among those 65-74 years. When

adjustments are made for the differential, sampling ratios used in the age-sex-income-defined

population subgroups, this represents an effective response rate of 75.2 percent.

The findings in this report are shown as

national estimates based on weighted observation; that is, the data obtained for each examined person are inflated to the size of the

total population of which the sample was represent ative.

The estimates have been calculated as

though the examined persons in each of the age

(at interview), sex, and income classes are a random subsarnple of the sample persons in the

same class. Although there is evidence from

earlier examination surveys and medical history

data from HANES I that this is not an unr~~asonable approximation, it is clear that some estimates are subject to considerable risk of bias

when more than one-quarter of the sample persons in a particular age-sex-income class were

not examined. All age-specific data in this report

are shown as age at the time of examination.

The dermatology component of HANES I

was planned at the request of and in cooperation

with the Committee on Planning for the National Program for Dermatology of the National

Academy of Dermatology. Dr. Marie-Louise T.

Johnson, Chairman of the Data Collection Unit

for the National Program, was primarily responsible for planning the content of the den~atology examination, recruiting the dermatologists,

2
and training them in the examination methodology so as to minimize interobserver variation.

Statistical notes on the sampIe design, reliability of the data, and sampling and measurement error are included in appendix I. The dermatology examination form is reproduced in

appendix II, and a glossary of the most prevalent

dermatological diseases or conditions may be

found in appendix 111.

DERMATOLOGY EXAMINATION

The dermatological part of the HANES I

examination included a complete clinical examination of the skin and subcutaneous tissue that

considered normal variations in texture and

color, certain manifestations of aging, and all

pathological changes. Whenever possible, significant diagnoses such as malignancy were documented by tissue biopsy and suspected infections by Tzanck smear or by culture to identify

fungi or bacteria. Estimates were made of actinic

exposure experienced, as well as actinic damage

sustained, and of occupational risk from irritant

and allergic contractants. For an examinee with

a significant hand, foot, or generalized problem,

a judgment was made about the burden to the

examinee in terms of discomfort or disability,

about care sought, and about the effect that

could be expected from the current best care

availabIe in the present state of the art.

The Dermatology Examination form which

provided for the recording of the examiner’s

findings was divided into five parts. The first

gave a summary of the major dermatological

findings and procedures as well as significant

historical and environmental data. The second

provided for information about the skin in general such as color, texture, the ectodernd

appendages, vascular lesions, pigmented nevi,

and those pathological changes that occur in a

generalized fashion such as purpura, seborrheic

keratoses, or warts. The third part was for regional findings pecuIiar to amanatomical area as

the head or neck, such conditions as xanthelasma, cheilosis, or scrotal tongue. The fourth

part focused on disease-oriented information

giving more detail on such common problems as

acne, psoriasis, atopy, and others. The last part

represented an effort to evaluate the impact of

the dermatoIogical condition observed-how it

had modified the individual’s life through physical or psychic incapacitation, and how it may

have precluded a preferred activity. An estimation was made by the examiner of the degree of

disfigurement the condition had produced as

well as the symptoms the exzuninee had suffered. Information was obtained from the

examinee about care sought for the skin problem or, if no care was sought, why not. Had it

been a matter of not knowing about available

therapy on the part of the examinee or his

physician? Had it been a problem of finances or

inconvenience in travel, or the unavadability of

care at any price or distance? If the person was

receiving treatment, a judgment was made by

the examiner concerning the adequacy of

therapy, and if inadequate, whether the current

best care in the present state of the art in medicine would improve the condition.

Mycological Studies

AH lesions that the examiner considered to

be fungous or to include fungous in the differential were scraped, as were all scaling lesions of

the hands and feet and all circumscribed scaling

lesions anywhere on the body that might be considered “ringworm” not only by the nondermatological physician but by the layman or the

pharmacist.

The Iesions were scraped with a scalpel or

slide, and the scrapings, sealed between two glass

slides, were sent the same day to Dr. WilIiam

Epstein, Department of Dermatology, University

of California Medical Center, for examination

and culture to identify any fungus present.

Biopsies

Biopsies were taken only from adults who

could provide consent. With lesions on the head

or neck, ordy those were biopsied that were clinically suggestive of malignancy or of a diagnosis

of grave importance such as lupus erythematosus, the grarndomatous diseases; tuberculosis;

leprosy; sarcoid; and simikw conditions. On the

covered areas of the body, any significant Iesion

or any lesion of obscure or uncertain identification was biopsied as needed by the examiner,

but ordy if the examinee understood the reasons

for the procedure and consented to biopsy in

writing.

3
Photography

Lesions biopsied were photographed whenever possible (but always with the examinee’s

permission) and especially if they occurred in a

cosmetically significant area, or if, after excision, the defect would require suturing, or if

there were some question about the dia~osis.

These photographs were used in later review to

support the diagnoses when the biopsy findings

were available.

Classification of Disease

Conditions

Both the significant skin pathology and the

skin conditions of concern to the examinee were

identified and classified by the dermatologist

examiner using the Code of Skin Diseases of the

Department of Dermatology, New York University School of Medicines For a glossary defining

the more prevalent of these conditions see

appendix 111.

Quality Control

From the National Academy of DermatoIo~, Dr. Marie-Louise Johnson, Chairman of the

Data Collection Unit for the Committee on Planning for their National Program was primarily

responsible for recruiting the 101 survey dermatologists and for training them in the standard

dermatology examination procedures used at the

65 examination locations of the Health and

Nutrition Examination Survey in 1971-1974.

After concluding the examinations, findings

from the mycological studies and biopsies were

used to complete and modify the diagnostic

impressions of the dermatology examination.

A full review was then made with Dr. Johnson

to ensure that all examiners followed the examination protocol for identifying the various

types of skin pathology and for diagnosing

significant conditions.

As might be expected, despite the standard

protocol, frequent review, and constant surveillance, there is considerable variation among

examiners in the observations recorded. Closer

inspection would indicate that these reflect to a

greater extent geographic and environmentally

related differences in the distribution among

those examined rather than a true examiner variability. However, the conscientiousness of some

examiners in recording all freckles, for example,

was apparent in cont;ast to others who tended

to underreport banal lesions and normal variations. However, there was also a considerable

difference among examiners in numbers of

patients considered to have significant skin

pathology. The given guide of significance, a

condition that should be seen at least once by a

physician for assessment or care, permittt!d a

range of interpretation according to the examiner’s training and personal experience. When

the effect of any difference in the distribution

among those examined by the 101 dermatologists was removed by direct adjustment (applying the age-sex-specific rates for each exardiner

against the total number of examinees in $ach

age-sex group ), there were substantial differences among examiners in the findings of si~nificant skin pathology and in conditions about

which the examinee expressed concern. Ageadjusted prevalence rates of significant skin

pathology range from O to 90.4 percent,, the

average being 31.2 percent. Half of the, examiners found between 14 and 46 percent of

their examinees to have such pathology. The

range in the proportion expressing compl$nts

about skin conditions to the ex~miner was from

O to 70.8 percent per examiner, the avdrage

being 11.4 percent with half of the examiners

showing rates between 2.7 and 19.8 percent.

Further detail on examiner variability is given in

appendix I.

FINDINGS

Prevalence

Skzk pathology. –Nearly one-third (312.4

per 1,000 population), or an estimated 60.6

million of the U.S. population age 1-74 years

have some skin pathoIogy–one or more significant skin conditions (table 1) that should be

evaluated by a physician at least once. These

national estimates are based on findings from

the standardized examination given by a dermatolo~st among a natiomd probability sample of

the civilian noninstitutionalized population in

the Health and Nutrition Examination Survey of

1971-1974.

4
The prevalence of significant skin pathology

increases rapidly with age from a rate of 142.3

per 1,000 chddren age 1-5 years to 362.0 per

1,000 youths age 12-17 years and to 365.1 per

1,000 young adults age 18-24 years, due primarily to the increase in acne .vulgaris associated

with endocrine changes occurring around the

time of pubertyg’1 z (table 2 and figure 1). After

a slight decline at age 25-34 years, the prevalence of skin pathology again increases with age

but at a slower rate than among children and

adolescents, reflecting the rapid increases with

age in the prevalence of such diagnoses as psoriasis and vitiIigo and such problems as malignant

and benign tumors, actinic and seborrheic keratoses.

Skin pathology is consistently more prevalent among males than among females from 6

through 74 years (tables 3, 4, and figure 2),

although the differences in the rates across the

age range are too small to be consistently statistically significant (at the 5-percent probability

Ievel) among children and young to middle-age

adults; among youths age 12-17 years and adults

age 35-44 years the differences are negligible

(less than 3 per 1,000 difference). About onefifth of the population (21.7 percent or 42.0

600

200

I I I 1

0 20 40 60 80

AGE IN YEARS

Figure 1. Prevalence rates for significant skin pathology and

significant skin conditions among persons 1-74 years, by

age: United States, 1971-1974

‘r

Male

Female

1

20 40 eo so

AGE IN YEARS

Figure 2. Prevalence rate$ for significant skin pathology among

persons 1-74 years, by age and sex: United States, 1971-

1974

million persons) have only one such skin condition, 6.4 percent or 12.4 milhon have two, and

3.2 percent or 6.1 miUion persons have three

significant types of conditions (table 5). Because

the dermatologist examiner was limited to identifying no more than the three most serious conditions, the true prewdence rates of some of the

specific conditions in the population may be

slightly underestimated.

Types of conditions. –The increase with age

in the prevalence of significant skin conditions is

more rapid than that shown for skin pathology

in the individual. This is true among youths age

12-17 years, young adults age 18-24 years, and

adults age 35-74 years, indicating that over the

age of 12 years the individuals with essentially

normal skin are somewhat less likely to develop

skin pathology than those with some skin pathology are to deveIop a new problem. Furthermore, males age 12-74 years are abo more Iikely

than are females of comparable age to have more

than one type of significant skin condition

(figure 3).

The most frequently occurring groups of

significant skin conditions are those affecting

the sebaceous glands (84.8 per 1,000 persons);

dermatophytoses or fungal diseases (81.1 per

1,000); malignant or benign tumors (56.5 per

1,000); seborrheic dermatitis (28.5 per 1,000);

atopic dermatitis and eczema (18.4 per 1,000);

and contact dermatitis (13.6 per 1,000). Among

5
MALE

am —

~ew””

*#e

f Slgnlficant

,[ skin conditions

600 — )1

/’-%

/

/)

%

!

-%*’

s l“ /

8

:. 4(M /’

E 1’

Personswith

~

significant skin

/

pathology

?

~

/

200 —

FEMALE

c?oor

I

./”

I

/“

r-w% /’ $Ignificmt

-w6H~ skincondition%

;.%/’-’-

J

*...

I I I

0 20 40 60 80

AGE IN YEARS

Figure 3. Prevalence rates for significant skin pathology and

significant skin conditions among persons 1-74 vears, . . bv.

age and sex: United States, 1971-1974

males, the most prevalent skin conditions are the

dermatophytoses, diseases of the sebaceous

glands, turn ors, and seborrheic dermatitis;

among females, the diseases of the sebaceous

glands are the most prevalent followed by

tumors (malignant and benign), dermatophytoses, and seborrheic dermatitis (figure 4).

Among the individual types of significant

skin pathology diagnosed, the most prevalent are

acne vulgaris (68,1 per 1,000 population); fungal

conditions on the feet, tinea pedis (38,7 per

1,000); benign tumors (38.2 per 1,000); seborrheic dermatitis, type not identified (28,2 per

1,000); fungal conditions around the nails, tines

unguium (21.8 per 1,000); precancerous and

unspecified tumors (12,4 per 1,000); vmruca

vulgaris (8.5 per 1,000); folliculitis (8.0 per

1,000) and atopic dermatitis (6.9 per 1,000,).

The trend with age in the prevalence ~f the

principal types of skin conditions shows the

rapid increase in diseases of the sebaceous glands

(primarily acne vulgaris) to age 12-17 years,

when it is most prevalent, followed by a steady

decrease from age 18-45 years with essentially

no change from age 55-74 years. The rates for

the dermatophytoses increase with age from

6-54 years then decline slightly, while ~umor

prevalence generally increases from age 6 years

on with the most rapid increase observed among

older adults ages 55-64 and 65-74 years (table A~

figures 5 and 6).

Among males and females, the trends with

age in the prevalence rates for the mo~t frequently occurring skin conditions show a gem

erally similar pattern of peak preval~nce for

diseases of the sebaceous glands (primarily reflecting the pattern for acne vulgaris) itt age

12-17 years for both males and females (figure

7), The prevalence rates for the derm@o:phyto~

ses increase substantially more rapidly with age

from 12-54 years among males and remain

higher among nm.les than among females across

the age range 6-74 years. Among men, thd prevalence of tumors increases consistently with age

frmn 35-74 years, the rate of increase with age

being more rapid than that for worncn at age

35-54 years, but similar for both sexes frqm age

55-74 years.

Occupational exposure. –Nearly one-fourth

(23.9 percent) of adults 18-74 years of age with

significant skin pathoIogy indicate an exposure

in their work environment to various types of

chemicals, fumes, vapors, oils, or insecticides, or

to prolonged immersion of the hands or feet tit

work. Except for contactants and allerg~s, no

data were generated to infer causal relationships.

The proportion with skin conditions hssoci.

ated with occupational exposure is more than

twice as high among men (32.4 percent) as

women (14.4 percent ). There is a general increase with age in this rate among women but

not men age 18-64 years, Among both sexes the

rates drop off at age 65-74 years (figure 8).

Suppressed conditions, -In addition to the

significant skin conditions active at the time of

6
150

r Iz?Male

El Female

100 —

50 —

o Y/xl “ 1 P//a “i

Diseasesof Dermato. Tumors seborrheic Atopic contact Ichthyuis,

sebaceous phytoses dermatitis dermatitis, dermatitis keratosis

glands eczema

Figure 4. Prevalence rates for the 7 most frequently occurring types of skin pathology among persons 1-74 years, by sex: United States,

1971-1974

Table A. Rank order and rates (qreater than 10.0 per 1,000 population) of the most prevalent types of skin pathology, within each ane

1-5 years

Actopic dermatitis, eczema (24.9)

Tumors, malignant and benign (21 .7)

Contact dermatitis (13.9)

18-24 years

Diseases of sebaceous glands (191.1)

Dermatophytoses (61 .7)

Tumors, malignant and benign (43.0)

Seborrheic dermatitis (38.7)

Folliculitis (18.9)

Atopic dermatitis, eczema (1 5.4)

Contact dermatitis (14.2)

Verruca vulgaris (1 2.4)

45-54 years

Dermatophytoses (155.7)

Tumors, malignant and benign (84.9)

Seborrheic dermatitis (31.9)

Diseases of sebaceous glands (21.5)

Contact dermatitis (16.7)

Atopic dermatitis, eczema (13.9)

Psoriasis (11 .4)

group: United States, 1971-1974

6-11 years

Diseases of sebaceous glands (21.4)

Atopic dermatitis, eczema (20.0)

Tumors, malignant and benign (18.9)

Ichthyosis, keratosis (15.5)

Verruca vulgaris (13.1 )

25-34 years

Diseases of sebaceous glands (99.6)

Dermatophytoses (87.7)

Seborrheic dermatitis (41 .9)

Tumors, malignant and benign (39.6)

Atopic dermatitis, eczema (28.0)

‘olliculitis (15.4)

Ichthyosis, keratosis (1 1.5)

55-64 years

Dermatophytoses (1 50.8)

rumors, malignant and benign (100.2)

Diseases of sebaceous glands (32.0)

;eborrheic dermatitis (28.7)

2ontact dermatitis (23.6)

Seborrheic keratosis (18.3)

ltopic dermatitis, eczema (12.8)

Vitiligo (12.6)

12-17 years

Diseases of sebaceous glands (249.9)

Dermatophytoses (33.2)

Tumors, malignant and benign (31 .3)

Seborrheic dermatitis (18.8)

Atopic dermatitis, eczema (17.0)

Ichthyosis, keratosis (16.7)

Verruca vulgaris (15.5)

3544 years

Dermatophytoses (121 .5)

Tumors, malignant and benign (46.8)

Diseases of sebaceous glands (44.1)

Seborrheic dermatosis (41 .6)

Contact dermatitis (17.0)

Atopic dermatitis, eczema (14.7)

Folliculitis (12.8)

65-74 years

Tumors, malignant and benign (184.1 )

Dermatophytoses (126.8)

Seborrheic dermatitis (36.4)

Diseases of sebaceous glands (25.5)

Seborrheic keratosis (24.4)

Contact dermatitis (20.4)

Atopic dermatitis, eczema (18.3)

Vitiiigo (13.6)

7
— Diseases of sebaceous glands

‘r

----- Dermatophytoses

. . . . . . . . . . . Tumors

----- .%borrheic dermatitis

o

...

[

20 40 60 80

AGE IN YEARS

the examination and diagnosed by the dermatologist examiner, those previously diagnosed

significant skin conditions that were suppressed

or in remission at the time of the examination

were also recorded for each examinee. Recording was limited to the two most serious of such

conditions.

One in eight, persons (124.9 per 1,000) has

at least one such clinically inactive condition,

the rate increasing with age from 69.6 per 1,000

at age 1-5 years and 69.1 per 1,000 at age 6-11

years to 162.6 per 1,000 at age 35-44 years then

declining slowly to 123.4 per 1,000 at age 65-74

years (table 5). The proportion of persons with

such conditions is slightly higher among females

than among males, but the pattern across the age

range is not consistent. Less than 15 percent of

Figure 5. Prevalence rates for the 4 most frequently occurring

types of skin pathology among persons 1-74 years, bv aqe: the;e persons have two significant co;dltions in

United States,” 1971-1974 - remission.

300 —

$

G

s

3 200

$

i

--

a

k 100

:

~

o EEl

1.5years 6.11 years 12.17 yearn 18.24 years 25.34 years

❑ Amdcclemmtkk

T

❑ Contactdwmatitls ~ Tumors ~ Sebwrheickeratosls

~ Dwmatophytoses ❑ Dkeasesof sebaceo.sgla”d$ ❑ Seborrheicdermatltis

$

$

i

~ 20Q

0

i

,-.

K

v

$

0 m Fz ENWl

3544 years 45.54 years 55.64 years a5.74 years

AGE

Figure 6. Prevalence rates for the principal types of skin pathology within each age group among persons 1-74 years: Unitecl States,

1971-7974
_ Diseasm of sebaceous glands iflALE

300 .

--- Dermatophytos?s

. . . . . . . . Tumors

---- Seborrheic dermatitis

m

y 200

<

;.

a

2

/’

g 100 — /’

K

I

o 20 40 60 80

3CQ

r

FEMALE

o

/

/

/

....

I

?0 40 60 80

AGE IN YEARS

Figure 7. Prevalence rates for the 4 most frequently occurring

types of skin pathology among persons 1-74 years, by age

and sex: United States, 1971-1974

‘0r

~D

o

AGE IN YEARS

Figure 8. Prevalence rates for significant skin pathology with

occupational exposure among persons 18-74 years, by age

and sex: United States, 1971-1974

Approximately one in six persons . with

active- ~ignificant “skin pathology diagnosed also

has a significant skin condition suppressed or in

remission at the time of the examination; among

those with si~ificant skin conditions in remission, about one-third also have active pathology.

The prevalence rate of significant active and suppressed pathology is 47.4 per 1,000 persons, the

rate generally increasing with age from 12.4 at

age 1-5 years to 68.4 per 1,000 at age 55-64

years.

The coexistence of active and suppressed

skin pathology is greater among males than

among females from age 6-64 years (table 5).

The most prevalent of the specific types of

skin condition s-u~pressed or in remission are the

contact dermatltldes (31.9 per 1,000 persons),

diseases of the sweat and sebaceous gkmds (19.3

per 1,000), atopic dermatitis and eczema (16.0

per 1,000), dermatophytoses (1 1.0 per 1,000),

benign and malignant tumors (10.5 per 1,000),

and infections of the skin including evidence of

a history of verruca vulgaris (10.4 per 1,000) as

shown in table 6.

Aronsignificant pathology. –The dermatologists recorded all skin pathologies identified in

various stages of the examination, whether the

condition was considered significant or not. Mild

seborrheic dermatitis, for example, would not be

considered sufficiently serious to warrant a visit

to a physician. Nevertheless, it wouId be recognized as an other-than-normal scalp condition

and its presence recorded. By gathering such

data it is possible to determine the total prevalence of the various types of skin conditions in

the U.S. population as identified in this survey

examination and the extent to which each was

considered a si~ificant health problem (tabIe

6).

The most prevalent of the skin conditions, as

shown in tabIe B, is the group of disorders that

includes traumatic and surgicaI scars, ephelides,

and other derrnatitides that affect more than

half the population age 1-74 years; ichthyosis

and keratosis, 43 percent; malignant and benign

tumors, 36 percent; diseases of the sweat and

sebaceous glands, 21 percent; diseases of the circulatory system, other than the veins, including

Osler-Weber’s disease, telangiectasis, and simiIar

9
Table B. Prevalence ratas for selectad significant and nonsignificant types of skin conditions and Drooortion of each tvoe rated as

significant among persons 1-74 years: United States, 1971-1974

Condition and NYU codel

Other skin disorders (vitiligo, traumatic scars, ephelides, etc.) .............................................716

Ichthyosis, keratosis ............................................................................................................71 O

Tumors, malignant and benign, and Ieukemias .. .......... ...... 19x,2(jx,22x,23x,23y, e)(~l”ding

22X,44X

Malignant tumors ........................... ........ ...... .. .......................... ............................... 19X

Diseases of swaat and sebaceous glands ......................... .......................................................7l4

Other diseases of circulatory system (Osler’s disease, telangiectasis, etc.)

.....................467-468

Corns, callosities .........................................................................................................c........7Og

Lichen planus .....................................................................................................................7o7

Seborrheic karatosis ............................... ..................................................................... 22X44X

Seborrheic dematitis .........................................................................................................$o7OO

Diseases of veins (varicosa veins, phlebitis, etc.) .....................................................o......46O~66

Darmatophytoses ................................................................................. .................c..$...........l3l

Diseases of buccal cavity, salivary glands, lips, pancreas, etc. .....<........,.. ......................530-587

Infections of skin (boils, impetigo, infectious warts, etc.)

.............................................69O698

Contact dermatitides ...........................................................................................................7o3

Diseases of hair and hair follicles ....

.....................................................................................7l3

pruritus ................................... ...........................................................................$.....m...........7O8

psoriasis ....................................................................................<...............................c..........7O6

Malignant tumors ............................................................... .................................................lgX

Deep fungal infections ..................................................................................................l32.l34

Injuries, adverse effacts of chemicals and other external conditions .............................850-999

Zoonoses ......................................................................................................................l35.l37

Leishmaniasis and other parasitic diseases .......................r................... ..........................l2O.l3O

lSee reference 8.

Skin conditions

EEIEz

Rate per 1,000 population

516.2

432.7

357.1

11.6

209.5

182.7

156,9

140.6

124.1

116.7

95.6

81.1

62.0

60.0

53.9

50.5

25.8

14.3

11.6

4.4

3.8

1.0

0.2

27.5

21.8

56.7

5.9

87.0

1.0

3.2

0.8

5.2

28.5

7,5

81.1

2.4

15.9

13.6

15.8

13.7

8.8

5.9

2.4

3.7

0.8

0.1

488.7

410.9

300.4

5.7

122.5

181.7

153.7

139.8

118.9

88.2

88.1

59.6

44.1

40.3

34.7

12.1

5.5

5.7

2.0

0.1

0.2

0.1

Proportion

:Iassed

as significant

.—

Percent

5.3

5,0

15.9

50.9

41.5

0.5

2.0

0.6

4.2

‘24.4

7.8

100.0

3.9

26.5

25.2

31.3

53.1

‘61.5

50.9

54.5

97.4

80.0

50.0

conditions, 18 percent; corns and callosities, 16 Extent of Concern for Skin

percent; lichen- pkmus, 14 percent; seborrheic Pathology

keratoses, 12 percent; and seborrheic dermatitis, Nearly one-eighth (11 8.2 per 1,000 persons)

nearly 12 percent. or an estimated 22.9 million of the U.S. popula10
tion 1-74 years of age have one or more skin

conditions about which they complain or express concern (table 7). For most of these persons (96 percent with such conditions or a rate

of 113.6 per 1,000 in the population), a specific

condition affecting their hands, feet, or other

part of the body was identified as the cause of

their concern (table 8). For the remaining 4 percent (rate of 4.6 per 1,000 in the population)

with multiple types of skin complaints, the

pathology was more generalized, not limited to

one or two specific areas of the body.

For some 9 percent of those who complained about an identified type of skin condition, it is one that affected their hands; for 16

percent, their feet; and for 75 percent, their

face, neck, or other area of the body.

Nearly one-third (31 percent) of persons

with significant skin pathology diagnosed by the

dermatologists express concern about these

specific skin conditions; nearly 18 percent of

those who complain about their skin conditions

are concerned about conditions not considered

serious or significant by the dermatologists

(table 7).

Skin complaints are more prevalent among

youths and adults than among children age 1-11

years, the prevalence rates being 2% to 3%!times

greater than those among children, but showing

no other significant trend with age. Rates for

significant pathology not of concern to the

affected individual increase with age from 1-24

years, drop back at age 25-44 years, then steadily increase with age; the proportion with nonsignificant pathology of concern tend to decrease slightly with age among adults (table 7

and figure 9).

Skin conditions of concern to the affected

individual are slightly, but not significantly,

more prevalent among males and among females

(rates of 128.2 per 1,000 and 108.8 per 1,000,

respectively), but only from 18-74 years of age

are the rates among males consistently the

higher (figure 10).

Males are slightly more likely to be concerned about a significant type of skin pathology at age 35-64 years than are females, and

preschool-age girls are somewhat more likely to

be concerned than a-e boys of like age. “Concern

regarding nonsignificant skin pathology is about

as likely to be expressed by males asby females

except at ages 1-5 years, 12-17 years, and 55-64

1

Significant patholcgy “d **

of concern 0“”0

~4*\ //0

i

\

\

/“””

/

\

-.””

h-—— i

/’

Skin condition of concern

,/”

,/

~

............................... ...........

20 40 60 80

AGE IN YEARS

Figure 9. Prevalence rates for skin conditions of concern (complaints), significant skin pathology not of concern, and

nonsignificant skin pathology of concern among persons

1-74 years, by age: United States, 1971-1974

0 20 40 so ao

AGE IN YEARS

figure 10. Prevalence rates for skin conditions of concern

(complaints) among persons 1-74 years, by age and sex:

United States, 1971-1974

years where these rates are higher among females

and age 45-54 where the rate among males is the

higher.

Types of conditions of concern. –The most

frequently reported skin complaints axe those

affecting the sebaceous glands (28.2 per 1,000

persons 1-74 years of age), dermatophytoses

(fungal conditions–21.6 per 1,000 persons),

atopic dermatitis and eczema (allergies and related conditions–10.8 per 1,000 persons), malignant and benign tumors (8.1 per 1,000 persons),

11
Table C. Rank order and rates (greater than 3.0 per 1,000 population) of the most prevalent types of skin conditions of concern

(complaints), within each age group: United States, 1971-1974

1-5 years

Atopic dermatitis, eczema (10.9)

Contact dermatitis (3.9)

18-24 years

Diseases of sebaceous glands (71 .4)

Dermatophytoses (1 5.6}

Contact dermatitis (8.7)

Atopic dermatitis, eczema (7.7)

Foilicuiitis (4,6)

Tumors, malignant and benign (4.2)

Psoriasis (3.1 )

45-54 years

Dermatophytoses (49.6)

Tumors, malignant and benign (14.6)

Seborrheic dermatitis (12.3)

Psoriasis (10.4)

Atopic dermatitis, eczema (9.0)

Malignant tumord (7.5)

Contact dermatitis (4.4)

6-11 years

Actopic dermatitis, eczema (14.5)

Verruca vulgaris (6.8)

Contact dermatitis (3.7)

Dermatophytoses (3.1)

25-34 years

Diseases of sebaceous glands (35.4)

Dermatophytoses (27.7)

Atopic clermatitis, eczema (16.4)

Seborrheic dermatitis (!3.9)

Contact dermatitis (6.7)

Psoriasis (3.9)

55-64 years

Dermatophytoses (22.9)

Tumors, malignant and benign ( 19.6)

Atopic dermatitis, eczema (8.9)

Contact dermatitis (8.3)

Psoriasis (7.2)

Diseases of sebaceous glands (5.4)

Malignant rumorsl (5.2)

Seborrheic dermatitis (4.4)

lSubgroup of tumors, maIignant and benign.

contact dermatitis (6.4 per 1,000 persons),

seborrheic dermatitis (chronic inflammation—

5.4 per 1,000 persons), and psoriasis (3.8 per

1,000 persons) (table 8). These are the principal

conditions of concern among both males and

females, although the proportion of females concerned about fungal conditions (8.2 per 1,000)

is substantially less than that of males (35.9 per

1,000), consistent with the lower prevalence of

such conditions among females.

Among children 1-11 years, atopic dermatitis is the most prevalent skin complaint; at ages

12-34 years the major complaint is about

diseases of the sebaceous glands; from 35-64

12-17 years

Diseases of sebaceous glands (86.4)

Dermatophytoses (9.0)

Atopic dermatitis, eczema (8.4)

Contact dermatitis (5.5)

Tumors, malignant and benign (4.4)

Ichthyosisr keratosis (3.4)

Verruca vulgaris (3.1)

3544 years

Dermatophytoses (39.8)

Diseases of sebaceous glands (1 7.6)

Contact dermatitis (10.3)

Atopic dermatitis, eczema (9.2)

Seborrheic dermatitis (5.9)

Folliculitis (5.2)

Tumors, malignant and benign (3.6)

65-74 years

Tumors, malignant and benign (34.6)

Dermatophytoses (21 .8)

Atopic dermatitis, eczema (10.5)

Malignant tumorsl (8.5)

Seborrheic dermatitis (7.6)

Contact dermatitis (5.8)

Psoriasis (4.9)

Seborrheic keratosis (4.7)

Vitiligo (3.3)

years, the dermatophytoses; and in the oldest

group 65-74 years, rn~ignant and benign tumors

(tables 9-11, C, and figure 11). The trend with

age for the more prevalent skin conditions o“f

concern is generzdly similar to that for the si@&ificant conditions dia~osed, although the rates

for the former are, as expected, consistently

lower (figures 5 and 12).

Persons with significant skin conditions diagnosed in the survey examination are most Ii,kely

to express concern if the condition is psoriasis

(of those diagnosed 69 percent expressed concern), atopic dermatitis (59 percent concerned),

contact dermatitis (47 percent concerned),

12
~ Atoplcd.gnnatitis W Disemesof sebamo.sglands ~ p~~i.~is

~ mrmavaphyroae$ @ T.mom,malig.anta.d k.ign

~ Oamactderrmtitls ~ Seborrhdcdenn.titis

c1.5 6-11 12.17 18.24 25.24 3a-44

years years years yem yews yam

!3--

K

2

ITnTnrl ...,

:0

45.s4 55.84 65.74

years yenri years

AGE

Fiaure 11. Prevalence rates for the major types of skin conditions of concern (complaints) within each age group among

persons 1-74 years: United States, 1971-1974

100r

Direamof ScbaCZOUs91*WS

---- Dermtophytoses

0

t h -=J=J. .

20 40 60 80

AGE IN YEARS

Figure 12. Prevalence rates forthemajor types ofskinconditions of concern (complaints) among persons 1-74 years,

by age: United States, 1971-1974

malignant tumors (34 percent concerned) and

diseases of the sebaceous glands (33 percent concerned) (tables 1, 8, and D).

Males are the most likely to express concern

about conditions of psoriasis (64 percent concerned), atopic dermatitis and eczema (60 percent concerned), contact dermatitis (50 percent

concerned), malignant tumors (36 percent concerned), and diseases of the sebaceous glands (33

percent concerned). Among females, the most

Table D. Proportion of persons with saiected specific types of significant skin pathology who complained about the condition, within

each age group: United States, 1971-1974

1-5 years

None

18-24 years

Seborrheic keratosis (225%)

Psoriasis (207%)

Contact dermatitis (61%)

Atopic dermatitis, eczema (50%)

Harpes simplex (50%)

45-54 years

Psoriasis (91%)

Ma/ignant tumod (79%)

Atopic dermatitis, eczema (65%)

lsubg~~up of tumom, malignant and beni

6-11 years 12-17 years

Contact dermatitis (76%) Psoriasis (88%)

Atopic dermatitis, eczema (72%) Contact dermatitis (64%)

Verruca vulgaris (52%) Urticaria (56%)

25-34 years 35-44 years

Seborrheic keratosis (1 75%) Atopic dermatitis, eczema (63%)

Contact dermatitis (70%) Contact dermatitis (61 %)

Psoriasis (63%)

Atopic dermatitis, eczema (59%)

Vitiligo (53%)

55-64 years 65-74 years

Folliculitis (71%) Ichth yosis, keratosis (100%)

Atopic dermatitis, eczema (70%) Atopic dermatitis, eczema (57%)

Psoriasis (66%) Psoriasis (52%)

1.

13
eczema ceous glands

Figure 13. Percent of persons 1-74 years with selected significant skin pathology who are concerned about the condition, by sex:

United States, 1971-1974

frequently cited conditions of concern are psoriasis (74 percent ), atopic dermatitis and eczema

(58 percent), contact dermatitis (44 percent),

urticaria (38 percent), malignant tumors (34 percent), diseases of the sebaceous glands (34 percent ), and vitiligo (32 percent) as shown in

tables 1 and 8 and figure 13.

Recurrence and Duration of

Skin Pathology of Concern

An estimated 62.8 per 1,000 in the U.S.

civilian noninstitutionalized population age 1-74

years or 56 percent of those with skin complaints indicate that the condition or conditions

are recurrent. Those conditions affecting the

hands and feet are slightly more likeIy to be

recurrent (66 and 64 percent, respectively) than

those on the face or other parts of the body (54

percent) (tables 7, 12, and E).

Skin conditions affecting the feet are si~ificantly more likely to be recurrent among males

(70 percent) than among females (45 percent) as

are those affecting the hands (70 percent compared with 60 percent for females); those skin

conditions affecting the face and other parts of

the body are only slightly less likely to be recurrent in males (52 percent) than in females (56

percent).

The recurrence of skin conditions of concern

shows no consistent increasing or decreasing

trend with age among youths or adults. For all

types of such conditions the proportion that

recurred is highest at age 25-44 years and lowest

among children age 1-5 years. Conditions affecting the hands are the most likely to be recurrent

among young children age 1-5 years (100 percent ) and adults age 45-54 years (78 percent),

but least likely to be recurrent among the oldest

adult age group in this study (46 percent alt, age

65-74 years) and children age 6-11 years (50 percent). Skin conditions affecting the feet are the

most likely to be recurrent among you~ger

adults age 25-44 years (77 percent at 35-44

years and 70 percent at 25-34 years) and least

likely to be a (recurrent) problem among children 1-11 years (O percent at 1-5 years and 35

percent at 6-11 years). The recurrence rate for

conditions affecting the face and other parts of

the body is highest among young adults 18-34

years (66 percent at 25-34 years and 56 percent

at 18-24 years) among whom acne vulgaris and

other diseases of the sebaceous glands (although

just past the peak prevalence for such conditions

at 12-17 years) are still the most prevalent of the

skin conditions of concern in those age groups,

making up about one-half and one-quarter of all

skin conditions of’ COTrem at 18-24 and 25-34

years, respectively.

Nearly half (49 percent) of recurrent skin

conditions have been active in the preceding

7-12 months, 30 percent longer ago than 12

14
Table E. Percent of persons 1-74 years with skin conditions of concern (complaints), by the recurrence and duration of condition, the degree of

resultant handicap or disfigurement, part of body affected, and sex, showing selected standard errors: United States, 1971-1974

Recurrence, duration, and handicap

Condition recurrent ...................................

Recurrent condition active in:

Past 12 months . ..................................

Past 3 monthsl .....................................

Past 6 monthsl .....................................

Condition present:

Less than 2 years ..................................

2-4 years ...............................................

5 years or more .....................................

Condition limits activity:

To any extent .......................................

10 percant or less..................................

More than 25 percent ...........................

Degree of handicap to employment or

housework:

Severe ...................................................

Minimal ................................................

None .....................................................

Dagree of handicap to social relations:

Severe ...................................................

Minimal ................................................

None .....................................................

Condition recurrent ...................................

Recurrent in past 12 months ......................

Present-less than 2 years ...........................

Condition limits activity ............................

Employment-housework handicap:

Severe ...................................................

Minimal ................................................

Nona .....................................................

Social handicap:

Severe ...................................................

Minimal ................................................

None .....................................................

One or more areas of

bndy affected II

i-lands

I

Feet I

Other area(s)

Percent of persons with skin condition of concern

56.3

69.7

11.8

20.7

16.8

21.5

61.6

6.9

6.0

0.8

1.4

8.5

90.1

1.3

31.4

67.3

. . .

..-

. . .

. . .

. . .

. . .

-..

. . .

. . .

. . .

67.5

69.7

10.6

20.1

16.1

19.0

70.1

7.7

5.4

0.5

1.3

8;:;

0.7

27.0

72.3

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

55.0

69.6

13.3

21.4

17.6

24.6

57.7

10.3

6.8

1.1

1.6

6.5

91,9

1.8

36.5

61.7

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

65.8

73.2

22.0

36.2

23.8

20.1

58.1

74.9

10.4

1.0

2.4

23.6

74.0

1.1

27.4

71.5

8.39

5.96

2.84

4.53

1.41

6.15

6.09

1.40

4.19

4.26

70.2

71.4

22.4

38.1

23.3

14.0

62.7

12.0

7.7

1.1

1.6

14.6

83.8

25.8

74.2

60.0

75.5

21.4

33.6

24.6

26.1

47.3

18.7

14.0

0.8

3.5

35.9

60.6

2.5

28.4

58.1

63.5

70.8

9.6

18.1

10.0

14.7

75.3

8.2

5.6

1.4

1.4

7.7

90.9

0.7

9.0

90.3

69.6

77.9

10.6

21.0

8.9

14.8

76.3

6.6

5.6

0.3

0.3

6.6

93.1

::

91.3

7.35

7.72

3.67

3.72

1.63

4.82

4.72

2.35

4.33

4.33

Standard error of percent

6.01

7.72

3.55

7.73

2.42

9.22

8.97

2.45

8.42

8.49

4.99

5.17

3.08

2.85

0.79

2.06

2.38

3.61

1.86

1.92

5.12

4.97

3.86

3.04

0.30

2.95

2.96

2.24

2.24

46.2

49.7

6.1

9.6

13.4

14.3

72.3

13,0

6.2

4.9

4.7

11.0

64.3

2.5

10.2

87.3

8.08

8.o4

2.62

4.01

3.20

4.72

4.51

2.62

3.03

3.59

53.6

69.0

11.0

19.3

17.4

23.2

59.4

6.3

%:

1.3

6.8

91.9

3Z

62.0

3.05

3.52

1.08

1.69

0.80

1.58

1.72

0.82

3.37

3.37

51.8

88.8

8.9

17.2

17.4

21.0

61.6

7.4

4.9

0.5

1.6

7.2

91.2

1.1

32.9

66.0

3.57

3.48

1.73

1.19

0.61

1.98

2.26

2.53

2.71

2.67

55.5

71.1

13.2

21.4

17.5

25.3

57.2

9.1

6.1

0,7

1.0

9:::

1.7

40.1

66.2

3.77

2.86

1.34

2.33

0.73

1,56

1.66

2.42

4.88

5.01

lperc.nt of tho~e ~h~se skin condition is mcu~ent.

months, and 21 percent within the preceding 6 concern that have persisted at Ieast 5 years (70

months (table E): percent) than are f;males (58 percent),- the rates

Duration. –The majority of skin complaints being significantly lower among females only for

have been present for 5 years or longer (62 per- skin conditions affecting the hands (table E).

cent). Those affecting the feet are more likely to

have been present this Iength of time (75 percent) than those affecting the hands (56 perHandicap From Skin Condition

cent) and other parts of tie body (59 p-erce~t). Activity limitation. –Skin complaints are

Males are more likely to have skin conditions of reported to limit activity of 10.5 per 1,000 of

15
the population age 1-74 years or 9 percent of

those persons with such skin conditions (table

E). However, only about one-third of these persons indicated that their activity is more than

minimally limited (more than 10 percent) by

their skin condition(s). Males are slightly less

likely than females are (8 percent compared

with 10 percent) to report any limitation but

among those with some degree of this the proportion with more than minimal limitation is

similar in both sexes (3 percent). No consistent

trend with age is evident in the proportion with

such limitation from a skin condition, although

adults 55-64 years of age and children 6-11 years

of age are slightly more likely than those of

other ages to have such limitation (12 percent

compared with 5-10 percent).

Conditions affecting the hands are more

likely to limit activity (15 percent) than are

those affecting the feet (8 percent) or other

parts of the body. Females are more likely than

males are to have skin conditions affecting their

hands and feet, which limit their activity.

Degree of handicap to employment or

housework. –About 10 percent of those persons

with skin complaints consider the condition(s)

to be a handicap to their employment or housework (table E). Only 1 percent indicate they

were severely handicapped, and the remaining 9

percent consider the handicap to be minimal.

Conditions on the hands are more likely than

those on the feet or other parts of the body to

be considered a handicap (26 percent of skin

conditions of concern on the hands compared

with 9 percent of those on the feet and 8 percent of those on other parts of the body) and

such conditions on the hands are somewhat

more likely than those on the feet or elsewhere

to be considered a severe handicap (2 percent on

the hands compared with 1 percent elsewhere).

The proportion with handicapping (for

employment or housework) skin conditions

among all those with skin complaints is, as

expected, lowest among children age 1-11 years

(less than 3 percent) and highest at 25-34 years

(12 percent), 55-64 years (12 percent), and

18-24 years (11 percent) (figure 14). Among

males, only at age 18-24 years does the proportion considered handicapping exceed 1 in 8,

reaching the maximum of 15 percent; among

females, this proportion is exceeded at ages 25-

60

Employ rrtent-houswvork

- handicap

L

::.. . . . . . . . . . . . Social handicap

; .-.+ Oifigurement–

...

%. ‘-- - moderase-s?vm

/ %

1/! , , ,

0

20 40 60 So

AGE IN YEARS

Figure 14. Percent of skin conditions of concern (complaints)

considered social or employment-housework handicap by

the individual or to be disfiguring to at least some extent

by the examiner, by age: United States, 1971-1974

34 years (16 percent) and 35-54 years (13 percent ) (tables 7 and 12).

Although there is no consistent age-related

trend in the proportion with handicapping’ (for

employment or housework) skin conditions,

girls of age 12-17 years are more likely to consider skin conditions of the hands and feet t’o be

a handicap than not (58 percent of those ‘skin

conditions affecting the hands are rated as a

handicap compared with 42 percent not so

rated, and 60 percent of conditions affecting the

feet are considered handicapping). Adult women

55-64 years of age are also more likely to consider skin conditions on the hands (but not the

feet ) as being handicapping than not (63 pe~cent

compared with 37 percent not considered h~dicapping); about one-half of those women 1,8-34

years of age consider skin conditions on their

hands to be handicapping.

The handicap from skin conditions of ‘concern is substantially more likely to be miriimal

than severe, except for those affecting the hands

and feet of girls 12-17 years of age and those

affecting parts of the body other than hands and

feet of men age 45-54 years.

Social handicap. –An extimated 35.1 per

1,000 of the U.S. population 1-74 years of age

or about one-third (33.0 percent) of those persons with skin conditions that concern them

indicate that the condition(s) is (are) a handicap

16
in their social relations (tables

proportion increases with age

12 and E). The

among children

from less than 10 percent among those of preschool age to a maximum of 47 percent among

youths age 12-17 years, then decreases with

increasing age among adults to less than 17 percent at age 65-74 years (figure 14). The proportion sociaIly handicapped from their skin condition is substantially greater among females (34

percent) than among males (25 percent), the

pattern being consistent across the age range in

this study.

Extent of disfigurement. –More than twothirds (68. 1 percent) of the skin conditions of

concern to the individual affected are rated as

disfiguring by the dermatologist examiner (table

F). The disfigurement is substantially more

likely to be minimal (48 percent) than moderate

or severe (20 percent). Skin conditions on the

face and parts of the body other than the hands

and feet and skin conditions on the hands are

more likely to be rated as disfiguring (71 percent

and 69 percent, respectively) than skin conditions on the feet (54 percent). The examiners are

slightly more likely to rate skin conditions of

females as disfiguring to any extent and as

moderately or severely disfiguring than those of

males whether the hands, feet, or other parts of

the body were affected. For each sex, skin conditions on the feet are the least likely of the

three sites to be considered (by the examiner) as

disfiguring to any extent, as well as the least

likely to be considered moderately or severely

disfiguring.

Children ages 1-11 and adults 45-54 years

are least likely to have skin conditions rated as

disfiguring to any extent by the examiner (about

50 percent of those with skin conditions of concern to person affected); these rates are highest

among youths age 12-17 years and adults 55-74

years of age. Moderately or severeIy disfiguring

skin conditions are least prevalent among preschool-age children 1-5 years old and adults age

45-54 yeas, but most prevalent among those

older adults age 55-64 years (figure 14).

Discomfort From Skin Condition

Pain or burning. –An extimated 22.6 per

1,000 in the U.S. civilian noninstitutionalized

population age 1-74 years or nearly one-fourth

(22.8 percent) of

indicate thev felt a

those with skin complaints

burnirw sensation or ~ain to

some degre~ from the co~dition(s) (ta~les 12

and F). The pain or burning sensation is rated as

moderate or severe for nearly one-third of these

people (6.4 percent of those with skm conditions of concern). Conditions affecting the

hands or feet are less likely than those affecting

other parts of the body to be reported to cause

at least some pain or burning.

School-age children 6-17 years old =e the

,least likely to have these symptoms (16 percent

at 6-11 years and 14 percent at 12-17 years);

preschool age children are the most likely (32

percent). Young adults age 25-34 years are

slightly more likely to have these symptoms (25

percent) than older or younger adults.

Males are less likely than females to report

symptoms of burning or pain from skin conditions on their hands and feet, but are slightly

more likely to do so for conditions affecting the

face or other parts of their bodies.

Itching. –Nearly one-half (45.4 percent) of

persons with one or more skin complaints indicate that the condition(s) itched minimally (25

percent) or to a moderate or severe degree (20

percent ). Preschool-age children 1-5 years of age

are most likely to have such symptoms (58 percent) and, when they do, to have moderate or

severe itching (64 percent) than minimal (36 percent); young adults age 18-24 years are the least

likely to indicate that the skin condition(s)

itched (26 percent), but those 25-34 years of age

are the least likely to have a moderate or severe

itching (30 percent). Males are slightly more

likely to report such symptoms (48 percent

compared with 42 percent of femzdes) but, when

they do, to consider the itching minimal

(table F).

Motion limitation. –Skin condition(s) are

extensive enough or Iocated in areaa so that they

cause limitation of motion for nearly 6 percent

of persons who have skin conditions that concerned them (table F). The rates are highest

among the oldest aduIts, age 65-74 years and the

lowest among adults age 45-64 years. Males are

about as likely as femzdes are to have such limitation from skin conditions that concerned them

(5 percent of males, 6 percent of females) and

both sexes are more likely to have a minimal (4

percent) than moderate or severe limitation (1

17
Table F. Percent distribution of persons 1-74 years with skin conditions of concern (complaints) by extent of discomfort from condition, according to

part of body affected end sex, showing selected standard errors: United States, 1971-1974

Extent of discomfort

Extent of disfigurement:

ModeratPswere ....................................

Minimal ................................................

None .....................................................

Causing pain or burning:

Moderate+evere ....................................

Minimal .................................................

None .....................................................

Causing itching:

Moderate$evare ....................................

Minimal ................................................

None .....................................................

Ceusing motion limitation:

Moderate-sewre ....................................

Minimal ................................................

Ndne .....................................................

Causing ovatall discomfort:

Moderate.severe ....................................

Minimal ................................................

Disfigurement:

Motferate-savere ....................................

Minimal ................................................

None .....................................................

Pain or burning:

Modetate.sevare ....................................

Minimal ................................................

None .....................................................

Itching:

Moderate+evere ....................................

Minimal ................................................

None .....................................................

Motion limitation:

Moderat&severe,., .................................

Minimal ................................................

None .....................................................

Overall discomfort:

Moderate*evere ....................................

Minimal ................................................

None .....................................................

One or more areas of

body affected Hand Foot Other area(s)

Both Male Female

Both

Male Femala Both

Male Female

Both

sexes sexes sexes

Male

sexes

Female

Percent distribution of persons with skin conditions of concern

20.4 19.1

47.7 46.4

31.9 34.5

6.4 5.9

16.4 17.3

77.2 76.8

20.4 19.3

25.0 28.9

54.6 51.8

1.3 1.1

4.3 4.3

94.4 94.6

16.3 14.4

47.7 44.4

42.0 41.2

. . .

. . .

. . .

..-

. . .

. . .

. . .

. . .

-..

-..

..-

..-

. . .

.. .

. . .

. . .

. . .

. . .

-..

..-

. . .

.-”

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

21.7

49.4

28.9

7.0

15.2

77.8

21.7

20.2

58.1

1.6

4.2

94.1

18.6

38.4

43.0

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

-..

..-

. . .

.-.

.-.

. . .

. . .

18.8 19.4

50.0 48.1

311.2 32.5

7.9 6.5

311.6 28.6

6(1.5 84.9

2(L6 10.8

40.2 46.9

39.2 42.3

0.5 0.2

9.8 11.2

89.7 88.6

1‘1.4 6.4

52.8 56.3

35.8 37.3

. . .

5.19

5.42

2.42

4.90

,.. .

3.31

4“74

,,. .

0,34

2 A4

-..

2.70

4.87

.-.

---

7.07

6.61

3.83

6,06

..-

4.10

6.30

..-

0.18

3.53

..-

2.28

5.49

. . .

18.1

52.5

29.4

9.7

35.7

54.6

33.8

31.1

35.1

1.0

7.7

91.3

18.5

48,0

33.5

12.1 9.7

41.5 41.7

46.4 48.6

9.8 7.0

25.6 25.7

64.6 67.3

18.5 19.6

35.7 40.0

45.8 40.4

1.4 -

3.8 2.9

94.8 97.1

14.2 12.9

52.8 55.0

33.0 32.1

Standard error of percent

. . .

5.95

5.95

3.63

7.82

. . .

5.30

5.58

. . .

0.60

3.49

. . .

5.45

7.52

.-.

. . .

4.15

4<64

2.34

4.92

. . .

2.70

4.74

. . .

1.07

1.12

---

3.10

4.08

. . .

. . .

5.95

5.92

2.41

5.67

. . .

3.60

5.68

. . .

1.07

---

5.10

5.09

. . .

19.2

40.7

40.1

18.3

25.2

56.5

14.9

22.1

63.0

5.6

6.7

87.7

18.2

46.0

35.8

. . .

9.50

7.77

4.91

6.34

. . .

2.90

6.05

. . .

4.49

2.48

. . .

6.90

6.80

. . .

22.3

48.8

28.9

5.5

12.5

82.0

20.8

20.8

58.4

1.4

3.7

94.9

17.4

37.9

44.7

.-.

2.07

2.33

0.90

1,22

-..

1,35

1.48

. . .

0.28

0.43

.-.

2.10

2.48

.-.

22.1

47<6

30.3

5.4

13.1

81.5

20.4

22.8

56.8

1.5

3 .s

94.7

16.0

39.3

44.7

---

2,33

3.23

1.20

1.88

. . .

2.01

2.62

..-

0.52

0.61

---

2.69

3,54

..-

22.4

50.0

27.6

5.5

11.9

82.6

21.1

18.8

60.1

1.3

3.6

95.1

18.7

36.6

44.7

.-.

2.70

2.55

1.02

1.69

.-.

1.98

1.73

---

0.31

0.86

. . .

2.30

2.87

-..

~ercent of males and nearlv 2 ~ercent of vears and lower at age 12-17 Years than at other

;emales).

. L

~ges (table F). Only” about one-fourth (28 perOverall discomfort. –More than half (58.0 cent) of those with some overall discomfort

percent) of those persons with skin complaints from the skin condition(s) indicate the discomhave some overall discomfort from the condi- fort was more than minimal; this proportion

tion, the rates being slightly higher at age 1-5 ranges from a maximum at age 6-11 years (60

18
percent) to a minimum at 12-17 years (46 percent). Females are nearly as likely as males to

have some overall discomfort from a skin condition (57 for females, 59 for males), but when

they do to indicate moderate or severe discomfort (33 percent compared with 24 percent).

Disfigurement–handicap or disability. –

Nearly all (89 percent) of those persons who

consider their skin condition(s) a social handicap

to some degree are also rated as disfigured by

the examiners. This agreement is slightly closer

among adults age 45-64 years and youths age

12-17 years (nearly 95 percent) than other persons among whom the proportion rated as disfigured of those considering themselves socially

handicapped by their skin condition ranges from

80 percent at age 35-44 years to 88 percent at

age 65-74 years with no consistent age-related

trend. The agreement is slightly better for

females (92 percent) than for males (86 percent)

(table G and figure 15).

The agreement between the examiner’s rating of some disfigurement and the individual’s

indication that his or her skin condition is a

handicap to employment or housework is

slightly less than that for social handicap, the

proportion being 80 percent and again being

somewhat higher among females (82 percent)

than among males (77 percent).

More than two-thirds of those persons with

some overall discomfort from their skin condiSo

60

40

20

0 I

Male Female

pJ %&%%wjsk’n

asdisfiguring

lzhzJ Male Female htde Female

condition rstsd Condition Condition Condition causss

by examineras

disfiguring

considered considered overalldiscomfort

employment. social

houwvork handicap

handicap

TO SOME DEGREE

Figure 15. Percent of males and females 1-74 years with skin

conditions of concern (complaints) rated as disfiguring by

examiner or causing some type of handicap to the affected

person: United States, 1971-1974

tion(s) are also rated as disfigured to some

degree by the examiners. No consistent trend

with age is evident in this agreement, the proportion with some discomfort who are also rated as

disfigured ranges from 57 percent at ages 6-11

years and 45-54 years to 82 percent at age 55-64

Table G. Percent distribution of persons 1-74 years with skin conditions of concern (complaints) reporting some degrea of resultant handicap-employmenthousawork, social, or overall discomfort-by examiner’s rating of extent of disfigurement, age, and sex: United States, 1971-1974

Type of handicap and degree of disfigu rement

Employment.housework handicap with disfigu rement rated:

Moderate~evere .. .... .............. ... ... ... ...... ..........

Minimat .,, ... ... ................. ... ... .... .. .. .... .............

Ntme ..... .... .. .. ...... .... .. ...... .. ...... .. .... .. .. .. .... .. ....

Social handicep with disfigurement rated:

Moderate.sewre ...... ... ... ............ ...... .. .... ..... ... .

Minimel .. .. ...... .... .... .... .. ... ... ........... ... .. .... .. .... .

None ......... .. ... ... ................. ... ... .............. .......

Overall discomfort with disfigurement rated:

Moderate%evere .... ... ........... ...... ... ... .... .. .. .... .. .

Minimal ..... ..... ...... ... ... ... ...... ........... .... .. ...... ...

None ... ...... ........ ...... ... ... .................... ... ... ......

Both

sexes 1-5 6-11 12.17 18-24 25-34 3544 45-54 55-84 65-74 1-74 years

1-74 years years years years years years years ~ear.s yaars

years

Male Femele

Percent distribution of persons with some degree of specified handicap from skin complaint

1

39.3 -

40.7 -

20.0 100.0

37.2 73.2

51.9 8.1

10.9 18.7

25.6 19.2

43.8 43.6

30.6 37.2

100.0

31.6

52.8

15.6

21.5

36.1

42.4

63.2

26.4

10.4

34.4

60.2

5.4

37.2

38.1

24.7

34.2

47.3

18.5

34.5

51.2

14.3

24.8

50.1

25.1

37.2 35.6

44.8 32.2

18.0 32.2

39.5 36.4

47.4 44.1

13.1 19.5

22.7 20.9

50.1 43.3

27.2 35.8

36.3

41.8

21,9

31.7

62.6

5.7

17.5

38.6

42.9

34.0

49.2

16.8

53.7

41.1

5.2

38.1

44.0

17.9

42.4

37.2

20.4

39.6

48.4

12.0

25.6

46.9

27.5

35.8

41.6

22.6

35.6

50.1

14.3

23.8

43.6

32.6

42.4

39.9

17.7

38.4

53.4

8.2

27.8

44.2

28.0

19
years and is slightly lower among males (67 per- 1-74 years of age or nearly one-fifth (18.9 percent) than among females (72 percent). cent) of those persons with skin condition(s)

about which they express concern are now

Adequacy of Treatment for

Skin Condition

under the best care pos;ible for the condition(s)

(tables 13 and H). The proportions are slightly

higher among children age 1-11 years and lower

More than 2 percent (21.5 per 1,000) of the ~ong young adults age 18-24 years than among

U.S. civilian noninstitutionalized population adults age 35-74 years. The proportion that the

Table H. Percent of persons 1-74 years with skin conditions of concern (complaints), by tYPa Of cam sought, edBqUeW of prasent treatment, radons for

pot seeking care, part of body affected, and sex, showing selectad standard error$: United Stetas, 19714974

Care status

Cara sought from:

Nonprofessional ....................................

Pharm~y ..............................................

Physician ..............................................

Dermatologist .......................................

Undar bast care now ..................................

Expert cara would improve ........................

No advice sought........................................

inadequate edvice given .............................

Did not cooperate with doctor ...................

Other raeaons for not seeking medical

care:

Too far to doctor ..................................

No transportation .................................

Insufficient money ...............................

Other ....................................................

Care sought from:

Nonprofessional ....................................

Phamacy ..............................................

Physician ..............................................

Dermatologist .......................................

Under best care now ..................................

Expart care would improve .....................

No edvica sought........................................

Inadequate edvica given .............................

Did not cooperate with doctor ...................

Other “reastms for not seeking medical

care:

Too far to doctor ..................................

No transportation .................................

Insufficient money ...............4...............

Other ....................................................

One or more areas of

body affoctad II

Hands I

Fact

I

Other area(s)

EEzEiiEllMa’elFama’e” ‘~41Ma’elFama X4”a’al;iii

pemant of person$ with skin conditions of concern

16.2

5.1

24.1

18.2

18.9

93.7

50.1

14.9

6.1

0.9

0.5

3.7

7.9

...

.-.

.-.

...

...

...

1.69

1,44

0.82

0.24

0.21

0,68

1.10

17.5

5.4

21,3

15.6

15.1

93.8

55.8

13.9

6.3

0L7

0.3

3.2

7.0

...

...

...

...

...

...

2.37

1.72

1.19

0.35

0.27

0.91

0.98

14.7

4.7

27.5

21.3

23.5

93.4

43.7

16,0

5.9

1.1

0.8

4.2

9.0

...

...

...

...

-..

..-

2.14

1.79

1.02

0.40

0.33

0.80

1.53

18,5

2:::

1g,,4

21.0

91.9

...

..-

.-.

...

...

---

...

4.52

2.50

4.08

3,82

3.16

2.68

,,.

,..-

...

...

...

...

..-

-—

18,7

2.2

27.8

18.6

17.2

88.2

-..

..-

-..

. . .

. . .

. . .

. . .

18.2

7.5

30.3

20.5

26.0

97.2

. . .

. . .

.-.

. . .

-..

. . .

. . .

1764

7.9

19.6

9.2

10.2

t12.3

. . .

. . .

. . .

. . .

. . .

. . .

. . .

19.8

10.4

18.0

10.6

6.5

92.-4

...

..-

...

...

...

...

...

5,38

1.85

5.83

4.33

3.92

3.80

. . .

. . .

-..

. . .

. . .

. . .

.-.

—

Standard error of Pemeflt

6.19

5.49

5.18

5!35

6.23

1.77

. . .

. . .

.-.

. . .

. . .

-..

. . .

3.7(

3.3[

2.9’

2,3!

3,()[

2.3”

. .

.-

. .

. .

. .

. .

-.

—

4.57

4.51

3.21

2.96

2.95

2.49

. . .

. . .

..-

.-.

. . .

.-.

. . .

—

10.2

0.5

24.3

5.0

21.0

91.9

. . .

. . .

. . .

. . .

. . .

. . .

2.71

5.44

6,62

2.86

6.02

4.30

. . .

. . .

..-

. . .

. . .

. . .

. . .

15.7

4.6

24.5

19.9

20.5

94.2

. . .

..-

-..

. . .

.-.

. . .

2.36

1.32

1.58

1.17

1.73

1.18

. . .

. . .

. . .

. . .

. . .

. . .

. . .

16.6

4.3

21,4

16.8

17.5

b5.1

. . .

. . .

. . .

. . .

. . .

. . .

.-.

2.94

1,30

2,01

1.99

2,68

1.35

...

...

-..

...

...

...

...

—

14.8

4.8

27.6

23.1

23.5

93.2

. . .

. . .

..-

. . .

. . .

2.82

1,45

2.42

1.61

1.47

. . .

. . .

. . .

. . .

. . .

. . .

. . .

20
dermatologist examiner consider as now receiving the best care ranges from 27 percent of preschool children age 1-5 years to 13 percent

among young adults age 18-24 yearn (table H

and figure 16). Females are more likely than

males are to be receiving the best care possible

(24 percent compared with 15 percent of those

with skin complaints).

Skin conditions affecting the feet are substantially less likely than those on the hands or

other parts of the body to be receiving the best

available treatment (10 percent for those on the

feet compared with 21 percent for those on the

hands and 20 percent for those on the face or

other parts of the body). Males are less likely

than females are to have skin condition(s) under

the best care, regardless of the location of the

condition(s), the difference being greatest (and

large enough to be statistically significant) for

those on the feet (6 Percent for males compared .

with 21 percent fo; f;males).

‘a Not underbest

carenow

❑ SOmec;iititxo”ld

Is Under besrcare now

n

1.5 6.11 12.17 1S-24 25.34 3544 45.54 55.64 65.74

years Yin-s yem years years years years years years

AGE

Figure 16. Percent distribution of persons with skin conditions

of concern (complaints), by adequacy of treatment for

condition(s) and age: United States, 1971-1974

Among the remaining (81 percent) persons

1-74 years of age with skin conditions that concern them but who are not now receiving the

best care available for the condition, about 94

percent of the persons with complaints have

conditions that could be improved with expert

care. These proportions range from 84 percent

among preschool-age children 1-5 years to 96

percent in the oldest age group 65-74 years

(table J). The proportion that could be improved is similar among males and females and is

nearly as high for conditions affecting the hands

or feet (92 percent) as those on other parts of

the body (94 percent).

About one-half of the U.S. population 1-74

years of age with skin conditions of concern to

them have not sought medical advice for the

problem. The proportion is lowest among children 1-11 years of age (37 percent) and adults

55-64 years (38 percent), and highest among

youths 12-17 years (66 percent).

Males are more likely than females are to

have not sought medical care for skin conditions

that concern them (56 percent compared with

44 percent) and across the ages from 12-74 years

the proportion who had not sought such care is

consistently higher among maies.

In addition to those (50 percent) not seeking

medicaI care, nearly 15 percent have been given

medical advice that the dermatologist examiner

considered inadequate. This proportion ranges

from 8 percent at age 12-17 years to 20 percent

at age 55-64 years but shows no consistent trend

with age (table J). Males are about as likely as

females are to have received inadequate medical

advice concerning their skin problem (14 percent compared with 16 percent).

About 6 percent of those with skin conditions that concern them did not cooperate with

the doctors they had consulted, the proportion

being simikr among males and females.

Other obstacles to improvement cited by the

persons with skin conditions of concern are that

they were too far from the doctor (0.9 percent),

that transportation to the doctor was not available (0.5 percent), that they had insufficient

money for such medlcaI care (3.7 percent), and

a variety of other reasons (7.9 percent) including

“not being aware the condition could be

treated,“ “under care but discouraged because

21
Table J. Percent of persons with skin conditions of concern (complaints), by rea$on no care was sought and adaquacy of treatment sought, according to age and

sex: United Statm, 1971-1974

~,

T

Both

Treatment status

sexes 1.5 6-11 12-17 18-24 25.34 3644 46.54 55.64 65.74 7-j4 Yeats

1-74 years years yew’s yaerg years yaars years years years

years

Male I

Female

Total .. ...... .... .... .... .... .... .. ........ .. .... .....

L ‘00’0 w

Percent of persons with skin complaints

a=- 100.0

36.5

100,0

6fi.9=10040

~

49.4

100do

~

55,1

100.0

=

49.1

100.0

~

43.3

100.0

~

37,7

100.0

6!245

100,0

66,8

100,0

43,7

.—

1.1

0.8

4.2

9.0

28,6

56,3

16.0

5.9

23.5

10.9

43,7

3847

5’0

56,3

No medical advice sought ... ............ .. ... ... 50,1 36.8

Too far to doctor ...... .. ... ... ........ ... ... ........ ... ... .... 0.9 2,8

No transportation ....... ... ........ ... ........ ... ...... ....... 0.5 1.0

Insufficient mOney ... ..... .. .. .. ........... ........... .... .. .. 3.7 3.5

Other reason ......... ... ..... ... ........ ... ... ........... ...... .. 7.9 11.0

No reason given ....... ........... ... ... ..... ... ........ ....... .. 37.1 18,6

Medical advice sought..., .. ....... .... ... ......... 49,9 63.2

Care inadequate ..... ........ ........... ...... ......... ..... .... 14.9 14.8

Did not cooperate with doctor.., .......... ............. 6.1 4.7

Under best care now ........ ... ... ........ ... ........... ... .. 18,9 30.4

Care could be improved ... .. ...... ... ... .... .... ... ........ 10,0 13.3

No madical advice sought..., .. .............. ... 50,1 36.8

Expert care would improve,.,.,...,..,., ... .. ........ ... . 44.9 25.9

Expert care would not improve . .... .. ........ .. .... .... 5.2 10.9

Medical advice sought .... ...... ... ........... ... .. 49.9 63.2

Under best cara now ..... ........... ........... ...... ........ 18,9 30,4

Expert cara would improve ........... ... .............. ... 31,0 32.8

Total not utldar best care ... ... ........ .... 81.1 89.6

Could be improved with axpert oare . ... ............. 75.9 58.7

Could not be improved with expart care ... ...... .. 5.2 10,9

0.4

0.4

5,8

3;::

50.6

i 5,0

7.6

14.3

13.7

49.4

1.0

0$5

2.0

4X

44.9

14.7

3,4

17.7

9.1

55.1

1,2

0.3

2.2

12.8

32.6

50.9

18.1

2?8

9.$

49.1

1.8

1,7

4.9

2;::

66,7

17,5

9.0

19,6

10.7

43.3

0.9

5.0

2:::

62.3

20.2

2%

15.1

37.7

;::

2.1

3::;

47,6

14.9

11.5

20,9

0.2

52,5

0.7

Q.3

3.2

7.0

44,6

44.2

13.9

6.3

15.1

8,9

56,6

5.7 u.9

9.2 7,1

16.6 56,9

T

63.6 34.1

16.7 [Lo

8.2 3.4

23,7 16,7

14.9 6.0

36.51 6$.9

33.1 60.4

3.4 !L5

44.4

5,0

60.6

50.3

4.8

44.9

43.3

6,8

50.9

33,9

9,4

56.7

32.8

4,9

62.3

4941

3.4

47.5

50.5

5.3

44,2

16.1

29.1

84.9

63.5 I 34.1

23.7 16.7

39,8 1:7.4

14.3

36.3

85.7

80.7

5,0

17.7

27.2

62,3

20.8

30,1

79.2

19.5

37,2

80,5

20.6

41,7

79.4

20.9

26.6

7!9.1

23,5

32.Q

76,5 -1-” 76.3 83.3

72.9 77,8

3.4 15.5

77.5

4.8

73.4

5.8

71.1

9.4

74.6

4.9

75.7

3.4

79.6

543

71,5

540

there was no improvement so stopped, ” “treatment was too painful, “ “medication needed for

other condition was causing the skin eruption, ”

“condition does not bother person that much, ”

“person knows cause,” and “person is treating

himself or herself.” In each category of other

obstacles to improvement the proportions are

slightly higher among females than among males.

Care for skin conditions is most likely to

have been sought from a nondermatologist

physician (24. 1 percent of those with skin conditions that concerned them), a dermatologist

(18.2 percent), or a nonprofessional (16.2 percent), and least likely from a pharmacist (5.1

percent) or from a podiatrist or osteopath (less

than 1 percent) (table H). As expected, physicians are usually consulted for such conditions

of preschool-age children 1-5 years (42, percent

compared with 17 percent for whom care was

sought from a dermatologist, pharmacist, or

nonprofessional). Among school-age children

6-11 years, a nondermatologist physician (3 1

22

percent) or dermatologist (21 percent) is more

fikely to have been consulted than is a norlprofessional (8 percent) or pharmacist (0.4 percent). Among youths, a nonprofessional is the

most likely to have been consulted rather Wan a

nondermatologist physician or dermatolo&st.

Females are more likely than males are to have

consulted either a nonderrnatologist physician

(25 percent for females compared with 21 ,percent for males) or a dermatologist (2 O percent

for females compared with 15 percent for

males); the males are more likely than feniales

are to have sought care from a nonprofessitmal

(17 percent compared with 14 percent for

femaIes).

Comparison With Previous

Studies

Published national estimates of the prevalence of various types of chronic skin conditions

among the U.S. civilian noninstitutionalized
population of all agesbased on findings from the

Health Interview Survey of 196918 are available

for comparison with the findings in this report

from the dermatology examination of the

1971-1974 Health and Nutrition Examination

Survey. In comparing the estimates based on

findings from the national probability samples in

the two surveys, it should be kept in mind that

the Health Interview Survey data were obtained

through household interview of a responsible

adult for all members of the household in

answer to the question “During the past 12

months did anyone in the family have any of

these conditions?” Skin conditions on the list

used by the interviewer included tumor, cyst, or

growth; eczema or psoriasis; trouble with dry or

itching skin; trouble with acne; skin ulcer; any

kind of skin allergy; dermatitis or other skin

trouble. These conditions were later classified

using the Eighth Revision International Classification of Diseases, Adapted for Use in the

United States (ICDA). 14 Conditions considered

chronic irrespective of onset and those which

had their onset more than 3 months prior to the

week of the interview and lasted more than 3

months were all considered chronic.

The national prevalence estimates for the 10

groups of skin conditions identified in the

Health Interview Survey (HIS) and the rates for

these groups based on significant pathoIogy,

nonsignificant pathoIogy, and skin complaint

findings from the dermatology component of

the Health and Nutrition Examination Survey

are shown in table K. Estimates for the fungal

conditions—dermatophytoses or dermatomycoses—and for chronic infections of the skin

and subcutaneous tissue are substantially

less, and the rates for corns and callosities and

diseases of the nails are substantially higher from

HIS than the HANES estimates based on significant pathology or skin complaints. The prevalence of corns and callosities and diseases of the

nails, which increase markedly with age, wouId

also be expected to be somewhat higher from

HIS than from HANES since only the former

survey included persons 75 years and older.

The national prevalence estimates for acne

among youths 12-17 years of age from the

1971-1974 Health and Nutrition Examination

Survey and that from the standard physician

examination in the 1966-1970 Health Examination Survey among a probability sample of

youths are in close agreement-25.O per 100

youths from the present HANES data and 28.3

per 100 youths from the 1966-1970 HES data

when the latter are limited to the moderate to

severe (II-IV) grades of acne.15

Information on the extent of medical care

received by the civilian noninstitutionalized U.S.

population, characteristics of the persons seeking such care, and the type of care given by

physicians (doctors of medicine and doctors of

Table K. Prevalence of selacted skin conditions from the Health Intewiew Survey (HIS) of 1969 and the dermatology component of the Health and Nutrition

Examination Survey (HANES) of 1971-1974: United States

Condition

Derrrmtophytosasand dBmtatomycoses..............................................

Chronic infections of skin and aubcutanaoustissue..,..........................

Eczema,,dermatitis, and urticaria ........................................................

Psoriqsisand similar tisorders .............................................................

OJherinflammatory conditions of skin and subcutaneoustissue.........

Corns and callositiM............................................................................

Othar hypartrophic and atrophic di$aasesof skin..,,...,, .......................

Diseasesof nail....................................................................................

Diseasasof sebaceousglands...............................................................

Othar disaaaasof skin and subcutaneoustisaua...................................

ICDA coda

usadin

HIS, 1969

110,111

680-662,&64.688

690-693,708

696

694,695,697,696

7W

701

703

708

702,704,705,707,

709.op,708.l ,708.9

NYU coda used in

HANES, 1971-1974

131

680-S98

700,701 ,703,704P,243

706

704P,705,707,706

708

710

712

7141-7149

713,7140,715,

716

mPrevalence ratas per 1.000

2.7

3:::

6.5

7.2

41.5

6.8

22.9

19.7

5.4

population 1

81.1 --- 21.6

15.9 44.1 22.8

53.8 161.5 17.6

6.S 5.5 23.8

19.3 166.5 ---

153.7 0.6

2::: 410.9 1.3

2.7 --- 0.5

64.8 120.4 282

45.7 525.5 ---

lNati~nal estimates for the civi]ian noninstitutionaIized population of aI1agesfrom HIS and for ages 1-74 years from HANES.

2prevaIe”ce of complaints for these 2 groups will slightly exceed these value~.

23
osteopathy) in their offices is obtained through

national probability samples of physician practice in the NationaJ Ambulatory Medical Care

Survey (NAMCS). From the 1975 findings of

NAMCS,l 6 there were an estimated 28.6 million

visits to physicians offices for conditions in

which the primary diagnosis was a disease of the

skin and subcutaneous tissue (ICDA codes

680-709). Nearly half of these (49 percent) were

return visits to the same physician.

The prevalence of chronic conditions and

related information among the U.S. institutionalized patients living in nursing homes is obtained through national probability samples of

such homes in the National Nursing Home Survey (NNHS). From the findings of the NNHS of

August 1973-April 1974,17 an estimated 6,000

of the 1,075,800 residents or 5.6 per 1,000 residents had a primary dia~osis at their last examination of a disease of the skin and subcutaneous

tissue (ICDA codes 680-709). At that time, 75

percent of the residents of such homes were 75

years or older.

SUMMARY

Skin condition findings as well as the extent

of resultant handicap and related need for medical care among persons 1-74 years of age in the

civilian noninstitutionalized population of the

United States as determined through the Health

and Nutrition Examination Survey of

1971-1974 are described and analyzed in this

report. Age and sex differences in these factors

are included.

The dermatology examination component of

this survey was planned and cIoseIy supervised

by the Data Collection Unit of the Committee

on Planning for the National Program of the

National Academy of Dermatology. For the survey, a national probability sample of 28,043 persons was selected to represent the 194 million of

that age at midsurvey time in the target population. Of these sample persons, the 20,749 or 74

percent examined by the survey dermatologists

(when the data are adjusted for the differential

sampling ratios used in the age-sex-incomedefined population sub~oups) represent an

effective response rate of 75 percent.

Nearly one-third (312.4 per 1,000 population) or an estimated 60.6 milIion of the U.S.

civilian noninstitutionalized population age 1-74

years have some skin pathology that shoukl be

evaluated by a physician at least once.

The most prevalent of the significant skin

conditions are those affecting the sebaceous

glands (84.8 per 1,000 population) incIuding

acne vulgaris; dermatophytoses or fufigal

diseases (81.1 per 1,000); malignant or behign

tumors (56.5 per 1,000); seborrheic dermatitis

(28.5 per 1,000); atopic dermatitis and eczema

(18.4 per 1,000); and contact dermatitis (13.6

per 1,000).

The prevalence of significant skin pathology

increases rapidly with age from 142.3 per 1,000

preschooI-age children to 365.1 per 1,000 young

adults age 18-24 years due primariIy to the

increase in acne vulgaris; then decreases sIightIy

at 25-34 years before starting the consistent

increase with age from such skin conditions as

psoriasis, vitiIigo, malignant and benign tumors,

and actinic and seborrheic keratoses.

NearIy one-eighth (118.2 per 1,000) or an

estimated 22.9 milIion of the U.S. population

age 1-74 years have one or more skin conditions

about which they complained or expressed concern. Nearly one-third of the persons with skin

conditions that the survey dermatologists d&ermined should be evaluated by a ph ysicia,n at

least once express concern about their condition; an additional one-fifth (18 percent) complain about skin conditions the examiners did

not feel were serious.

The majority of skin complaints have Oeen

present 5 years or longer, with skin conditions

affecting the feet more likely than those affecting the hands or other parts of the body to have

been present this long.

Among persons with skin complaints, 9 percent indicate the condition limited their activity

to some extent, 10 percent consider it a handicap in their employment or housework, and

about one-third feel it was a social handicap to

at least some extent.

The dermatological examiners rated more

than two-thirds of those persons with skin complaints as disfigured to some extent from the

condition; about one-fifth of those were rated

moderately or severely disfigured.

More than half of those persons with skin

24
complaints report some overall discomfort from

the condition, such as itching or burning. For

nearly 6 percent of those with skin complaints,

the condition is extensive enough to cause Imitation of motion.

Nearly one-fifth of those persons with skin

complaints are receiving the best possible care

for the condition, Of the remaining 81 percent

who are not, nearly all (94 percent) could, in the

judgment of the survey dermatologist examiners,

be improved with more expert care; this proportion ranges from 84 percent among preschoolage children to 96 percent among the oldest age

group in this study (65-74 years).

About one-half of those persons with skin

complaints have not sought medical advice for

the condition; an additional 15 percent who did

are, in the opinion of the dermatologist examiner, given inadequate medical advice. About

6 percent did not cooperate with the doctors

they had consulted. Other obstacles to improvement are cited by 13 percent of persons with

skin complaints, including insufficient money

(nearly 4 percent), too far from the doctor or

transportation not available (1.4 percent), not

being aware the condition could be treated, discouraged with the treatment, treatment was too

painful, medication needed for other condition

was causing eruptions, and persons were treating

themselves.

000

25
REFERENCES

1National Center for Health Statistics: Prevalence of

dermatological disease among persons I-74 years of age:

United States. Advance Data From Vital and Health Statistics. No. 4. DHEW Pub. No, (HRA) 77-1250. Health

, Resources Administration. Rockville, Md,, Jan. 26, 1977.

2National Center for Health Statistics: Origin, program, and operation of the U.S. National Health Survey.

Vital and Health Statistics. PHS Pub. No. 1000-Series

l-No. 1. PubIic Health Service. Washington. U.S. Government Printing Office, Aug. 1963.

3National Center for Health Statistics: Plan and

initial program of the Health Examination Survey. Vital

and Health Statistics. PHS Pub, No. 1000-Series l-No. 4.

Public HeaIth Service. Washington. U.S. Government

Printing Office, July 1965.

4National Center for Health Statistics: Cycle I of the

Health Examination Survey: sample and response,

United States, 1960-1962. Vital and Health Statistics.

PHS Pub. No. 1000-Series 1 l-No. 1. Public Health Service. Washington. U.S. Government Printing Office, Apr.

1964.

5National Center for Health Statistics: Plan, operation, and response results of a pro~am of children’s

examinations. Vital and Health Statistics. PHS Pub. No.

1000-Series l-No. 5, Public Health Service. Washington,

U.S. Government Printing Office, Oct. 1967.

6National Center for Health Statistics: Plan and operation of a health examination survey of U.S. youths 12-

17 years of age. Vital and Health Statistics. PHS Pub.

No, 1000-Series l-No. 8. Public Health Service. Washington. U.S. Government Printing Office, Sept. 1969.

7National Center for Health Statistics: Plan and operation of the Health and Nutrition Examination Survey,

United States, 1971-1973 (extended through mid-1974).

Vital and Health Statistics. Series 1-Nos. 10a and 10b.

DHEW Pub. Nos. (HSM) 73-1310. Health Services and

Mental Health Administration. Washington. U.S. Government Printing Office, Feb. 1973.

8DePartment of Dermatology, New York University

School of Medicine: Code of Skin Diseases, 1st rev. New

York. New York University, Feb. 1968.

9 Nelson, W. E. (cd.): Textbook of Pediatrics, 8th ed.

Philadelphia. W. B. Saunders Co., 1964.

10 Reisner, R. M.: Acne vulgaris. Symposium of

Adolescent Medicine. The Pediatric Clinics of North

America. 20(4):85 1-864, Nov. 1973. (W. B. Saunders

Co., Philadelphia.)

11 Ebling,F.j.G.,and Rook, A.: The sebaceous gIand,

in A. Rook, D. S. Wilkinson, and F. J. G. Ebling, eds.

Textbook of Dermatology, 2d ed. Vol. II. Ok ford.

Blackwell Scientific Publication, 1972. pp. 1545-1553.

12 Freinkel, R. K.: Medical intelligence-current con.

cepts, pathogenesis of acne vulgaris. N, Engl. J. Meal,

280(21):1161-1163, May 22, 1969.

13 National Center for Health Statistics: preva~erice of

chronic skin and muscuIoskeletal conditions, United

States, 1969. Vital and Health Stati&s. Series 1O-NO.

92. DHEW Pub. No. (HRA) 75-1519. Health Resburces

Administration. Washington. U.S. Government Printing

Office, Aug. 1974.

14National Center for Health Statistics: Eighth, Revision International Classification of Diseases, Adapted for

Use in the United States. PHS Pub. No. 1693. Public

Health Service. Washington. U.S. Government Printing

Office, 1967.

15National Center for Health Statistics: Skin conditions of youths 12-17 years, United States. Vital and

Health Statistics. Series 1 l-No. 157. DHEW Pub. No.

(HRA) 76-1639. Health Resources .4dminist~ation.

Washington. U.S. Government Printing Office, Aug.

1976.

16NationaI Center for Health Statistics: The National

Ambulatory Medical Care Survey: 1975 Summary.

United States, January-December 1975. Vital and @eqlth

Statistics. Series 13-No. 33. DHEW Pub. No. (PHS) 78-

1784. Public Health Service. Washington. U.S. Government Printing Office, Jan. 1978.

17 National Center for Health Statistics: Profiles of

chronic illness in nursing homes. United States: National

Nursing Home Survey, August 1973-April 1974. Vital

and Health Statistics. Series 13-No. 29. DHEW P~b, No.

(PHS) 78-1780. Public Health Service. Washington. U.S.

Government Printing Office, Dec. 1977.

18 National Center for Health Statistics: Replication:

An approach to the analysis of data from complex surveys. Vital and Health Statistics. PHS Pub. No. 1000-

Series 2-No. 14. Public Health Service. Washington. U.S.

Government Printing Office, Apr. 1966.

19 National Center for Health Statistics: PseudorepIication: Further evaluation and application of the balanced

half-sample techniques. Vital and Health Statistics. PHS

Pub. No. 1000-Series 2-No. 31. Public Health Service.

Washington. U.S. Government Printing Office, Jan.

1969.

26
LIST OF DETAILED TABLES

1. Prevalence of significant skin pathology of all types and the most frequently occurring types of conditions among parsons

1-74 years, by sex, showing rates, number of persons affected, and selected standard errors: United States, 1971 -1974 ..........

2. Prevalence of significant skin pathology of all types and the most frequently occurring types of conditions among pemons

1-74 years, by age, showing rates and selected standard errors: United States, 1971-1974 ..... ............... ..................... ...............

3. Prevalence of significant skin pathology of all types and the most frequently occurring types of conditions among males 1-74

years, by age: United States, 1971-1974 .................................................. ............... ..................................................................

4. Prevalence of significant skin pathology of all types and the most frequently occurring types of conditions among females

1-74 years, by age: United States, 1971-1974 ............ ................................................ ...............................................................

5. Prevalence of significant active skin pathology, significant skin pathology now in remission, and the coexistence of significant

active skin pathology and condition(s) in remission, among persons 1-74 years, by age and sex, showing rates, selected stand.

ard errors, and number of persons affected: United States, 1971-1974 .............. ...... ....................................... ............... ...... .....

6. Prevalence of significant active skin pathology, significant skin pathology in remission, and nonsignificant skin pathology

among persons 1-74 years, by type of condition, showing rates and number of persons affected: Unitad Statas, 1971 -1974...

7. Prevalence of skin conditions of concern (complaints), significant skin pathology of concern and not of concern to the

affected individual and nonsignificant skin pathology of concern to the individual among persons 1-74 years, by age and

sex, showing rates, selected standard errors, and number of persons affected: Unitad States, 1971-1974 .................................

8. Prevalence rates for skin conditions of concern (complaints), all types and the most frequently reported tyPa& amon9 Parsons 1-74 years, by sax and part of body affected: United States, 1971-1974 .............................. ............ ................................

9. Prevalence rates for skin conditions of concern (complaints), all types and the most frequently repotted types, arnon9 Pfsrsons 1-74 years, by age and part of body affected: United States, 1971-1974 .............. ............ ...................... ..........................

10. Prevalence rates for skin conditions of concern (complaints), all types and the most frequently reported types, among males

1-74 years, by age and part of body affected: United States, 1971-1974 ........................... ...... ....................................... ..........

11. Prevalence rates for skin conditions of concern (complaints), all types and the most frequently rePortad MM% amon9

females 1-74 years, by age and part of body affected: Unitad States, 1971-1974 ............?.................................. ................. .....

12. Prevalence of skin conditions of concern (complaints) among persons 1-74 years, by recurrence, duration, handicap, disfigurement and discomfort from condition, age and sex of person affected, showing rates, selected standard errors, and

number of persons affected: United States, 1971-1974 .................................... .................................... ....................................

13. Type of care sought and adequacy of treatment for skin conditions of concern (complaints) among parsons 1-74 years, by

age and sex, showing rates, selected standard errors, and number of persons affected: United States, 1971-1974 ...... ..............

28

29

30

31

32

33

34

35

36

39

45

46

27
Table 1. Prevalence of significant skin pathology of all typas and the most frequently occurring types of conditions among persons 1-74

years, by sex, showing rates, number of persons affected, and selected standard errors: United States, 1971-1974

Condition and NYU codel

Persons with one or more significant skin conditions ..................

Significant skin conditions, all types .... .......... .............................

Diseases of sebaceous glands ............ ...........................................7l4l.7l49

Acne vulgaris ..............................................................................7l4l5O

Cystic acne .................................... .......................................... ...714180

Acne scars ..................................................................................7l4l9O

Xerosis .......................................................................................7l493O

Dermatophytoses .......... ........................................................................l3l

Tinea pedis .....................................................................................1310

Tinea unguium ............................................................................... 1312

Tinaa versicolor ..........................................................................131910

Tinea cruris ..................................................................................13131

Tumors2 ........................................................................ 19 X,22 X,23 X,23Y

Malignant ........................................................................................l9x

Basal%ell epithelioma ..............................................................l9Xl

Benign2 .......................................................................................t...22X

Lipoma , .. ............................................................................“22X959

Precancerous and not specified ............................................... 23 X,23Y

Actinic keratosis ....... .................... .......................................23XO8l

Seborrheic dermatids ............................................................................7OO

Seborrheic dermatitis, type not indicatad ..................................700010

Atopic dermatitis, eczema ..............................701.708300.7083 lO.7O832O

Atopic dermatitis ............... ........................................................7 0831 O

Lichen simplex chronicus ...........................................................7 O832O

Hand eczema.. ............................................................................7olooo

Nummular eczema .....................................................................7'0101 O

Dyshidrotic eczema .......................................+............................7olo3o

Contact dermatitis .................................................................................7O3

Ichthyosis, keratosis ........................................... ................71 O130.71 Ol5O

Verruca vulgaris ...............................................................................696O3O

Follicul itis .......................................................................................l~l39O8

Psoriasis ............................................................................................~O6O9O

Seborrheic keratosis ...................................................................... 22X44X

Vitil igo ............................................................................ ................1~1621 O

Urticaria (hives. etc.) ..................... .......... ................ .......................242.243

Herpes simplex ........................ .................................. ......................t.....O96

All other skin conditions .................... ........................................................

Persons with one or more significant skin conditions ...... ............

~ate per 1,000 population

312.4

439.7

84.8

68.1

1.9

1.7

6.5

81.1

38.7

21.8

8.4

6.7

56.5

5.9

4.1

38.2

2.1

12.4

9.6

28.5

28.2

18.4

6.9

4.5

1.6

1.7

2.1

13.6

9.5

8.5

8.0

5.5

5.2

4.9

4.8

4.2

106.2

339.8

499.4

87.9

70.5

3.3

2.0

5.3

131.4

68.4

30.3

10.9

12.9

59,6

6.4

4.7

35.8

2.6

17.4

13.9

26.7

26.4

19.5

8.2

4.7

1.1

1.0

3.1

13.8

9.3

10.3

12.3

5.9

4.6

3.6

3.8

4.0

106.7

286.6

383.4

81.9

65.9

0.6

1.3

7.7

33.7

10.7

13.9

6.0

0.9

53.7

5.3

3.5

40.5

1.6

7.9

5.5

30.1

29.9

17.4

5.6

4.4

2.1

2.4

1.2

13.4

9.6

7.2

4.0

5.1

5.8

6.2

5.8

4.5

105.0

Number in thousands

60,601

85,287

16,465

13,217

375

321

1,260

15,733

7,509

4,232

1,623

1,301

10,968

1,136

796

7,412

401

2,420

1,858

5,520

5,476

3,575

1,332

882

311

332

405

2,641

1,835

1,684

1,553

1,070

1,010

957

933

824

20,519

31,988

47,018

8,279

6,638

312

192

497

12,372

6,438

2,856

1,022

1,214

5,606

602

445

3,372

244

1,632

1,306

2,514

2,490

1,B37

771

441

105

92

288

1,303

880

967

1,154

556

431

347

354

376

10,048

Standard error of rate

20.05 21.06

28,613

38,269

8,186

6,579

63

129

763

3,361

1,071

1,376

601

87

5,362

534

351

4,040

157

788

552

3,006

2,986

1,738

561

441

206

240

117

1,338

955

717

399

514

579

616

578

448

10,472

. . .

lSee reference 8.

z~xclude~ seborrhej~ keratosjs (22x44X) which is listed with benign tumors in the NylJ classification.

28
Table 2. Prevalence of significant skin pathology of all types and the most frequently occurring types of conditions among persons 1-74 years, by age,

showing rates and standard errors: United States, 1971-1974

Condition and NYU codel

Personswith one or mora significant skin conditions ...........

Significant skin conditions, all types....................................

Diseasesof sebaceousglands...............................................7l4l.7l49

Acne vulgaris......................................................................7l4l5O

Cystic acne .........................................................................7l4l8O

Acne scars..........................................................................7l4l9O

Xerosis ...............................................................................7l493O

Dermatophytoses ...........................................................................l3l

Tinea pedis .............................................................................1310

Tinea unguium .......................................................................1312

Tinea versicolor ..................................................................131910

Tinea cruris ..........................................................................l3l3l

Tumors2 ................................................................l9X.22Xz3X23Y

Malignant ........<...#...................................................................l9x

Basal+ell epithelioma ....................................................... 19X1

Benign2 ...................................................................................22X

Lipoma ........................................................................22X959

Precancerous and not specified ........................................ 23 X,23Y

Actinic keratosis ..........................................................23XO8l

Seborrheic dermatitis .....................................................................7oo

Seborrheic dermatitis, type not indicated ...........................7WOl O

Atopic dermatitis, eczama ......................701 ,7083 OO,7O831O,7O832O

Atopic dermatitis ...............................................................7 0831 O

Lichen simplex chronicus ...................................................7 O832O

Hand eczema ......................................................................7olooo

Nummuiar eczema ..............................................................7 0101 O

Dyshidrotic eczema ............................................................701 O3O

Contact dermatitis .........................................................................7O3

Ichthyosis, keratosis ...................................................71 Ol3O.7lOl5O

Verruca vulgaris .......................................................................696O3O

Folliculitis ...............................................................................7l39O8

Psoriasis...................................................................................7MO9O

Seborrheic keratosis...............................................................22X~X

Vitil igo ....................................................................................7l62lO

Urticaria (hives, etc.) ..............................................................242.243

Herpes simplex ..............................................................................O96

All other skin conditions .....................................................................

1-5 6-11 12-17 18-24 25-34

years yaars years yaars years

142.3

166.4

6.3

0.4

2.8

3.4

0.4

1.1

21.7

21.7

9.8

9.6

24.9

19.3

1.9

13.9

8.6

4.7

1.2

3.1

0.2

0.6

3.1

3.4

61.5

174.2

195.4

21.4

11.9

6.7

8.4

4.0

0.9

1.5

18.9

18.9

0,8

6.7

6.7

20.0

13.8

1.7

1.3

1.9

4.9

15.5

13.1

3.2

1.9

5.5

1.8

5.3

68.8

362.0

468.5

249.9

23? .9

2.0

4.5

3.9

33.2

14.1

1.9

10.2

4.7

31.3

0.5

30.7

0.1

18.8

18.5

17.0

10.7

4.1

0.2

0.6

0.4

8.6

16.7

15.5

5.3

2.5

1.0

3.4

5.1

60.2

3544 45-54

yaars years

Rate per 1,000 population

365.1

499.9

191.1

172.2

5.4

5.2

3.7

61.7

24.9

7.0

17.8

6.7

43.0

0.1

0.1

40.7

0.9

2.2

38.7

38.7

15.4

5.1

1.2

0.3

4.9

2.6

14.2

8.8

12.4

18.9

1.5

0.4

3.6

4.3

3.2

82.7

318.0

452.9

99.6

83.6

5.2

0.9

4.0

87.7

49.1

13.4

9.9

10.2

39.6

0.1

38.9

0.6

0.6

41.9

41.9

28.0

6.0

5.8

4.9

2.5

5.9

9.6

11.5

6.3

15.4

6.2

0.4

3.0

4.6

5.2

93.9

328.2

475.2

44.1

25.4

2.6

1.7

6.8

121.5

62.0

24.9

13.0

11.7

46.8

3.2

3.2

38.2

1.6

5.4

1.5

41.6

41.1

14.7

1.4

5.5

3.7

0.1

1.3

17.0

7.7

6.2

12.8

4.9

4.5

3.4

3.6

4.8

141.6

356.8

529.7

21.5

B.7

0.9

5.4

155.7

80.9

46.2

7.2

13.1

64.9

9.5

9.1

52.9

5.3

22.5

15.9

31.9

31.9

13.9

2.4

5.2

1.5

0.7

4.0

16.7

2.7

8.9

5.5

11.4

9.7

5.9

8.8

2.8

149.4

55G4 65-74

years years

161.0

i63.9

32.0

2.5

15.3

150.8

57.9

68.5

7.3

8.9

100.2

18.9

13.3

44.9

4.4

36.4

32.8

28.7

27.4

12.8

1.0

9.4

1.9

0.6

23.6

7.0

2.4

2.1

10.9

18.3

12.6

7.6

3.3

151.6

Standard error of rate

Personswith one or more significant skin conditions ........... 13.03 18.45 28.57 27.50 24.90 25.28 23.08 23.27

409.5

654.8

25.5

0.7

0.1

14.9

126.8

59.6

54.7

2.3

1.3

184.1

36.4

19.9

68.1

7.7

79.6

65.1

36.4

36.3

18.3

1.7

10.3

0.9

3.2

0.4

20,4

1.5

3.6

1.1

9.5

24.4

13.6

7.4

4.9

177.3

24.91

lSee reference 8.

2Exc]udes ~ebOmheic keratosjs (22X44X) which is listed with benign tUmOrSin the NyLJ classification.

29
Table 3. Prevalence of significant skin pathology of all types and the mosl; frequently occurring types of conditions among males 1-74 Years, by age:

United States, 1971-1974

Condition and NYU codel

Personswith one or more significant skin conditions ...........

Significant skin conditions, all types ...................................

Diseaseof sebaceousglands ................................................7l4l.7l49

Acne vulgaris ......................................................................7l4l5O

Cystic acne .........................................................................7l4l8O

Acne scars............!.......................................<.....................7l4l9o

Xerosis ...............................................................................7l493O

Dermatophytoses ...........................................................................l3l

Tinea pedis .............................................................................l3lO

Tines unguium .......................................................................l3l2

Tinea versicolor ..................................................................13191 O

Tines cruris ..........................................................................l3l3l

Tumors2 ................................................................l9X.22X.23X.23Y

Meiignant ................................................................................l9x

Basal-cell epithelioma .......................................................l9Xl

8enign2 .............#.....................................................................22x

Lipoma ........................................................................22X959

Precancerous and not specified ........................................ 23 X,23Y

Actinic keratosis ..........................................................23XO8l

Seborrheic dermatitis .....................................................................7OO

Seborrheic dermatitis, type not indicated ...........................7 0001 O

Atopic dermatitis, eczema ......................701 ,708300,708310,708320

Atopic dermatitis ...............................................................7O83lO

Lichen simplex chronicus ...................................................7O832O

Hand eczema ......................................................................7olooo

Nummuler eczema ..............................................................701 OlO

Dyshidrotic eczema ............................................................701 O3O

Contact dermatitis .........................................................................7O3

Ichthyosis, keratosis ...................................................71 Ol3O.7lOl5O

Verruca vulgaris .......................................................................696O3O

Folliculitis ...............................................................................7l39O8

Psoriasis...................................................................................7O6O9O

Seborrheic keratosis...............................................................22X44X

Vitiligo. ...................................................................................716210

Urticaria (hives, etc.) ..............................................................242.243

Herpes simplex ..............................................................................O96

All other skin conditions .....................................................................

I&l&l@

135.9

155.8

4.9

3.1

3.6

0,8

1.0

14.5

14.5

7.1

7.1

21.2

17.0

11.2

10.7

5,2

2.0

%8

CI.2

41.4

:!.7

62,3

182.4

209.7

19.5

6.7

9.1

12.4

7.1

1.2

2.5

22.1

22.1

5.5

5.5

29.3

19.7

3.0

2.6

2.5

5.7

18.4

12.8

3.5

1.2

4.3

1.7

4.8

68.5

363.6

477.2

248.0

232.5

2.4

3.5

3.9

54,0

26.0

3.7

10.9

9.2

25.5

1.0

24.3

0.2

13.9

13.9

19.4

15.5

2,5

6.9

12.7

14.8

7.5

1.1

1.3

7.4

64.7

Male

Rate per 1,000 males

393.4

564.7

206.6

182.8

9.3

8.9

2.7

101.8

46.7

10.0

24.7

13.8

44.9

42.1

1.8

2.8

37,6

37.6

to.7

5.6

1.1

3.5

19.5

10.3

21.5

29.9

3.1

4.0

0.5

74.3

lSee reference 8.

2Exclude~ ~ebOrrhei~ ker~tO~is (ZZX44X) which is Iiated with benign tumors in the NyU classification,

358.4

532.8

102.6

85,1

10.8

1.5

152.9

94.0

21.4

11.5

19.3

41.4

.40.1

1.3

1.3

40.5

40.5

28.9

5.7

6.9

3.1

2.9

8.1

9.6

10.4

7.4

25.4

9.9

2.1

2.0

7.6

92.1

335.8

508.4

38.2

17.7

3.5

3.1

5.5

198.4

106.4

34.2

17.7

21.8

41.1

3.5

3.5

30.8

0.9

6.8

1.8

28.8

28.8

10.1

1.1

4.3

2.4

14.2

6.8

8.5

22.2

3.1

4.3

0.8

3.1

128.8

45-54

years

438.0

677.4

30.0

15.3

1.2

4.6

268.5

153.4

64,7

9,4

24.6

92.3

11,3

10.7

48.0

5.7

33.0

25.4

40,1

40.1

17.4

3.6

4.7

1.2

7.7

14.1

3,1

8.7

6.3

10.4

10.4

3.5

10.5

4.4

157.7

E_l&-

424.4

717.9

31.7

5.3

9.6

247.5

98.8

103.2

10.2

18.5

128.4

20.6

15.5

50.2

8.1

57.6

53.2

32.0

29.3

14.2

11.9

2.3

33.1

3.5

2.6

1.2

15.2

15.3

9.5

4.8

0.6

178.3

467.8

782.4

25.7

1.6

0.2

11.8

186.5

95.9

71.3

4.9

2.9

222.7

44.0

27.1

65.5

10.9

113.2

96.3

39.3

39.3

23.3

1.6

18.0

1.6

0.2

18.0

2.0

4.5

2.5

14.4

24.4

16.4

7.1

1.8

193.8

30
Table 4. Prevalence of significant skin pathology of all types and the most frequently occurring types of conditions among females 1-74 years, by age,

United States, 1971-1974

Condition and NYU codal

Personswith one Or more significant skin conditions ...........

Significant skin conditions, all types ..................................

Disease of sebacaousglands .. .. .. .... .. ... .. ... .... .. ... .... . .. .. .... . .....7l4I.7I49

Acne vulgaris ......................................................................7l4l5O

Cystic acne .........................................................................7l4l8O

Acne scars..........................................................................714l9O

Xerosis ...............................................................................71493O

Dermatophytoses ...........................................................................l3l

Tinaa pedis .. ..........................................................................l3lo

Tinea unguium .......................................................................l3l2

Tinaa varsicolor ...........<......................................................l3l9lo

Tinea cruris ..........................................................................l3l3l

Tumorsz ................................................................ 19X,22X,23 X,23Y

Malignant ................................................................................l9X

Basal+all epithelioma ....................................................... 19X1

Benignz ...................................................................................22x

Lipoma ........................................................................22X959

Precancerous and not specified ........................................ 23 X,23Y

Actinic keratosis ..........................................................23XO8l

Seborrheic dermatitis .....................................................................7oo

Seborrhaic dermatitis, type not indicated ...........................7 0001 O

Atopic dermatitis, eczema ......................701 ,708300,706310,708320

Atopic dermatitis ...............................................................7O83lO

Lichen simplex chmnicus ...................................................7O832O

Hand aczema ......................................................................701 OOO

Nummular eczema ..............................................................7ololo

DyshidrOtic eczema ......................... .................................701030

Ccmtact dermatitis .........................................................................7o3

Ichthyosis, keratosis ...................................................7lol3o.7lol5o

Verruca vulgaris .......................................................................696O3O

Foliiculitis ... ...........................................................................7l39O8

Psoriasis...................................................................................7O6O9O

Seborrheic keratosis............................................................... 22X44X

Vitiligo ....................................................................................71621 O

Urticaria (hives, etc.) .............................................................242.243

Harpes simplex ..............................................................................O96

All other skin conditions ... .... . .... . .... .... . ... . . .... .. .. . .... .. ... ... .. .... .... . ... .. .... .

~See reference 8.

1-5 I

6-11

years years

148.9

177.4

7.7

0.7

2.5

3.2

1.0

29.2

29.2

12.6

12.3

28.7

21.4

4.0

16.8

6.4

4.1

0.4

0.2

0.5

1.1

1.8

4.1

60.6

166.0

180.7

23.5

17.3

4.1

4.1

0.8

0.7

0.6

15.7

15.7

1.7

7.9

7.8

10.6

7.7

0.4

1.3

4.1

12.5

13.4

2.8

2.8

6.7

1.9

5.9

68.8

12-17

years

360.4

159.3

251.8

231.3

1.6

5,5

3.9

11.4

1.5

9.4

37.4

37.4

23.8

23.3

14.4

5.5

5.7

0.3

1.2

0.7

10.4

20.8

16.4

3.1

5.1

0.8

5.6

2.8

55.5

Famale

Rata per 1,000 females

338.5

439.2

177.1

162.2

1.7

1.9

4.5

22.3

4.5

4.2

11.4

41.1

0.2

0.2

39.4

1,5

39.8

39.8

19.7

4.6

1.2

0.7

9.6

1.7

9.2

7.3

4.0

8.7

3.1

0.8

4.0

4.6

5.6

91.9

281.2

380.0

96.7

62.2

1.8

6.4

28.3

8.3

6.1

6.5

1.7

38.1

0.2

37.9

43.2

43.2

27.2

6.3

4.7

6.6

2.1

3.9

9.4

12.6

5.1

6.1

2.6

0.9

3.9

6.9

2.9

96.1

321.1

$44.8

49.5

32.4

1.8

0.4

8.0

51.1

21.3

16.3

8.5

2.4

52.1

3.0

3.0

45.2

2.4

3.9

1.2

53.3

52.4

18.9

2.6

9.6

3.2

0.2

0.3

19.5

8.2

4.1

4.1

6.5

4.7

6.5

6.2

6.5

53.6

282.3

394.0

13.7

2.7

0.7

6.2

52.2

14,5

29.2

5.1

2.5

78.3

8.0

7.6

57.5

4.9

12.8

7.3

24.3

24.3

10.8

1.3

5.7

2.9

0.2

0.7

19.1

2.3

9.2

4.7

12.4

9.1

8.2

7.3

1.2

141.2

55-84

years

306.1

426.5

32.2

20.7

64.6

21.1

37.7

4.7

0.4

75.2

17.5

11.4

40.3

1.0

17.4

14.6

25.7

25.7

11.7

1.9

7.1

1.6

1.1

15.3

10.1

1.1

2.8

7.1

21.1

15.4

10.1

1.5

132.6

65-74

years

365.5

558.5

25.3

17.5

81.8

32.2

42.2

0.4

154.8

30.5

14.6

70,2

5,2

54,1

41.6

34.2

34.1

14.6

1.6

4.4

1.6

4.4

0.4

22.3

1.1

2,1

5.8

24,5

11.5

7.7

7.1

165.7

‘Excludes seborrheic keratosis (22X44X) which is listed with benign tumors in the NYU classification.

31
Table 5. Prevalence of significant active skin pathology, significant skin pathology now in remission, and the coexistence of significant

active skin pathology and condition (s) in remission among persons 1-74 years, by age and sex, showing rates, selected standdrd

errors, and number of persons affected: United States, 1971-1974

Significant active skin

conditions

=_L=E

Significant skin pathology

Age and sex

Rate per 1,000 population

Both sexes, l.74years ............. ........ .............. .......... ..... 31.6 64.1 216.7 124.9 106.4 18.5 47.4

*4.1

*:2.7

“18.4

*3 1.6

*2!LI.9

●3!5.7

46.7

63.2

70.1

43.2

16.0

15.7

69.7

71.6

75.1

75.7

79.4

75.6

105.1

73.3

122.2

155.8

273.9

261.9

213.0

216.8

230.7

223.1

234.3

223.3

69.6

69.1

94.1

131.2

156.1

162.6

161.3

145.5

123.4

121.4

65.0

63.5

82.7

117.8

133.6

131.1

131.1

123.8

111.2

104.4

*4.6

*5.6

*11.4

+13.4

●22.5

*3 I .5

*30.3

*2 I .7

*12.2

*17,0

*’12.4

*’16.7

41.1

51.1

60.4

52.4

62.5

68.4

62.3

Male, 1-74 years ................................................................. 51.4

l.5years ................. .................................. ................................ ....

6-11 years ... .......... ........ .. ................ .......... ................ ................ ....

12-17 Vears .. .. ...............................................................................

18-24 Vears .... ........ ........ ...................................................... .........

25-34 years ...................................................................................

35-44 years .... ........ .. ...... .. .. ....c. .. ...... ........ .. ........ .. ...... .......... .........

45-54 years ...................................................................................

55-64 yaars .... .. ...... .......... .. ........ ........ ...........................................

65-74 years .... .. .................. ................................ ...........................

*3.3

*4.6

*’24.6

*43.7

●4,1 .0

●4.8.2

‘85.0

99.5

92.5

*20.7

“13.3

*18.1

64.4

84.0

92.5

76.2

109.4

94.6

129.7

55.4

119.3

159.7

274.6

265.7

224.9

211.4

263.6

230.3

245.6

210.5

62.4

53.6

92.5

132.1

145.5

176.4

159.5

152.7

116.1

128.3

59.5

46.9

87.5

118.3

132.3

137.3

122.9

131,3

101.8

110.3

*2.9

‘6.7

‘5,0

*13.8

*13.2

*39.1

*36.6

*21.4

*14.3

*18.O

*12,0

*17.5

*4 I .9

51.7

71.3

56.4

66.8

88.3

62.4

Female, 1-74 years ............................................................. 43.6

1-5 years .. .....................................................................................

6-11 years .....................................................................................

12-17 years ....... ........ ...... .. ........ .. ........................ ..........................

18-24 years ...................................................................................

25-34 years ............. .. ........ ........ .......... ...... ....................................

35-44 Vears ...................................................................................

45-54 Vears ..... .. ................ ........ .... ......................cc.................c......

55-64 Vears ...................................................................................

65-74 years ..... .................... ...... ....................................................

‘~4.8

“0,8

*’11.8

●20.3

●’19.8

*124.2

*:29.9

“30.8

!53.2

*18.9

*13.2

75.3

60.0

59.2

75.3

51.9

58.7

86.6

125.2

152.0

273.3

258.2

202.2

221.6

200.5

216.6

225.7

77.1

85.0

95.7

130.4

165.8

149.9

162.9

139.1

128.9

70.7

80.6

77.5

117.4

134.9

125.4

138.6

117.2

118.3

*6,4

*4.4

‘18.2

*13.O

*30.9

“24.5

‘24.3

*2 I .9

‘10.6

*12.8

“15.9

40,3

50.5

50.3

48.7

58.5

‘50.6

62.2

Standard error of rate

Both sexes, ‘I-74 years ......................... ........ ........ .........

+-

7.46 15.10

=

8.65 14.70

6.50 17.40

31.301 ---l ---l ---1 ---

Maler 1-74 years ............................................................................

Female, 1-74 years ............. ........ .................. .................. ............... :Ml :::1 :::I :::1 :::

Nun }er of persons affectad in thousands

8oth sexes, 1-74 years .................. ...... .... ...................... 6,127

*

12,433

=

4.,063 6,904

;!,064 5,529

42,044 24,236 20,834 3,402 9,193

-

21,021 11,427 9,826 1,601 4,839

21,020 12,809 11,008 1,801 4,354

Male, 1-74 years .................. ...... .... ...... .......... ................ ...... ..........

Female, 1-74 years ........................................................................

32
Table 6. Prevalence of significant active skin pathology, significant skin pathology in remission, and nonsignificant skin pathology among persons 1-74

years, by type of condition, showing rates and number of persons affected: United States, 1971-1974

Condition and NYU codel

Syphilis ... .. .......... ............ .......... .. .......... .. .......... ...................... ........................... ...O2O429

Other venereal diseases ..................... .......... .. .......... ............ .......... ................. ........O3O039

Bacterial diseases ...... .. .... ...... .... ...... ............ .. .......... ............ ..... ..... ..... ....................O5O~59

Other spirochetal disemes ..... ............ ........ .. .. .. .... .. .. ............ .......... .......... .......... .....O7O~79

Viral diseases ............ .......... .. .... ....... ......... .. .......... .. .. ........ .......... .. .......... ........ .......O84~96

Rickettsial diseases .................. ...... ...... ............ .................... .. .......... .. ... .................l OO.lO8

Leishmaniasis and other parasitic diseases .. .......... .. ........ .......... .. .... ...... .......... .......l2O.l3O

Dermatophytoses. ............ ....... ..... ............ .... .. .... ............ .......... ..... ...................... ..... ....l3l

Deep fungal infections .... .. ............ ...... .... ............ .......... .. .... ........... ........................l32.l34

ZOOnOses ....... .............. ...... .... ....... ..... ............ ..... ..... ............ .......... .......... ............ ..l35.l37

Sarcoidoses and other parasitic diseases.. ............ .......... ............ .......... ..... .....................l3s

Malignant tumors ..... ........... ....... .. ........ .. ..... ................. .......... .......... .. .......... .......... ..... 19X

Bowen’s disease, Paget’s disease, erythrophasia ..... .. .. .... .. .. .... .. .... .. ........ .. ...... .... ... 19X0

Basal-cell epithelioma, fibroepithelial tumor .............. ............ ............ ...... .... ..... ... 19X1

Base-squamous epithelioma or carcinoma and related conditions ......... .......... ..... 19X2

Malignant melanoma, lentigomaligna ............. ..... ..... ...................... .......... ............l9X6

Squamous+ell carcinoma .... .......... ...................... .... ...... ............ ..... ..... .. ...............l9X8

Adenocercinoma and related conditions ....... ...... .... ...... ................ ............ .......... . 19X9

Malignant tumor, skin, NOS ... .... ...... .. ...... .... .. .. .... .. .. .......... ...... .... ........ .... ...... .... . 19XX

Lymphoma, leukemia . .. ........ .. ........ .. .. ........ .. .......... .......... .. ...... .... ............ .......... ...... ...2ox

Benign tumor3 .... .... ......... .... ...... ............ .......... .......... .. .......... .. ........ .. ...... ...... ........ .. .... 22x

Seborrheic keratosis ............. .......... .. ........ ............ .......... .. .......... .......... ............ ....22X44X

Precancels .... .... ...... .. .. ........ .. .... .... .. .......... .. .. ........ .......... .. .......... .. ........ .. ........ .. ...... .. ...23X

Tumor, malignancy unknown .... .......... ...................... .......... .. ........ .... .. ...... .. .. ...... ........23Y

Urticaria< .... ....... ....... ........<. ................. .......... ...................... .......... ........................242.243

Allergic eczema or dermatitis due to extarnal sgant ................. ..... ..... ..... ................. ....2a

Other allergy ........ .. .......... .. ...... ...... ........ .. .... .. .... ..... ..... ............ .......... .......... ............ ....245

Diseases of thyroid glands ..... .. .......... .. .... .... .. .......... .................... .. .......... .......... ....25O.2W

Diabetes mellitus .. .. .. .. ....!... ...... .... .. .... .... .. .. .. .. .... .... .. .. .. ...... .... .. ...... .. .. ...... .... .. .. .. .... .. ....2643

Other endocrine disorders ........ .. .......... .. ...... .... .......... ............ ...................... .........27 O.277

Avitaminosis and nutritional deficiencies .. .... .... .. .. .. ........ .. .. ...... ............ ..... ..... ......28O.2B6

Lipoidoses and other metabol ic diseases ......... ..... ..... ..... .. .......... .......... ..................288-289

Anemias . .. .. ........ .. ...... .... .......... .. ...... .. .. .... .... .. .... .. .... .. .................... .......... .. ........ ...29O.293

Other blood dyscraaias ..... ....... ..... ..... ................. ...... ......... ............ ..... ....... ...........294.299

Psychophysiological and related conditions ... .. .. .... .. .. .. .. .... .. .... .... ...... ............ ...... ..32 O.324

Diseases of nerves ....... ...... ...... .. ........ ........ .. .. .... .. .... .. .. ........ .... .. .... ............ ........ .....36O.369

Diseases of eyes (arcus senil is, etc.) .. .. ........ .. .... .. .... .. .. .. ...... .......... ............... ..... .....37O.3B9

Diseasas of ear ..... .. ............... ............... ............ .......... .............. ........ ............ ..........390-398

Rheumatic fever ..... ................. ..... ............ ..... ................. ..... ........................... .......4OO4O2

Diseases of arteries, connective tissue ....... ............ ........ .. .. .......... .... ...... .......... .......45O4%

Diseases of veins ............ ............................ .... ................. .......... ............ ..... ............460-466

Other diseases of circulatory system .. ...................... ............ ..... ..... ..... ..... .. ............467468

Diseases of digestive Wstem ..... .......... ............ .......... .. .... ...... ........ .. .. .... ...... .... ...... ..53 O.567

Diseases of genito-urinary system ...... .......... .. ..... ..... ............ ...... .... .... ...... .......... .. ..6 OO+37

Infections of skin, subcutaneous tissue .... .... .. ..... ..... ...... .... .. .......... ...... .... .. ............69O.698

Seborrheic dermatitis ..... ............ .. .......... ............ .. ... ..... ...... ...... ..... ... .. .......... .... ........ ....7w

Eczema .. .. .... .... .. .......... .. ...... .... .......... .... ........ .......... ................ ...... .......... .......... ...........7Ol

Contact and other dermatitides ....... ... .... ..... ... ................... ..... ..... ..... ..... .. .......... ...........7O3

Pemphigus and relatad conditions .. .... .. ........ .... .. ........ ............ ........ .. .. .. ........ .. ..............7M

Ewthemas .. ........ .. ........ .. .. ........ .. .. .. ...... ..... ....... .. .................... .......... .. .. ........ .. ...... .. ......7O5

Psoriasis .......d. .. .......... .... ...... .. .......... .. ...c.... .. ........ .. .......... .. .. .... .... .......... .. ........ .. ........ ...7W

Lichen planus and related conditions ....... .. ........ .. .. .. .. .. .. .. .. .... .. .. .......... .. ... .... .. .... .. .. .. ..7o7

Pruritis and related conditions ............. .... ...... .......... ............ .......... .......... .. ..... ..... .. .......7O8

Corns, callosities .. .......<.... .. ...! .... .. ........ .. .. ........ .. .. .... .. .......... .. .. ........ .. .......... .......... .. .....7o9

Other hypertrophic and atrophic skin conditions ..... ...... ..... ..... .. .......... .......... .. ...... .. .. ..71 O

Diseases of nails ............. ..... ........ .... ...... .... ............ ............... .......... ..... .......<.... .......... ....7l2

Diseases of hair, hair follicles ........ .. .... ...... ............ .......... ..... ..... ........................... ..... ....7l3

Diseases of sweat, subcutaneous glands ..... .... .. .......... .... .. .... .......... .. ........ .. .... .. .... .. .. .....7l4

Chronic ulcers of sKn .... .......... .. .......... .... .. .... ...... .... ............ .......... ..... ..... ............ .... .....7l5

Other skin diseases ........... ........ ................ .... .. .... .......... ...................... ......... .................7l6

Diseases of bones, organs of movement ....... .. ...... .... .......... .......... ............ ..... ..... ....74O.744

Congenital malformations . .. .... .... .. .... .. .... ...... ...... ........ .. ...... .... ..... ..... .. .......... ........751 .759

Diseases of early infancy ... .......... .. .......... ..... .... ............ .......... .......... ............ ........766.7BO

Symptoms, senility, and illdefined conditions .. ...... .. .. .. ........ .. ........ .. .......... .. .... ....78l.795

Injuries, adverse effects of chemicals, and other external conditions such as sunburn .. .. .......... .. .......... .. .... .. .... ...... ...... .... ...... .. ........ .. .......... .......... .......... ..............850.988

lSce reference 8.

Significant skin I

Nonsigpathology nificant

Active

Remis-

. sion

skin

pathol09Y

Rate per 1,000 population

0.1

2.5

0.2

4.5

0.3

0.1

81.1

2.4

0.8

5.9

0.2

4.1

0.7

0.4

0.3

0.2

3:;

5.2

12.1

0.4

4.8

0.3

0.9

0.1

0.0

1.2

0.6

3.6

0.6

0.1

0.1

1.0

7.5

1.0

2.4

0.3

16.9

28.5

6.8

13.6

0.2

4.7

8.8

0.8

13.7

3.2

21.8

2.7

15.8

67.0

0.2

27.5

0.2

4.1

1.9

3.7

0.7

0.1

0.1

0.0

5.9

0.1

11.0

0.7

0.1

0.0

5.6

3.4

0.2

0.6

1.1

0.2

0.0

4.8

0.4

2.5

0.1

5.9

3.3

0.1

0.0

0.3

0.1

0.2

0.1

0.0

0.4

0.0

0.1

0.1

1.1

0.0

1.4

10.4

4.1

6.3

31.9

0.0

0.7

5.1

0.1

7.7

0.2

1.1

0.2

2.1

19.3

0.3

4.1

0.1

0.4

0.0

0.3

1.3

2.s

(21

F)

(21

F)

(2)

0.1

2.0

0.2

0.1

5.7

F)

F)

(2)

[2)

F)

(2)

F)

0.1

158.6

118.9

136.0

(=’1

21.8

(2)

(2)

F)

(2)

(2)

0.1

4.7

(21

41.5

F’)

P)

17.0

0.4

(2,

7.5

88.1

181.7

59.6

1.8

44.1

88.2

11.2

40.3

[2)

6.6

5.5

139.8

12.1

153.7

410.9

(21

34.7

122.5

F)

488.7

(2)

12.1

(2)

20.7

0.1

Significant skin I

Nonsigpath.dogy nificant

Number of persons affected

in thousands

8

494

4

878

62

23

15,734

463

164

1,136

36

796

145

72

61

36

12

7,412

1,010

2,347

72

933

52

184

29

1

235

116

703

123

29

24

195

1,464

1s8

462

56

3,081

5,520

1,325

2,841

48

915

1,710

156

2,663

622

4,234

522

3,067

16,878

32

5,340

35

789

378

713

136

13

21

7

1,141

24

2,126

140

16

4

1,077

668

47

111

219

32

92;

74

493

16

1,141

639

20

5

57

11

31

14

5

69

2

27

24

218

9

26B

2,008

BO1

1,608

6,1S4

2

139

992

20

1,500

41

211

44

408

3,735

63

788

14

72

9

53

260

537

(2}

(21

(2)

F)

(2)

14

380

35

27

1,112

(2)

F’)

(2)

F’)

(2)

F)

(2)

12

30,770

23,073

13,704

(2)

4,235

PI

(2)

(2)

F)

[2)

26

904

[2)

8,053

F’)

F)

3,298

l?

1,449

17,087

32,250

11,557

358

8,552

17,101

2,176

7,810

[2)

1,285

1,076

27,122

2,349

29,818

79,708

(2)

6,729

23,754

(2)

94,7B7

[2)

2,339

F’)

4,016

29

‘Conditicm not-specifically identifiable On record,

3Hxcludes seborrheic keratosis (2 2X44X) which is listed with benign tumors in the NYU classification.

NOTE: NOS= not othwwise specified.

33
Table 7. Prevalence of skin conditions of concern (complaints), significant skin pathology of concern and not of concern to the affected individual, and

nonsignificant skin pathology of concern to the individual among persons 1-74 yeara, by age and sex, showing rates, selected standard errOrs, and number ~f

persons affected: United States, 1971-1974

Age

Total, 1-74 years.. .. .. .

1-5 year. .... .. ...... .. .... .. .... .... .. .... .

6-11 years . ...... .. .. .. .. .. .. .. .... .. .. .. .. .

12-17 years .. .. ...... ...... ... ... ... ... .. ..

18-24 veals .. .. .. .. .. ...... ........ ...... ..

25-34 years .. .. .. .... ...... ...... .. .. .. .. ..

35-44 years ... .. .. .. .. .... .. .. .. .. .... .. .. .

45-54 years ... ... .... ..... ... .. .... ... ... ..

56-84 years ... .. .... ...... .... .. ...... .... .

65-74 years .. .. .. .. ...... ...... ...... .. .. ..

Total, 1-74 years ...... .

Total, 1-74 years .. .... .

6oth sexes

m

118.2

40.4

46.2

148.1

150.0

134.0

130.6

141.0

122.6

138.6

7.58

97.1

30.8

40.4

126.8

116.5

107.1

108.9

113.4

97.3

126.2

6.23

215.3

111.5

133.8

235.2

248.6

210.9

219.3

243.4

284.6

283.3

13.82

21.1

9.6

5.8

21.3

33.5

26.9

21.7

27.6

25.3

10.4

1.35

-

Male

Skin

IzI

Significant skin Nonsigcon - patholcgy of: nificant

ditivn skin

of

Con.

No patholcOn- cOn- Ogv of

tern tern tern concern

Rate per 1,000 population

128.2

33.2

51.3

139.2

159.0

148.8

146.5

184.51

130.5

155.:1

108.0

28.0

46.0

120,5

124.5

121.8

125.0

152.7

111.8

144.1T

231.8 20.2

107.9 10.2

136.4 5.3

243.1 18.7

268.9 34.5

236.6 27.0

210.8 21.5

285.3 31.8

312.5 18.7

323.6 11.7

Standard error of rate

7.94 j 6.69 1 14.36 I 1.25

Skin

cOndition

of

cOncern

108.8

47.9

41,0

157.3

141.5

120.5

116.0

100.9

115.4

122.2

Female

m:

Significant skin Nonsigpathology of: nif icant

skin

COn -

No patholcOn- Ogv of

tern tern concern

86.9

33.8

34.6

133.4

109.1

93.6

94.2

77.3

84.4

112.6

7.64 I 6.10

199.7

115.0

131.3

227.0

229.4

187<6

226.9

205.0

221.8

252.9

21.9

-

14.1

6.4

23.9

32.4

26.9

21.8

2!3.6

31.0

9.6

14.02 I ‘1,61

Number of persons (in thousands) with one or more such conditions

22,929 18,841 41,760 4,088 12,072 10,168 21,820 1,904 10,857 8,673 19,940 2,184

34
Table 8. Prevalence rates for skin conditions of ccmcern (complaints), all types and the most freauentlv reDorted tvPes, am.mg persons 1-74 years, by sex and Part of body

affected: United States, 1971-1974

Condition and NYU codel

Skin conditions of concern, total .............. ......................

Skin conditions of concern with site and type specified.,

Diseases of sebaceous glands ..........................................7l4l.7l49

Acme vulgaris .......... .............. .............. ................ ...........714150

Cystic acne ....................................................................7l4l8O

Acne scars ..................... .. .............. ............ ....................7l4l9o

Xerosis .. ............ ............ .. .............. .............. ..................7l493O

Tumors2 .. ............ .............. ...............................l9X.22X23X.23Y

Malignant .. .............. ................................................ .......... 19X

Basal-xdl epithelioma ..................................................l9Xl

Benign2 ........ .. .............. .. .... ........ .. .. .............. .. .............. ......22x

Lipoma .............. .....................................................22X959

Precancerous and not specified ...................................23 X.23Y

Actinic keratosis .....................................................23XO8l

Seborrheic dermatitis .... .. .... .......... ................ ............................7OO

Sebmrheic dermatitis, type not indicated ......................7 OOOlO

Atopic dermatitis, eczema ....... .. ........701 ,708300,708310,708320

Atopicdermatitis . .............................. ...........................7 0831 O

Lichen simplex chrOnicus .......................... ....................7O832O

Hand eczema ... ............ ................................ .. ................701 OOO

Nummular eczema .........................................................7ololo

Dyshidmtic eczema ............ .. .........................................7OlO3O

Contact dermatitis ..................... ...............................................7o3

Ichthyosis, keratosis ........ .............. ........................71 O130.71 Ol5o

Seborrheic keratosis .................................... ......................22X44X

Vitiligo .................................. .............. ...............................71621 O

Urticaria (hives, etc.) ........... ................ .. .............. ..............242.243

Herpes simplex . . .................. ............................ .. ...................O96

All other conditions ...... .. .............. ..................................................

Type and location not specified .... .. ................................ ................

8oth sexes

~

118.2

113.6

28.2

23.6

1.7

0.3

0.9

21.6

9.7

4.5

2.7

3.2

8.1

2.0

1.7

2.4

0.1

3.7

3.1

5.4

5.4

10.8

4.5

1,9

1.1

0.8

1,6

6.4

1.3

1.4

1.B

3.8

0.7

1.4

1.4

0.8

20.5

4.6

10.8

10.8

0.1

0.1

0.0

1.1

0.1

0.2

0.6

0.0

0.1

0.5

0.5

0.1

0.1

3.1

0.6

0.1

1.1

0.2

1.0

2.5

0.8

0.5

0.1

1,9

. . .

17.9

17.9

0.1

0.1

0.0

0.1

12.5

9.3

3.1

0.4

0.1

0.1

0.2

0.0

0.1

0.0

0.0

1.3

0.1

0.2

0.2

0.5

0.4

0.2

0.0

0.0

3.0

. . .

—

Other

64.9

84.9

28.0

23.4

1.7

0.3

0.8

8.0

0.3

1.2

2.7

3.2

7.1

1.9

1.6

2.1

0.1

3.1

2.6

5.3

5.3

6.4

3.8

1.6

0.4

0.1

3.5

1.3

0.4

1.8

3.3

0.7

1.3

1.4

0.8

15.6

. . .

—

Male

Total Hand Foot Other

Rate per 1,000 population

128.2

[27.7

29.0

23.1

3.1

o.B

35.9

17.8

5.7

3.5

6.3

8.3

2.3

2.1

1.5

0.2

4.5

3,8

4,8

4.8

11.7

5.1

2.1

1.0

0.8

2.1

6.9

1.3

0.9

2.7

3.8

0.4

0.7

0.6

0.6

20.1

0.5

—

12.6

12.6

1.8

0.2

0.3

0.5

0.5

0.5

0.2

0.2

3.4

0.8

1.0

0.3

1.0

2.7

0.3

0.7

0.1

2,9

. . .

—

27.6

27.6

0.0

0.0

0.0

21.3

17.1

3.8

0.2

0.2

0.2

0.1

0.1

1.9

0.1

0.4

0.3

1.1

0.6

0.1

0.1

3.3

. . .

—

87.5

87.5

29.0

23.1

3.1

0.8

12.B

0.5

1.6

3.5

6.3

7.6

2.1

1.9

1.5

0.2

4.0

3.3

4.6

4.5

6.4

4.2

1.7

0.2

3.6

1.3

0.5

2.7

3.1

0.4

0.5

0.6

0.6

13.9

. . .

Female

Total IIHand Fcmt I Other

108.8

100.3

27.5

24.1

0.3

0.7

0.9

8.2

2.0

3.2

2.0

0.2

8.1

1,8

1.3

3.4

0,0

2.9

2.4

5.9

5.9

10.0

3.8

1.8

1.2

0.8

1.2

5.9

1.3

1.8

0.9

3.8

1.1

2.0

2.2

0.9

20.7

8.5

9.0

9.0

0.2

0.2

0.0

0.4

0.0

0.2

0.8

0.1

0.3

0.4

0.4

3.0

0.3

0.1

1.2

1.0

2,3

1.3

0.2

0.0

0.8

. .

8.8

8.8

0.2

0.1

0.1

4.4

2.0

2.3

0.5

0.4

0.0

0.1

0.6

0.1

0.0

0.0

0.2

0.2

0.1

0.0

2.6

. . .

82.5

82.5

27.1

23.8

0.3

0.7

0.8

3.4

0.0

0.7

2.0

0.2

6.8

1.7

1.3

2.7

0.0

2.4

2.0

5.9

5.9

6.4

3.4

1,7

0,8

0,2

3,4

1.3

0,3

0.9

3.5

1.1

2,0

2.2

0.9

17,3

. . .

lSec reference 8.

‘Excludes seborrheic kcrstmis (22 X44 X) which is listed with benign tumors inthe NYU classification.

35
Table9, Prevalence rates far skin conditions of concern (complaints), all types and themmtfrequently repoited tvpes, among persons l-74 year$, byageandpart of body

affected: United States, 1971-1974

Condition and NY Ucodel

1.5 years

40,4

34,8

1.7

0.8

0.8

2.5

2.5

2.7

2.7

10,9

8.3

0.7

3.9

0.1

0.6

1.2

0.9

9.5

...

0.5

0.1

0.4

...

1.1

0,5

0.5

0,5

0.2

0.1

...

33.2

1,7

0.8

0.8

2,0

2.0

2.7

2.7

10.3

8.1

0.7

3.9

0.1

0.6

1.2

0.8

9.0

6-11 years I

12.17 years

Total

II

Hand Foot Other Total Hand Foot Other

Rate per 1,000 population

46.2

42.6

2.2

0.8

1.3

3.1

2.1

0.2

1.9

1.2

0.7

0.6

0.6

14.5

10.0

1.3

1.9

3.7

2.7

6.8

0.3

0,6

0.5

5.7

...

6.2

1.7

1.0

0.6

3.9

...

5.7

1.7

1.7

2.3

0.3

1.3

0.2

0.9

0.8

...

30.7

2.2

0.8

1.3

1.4

0,4

0.2

1.8

1.2

0.7

0.6

0.6

10.5

9.7

0.7

3.1

2.7

2.0

0,3

0.8

0.5

4.8

148.1

141.6

86.4

79.3

1.2

0.9

0.1

9.0

2.4

3.2

2.8

4.4

4.4

2.0

2.0

8.4

5.s

1.7

0.6

5.5

3.4

3.1

O.g

2.2

0.2

1.9

1.9

12.7

...

8.3

0.7

0.7

0.7

0.8

0.8

1.9

1.5

1.4

1.3

1.5

...

6.5

2.4

2.4

0.8

0.8

0.4

0.4

0.7

0.6

1.6

...

126.8

85.7

78.6

1.2

0.9

0.1

5.9

3,2

2.8

2.8

2.8

2.0

2.0

6.1

4.3

1.3

0.6

3.4

3.4

1.2

0.5

2.2

0.2

1.9

1.9

9.6

36
Table9. Prevalence rates forskinc onditionsof concern (complaintsl, all types and themost frequently reported Wpes, among penon$l-74 years, byweatipa~ofbody

affected: United States, 1971-1974-Con.

Condition and NYU ~Odel

Skin conditions of concern, total ........ ............................

Skin conditions of concern with site and type specified.,

Diseases of ssbaceous glands ............... .................... .......7l4l .7I49

Acne vulgaris ............ ................ .....................................7l4l5a

CY$tic aCnC........ .. ................................................ ..........7l4l8O

Acne scars ...... ............................!..................................7l4l9o

XerOsis ........... .............................................. .................7l493o

Dermatophytoses .......................................................... ............l3l

_finea pedis .............................................. ..........................1310

Tines un9uium ........................................ .. ........................l3l2

Tineaversicolor ....................... .. ....................................13191 O

TinBacruris . . .............................. ................ .................... 13131

Tumors2 ............. .............. .. ................ ..............lgx.22x23x.23y

Malignant ........ .............. ................ .. .............. .. ...................lgx

Ba~al-cell epithBlioma ........................ ................ .. ........l9xl

BenignZ ........... .........!...... .................................. ................. 22x

Lipoma ............................. .................. ................ ....22X959

precancerous and not specified .......... .................. ....... 23x,23y

Actinic keratosis ................... ..................................23XOSl

Seborrheic dermatitis ................................................................7oo

Seborrheic dermatitis, type not indicated ......................700010

Atopic dermatitis, eczema .................701 ,70 B300,70B310,708320

Atopic dermatitis ........... .................. ................ .. .... .......7O83l o

Lichen simplex chronicus ........ .................. ....................7W32O

Hand eczema ......................<........................................ ..7olooo

Nummular eczema .............................. .................. .........7ololo

Dyshidrotic eczema ........ ............... .............................!..7olo3o

Contact dermatitis .............. ......................... ........................... ..7o3

Ichthyosis, keratosis ...................... ........................7 10130,710150

Verruca vulgaris ..................................................................696o3o

Folliculitis ..........................................................................713906

p$Oriasis..............................................................................7O6WO

S&borrhoic keratOsis ............................ ................ ...... ........22Xwx

~tili90 ........................... .................................. .. ................7l62lO

Urticaria (hives, etc.) .........................................................242.243

Herpes simplex ....................................................................... ..W6

All other skin conditions ............... .................................................

See footnotes at end of table.

18.24 years

Total II Hand Foot

150J

141.1

71.,

64.(

4.[

0.!

0;

15.(

3.(

2.:

33

5.’

4:

3.,

0.[

(7.,

2.(

2.[

7.7

4.f

0.1

o?

Z:i

8.7

0.6

1.C

4.G

3.1

0.6

1.1

1.6

1.6

16.1

...

9.1

0.3

0.1

0.1

2.3

1.1

0.1

1.2

4.6

1.0

0.8

..

132

5.[

3.5

z<..

0.4

0.4

1.7

0.1

1.6

0.8

4.5

I 2534 wars I 35-44 vears

I I

---

Other Total Hand Foot Other Total IIHand Foot Other

..

118;

71.4

84.(

4.[

rJ,$

0;

9.!

0.1

O.d

3.$

5.1

3.i

37..

0.4

0.4

2.E

Zve

3.7

3.4

0.0

0.3

3.3

0.6

4.6

3.1

0.9

1.1

1.6

1,6

10.8

Rate per 1,000 population

134.(

131.’

35.4

28.!

4.!

OJ

0:

27;

13.!

4.!

4.(

5.1

1.5

1.!

9J

9.$

16.4

5.3

2.0

4.C

0.4

2.7

6.7

0.5

0.2

2.0

3.9

0.7

1.6

0.3

0.4

23.9

.-

165

0.1

0.1

0.1

7.5

1.2

0,3

4.0

1.4

3.6

0.1

1.8

3.0

..

22.:

0.1

0.1

14.s

13.8

1.1

0.2

0.2

2.4

0.4

0.4

1.3

0.7

3.9

..

92.;

35.2

28.t

4.5

0.$

0:

12.7

0.1

3.4

4.C

5.1

1.4

1.4

9.7

9.7

6.5

3.7

1.3

0.4

2.4

0.5

0.1

2.0

2.1

0.7

1.6

0.3

0.4

17.0

130.[

130.!

17.(

12;

2:

0.1

0.!

39.Z

20,i

?:

5.5

3.E

O.i

0.2

1.E

1.E

0.2

5.s

5.9

9.2

0.6

2.7

1.2

0.4

3.4

10.3

0.8

0.4

5.2

1.8

1.0

1.2

1.7

32.4

..

15.3

5.0

1.6

3.9

1.2

0.4

2.0

3.3

0.4

2.7

..

31;

0>

0.,

0.

23.’

18.i

3.!

1.4

1.4

O.e

5.6

...

84.3

17.1

12.3

2.6

0.1

0.5

11.7

1,9

3,6

5.5

3.6

0.2

0.2

1.8

1.6

0.2

5.9

5.9

3.9

0.6

2.7

6.2

0.8

.-

5.2

1.8

1.0

1.2

1.7

24.2

37
Table 9. Prevalence rwes for skin conditiomof concern (complaints), all types and themOst frequently reported types, amOngpepOns l.74years, byageandpart0fb0dy

affected: United States, 1971.1974–cOn,

COnditio” and NYIJcOdel

Total

141.C

137,2

2.9

0.7

2.2

49.6

25.6

12,8

3.9

2.9

14.6

7.5

7.5

2.4

4.7

4.7

12,3

12.3

9.0

1.3

3.0

1.7

0,7

2.2

4.4

0.8

10.4

0.9

2.9

2.8

26.6

—

45-54 vears

iand

..

13.6

2.3

0.9

1,1

1.1

1.1

0.9

0.9

3.8

1.7

2.1

2.3

0.9

2,3

...

39,4

37.5

24.7

12.1

0.3

0.2

0.1

1.6

55-64 years 65-74 years

)ther Total Hand Foot Other Total

II

Hand Foot Other

...

84.2

2.9

0.7

2.2

9.8

0.7

3.9

2.9

13.5

7,5

7.5

2.4

3.6

3,6

11,4

11.4

4.9

1.3

2,8

0.7

2.1

0.8

9.5

0.9

2.9

2,8

22.7

Rate per 1,000 population

122.6

114.4

5.4

0.2

1.2

22,9

5.8

8.2

4.1

4.3

19,6

5.2

3.9

1.4

0,2

13.0

11.5

4.4

4.4

8,9

1,8

4.4

1.6

1.1

8,3

1.6

1,5

7.2

1.2

2,7

2.5

43.9

...

15.1

0.5

0,2

1.5

1.5

1.5

3.6

0.8

1.6

1.1

4.2

1.2

0.2

-1

3.9

..

18.1

0,4

0.4

10.1

5.8

4.2

1,1

1.1

1.1

0.7

0.7

5,8

..

81.2

5.0

0.2

0,8

12.3

3.8

4.1

4.3

17.0

4.1

2.6

1,4

0.2

11.5

10.0

4.4

4.4

4.7

1.0

3.7

4.1

1.6

1.5

6.0

1.2

2.5

2.5

18.4

136.6

134.5

2.7

0,2

1.8

21.8

11,0

8,0

0.4

0.8

34.6

8,5

6.7

3.7

1.2

22,4

20.4

7.6

7.6

10.5

1.2

4.8

1.0

2.5

0.2

5.8

1.5

4,9

4,7

3.3

1.4

35.7

...

9.7

0.2

0.2

0.3

0,1

3.2

0.6

0.1

2.5

2.5

1.3

.,

1.0

0.2

1.7

0.6

I

2.4

...

22.1

0.3

0.3

16.3

11.0

5.3

0,5

0.6

0,1

0.5

0.6

0,6

3.3

...

102.7

2,2

0.2

1.3

5,2

2.6

0.4

0.8

30,9

7.9

6.1

3.1

1,1

79.9

17.9

7.6

7.6

8.7

1,2

4.9

2.5

4,1

1,5

4.3

4.7

2.1

1,4

30.0

lSee reference 8,

‘Excludes seborrheic dermatosis (22X44X) which is listed with benign tumorsin the NYU classification,

38
Table 10. Prevalence rates forskin conditions of concern (complaints), all types and the most frequently repofled Wpes, among males l-74years, byageandpartof body

affected: United States, 1971-1974

Condition and NYU codel

Skin conditions of concern, total .. .................. ................

Skin conditions of concern with site and type specified..

Diseases of sebaceous glands ............. .. .............. .............7l4l.7l49

Acne vulgaris .......................... .. .....................................7l4l5o

Cystic acne ........ .. ............ .............. .............. .. .............. ..7l4l8O

Acne scars ......... .. .......... .. .............. .............. .. ................7l4l9O

Xerosis ......... ............................ .............. .......................714930

Dermatophytoses ...... .............. ............................ .................. ....l3l

Tineapedis ... .. ............................ .............. .............. .. .........131 O

Tineaunguium .. ...................................................... .........1312

Tinea versicolor ................................... ..........................?3191 O

Tineacr.ris ........... ............................ .. ............................l3l3l

Tumorsz ..................... ................ ................ ......l9X.22X23X.23Y

Malignant .. .............. .............. ............................................. 19X

8asal-cell eptthelioma ....... ....................................... ....l9Xl

Benign2 ................... .............. ................ .............. ...............22x

Lipoma .............. .............................. ................ .......22X959

Precancerous and not specified ....................... ............ 23x,23Y

Actinic keratosi$ .. .............................. .. .............. .. ...23XO8l

Seborrheic dematitis ...................... ..........................................7oo

Seborrheic dermatitis, type not indicated ......................7ooolo

Atopic dermatitis, eczema .................701 ,708300,708310,708320

Atopic dermatitis ..... .....................................................7O83lO

Lichen simplex chronicus ....................... .......................7o832o

Hand eczema ............ .....................................................7OlOOO

Nummulnr eczema ............. .............................. ..............7OlOlO

Dyshidrotic eczema .................................. .....................701 O3O

Contcct dermatitis. ... .............. ................ ................................ ..703

lchthyosis, keratosis ..............................................7lol3o.7lol5o

Verruca vulgaris .............. .............. ................................ ......696o3o

Folliculitis ............... ................ ...........................................713908

PsOriasls......... .....................................................................706090

‘Seborrheic keratosis ........................................................ .. 22X44X

Vitiligo. .... ..........................................................................7l62lO

Urticarta [hives, etc.) .. ............ ...........................................242.243

Herp% simplex .. .............. .............................. .............. .. ...........o96

At” other skin conditions ...... .................. .............. .. ........................

See footnotes at end of table.

Male

Total

33.2

28.9

0.2

0.2

0.2

1.3

1.3

0.6

0.5

6.1

5.0

4.8

0.2

1.3

1.7

1.0

11.6

1-5 years I

6-11 wars I 12-17 years

Wmd I Foot I other

...

0.7

0.7

...

0.1

0.1

...

28.1

0.2

0.2

0.2

1.3

1.3

0.5

0.5

6.1

5.0

4.8

0.2

1.3

1.7

1.0

10.8

1

Total Hand Foot Other Total Hand

Rate per 1,000 population

61.3

48.0

1.9

1.9

4.1

4.1

1.9

0.4

1.5

1.2

1.2

22.3

15.8

2.6

2.3

4.2

3.2

3.8

0.7

1.2

1.1

2.4

...

6.1

3.4

2.0

1.2

1.5

...

7.3

3.3

3.3

2.9

2.6

0.3

1.1

...

34.6

1.9

1.9

0.8

0.8

1.9

0.4

1.5

1.2

1.2

16.0

15.8

3.0

3.2

1.2

0.7

1.2

1.1

2.4

139.2

139.0

83.3

74.1

2.1

0.2

14.7

4,6

3.2

5.5

2.7

2.7

10.6

9.6

0.8

5.6

2.3

2.4

1.0

0.3

3.4

12.7

...

9.1

1.4

3,0

3.0

2.7

2.0

E

...

9.8

4.6

4,6

0.8

0.8

1.4

3.0

...

120.1

83.3

74.1

2.1

0.2

8.7

3.2

5.5

2.7

2.7

6.8

6.8

1.5

2.3

2.4

1.0

0.3

3.4

7.7

39
Table 10. Prevalence rates for skin conditions of concern (complaints], all types and the most frequently reported types, among males l-74years, byageandpart of body

affected: United States, 1971.1974—Con.

Condition and NYU cede]

Skin conditions of concern, total..., .... .............. .. ............

5kin conditions of concern with site and type specified..

Diseases of sebaceous glands ........ ..................................7l4l.7l49

Aone vulgaris ............ .................................... .. ...............7l4l5O

Cystic 8cne ...................... ............ ..................................7l4lSO

Acne scars ................................................................ .....7l4l9O

XerOsis ..........................................................................7l493O

Dermatophvtoses ........... .......................... ............................ .....l3l

Tines pfidis ........ .............................................!..................l3lo

Tines unguium ..... .............. .......................... .. .......... .........l3l2

Tineaversicolor ......... ....................................................13191 O

Tines cruris ............. ............ ............................................l3l3l

Tumors2 ............ .. ............ .......................... .......l9X.22X.23X.23Y

Malignant .......... ............ .....................................................91 X

Basal<ell epithelioma..,...,,., ........................................l9Xl

13enignz .... ........................ ............ .............. ........................22x

Lipoma ................... ............................ ............ ........22X959

Precancerous and not specified.,..,., ............................ 23 X,23Y

Actinic keratosis .....................................................23XOSl

Seborrheic dermatitis .......... .......................... ............................7OO

Seborrht?ic dermatitis, type not indicated ......................7OOOlO

Atopic dermatitis, eczema ............. ....701 ,708300,7083 10,70S320

Atopic dermatitis ................................. ............ .............70831 O

Lichen simplex chronicu$ ..............................................7O832O

Hand eczema.. ........ .. .......... .............. .............. ...............7olooo

Nummular eczema .........................................................701 OlO

Dyshidrotic eczema ...................... .................................701 O3O

Contact dematiris ....................... .. ...........................................7O3

Ichthyosis, keratosis ...... ............ ............ ............ .. ..71 O130.71 Ol5O

Verruca vulgaris .. ................................................................696O3O

Folllculitis ..........................................................................7l39O8

Psoriasis...... ............ ............................................................7 O6O9O

Seborrheic keratosis ... .......................................................22X44X

Vitiligo .......................................................... .....................7l62lO

Urticaria (hives, etc. ) ............ ............ .............. ...................242.243

Hwpc+$ simplex ........................ ...................................... ...........O96

All other skin conditions ................................................................

See footnotes at end of table

Male

18-24 years

EnIz

159.0

151.3

76.6

67.6

8.S

25.5

7.2

3.4

4.2

10.6

2.1

2.1

1.1

1.1

74

3,0

4.5

13.1

1.0

6.2

2.4

1.9

0.4

13.6

...

13.0

2.7

1.5

1.3

7.6

1.0

1.7

:Oot

...

21,7

10.7

7.2

3.4

3.2

3,2

1.6

6.2

25.34 years 35.44 years

Other Total Hand Foot Other Total Hand I

Foot

Rate per 1,000 population

...

116.6

76.6

67.6

S.8

14.s

4.2

10.6

2.1

2.1

1.1

1.1

1.5

1.5

3.9

6.2

2.4

1.9

0.4

5.7

148.8

151.4

36,o

25.1

9,1

49,4

23.4

S.9

6.4

10.7

1,2

1.2

S.3

8.3

16.4

5,5

2.8

3.1

2.8

4,8

0.8

4,2

7.3

0.8

22.2

...

16.4

4.8

1.7

3.1

3.5

3.7

4.4

...

3s.1

25.7

23.4

2.3

0.5

0.5

4.5

0.9

0.8

2,8

7.4

...

96.9

38.0

25.1

9.1

23.7

6.6

6.4

10.7

1.2

1.2

7.8

7.8

7.1

2.9

2.0

1.3

0,s

4.2

3,6

0.8

10.4

146.5

56.5

17.4

11.0

4.7

70.9

40.8

4.2

4.8

11,1

3.1

3.1

0.5

3.3

3.3

8,1

0.6

0.8

6.6

6,0

1.7

9.5

1.8

I),g

33.s

...

16,8

S.7

2.1

5.2

0.6

0.8

3.7

2.9

...

49.5

0.3

0.3

40.6

36,9

2.1

2.9

2.9

1.6

4.1

)ther

...

90.2

17.1

11.0

4.4

21,6

3,9

4.8

11.1

3,1

3.1

0.5

3.3

3.3

4.4

1.7

9.5

1,8

0,9

26.8

40
Table 10. Prevalence rates forskin conditions of concern (complaints), all Wpesand themost frequently repotied tvPes, among males l-74years, byageandpan of body

affected: United States, 1971-1974-Con.

Condition and NYU codel

Skin conditions of concern, total ....................................

Skin conditions of concern with site and type specified..

Diseases of sebaceous glands ..........................................7l4l.7l49

Acne vulgaris ............ ................ ................ .............. .. ...t.7l4l5O

Cystic acne ............... ................ ................ ................ .....714180

Acne scars ....................... .. .............................. ..............7l4l9O

Xerosis ..... .............. .................................. ................ .....7l493O

Dermatophvtoses ........... .............. .. .............. .. ................ ...........l3l

Tines pedis ................................................................. ....... 1310

Tinea unguium .. ....................................................... ........1312

Tines versicolor ............................................................. 131910

Tines cruris ....... .. ................................................ ............13131

Tumom2 ... .............. .. .............. ................ .. ........l9X.22X23X.23Y

Malignant ............................ ................ ...............................l9x

Basal.cell epithelioma ............ .................................. .. .. 19X1

Benignz ........................................................................ ...... 22x

Lipoma ... ............ .. .................................................. 22X959

Precancerous and not specif ied ............ ................ .. ..... 23 X,23y

Actinic keratosis ............ ......................................... 23X081

Seborrheic dermatitis ......................... .. ................ .....................7OO

Seborrheic dermatitis, type not indiciated ........ .............7OOOl O

Atopic dwrnatitis, aczema .................701 ,70B300,70831 0,708320

Atopic dermatitis ...................................................... ....7 0831 O

Lichan simplex chronicus ..............................................7O832O

Hand eczema ....................................<.<............... ...........7olooo

Nummular eczema ................................... .................. ....701 OlO

Dyshidrotic eczema .......................................................7olo3o

Contact dermatitis ..................... .................................. .............7O3

Ichthyosis, keratosis .... .. .............. ................ ..........71 Ol3o.7lol5o

Verruca vulgaris ..................................................................696O3O

Folliculitis ..........................................................................713908

Psoriasis ......... ................ .................................................. ...7WfflO

Seborrheic keratosis .......................................................... 22X44X

VitiligO ... .. .............. .............. .. .................. ..........................7l62lO

Urticaria [hives, etc.) ................................ .............. .. .........242.243

Herpes simplex ......... .. ............ .... ..............................................W6

All other skin conditions .......... .................................................... ..

45-54 years

Total Hand Foot Other

184.5

185.8

3.4

1.5

1.9

86.4

48.4

16.7

6.1

5.2

22.9

9.9

9.8

5.0

8.0

8.0

16.5

16.5

9.2

1.3

2.6

2.7

1.2

6.9

0.4

6.8

2.7

28.6

—

...

19.5

4.4

1.6

2.4

2.4

2.4

1.9

1.8

4.0

2.7

2.7

4.1

...

66.0

66.0

47.8

16.7

...

100.3

3.4

1.5

1.9

16.0

6.1

5.2

20.5

9.9

9.9

5.0

5.6

5.6

14.6

14.6

5.2

1.3

2.6

1.2

4.2

0.4

8.8

2.7

24.5

Male

55-64 years 65-74 years

Total Hand Foot Other Total Hand Foot

Rate per 1,000 population

130.5

128.1

7.3

0.3

1.8

36.0

10.5

12.8

3.4

8.7

20.6

5.3

5.3

0.8

0.4

14.5

14.5

2,7

2.7

11.0

6.3

2.3

2.4

10.3

1.1

7.6

0.4

31.1

...

21.7

0.6

0.4

0.4

0.4

4.7

2.3

2.4

5.0

2.6

8.4

...

28.5

18.5

10.5

8.0

2.4

2.4

2.4

1.5

1.5

6.1

...

77.9

7.3

0.3

1.8

16.9

4.8

3.4

8.7

17.8

2.9

2.9

0.8

0.4

14.1

14.1

2.7

2.7

4.8

4.8

5.3

1.1

6.0

0.4

16.6

155.B

152.3

2.7

0.5

1.3

28.8

17.5

6.8

0.9

1.8

42.4

10.2

7.5

4.7

2.2

27.5

25.1

6.9

6.8

11.5

0.7

10.6

6.4

1.6

6.2

2.5

5.5

1.3

36.5

...

6.4

0.7

0.2

2.9

2.9

2.9

0.2

1.3

1.3

...

22.4

0.2

0.2

19.7

17.5

2.2

1.1

1.4

Other

...

123.5

2.5

0.5

1.1

8.4

4.4

0.9

1.8

39.5

10.2

7.5

4.7

2.2

24.6

22.2

6.8

6.9

11.3

0.7

10.6

6.4

1.6

6.2

2.5

.3.1

1.3

33.8

lSee r~ference 8.

2Excludes seborrheic keratosis (22 X44 X) which is listed with benign tumors inthe NYUcla.ssification.

41
Table 11. Prevalence rates for skin conditions of concern (complaints), alltypes andthemost frequently reporfed wpes, among females l-74years, byageandpartofbody

affected: United States, 1971-1974

Female

1-5 yews I 6.11 years I 12-17 vear5

Total II Hand

47.9

41.0

3.4

1.4

1.3

3.9

3.9

5.1

5.1

15.7

11.6

1,4

3.0

0.7

1.0

6.9

...

0.2

0.2

,

Fmx Other Total Hand Foot Other Total Hand Foot Other

Rate per 1,000 population

...

2.2

1.1

1.1

1.1

0.4

...

38.6

3,4

1.4

1.3

2.8

2.8

5.1

5.1

14,4

11.2

1.4

3.0

0.7

1.0

6.9

41.0

37.2

2.6

1.6

0.7

1,9

0.3

1.9

1,9

6.6

4.2

1.3

2.4

2.1

9.7

10.4

6.3

6.3

...

4.1

1.8

0.7

0.7

1.6

...

26.8

2.6

1.6

0.7

1.9

0.3

1.9

1.9

4.8

3.5

1,3

2.4

2.1

2.7

8.4

157.3

144.4

89.6

84.7

0.2

1.9

3.0

3.0

9.2

9,2

1.1

1.1

6.3

1.6

2.6

1.2

5.4

4.3

3.7

4.4

3.8

0.4

13.2

...

7.5

1.4

1.4

1.7

1.7

0.8

2.6

1.0

...

2.9

1.7

1,7

1.1

0.1

...

134.0

88.2

83.3

0.2

1.9

3.0

3.0

5.8

5.8

1.1

1.1

5.5

1.6

2.6

1.2

5.4

4.3

4.4

3.8

0.4

12.1

42
Table 11, Prevalence rates forskin conditions ofconcern [comtiaintsl, all Wpesand themost frequently reported types, among females l.74years, by W?andpartofhdy

affected: United States, 1971-1974-Con.

Condition and NYU codel

Win conditions of concern, total ................................. .. .

Skin conditions of concern with site and type specified..

Diseases of sebaceous glands ... .......................................7l4l.7l49

Acne vuIgaris ............................ .....................................7l4l5O

Cystic acne ........ .. ............ ................ ................ ..............7l4l8O

Acne scars ........... ..........................................................7l4l9O

Xerosls ................ ............ .. .............. ..............................7l493O

Dermatophytoses ......................... .. .. .............................. ...........l3l

Tines pedis ........................................................................1310

Tines unguium ......................... .........................................l3l2

Tines v.wsicolor ................. ............................................131910

Tines cruris ......... .............. ................................ ..............l3l3l

Tumors2. .................... ............ .. ........................l9XZ2X.23XZ3Y

Malignant ............ .............. ................................................. 19X

Basal@ll epithelioma .............................. .............. ...... 19X1

BeniSn2 ........<.n....<......a............... ........................................22x

Lipoma .......... .............. ................................ .. ......... 22X959

Precancerous and not specified .......................... .........23 X.23Y

Actinic keratosis ..... ................................................23XWl

Seborrhelc dermatitis ....................... .............. .. .........................7OO

Seborrheic dermatitis, type not indicated .......... ............70001 O

Atopic dermatitis, eczema .......... .......701 ,70S300,708310,708320

Atopic dermatitis ..........................................................70S31 O

Lichen simplex chronicus ..............................................7O832O

Hand eczema ......... .............. ................ ................ ..........7olwo

Nummular eczema ...................... ...................................7 OlOlO

Dyshidrotic eczema ............. ................ ................ ..........701030

Contect dermatitis .................... .......................................<........7o3

Ichthyosis, keratosis .......................................... ....71 Ol3O.7lOl5O

Verruca vulgaris ... ................ .............. .................................696O3O

Folllculitis ...................... ....................................................7l39OS

Pmriasis .............. .......................... .................. ....................7O6O9O

Seborrheic keratosis ...... .................................................... 22X44X

Vltiligo ........................................... ............................ ........71621 O

Urticaria (hives, etc.] .... .............................. .. ....................242.243

Herpes $Implox ... .......................... .. .............. ............................O96

All other skin conditions ....... .........................................................

Sce footnotes at end of table

Female

18-24 years I

25-34 years I

35-44 years

Total Hand Foot Other Total Hand Foot

I

Other Total Hand Foot

Rate per 1,000 population

141.5

131.2

66.6

60.6

1.0

1.7

0.4

6.3

0.2

1.9

3.6

6.3

4.7

1.5

0.7

4.4

4.4

6.0

6.0

0.3

0.6

1.3

4.7

1.2

1.0

3.1

3.8

2.1

2.8

3.1

17.8

...

5.4

0.5

0.2

0.2

1.9

0.7

0.2

1.2

1.8

1.0

...

5.2

1.2

1.2

0.8

0.6

0.2

0.2

0.1

0.1

2.9

...

120.6

66.6

60.5

1.0

1.7

0.4

4.6

0.2

0.7

3.6

5.3

4.5

0.7

0.7

4.4

4.4

5.8

5.1

0.1

0.6

2.8

1.2

3.1

3.8

2.1

2.6

3.1

14.9

120.5

112.5

34.6

31,5

0<3

1.6

0.6

7.9

5.2

0.6

1.6

0.1

1.7

1.7

11,5

11.5

16.5

5.1

1.3

4.9

0.8

2.7

6.4

0.2

0.3

0.6

1.4

2.4

0.6

0.9

25.3

...

16.0

02

0.2

0.2

10.0

0.7

0.6

4.9

2.7

3.7

02

1.7

...

7.7

0.1

0.1

5.1

5.1

0.6

1.4

0.5

...

88.8

34.7

31,4

0.3

1.6

0.6

2.6

0.1

0.6

1.8

0.1

1.5

1.5

11.5

11.5

5.9

4,4

0.7

0.6

3.3

0.2

0.1

0.6

1.4

2.4

0.6

0.9

23.1

116.0

107.5

17.9

14,3

1.0

0.2

0.9

11.3

2.3

6.0

2.2

0.4

4.1

0.4

0.4

3.4

0,3

8.3

8.3

10.2

1.1

5.3

1.8

0.5

14.2

0.7

1.3

1.8

1.9

2.4

2.4

31,0

...

13.9

1.6

1.2

2.8

1.8

0.5

6.3

0.7

2.5

...

14.7

0.8

0,8

7.1

2.3

4.8

6.8

Dther

. . .

76.9

17,1

13.6

1.0

0.2

0.9

2.6

2.2

0.4

4.1

0.4

0.4

3.4

0.3

8.3

6.3

7.4

1.1

5.3

7.9

1.3

1.8

1.9

2.4

2.4

21.7

43
Table 11. PrevalmIca rates forskln condltionsof concern (complaints), all Wpesand tll@most frequently reported types, among f#males l-74years, byageand part of, body

affected: United States, 1971 -1974 -Ccm.

Condition and NYu $~de~

Skin wnditicm$ of concern, total ................. .............. .....

Skin conditions of concern with site and typo specified,.

Dismses of sebaceous glands ..... ............ .............. ...........7l4l.7l49

Acne vulgaris .. .............. ........................ .............. ...........7l4l5O

CVstlcacne ............ ............ ............ ............................ ....7t41 SO

Acne scars. ... ..........................!.. !..............<....................7l4l9o

Xerosis .............. .. .......... ................................................714930

Dermptgphyto~ ..................... ...................................... ...........l3l

Tines pedls. ....................#........ .............. .......................... ..l3lo

Tines ungulum .................................... .......................... ....l3l2

~n8averslc010r ..................... .......................... ..............l3l9lO

Tines cruris !....... ...! ........ .... ........ ............#. .......................l3l3l

Tumors2 ........... ............ ............ ........................l9X.22X.23X23Y

Malignant ................................. .......................................... 19X

6asal-call eplthelioma .................... .. ........! ... ............ ...!l9xl

6enlgn2 ........ ............ .......................... ...... ..........................22X

Lkmma .,.................. ............ ........................ .. .........22X969

Precancerous and not $peclf lad .. ................................. 23 X,23Y

,Actinlc knratosis ........... ..........................................23XO8l

Sebarrheic dermatitis ......................... ............ ............ ...............7OO

.Seborrheic dermatitis, type nor indicated ...... ................70001 O

Atoplo dermatitis, eczema ...,..,. ,.......,701,708300,7083 10,70S320

Atopic dermatiti$ ,!,.,.. ,.........!... ...1......,..,...,,., ................70s310

Lichen simplex chmnicus ....... ........ .... ............ ............ ...7O832O

Hand emema .................................................................7OlWO

Nummular eczema ......... ................................................7OlOlO

Dyshidrotic aczema ..... .......<.... .. ........<............... ............7olo3o

Contsct dermatitis ..... ......................................,!, !...,.....,...,., .....703

Ichthyosis, keratosi$ ..... ...................................... ...710130.71 Ol5O

Verruua vulgaris ..... ...........!.... ........ .......... .......... .... ............ .696030

Folliculitls ......... .................................................. ...............7l39O6

PsOriUls .............................. ............ ............ ............ .. ..........7WO9O

Seborrheic ker?to$is ........! ............. ............ ...........i ............ 22X44X

VitlligO .......................................................... .....................71 S21 O

Urtlcaria (hives, etc.) ........................................ .................242.243

Hwpesslmplex . .......................................................................W6

All other skin conditions ...... ........................ .. .......... ............ .. ........

Female

45-64 y’clars 55.64 years 6s.74 years

Totpl Hand Foot Other Total Hand Foot Other Total Hand Foot Other

100.9

92.4

2.5

2.5

15.7

3.7

9.3

1.9

0.8

7.0

5!3

5,3

1.7

1.7

8.6

6.6

8.9

1,3

3,4

0.s

0.2

3.1

2.0

1,1

12.0

1.7

S.6

3.0

24.4

...

8.1

0.2

0.2

3.7

0.8

2.9

1.9

1.7

0.6

...

14.8

11.4

3.5

7.9

0.6

0.3

0.2

2.8

..

69.5

2.5

2.5

4.1

1,4

1.9

0.6

7.0

5,3

5.3

1.7

1.7

8.6

8.6

4,6

1.3

3,1

0,2

0.1

1.1

10.3

1.7

5.5

3.0

21.0

Rate per 1,000 population

115.4

102.1

3.7

0.7

11.0

1.7

4.2

4.7

0.4

18.6

5.2

2,4

1.9

11.5

8.7

5.8

5.9

6.9

3.4

2,6

1.0

5.0

1,9

2.8

7.0

2.2

4.6

4.7

27.8

...

9.1

0..4

0.4

2,4

Z.i

2.4

2.5

1,5

1.0

2.1

0.3

1.4

...

8.8

0.7

o.;

2.6

1.7

0.9

5.5

... 122.2

84.2 121.0

3.0 2.6

1.9

8.0 16.4

6.0

2.9 9.1

4.7 .

0.4 .

16.2 28,6

5.2 7.3

2.4 5.1

1.9 2,7

0,2

9.1 18.6

6.3 16,8

:: z

4.4 9,9

1.9 1,6

2.6 0,7

1,8

4.4

2.9 5,3

1.9 1.4

2.8 -

7.0 4.0

2.2 6.3

4.3 1.6

4.7 1.5

20.9 35.2

...

12.2

0.3

0.3

3.4

1.1

0,1

2.2

2.2

2,2

1,8

3.0

0,1

3.2

—

...

21.6

0.4

0.;

13.7

6.0

7,7

0.8

0.8

0.1

0.8

1.1

0.1

4,9

...

87.0

1.9

,-

1.2

2.7

1.4

24.4

6.2

5.1

1.8

0,1

16.4

14.6

6.2

6.2

6,9

1.6

0.7

4,4

2.3

1.4

2.9

S.3

1.4

1.5

27.1

lSee reference 8,

2~xc,u~88 $eb~~~h~i~ ker~t~$is (22X44X) which is listed with benign tumors in the NYu classification.

44
Table 12. Prevalence of skin conditions of concern (complaints] among persons l-74 years, by r~currence, duration, handicap, disfigurement and discomfort from

condition. wa and sex of persons affectad, showing rates, selected standard errors, and number of persons affected: United States, 1971-1974 —

Handicap to

employ.

ment or

housework

Pm.

eludes

preSocial

ferred handiemplOy- Cap

ment

Active

Recur- in

rent past

year

Present

less

than

2 years

Some

disfigurement

Some

pain or Some

burn- itching

ing

Some

motion

limitation

Some

overal I

Limits

activiw

Age and sex discom

fort

Rate per 1,000 population

10.2 —

0.6

1.2

6,9

16.5

16.8

11.9

9.1

14.9

12.6

9.9

1.1

2.4

2.6

23.3

14.5

8.8

10.9

15.3

11.2

10.4

1.5

_

1.0

0.7

2.2

0.7

3.0

0.2

1.8

1.6

2.2

1.3

35.1

_

3.0

7.4

68.8

62.5

44.2

35.3

25.2

27.1

22.0

32.6

1,6

6.1

58.5

59.3

43.8

38.2

28.6

77.4

20.1

37.4

71.4

_

19.5

21.3

99.6

93.4

8&9

79.0

73.3

80.7

66.6

74.7

15.7

21.8

87.1

92.4

82.8

90.2

95.4

91.6

99.8

68.4

59.2

—

20.0

25.7

71.0

64.8

69.4

71.3

77.3

55.2

70.2

66.0

12.9

33.9

70.9

Both sexes, 1-74 years ........ ....... 62.8

_

14.6

20.9

77.8

76.5

88.7

74.8

70.4

56.0

68.0

68.6

10.4

25.5

74.7

62.0

97.8

88.3

69.7

67.1

83.0

56.3

77.1

_

22.0

26.3

100.4

97.1

100.4

85.9

83.2

76.6

69.8

83.9

10.6

_

2.9

5.5

12.4

14.4

11.8

12.3

8.2

14.1

11.6

9.6

22.6

_

10.2

6.9

19.7

28.7

32.9

26.4

27.0

22.6

26.4

25.9

7.2

7.8

22.8

34.8

34.7

27.0

39.2

30.9

25.6

19.5

46.7

_

20.0

23.0

41.9

36.6

60.0

56.3

72.1

51.8

55.4

55,0

5.6

_

2.1

2.7

4.9

8.2

8.0

6.4

3.1

5.3

11.4

6.1

12.3

_

9.0

11.6

25.5

17.4

10.5

7.7

8.3

8.4

8.0

12.6

6.5

9.5

25.1

17.5

12.0

4.2

15.9

9.3

5.8

12.1

1-5 years ....................................................

6.11 years ................ .................. ................

12-17 years ................................................

18-24 vears .. ............ .. ................ ................

25-34 years .............. .. .............. .. ................

3544 years .............................. .. ................

45-54 years .. ..............................................

55.84 years .......................................c........

65-74 vears ................................................

Male, 1-74 years ..............................

2.5

6.3

7.6

14.4

7.0

15.6

8.8

18.1

7.8

11.1

0.2

1.1

3.0

3.7

1.1

3.6

1.7

13.9

31,s

40.9

39.1

71.2

73.1

100.6

60.4

61.1

39.0

1-5 years ............. ............ .................... .. .....

6.11 years .......... ................................ ........

12-17 years ................................................

18-24 years ....... ................ .................. .......

25-34 years .............. .. ................................

3544 yaars .............. .. ................................

45-54 yEas ..................... ...........................

55.64 years ..... ...........................................

65-74 years ..................... .............. .. ...........

Female, 1.74 years., ............. ...........

15.7

33.5

84.1

102.7

107.5

102.0

108.1

60.8

104.9

70.7

1.9

2.8

1.9

10.1

9.3

8.8

5.2

6.6

9.8

5.2

65.6

79.7

83.0

103.5

64.1

71.3

52.7

l.5years ......................... ................ ...........

6-11 years .. ................................................

12-17 yeafi ....... .............................. ...........

18-24 years ....... ............................ .. ...........

25-34 years ..................... .............. .. ...........

35-44 yearn ..................................... ...........

45-54 yaars .............................. .. ................

55-64 yean ................ ................................

55-74 yaars ....<...............c.................... .......

19.0

16.2

80.9

71.4

60.5

62.5

52.6

49.8

56.7

28.6

19.0

116.1

91.6

98.5

72.1

64.5

77.5

77.6

11.6

13.8

25.9

17.3

9.1

10.9

1.4

7.5

9.6

3.4

4.7

17.5

14.4

16.2

9.2

7.6

10.6

14.5

0.2

11.5

10.2

19.0

14.8

7.4

14.5

13.6

1.9

0.2

1.3

1.4

5.7

0.3

2.1

1.2

4.5

B.7

79.5

65.6

44.5

32,7

24.0

35.8

23.4

23.3

20.7

112.6

84.3

79.2

68.7

53.1

71.0

60.5

13.3

6.1

16.5

22.9

31.2

25.8

15.9

15.1

27.0

26.2

14.3

42.9

34.2

49.8

40.8

45.9

44.0

52.8

2.4

2.5

8.1

6.4

6.8

4.3

1.3

4.2

12.7

27.3

17.2

71.1

64.0

60.0

60.5

53.2

47.3

69.4

Standard error of rate

8oth saxes, 1-74 years ............... 6.22 7.30 1.70 2.06 2.04 0.45 3.95 6.65 2.61 4.02 0.70 5.80

7.11 8.41 2.25 1.63 2.04 0.50 3.30 7.63 3.69 5.61 0.93 6.81

6.63 7.49 1.63 2.62 2.26 0.51 5.65 6.63 2.20 3.41 0.95 5.92

Numbar of persons in thousands

Male, 1-74 years ....... .................................

Femda, 1-74 yaars ....................................

12,174 13,569 2,072 2,031 1,876 280 6,809 13.657 4,360 9,G65 1,086 11.475

6,551 7,153 962 919 936 124 3,071 7,033 2,435 5,174 573 6,217

5,623 6,416 1,110 1,112 1,040 166 3,736 6,624 1345 3,881 523 5,256

8oth :exec, l-74years ...............

Male, 1-74 yearn ................................... .....

Female, 1-74 years ....................................

45
Table 13. Type of care sought and adequacy of treatment for skin conditions of concern (complaints) among persons 1-74 Years, by age

and sex, showing rates, selected standard errors, and number of persons affected: United States, 1971.1974

All con.

Some

Care for skin complaint sought from

Not Could be ciitions

conNOW ditions

under now improved could

EzIIzlE. ‘~~ ‘:” ?r ‘:* ‘?? ‘:?

Age and sex

Rate per 1,000 population

Both sexes, 1-74 years.. 18.4 5.9 20.7 27.4 21.5 82,0 79.5 5.9 6,2

1.6

3.8

30,4

26.7

25.0

17.6

17.9

18.6

17.3

21.7

1.6

0.2

13.1

9.1

7.5

4.6

6.8

3.4

3.1

7.0

3.5

9.8

18.5

29.7

29.0

19.4

26.0

25.5

20.4

19.3

—,

1.4

13.9

7.3

29.8

26.8

14.7

32,2

26.2

20.0

22.0

17.1

14.5

17,6

22,2

28.1

43.9

40.5

31.6

33.2

27.2

10.9

10.7

24.4

20.6

24.8

25.1

26.9

22.7

27.5

19.3

22.8

28.5

108.9

110.2

96.1

89.7

95.0

76.2

98.7

93.0

20.3

28,5

110.0

104.3

93.3

86.4

87,3

75.5

98.9

90.5

16.1

34,9

109,7

111.3

113.4

109.2

118.1

79,9

114.0

69.1

24,5

21.8

110.4

97,7

75.1

65.5

59.0

71.8

87.5

4.9

0.5

4.6

8.9

7.0

‘10.4

6.9

3.9

5.7

6.2

4.9

0.5

4.6

8.9

7.0

10.4

9.0

3.9

5.8

6.4

3.9

0.6

6,9

9,8

6.2

12.3

7.8

3,4

6.3

$.9

1-5 years .............. ........ .................

6-11 years ... .. ...... .......... ...... ..........

12-17 years ... ................ .......... ......

18-24 years .......... .........................

25-34 years ..... .. ........ ...... .. ............

35-44 years ........ ................ ...... .....

45-54 years .................. ............ .....

55-64 years ... ...... ........ .. ...... ...... ....

65-74 years .......... .......... ............ ...

Male, 1-74 years .................

1.0

3.8

31.5

27.4

31.8

26.8

24.6

22.3

19.2

15.3

1.3

15.8

8,6

6.6

5.4

11.3

6.6

3.1

4.9

13.6

16.5

14.1

18.2

26.0

46.7

50.6

30.4

32.9

27.6

7.9

7.8

13.7

23.7

18.4

19.9

37.3

21.4

27.3

23.6

18.7

35.1

108.0

113.4

116,9

111,5

125.6

83.8

116.3

71.7

3.9

::;

9,8

6.2

12,3

5.7

3.4

6.3

5.7

1-5years . ...... .. ........ .. ...... ..............

6-11 years ...... .. ...... .. ...... .. .............

12-17years ........ ........ ...................

18-24 years ...... .............................

25-34 years . ........................ ..........

35-44 years ................ ...................

45-54 years .. .................................

55-64 years ...................................

65-74 years ...................................

Female, 1-74 years .......... ...

5.9

0.4

2.2

7.9

7.6

8.6

10.1

4,4

5.5

1-5years ............. .......... ...... ..........

6-11 years .... .. ...... .........................

12-17 years .... ...... .......... ...... .........

18-24 years ........... .. ......................

25-34 years .... ................ ...............

35-44 years ..... .. ...... .. .... .. .......... ....

45-54 years ........................ ........ ...

55-64 years ..... .... ...... ................ ....

65-74 years ........ ........ ...................

2<2

3.9

29.3

26.0

18.9

9.2

11.7

15.3

15.9

1.8

0.3

10.3

9.5

8.4

3.9

2.6

0.6

3.1

5.6

5.7

30.2

29.6

30.9

23.7

20.2

24.9

20.7

20.7

12,4

21.3

25.9

30.1

41.3

31.4

32.7

33.4

14.1

13.7

35.6

17.7

30.6

29.8

17.3

23.9

27.6

27.1

21.8

109,7

107.2

77.2

69.6

86.9

69.4

85.4

5.9

0.4

2.2

7.9

7.6

8.6

8.0

4.4

5.3

Standard error of rate

8oth sexes, 1-74years.. 2.87 1.68 1.75

3.79 2.16 2.30

2.98 1.65 2.14

2.60 I 2.36 i 7.68 i 7.29 i 1.30 I 1.39

2.96 I

2.81 9.72 I9,30 1,71 I

1,71

3.16 3.09 7.39 7,19 1.19 1.37

Male, 1-74 years.., .........................

Female, 1-74 years ........................

Number of persons in thousands

4,179 I 15,914 1, 15.419 I1,147 I 1,197

1

Both sexes, 1-74 years..

1,819 I8,753 8,525 583 I

606

2,361 7,161 6,894 565 592

Male, 1-74 years ....... ...... .......... .....

Female, 1-74 years ........................

46
APPENDIXES

CONTENTS

I. Statisticzd Notes .............................................................................................................................

The Smey Desi@ .........................................................ti..........................................................

Nonresponse .............................................................................................................................

Mksing Data ..............................................................................................................................

Small Numbers ..........................................................................................................................

SampIing and Measurement Error .............................................................................................

Tests of Significance .................................................................................................................

Examiner Variabtity .................................................................................................................

48

48

49

51

51

51

52

52

U. ~eDematolo~ Extinction Fom ............................................................................................. 60

III. Stin Patiolo~~assification mdGIoss~of Selected Terns ....................................................... 67

Cl=sification ............................................................................................................................. 67

GIOSSW ....................................................................................................................................69

LIST OF APPENDIX TABLES

I. United States civilhn nonirrstitutiontilzed population, by age, sex, and color, November 1,

1972 ............................................................................................................................................ 50

11. Percent distribution of nonresponse adjustment factors: Health and Nutrition Examination Survey, stands 01-65, 1971.1974 ...................................................................................................... 51

III. Total number of exasninecs and those not given the derrnatological component, by age and sex:

Health and Nutrition Examination Survey, United States, 1971-1974 ......................................... 51

IV. Range, mean, median, and quartiles in the distribution of dermatologist examiners, by the age-sex

adjusted proportion of examinccs with significant skin pathology, skin conditions of concern

(complaints), and their ratio: Health and Nutrition Examination Survey, 1971 -1974 ................. 53

V. Number of exarninees and age-sex adjusted proportion of exarninees with skin pathology, skin

conditions of concern (complaints), and their ratio, by dermatologist examiner and scx of

cxarnince: Health and Nutrition Examination Survey, 1971-1974 ............................................... 54

47
APPENDIX I

STATISTICAL NOTES

The Survey Design

The sampling plan for the first 65 stands of

the Health and Nutrition Examination Survey

(HANES) followed a stratified multistage probability design in which a sample of the civilian

noninstitutionalized population of the coterminous United States, 1-74 years of age, was

selected. Excluded from the selection were persons residing in Alaska and Hawaii and those

within the coterminous United States confined

to institutions or residing on reservation lands of

American Indians. Successive elements dealt

with in the process of sampling were the primary

sampling unit (PSU), census enumeration district

(ED), segment (a cluster of households), household, eligible persons, and finally sample persons.

The starting points in the first stage of this

design were the 1960 Decennial Census lists of

addresses and the nearly 100 PSU’S into which

the entire United States was divided. Each PSU

is either a standard metropolitan statistical area

(SMSA), a single county, or two or three contiguous counties. The PSU’S were grouped into 357

strata for use in the Health Interview Survey and

subsequently collapsed into 40 superstrata for

use in Cycles II and III of the Health Examination Survey and HANES.

Fifteen of the 40 superstrata contained a

single large metropolitan area of more than

2,000,000 population. These 15 large metropolitan areas were selected for the sample with certainty. The 25 noncertainty strata were classified into four broad geographic regions of

approximately equal population and crossclassified into four broad population density

groups in each region. Then a modified Goodman-Kish controlled selection technique was

used to select two PSU’S from each of the 25

noncertainty superstrata with the probability of

selection of a PSU proportionate to its 1960

population so that proportionate representation

of specified State groups and rate of population

change classes was maintained in the sample. In

this manner a total first-stage sample of 65

PSU’S was selected. These 65 sample PSU’S or

stands are the areas within which a sample of

persons would be selected for examination over

a 3-year survey period.

Although the 1970 Census data were used as

the frame for selecting the sample with PSU’S

when they became available, the calendar of

operations required that 1960 Census data be

used for the 44 of the 65 stands in the sample of

HANES. Census enumeration districts (ED’s) in

each PSU were divided into segments of an

expected six housing units each. In urban ED’s

the segments were clusters of six addresses from

the 1960 Census Listing Books. For ED’s not

having usable addresses, area sampling was

employed and, consequentIyj some variation in

the segment size occurred. To make the sample

representative of the current population of the

United States, the address or list segments were

supplemented by a sample of housing units that

had been constructed since 1960.

Within each PSU a systematic sample of segments was selected. The ED’s that fell into the

sample were coded into one of two economic

classes. The first class, identified as the “poverty

stratum, ” was composed of “current poverty

areas” that had been identified by the U.S.

Bureau of the Census in 1970 (pre-1970

Census), plus other ED’s in the PSU with a mean

income of less than $3,000 in 1959 (based on

1960 Census). The second economic class, the

48
“nonpovert y stratum, ” includes all ED’s not

designated as belonging to the poverty stratum.

All sample segments classified as being in the

poverty stratum were retained in the sample.

For those sample segments in nonpoverty stratum ED ‘s, the selected segments were divided

into eight random subgroups and one of the subgroups was chosen to remain in the HANES

sample. This procedure permits a separate analysis with adequate reliability of those classified as

being below the poverty level and those classified as being above the poverty level.

After identification of the sample segments,

a list of all current addresses within the segment

boundaries was made, and a person in each of

the households was interviewed to determine the

age and sex of each household member, as well

as other demographic and socioeconomic information required for the survey.

To select the persons in sample segments to

be examined in HANES, all household members

age 1-74 in each segment were listed on a sample

selection worksheet with each household in the

segment listed serially. The number of household members in each of the six age-sex groups

shown below were listed on the worksheet under

the appropriate age-sex-group column. The

sample selection worksheets were then put in

segment number order and a systematic random

sample of persons in each age-sex group was

selected to be examined using the following sampling rates.

Age Rate

1-5 years 1/2

6-19 years %

2044 years male 1A

2044 years female ?/?

45-64 years %

65-74 years 1

The persons selected in the 65-stand sample

of HANES make up a representative sample of

the target population and include 28,043 sample

persons 1-74 years of age of whom 20,749 or

74.0 percent were examined. When adjustments

are made for differential sampling for high risk

groups, the response rate becomes 75.2 percent.

All data presented in this report are based on

“weighted” observations. That is, data recorded

for each sample person are inflated to characterize the subuniverse from which that sample person was drawn. The weight for each examined

person is a product of the reciprocal of the probability of selecting the person, an adjustment for

nonresponse cases (i.e., persons not examined)$

and a poststratified ratio adjustment that increases precision by makiig the final sample estimates of the population agree approximately

with independent controls prepared by the U.S.

Bureau of the Census for the noninstitutionalized population of the United States as of

November 1, 1972 (approximate midsurvey

point), by color, sex, and age shown in table I.

Population estimates are included in some of the

tables in greater detail than that used for weighting. These population figures, while not precise

census estimates in this degree of age detail, are

included to give a rough idea of the number in

the population at risk.

A more detailed description of the survey

design and selection technique can be found in

the “Plan and operation of the Health and Nutrition Examination Survey, United States,

1971 -1973,” Vital and Health Statistics, Series

l-No. 10a.7

Nonresponse

In any heaIth examination survey, after the

sample is identified and the sample persons are

requested to participate in the examination, the

survey meets one of its more severe problems.

Usually a sizable number of sample persons will

not participate in the examination. Whether or

not an individual participates is determined by

many factors, some of them uncontrollable and,

therefore, may be reasonably treated as an outcome of a random event with a particular probability of occurrence. If these probabilities of participation were known and greater than zero for

all persons, then the examined persons would

constitute a probability sample from which

unbiased estimates of the target population

could be derived. In this situation, the effect of

nonparticipation would only be to reduce the

sample size, thereby increasing the sampling

NOTE: A list of references follows the text.

49
Table 1, Unit6d States civilian nonin~titutional ized populdtioh, by age, $@x,and oolor, November 1, 1972

1.

~

Age in years

Sex and color Total

1-5 6-19 2044 45.64 65-74

Total ............................................ 193,976,447 17,282,843 55,434,127 66,307,351 42,344,237 12,607,889

Male ..............t.............................................. 94,151,059 8)8 18,156 28,014,291 31,757,861 20,090,701 5,469,960

White ...................................................... 82,652,067 7,407,500 23,911,243 28,195,112 18,19C),f48 4,948,064

All other ................................................. 11,498,992 1,410,656 4,103,048 3,562,749 1,900,643 521,896

Femak ......................................................... 99,825,388 8,464,687 27,419,836 34,549)490 22,253,446 7,137,929

White ...................................................... g6,932,196 7,070,629 23,261,515 30,102,612 20,011,119 6,4%6,421

All other ................................................. 12,843,192 1,394,158 4,158,321 4,446,87g 2,242,327 651,508

Source: Unpublished estimates of September 27, 1974, from the U.S. Bureau of the Census.

errors of examination findings. In practice, howevert a potefitial for bias due to nonresponse

exists because the exact probabilities are never

known. A further potential for bias exists if: (1)

a sizable proportion of sample persons have a

zero probability of participation, that is, they

would nevet agree to participate in an examination survey of the same procedures and inducements, and also (2) these persons differ from

other sample persons with respect to characteristics under examination. It is for these reasons

that intensive efforts are made in HANES to

develop and implement procedures and inducements that would reduce the number of nonrespondents and thereby reduce the potential of

bias due to nonresponse, These procedures and

inducements are discussed in the “Plan and operation of the Health and Nutrition Examination

Survey, United States, 1971 -1973,” Series l-No.

10a.7

Despite these intensive efforts, 24.8 percent

of the sample persons from the 65 stands were

not examined. Consequently, the potential for a

sizable bias does exist in the estimates in this

publication, From what we know about the nonresponderits and the nature of nonresponse, we

believe that the likelihood of sizable bias is

small, For instance, orIly a small proportion of

persons gave reasons for nonparticipation which

would lead to the belief that they would never

agree to participate in examination surveys and

that they may differ from examined persons

with respect to the characteristic under examination. Only 15 percent of the nonrespondents

gave as their reasons for nonparticipation personal illness, physically unable, pregnant, antidoctor, or fear of finding something wrong.

Typical among the reasons given by the other

nonre,spondents were: unable because of $vork,

school, or household duties; suspicious or slfeptical of the program; just not interested in p~rticipating; and private medical care sufficient o}rjust

visited doctor.

An analysis of medical history data obtained

for most nonexaminees as well as examinee$ also

supports the belief that the likelihood of sizable

bias due to nonresponse is small. No large differences were found between the examined group

and nonexamined group for the statistics compared. For example, 11 percent of persons

examined reported having an illness or condition

that interferes with their eating as compared to

9 percent of persons not examined but who had

completed a medical history. The percent of persons examined reporting ever being told ~by a

doctor that they had arthritis was 20 percent;

the percent for high blood pressure was 1? percent and for diabetes, 4 percent. The corresponding percents for nonexamined persons

were: arthritis, 17 percent; high blood pressurej

21 percent; and diabetes, 4 percent.

As was mentioned earlier, the data in this

report are based on weighted ob servation$, and

one of the components of the weight assigqed to

an examined person was an adjustment for nonresponse. Because the probabilities of participation are not known for sample persons in

HANES, a procedure was adopted that rnulti50
plies the reciprocal of the probability of selection of sample persons by a factor that brings

estimates based on examined persons only up to

a level that would have been achieved if all

sample persons had been examined. This nonresponse adjustment factor is the ratio of the sum

of sampling weights for all sample persons

within a relatively homogeneous class defined by

age, sex, and five income groups (under $3,000;

$3,000-$6,999; $7,000-$9,999; $1o,ooo-

$14,999; and $15,000 and over) within each

stand, to the sum of sampling weights for all responding sample persons within the same homogeneous class for the same stand. To the degree

that homogeneous groups can be defined which

are also homogeneous with respect to the characteristics under study, the procedure can be effective in reducing the potential bias from nonratable II. Percent distribution of non response adjustment factors: Health and Nutrition Examination Survey, stands

01-65, 1971-1974

Number Percent

Size of factor of distri -

cells bution

Total ........................ ....................

l. 00.1.24 ................................................

l.25.1.49 ................................................

l.50.1.74 ................................................

l.75.1.99 ................................................

2.00-2.49 ................................................

2.50-2.99 ................................................

3.00-3.03 ................................................

325

106

125

59

24

9

1

1

100.0

32.6

38.4

18.2

7.4

2.8

0.3

0.3

sponse. For the 65-stand sample of HANES, the

percent distribution of the nonresponse adjustment factors used for the 325 income groupstand celk is shown in table H.

Missing Data

Examination surveys are subject to the loss

of information not only through the failure to

examine all sample persons, but ako from the

failure to obtain and record all items of information for examined persons. The dermatology

examination was not obtained for 111 or 0.54

percent of the 20,749 examinees in this HANES

I program. The age-sex distribution of these nonexamined persons is shown in table III. In the

detailed tables and fiidings of this report, no

estimate has been made for what skin findings

they might have had. Rather it has been assumed

that they had normal skin.

Small Numbers

In some tables, magnitudes are shown for

cells for which the sample size is so small that

the sampling error may be several times as great

as the statistic itself. Obviously in such instances

the numbers, if shown, have been included to

convey an impression of the overall story of the

table.

Sampling and Measurement

Error

In the present report, reference has been

made to efforts to minimize bias and variability

Table I I 1. Total number of exam inees and those not given the dermatological component, by age and sex: Health and Nutrition

Examination Surveyr United States, 1971-1974

Age

Both

Male

sexes

Female

I Total number examined

Ail ages, 1-74 years ......................4...................................... .............

1-5 years ............ ................ ...................... ........................................................

6-11 years ..... ..................... ...... ........................................................................

12-17 years ......................................................................................................

18-24 years .............................................. ........................................................

25-34 years ................ ........ ..............................................................................

3544 years ........ ...................................... ........................................................

45-54 years ........................ ..............................................................................

55-64 years ....... .. ....................<.....................<..................................... .....4.......

65-74 years ........ ...... .......... ...................... ........................................................r

20,749

2,953

2,019

2,132

2,297

2,694

2,327

1,599

1,262

3,466

8,819 t 11,930

1,502 1,451

1,001 1,018

1,068 1,064

770 1,527

799 1,895

666 1,661

767 832

591 671

1,655 1,811

II I

111

8

8

11

17

14

15

12

11

15 I

39 72

2 6

4 4

4 7

7 10

4 10

2 13

5 7

5 6

6 9

51
of measurement techniques. The potential of

residual bias due to the high nonresponse rate

has also been discussed.

The probability design of the survey makes

possible the calculation of sampling errors. Traditionally, the role of the sampling error has

been the determination of how imprecise the

survey results may be because they come from a

sample rather than from the measurement of all

elements in the universe.

The estimation of sampling errors for a

study of the type of the Health and Nutrition

Examination Survey is difficult for at least three

reasons: (1) measurement error and “pure” sampling error are confounded in the data–it is not

easy to find a procedure that will either completely include both or treat one or the other

separately, (2) the survey design and estimation

procedure we complex and, accordingly, require

computationally involved techniques for the calculation of variances, and (3) hundreds of statistics are presented in the tables in this report,

many for subclasses of the population for which

there are a small number of sample cases. Estimates of sampling error are obtained from the

sample data and are themselves subject to sampling error when the number of cases in a cell is

small or, even occasionally, when the number of

cases is substantial.

Estimates of the standard errors for selected

statistics used in this report are presented in

most of the tables in this report. These estimates

have been prepared by a replication technique

that yields overall variability through observation of variability among random subsamples of

the total sample.1 8)19 Again, readers are

reminded that these estimated sampling errors

do not reflect any residual bias that might still

be present after the attempted correction for

nonresponse. The standard error is primarily a

measure of sampling variability, that is, the variations that might occur by chance because only

a sample of the population is surveyed. As calculated for this report, the standard error also

reflects part of the variation that arises in the

measurement process. It does not include estimates of any biases that might lie in the data.

The chances are about 68 out of 100 that an

estimate from the sample would differ from a

complete census by less than the standard error.

The chances are about 95 out of 100 that the

differences would be less than twice the standard error and about 99 out of 100 that it would

be less than 2% times as large.

Tests of Significance

The procedure used in this report for testing

the significance of the difference between the

two means consisted of dividing the difference

between the two means by the standard error of

the difference; that is, a z statistic was computed. An approximation of the standard error

of a difference d = x - y of the two statistics x

and y is given by the formula

Sd = (s; + s; p

where SX and SY are the sampling errors, respectively, of x and y. Of course, where the two

groups or measures are positively or negatively

correlated, this will give an overestimate or

underestimate, respectively, of the actual standard error.

Examiner Variability

The Data Collection Unit of the Committee

on Planning for the NationaI Academy of Dermatology (NAD), under chairman Dr. Wu.-ieLouise T. Johnson, was responsible for planning

the content of the dermatology examination and

for recruiting and training the 101 dermatologist

examiners employed at the 65 examination locations in the Health and Nutrition Examination

Survey of 1971-1974.

Advance training in the dermatology examination protocol was given each dermatologist

before the survey examinations were started. In

addition, members of the NAD Data Collection

Unit periodically reviewed the methods used and

the recording of findings by the dermatologists

during the survey. After completion of the survey, Dr. Johnson thoroughly reviewed the

20,637 recorded examinations to ensure consistency with the standard examination protocol,

including the selection of the significant diagnoses, and resolved the diagnoses of skin cancer

and dermatophytoses on the basis of subsequent

findings from the biopsy and fungal laboratory

determinations, respectively.

52
The number of examinees per dermatologist

ranged from 4 to 638, with 27 percent examining fewer than 100 persons, 28 percent 100-199

persons, 26 percent 200-299 persons, and 20

percent 300 persons or more.

Variation would be expected among the

examiners in the proportion of their examinees

found to have significant skin pathology and in

the proportion with skin complaints because of

differences in the age-sex distribution among

them in the groups examined, regional differences, and the extent or type of environmental

exposure that may affect the prevalence of various types of skin pathology and other factors.

To assess the extent of examiner variability and

the effect that it may have had on the findings

from this dermatology examination, the effect

of age-sex differences in the groups examined by

each dermatologist have been controlled through

a direct adjustment method. In this the age-sexspecific rates for each examiner have been

applied against the number of persons in that

age-sex group for the total population and the

age-sex-adjusted rate recomputed.

Among persons examined, the age-sexadjusted proportions found to have significant

skin pathoIogy range from O to 90.4 percent

per examiner, with one-fourth of the dermatologists finding 13.7 percent or less of their

examinees to have such pathology, one-half finding between 13.7 and 46.1 percent, and the

remaining one-fourth finding 46.1 percent or

more with significant skin pathology (tables IV

and V). The range in such findings among

examiners is negligibly greater among females (O

to 90.0 percent) than among males (O to 88.2

percent).

Examiner variability in the proportion of

their examinees with skin complaints, when the

effect of age-sex differences among the groups

are removed by direct adjustment is somewhat

less than that for significant pathology because

of the lower rates in general for the complaints.

The range in the age-sex-adjusted rates of skin

Table IV. Range, mean, median, and quartiles in the distribution of dermatologist examiners, by the age-sex adjusted

proportion of examinees with significant skin pathology,

skin conditions of concern (complaints), and their ratio:

Health and Nutrition Examination Survey, 1971-1974

Measure and sex

Both sexes

Range .............................

Mean ..............................

Median ...........................

’25 ““””-”””””-”-”””””””””””””””””””

P75 ““””””””””””””””””””””’”””””””

Male

Range ............ .. ........ .......

Mean ..............................

Median ..... ...... .. ........ ......

’25 ““”””-””””’”””--””””””””””””””””

P75 ““”””””””””””””””””””””””””””’””

Female

Range .............................

Mean ....... .......................

Median ...........................

’25 ““””””-”””””””””””””-””-”””-””””

P75 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..-

SignifiRatio–Skin 100 X skin

cant condition complaint/

skin of conpatholsignificant

tern to

Ogy

skin

examinee pathology

1 1

Rate per 1,000 population

0-903.9

312.4

265.4

136.7

461.1

0-882.5

339.8

279.7

149.2

508.3

0-900.2

286.6

241.0

122.8

429.5

0-707.8

113.6

88.6

27.3

198.0

0-805.6

127.7

118.8

30.0

261.5

0-627.4

100.3

90.6

25.8

204.9

10-428.9

36.4

43.5

8.5

84.8

10-617.6

37.6

43.5

9.9

99.0

104,424.6

35.0

47.5

84.0

92.8

lExclude~ examiner finding of no simsificant DatholoW but

with examinee having conditions of c;ncern (~4.2 pe;;ent).

complaints is from O to 70.8 percent per

examiner, with one-fourth of the examiners

recording 2.7 percent or less, one-half of the

examiners between 2.7 and 19.8 percent, and

the remainder 19.8 percent or more of their

examinees with skin complaints.

The ratio of skin compktints to significant

skin pathology per examiner ranges from O to

4.29, with one-fourth of the examiners showing

0.08 or less, one-half from 0.08 to 0.85, and the

remainder 0.85 or more.

53
Table V. Number of examinees and age-sex adjusted proportion of examinees with skin pathology, skin conditions of concern

(complaints), and their ratio, by dermatologist examiner ancl sex of exam inee: Health and Nutrition Examination Survey, 1971-

1974

Examiner number

All examiners ............................................................................................

Signifi- Skin

Ratio–

100 X corn.

cant com - Nultiber

skin plaints

plaints/significant of

pathol- by the skin examinees

09Y examinee pathology

312.4

94.5

206.0

403.9

47.0

184.4

170.0

99.4

281.3

367.2

487.8

26.2

377.9

427’.7

198,6

249.1

116.1

188,6

134.4

217.0

362.4

53.7

96.0

436.8

106.2

456.0

380.1

581.6

244.8

614.8

198.3

364.2

89.2

58.7

314.5

230.7

227,6

244,7

107.4

164.0

256.8

500.3

275.6

670.5

250.7

221.7

715.9

853.7

466.2

791.4

Rate per 1,000 persons

113.6

141.0

88.0

400.5

38.7

203.0

146.6

43.4

234.6

156.0

205.5

14.4

390.8

190.6

204.7

48.5

142.0

95.0

74.4

129.0

361.1

60.9

0.0

352.1

9.7

0.0

10.6

236.7

12.5

0.1

196.5

128.8

18.3

0,0

196.2

27.6

72.2

44.8

29.4

107.5

90.4

40.0

153.6

93.7

57.4

44.6

33.2

28.2

10.8

2.6

36.4

149.2

42.7

99.2

82.3

110.1

86.2

43.6

83.4

42.5

42.1

55.0

103.4

44.6

103.1

19.4

122.3

50.3

55.3

59.4

99.6

113.4

0.0

80.6

9.1

0.0

2.7

40.7

5.1

0.0

99.1

35.4

20.5

0.0

62.4

11.5

31.7

18.7

27.4

65.5

35.2

7.9

55.7

14.0

22.9

20.1

4.9

3.3

2.3

0.6

20.638

274

438

91

31

221

303

174

312

183

629

218

119

217

216

370

98

638

216

266

552

181

160

116

247

229

603

427

417

75

43

241

258

241

404

328

277

41

284

251

234

176

89

500

217

215

481

139

166

54
Table V. Number of examinees and age-sex adjusted proportion of examinees with skin pathology, skin conditions of concern

(complaints), and their ratio, by dermatologist examiner and sex of examinee: Health and Nutrition Examination Survey, 1971-

1974–Con.

52 ... ...... .. ........ ...... ...... .. ...... .................... ...... .................... .. ...... .............. ...... ...... ......

53 ......... ........ ...... .......... .... .. .......................... ...... ........ ............ .. ................................

54 ............... ........ ........ .. ...... ...... ...... .............. ...... ...................... ................................

56 ........ ...................................... ...............................................................................

57 .......... .................... ........ ...... ............................ ...................................... ...............

58 ........ .. ...... .. ...... ...... .. ...... ...... ...... .............. .. ...... .......................... ............ .. ...... .......

59 .............. .................. .............................................................................................

60 ........................ .............. ...... ...... .. .................... ...................................... ...... .........

61 ............. ................................................................................................ ........ ........

62 ........ ...... .. ........ ...... ...... .. ...... .............. ............ ...... .. .......... ................ .............. .......

63 ...... .......................................................................................................................

64 ................ .... ........ ........ .. .... .. .................... .............. .... ................ ............ ...............

65 ...... .. ........ .... .. ............ ................ ...........................................................................

66 ........ ...... .. .. .... ...... .. .... .. ...... ...... .. .................... .............4.........................................

67 ..... .. ...... .. .... .. ...... .............. .. .............. ...... ...... .. .................. .. ........ .... ...... .. ..............

68 ...... ................ ...... ...... .................... ................ ............ ...........................................

69 .............................................................................................................................

70 .................... ................ .........................................................................................

71 ...... ................ .... .............. ........ ............................ ............................ .....................

72 ................ .... .. .............. .........................................................................................

73 ............................ ...... .. .................................. ................................ .............. .........

74 .................................. ............ .............. .................................................................

75 ...........e...... ...................... .................... .............. .. .................................. ...............

76 ................................................................................................................... ..........

77 ...... .... .. .. ...... .. ...... ...... .............. .. ...... ...... .. .... .. ...... ...... ...... ........ ........ .... .. ...............

78 .... .. ........ .... .. ........ ............ ...... ........ ...... ................ ...... ...... .................... ........ .........

........ ........ ...... ............ ...... ........ ........ .............. .......................................................

: ...... ...... .. ........ ...... .......................................... ...... .................. ........ .......................

81 ..... .. ...... .. .... .. .... .. .. .... ........ .... ..o. ...... .......................... ...... ................ .................. ....

82 ....... ...... .. .. .. ........ ...... .. ........ .... .. ............ ...... .. ...... ...... .............. .. .... .. ...... ...... ..........

83 ... .. ...... .. ...... ...... .. ...... ...... .. ........ .... .. ............ ........ ...... ...................... ...... ................

84 ... .... ...... ...... .. ........ ...... ...... ...... .. ............ ...... .................... ................ ...... ...... ........ ..

86 ....... .................... ................ .... .. ...................................... ................ ............ ..........

87 ..... .. ...... ...... .. ...... .. ....e. ........ ...... ............ ...... .............. ...................... ...... ...... ...... ....

88 ....... ...... .. ...... ........ .......... .. .. ........................ .................... ...................... ................

89 ..... .. ............................................................ .............. .......................... .. ................

91 ............................. ............................................................................... .................

92 ......... .... .. ........ ...... .............. ...... ............ ...... .. .................................. ......................

93 ..... .. ...... .. .... .......... .... ................ ...... .................... .......................... .. ............ ...... ....

94 ....... ...... .. .... ........ ...... .......................................... ...... ........ .............. ......................

95 ....... ..............................................` .................................................................. .....

96 ......... .............. .................... ................................................................... ..... ..........

97 ..... .. ...... .. .... .... .... .. .............. ...... ............ ...... ........ ...... ................ ...... ......................

99 ....................... ...... ........ .. .... ...... ............ ...................... .............. .................. ..........

loo .......... ................ .................................................................................................

101 ... .. ...... ...... ...e...... ............ .. ...... ...... ...... .............. .. ...... .............. .... .. .................. .. ..

102 ..... ...................... ............ .. ...... .................................. .... ................ .... ........ ..........

lw .................... .............. .............. ...... ........ ............ .................... .... .............. ...........

lo5 ..... ........ .............. ...... .. ...... ............ .. .......... .......... ...... .............. ...... .................. ....

Significant

skin

09Y

70.3

592.6

261.4

243.7

45.9

135.4

764.9

162.9

728.1

601.0

171.3

514.3

431.9

137.9

903.9

501.3

396.9

272.7

128.4

68.2

256.4

436.3

322.1

239.4

636.3

378.4

358.5

104.7

554.2

108.2

523.8

106.9

445.8

547.3

641.4

288.8

63.3

402.0

340.3

200.8

489.0

48.1

135.5

436.2

269.5

292.2

207.0

600.6

38.8

518.0

490.3

Skin

Ratio–

100 X com

com - Number

plaints

plaints/sigOf

by the

nificant

skin

examinees

examinee pathology

Rate per 1,000 persons

0.0

592.6

13.3

127.6

35.2

250.0

5.2

19.1

143.1

357.4

82.0

233.4

445.2

591.4

30.8

37.4

131.7

144.5

89.3

50.8

234.8

4.5

7.2

195.2

162.7

99.6

156.1

0.0

18.7

16.9

623.8

182.9

22.2

11.4

62.5

31.9

259.2

241.7

179.4

265.8

199.5

77.6

397.4

390.5

707.8

124.5

27.0

71.2

72.0

443.9

0.0

100.0

5.1

52.3

76.7

184.6

0.7

11.6

19.6

59.4

47.8

45.4

103.1

428.9

3.4

7.4

33.2

53.0

70.0

74.5

91.2

1.0

2.2

81.5

25.6

26.3

43.5

0.0

3.4

15.6

100.0

171.1

5.0

2.1

21.6

50.4

64.5

0.0

52.7

132.4

40.8

161.3

91.1

145.0

242.2

60.1

4.5

183.5

13.9

94.6

67

80

93

102

116

39

131

140

226

40

79

55

173

9

209

326

253

136

129

280

143

580

212

384

157

194

110

362

61

56

22

89

113

61

68

315

94

23

157

125

104

197

261

108

50

4

76

210

234

51

166

55
Table V. Number of examinees and age-sex adjusted proportion of examinees with skin pathology, skin conditions of’ concern

(complaints), and thair ratio, by dermatologist examiner and sex of examinee: Health and Nutrition Examination Survev, 1971-

1974–Con.

Examiner number

Signifi- Skin

Ratio–

100 X com

cant com - Number

skin plaints

plaints/sign if icant of

pathol- by the exam inees

Ogy

skin

examinee

pathology

Rate per 1,000 males

339.8

137.8

250.2

505.8

29.2

240.0

210.7

76.7

299,1

395.3

523.2

10.6

511.8

496.7

301.5

266.2

68.3

255.4

156.3

231.6

390.8

51.2

149.4

506.8

101.8

551.6

401.3

664.0

293.0

653,0

130,4

431,1

129.4

64.2

357.0

246.0

256.7

281.4

139.5

191.0

282.4

575.6

314.2

708.8

224.0

170.9

692.4

865.3

556.0

845.6

127.7

234.4

113.0

505.8

149.8

254.8

168.6

16.8

248.6

154.6

218.3

3.6

501.8

253.9

301.6

10.9

98.7

111.0

92,5

126,5

390.8

26.8

0,0

394.4

11.5

0.0

17.0

278.3

16.0

0,0

380,7

111.8

21.8

0.0

221.2

17.2

103,1

331,8

37.9

118.0

119.0

22.8

23’6.4

98.2

43.9

46.1

27.8

44.5

1.0

0.4

37.6

170.1

45.2

100.0

513.0

106.2

60.0

21.9

83.1

39.1

47,7

34.0

98.0

51.1

100.0

4.1

144.5

43.5

59.2

54.6

100.0

52.3

0.0

77.8

11.3

0.0

4.2

41.9

5.5

0.0

291.9

25.9

16.8

0.0

62.0

7.0

40.2

117,9

27.2

61.8

42.1

4.0

74.9

13,9

19.6

27.0

4.0

5.1

0.2

0.0

8,780

121

189

44

15

92

123

79

137

90

268

84

49

92

86

156

42

253

91

101

245

82

67

52

115

91

259

182

185

40

17

96

102

113

163

145

121

14

123

108

97

72

43

205

83

92

219

56

71

152

56
Table V. Number of examinees and age-sex adjusted proportion of examinees with skin pathology, skin conditions of concern

(comcdaints), and their ratio, by dermatologist examiner and sex of exam inee: Health and Nutrition Examination Survey, 1971-

1974~Con.

Examiner number

52 .............................................................................................................................

53 .............................................................................................................................

55 .............................................................................................................................

56 .............................................................................................................................

57 .........." .................................................................................................................

58 .............................................................................................................................

59 .............................................................................................................................

60 .............................................................................................................................

61 ...............................o.............................................................................................

62 .............................................................................................................................

63 .............................................................................................................................

64 ..............................................................................................................................

65 .............................................................................................................................

66 .............................................................................................................................

67 .............................................................................................................................

68 .............................................................................................................................

69 .............................................................................................................................

70 .............................................................................................................................

71 .............................................................................................................................

72 .............................................................................................................................

73 .............................................................................................................................

74 ............................u...................e............................................................................

75 .............................................................................................................................

76 .............................................................................................................................

77 ................................... .........................................................................................

78 .............................................................................................................................

79 .............................................................................................................................

80 .............................................................................................................................

81 .............................................................................................................................

82 .............................................................................................................................

83 .............................................................................................................................

84 .............................................................................................................................

86... !........o........................o....................!................................o.....o...........................

87 ......................................................0..!...................................................................

88 .............................................................................................................................

90 ............................................................................4..............................................0.

91 .............................................................................................................................

93 .............................................................................................................................

94 .............................................................................................................................

95 .............................................................................................................................

97 .............................................................................................................................

99 ..............................n..............................................................................................

100 ...........................................................................................................................

101 ...........................................!.... ...........................................................................

lo2 ......................................!.....o..............................................................................

104 ...........................................................................................................................

lo5 ...........................................................................................................................

I

Signifi- Skin

cant comskin plaints

pathol- by the

Ogy examinee

355.6

213.8

368.2

19.9

149.0

730.0

200.6

705.4

486.9

97.2

548.2

518.3

136.0

882.5

538.9

509.8

279.7

94.8

59.3

230.7

449.6

417.9

216.2

648.3

514.6

416.7

142.6

519.3

199.6

235.3

51.0

473.7

528.2

685.6

266.3

41.6

455.1

336,8

224.9”

412,7

75,8

175.0

525.1

110.5

194.4

180.4

666.0

58.2

213.0

453.0

Ratio–

IOOX com

plaints/significant

skin

pathology

Rate per 1,000 males

94.4

684.3

11.6

172.6

?22.9

422.6

119.6

34.1

132.5

530.4

30.3

286.6

583.8

690.8

37.4

45.9

154.3

175.9

60.0

53.9

193.9

6.6

0.0

130.8

138.4

61.8

95.7

0.0

0.0

48.0

728.4

44.2

11.5

18.6

59.9

29.7

339.0

449.6

103.4

314.0

390.5

98.8

533.2

307.9

805.6

268.2

33.4

85.3

392.2

414.8

..-

192.4

5.4

46.9

617.6

283.6

16.4

17.0

18.8

108.9

31.2

52.3

112.6

507.9

4.2

8.5

30.3

62.9

63.3

90.9

84.0

1.5

0.0

60.5

21.3

12.0

23.0

0,0

0.0

24.0

309.6

88.7

2.4

3.5

22.5

71.4

74.5

-..

30.7

139.6

84.6

130,3

101.5

278.6

414.4

148.7

5.0

146.6

164.1

91.6

Number

of

exam inees

28

32

35

42

52

17

47

55

105

17

39

27

69

5

80

164

112

59

47

115

62

233

90

171

69

81

40

150

24

25

7

37

82

46

28

28

132

40

8

62

55

43

60

119

44

23

2

35

89

106

21

77

57
Table V. Number of exam inees and age-sex adjusted proportion of exam inees with skin pathology, skin conditions of concern

(complaints), and their ratio, by dermatologist examiner and sex of examinee: Health and Nutrition Examination Survey, 1971-

1974–Con.

Examiner number

All examiners ...... .. ...... ........ ...... .......... .............. ........ ..... ........ ........ ..........

Sign ifi- Skin

Ratio–

100 X com

cant com -

plaints/sig- Number

skin plaints

n if icant of

pathol - by the skin exam inees

09Y examinee

pathology

I I I

Rate per 1,000 females

286.6

65.4

156.9

214.0

51.2

129.2

120.1

98.6

246.4

327.6

443,6

35.5

236.0

376.3

103.0

241.0

125.6

135.1

125.6

188.5

304.4

47.0

68.1

359.9

111.8

366.9

363.7

502,9

196,4

571.6

212.6

315,6

69.1

55.9

276.4

288.8

222.8

173.4

221.9

80.4

114.3

230.8

460.6

218.4

636.6

258.6

245.2

829.2

467.9

736.3

100.3

62.2

63.5

210.4

224.4

146.3

110.7

57.9

192.0

156,4

200.8

19.5

268.3

166.8

113.1

83.3

148.4

80.8

47.9

124.6

302.4

91.3

0.0

401.0

4,4

0.0

3.6

199.8

14.0

0.0

220.1

94.5

15.5

0.0

163.8

37.5

30,1

119.0

25.4

84.6

88.3

54.4

64.1

90.6

55.0

39.0

40.3

8.0

i6,7

4.8

35.0

95.1

40.5

98.3

438.3

113.2

92.2

58.7

77.9

47.7

45.3

54.9

113.7

44.3

109.8

34.6

118.2

59.8

38.1

66.1

99.3

194.3

0.0

111.4

3.9

0.0

1.0

39.7

7.1

0,0

103.5

29,9

22.4

0.0

59.3

13.0

13.5

68.6

11 “.4

105.2

77.3

23.6

13.9

41.5

8.6

15.1

16.4

1.0

3.6

0.7

11,858

153

249

47

16

129

180

95

175

93

361

134

70

125

128

214

56

385

125

165

307

99

93

64

132

138

344

245

232

35

26

145

156

128

241

183

156

27

161

143

137

104

46

295

134

123

262

83

95

205

58
Table V. Number of examinees and age-sex adjusted proportion of examinees with skin pathO109Y, skin conditions Of concern

(complaints), and their ratio, by dermatologist examiner and sex of examinee: Health and Nutrition Examination Survey, 1971-

1974–Con.

Examiner number

52 .............................................................................................................................

53 .............................................................................................................................

54 .............................................................................................................................

55 .............................................................................................................................

56 .............................................................................................................................

57 .............................................................................................................................

58 .............................................................................................................................

59 .............................................................................................................................

60 ............................................................................................................C................

61 .............................................................................................................................

62 .............................................................................................................................

63 .............................................................................................................................

64 .............................................................................................................................

65 .............................................................................................................................

66 .............................................................................................................................

67 ...........s.................................................................................................................

68 .......................%.....................................................................................................

69 .............................................................................................................................

70 .............................................................................................................................

71 .....................................!..................................................................t....................

72 .............................................................................................................................

73 .............................................................................................................................

74 .............................................................................................................................

75 .............................................................................................................................

76 .......................................... ..................................................................................

77 .........................................W..................................................................................

78 .........................................A..................................................................................

79 .............................................................................................................................

80 .............................................................................................................................

81 .............................................................................................................................

82 .............................................................................................................................

83 ........................................................................................................................4....

84 .............................................................................................................................

85 .............................................................................................................................

86 .............................................................................................................................

87 ........................................................................................!...... ..............................

.............................................................................................................................

; ...............s.............................................................................................................

90#...................!... o.........o..s.......................................................................................

91

92:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

93 .............................................................................................................................

94 ,!!,.............,,,,, .,.0.!,................................................................................................

95 ...........!.... ................................,.,....,,,,..,., .............................................................

96 ................................................,..,.....!,,.... .............................................................

97 ....,!.......................................................................................................................

99 .............................................................................................................................

100 ...........................................................................................................................

101 .#......................?..................................................................................@...............

lo2 .................s.........................................................................................................

lw ....................o!..o.m................................................................................................

105 ...........................................................................................................................

Significant

skin

pathology

Skin

complaints

by the

examinee

Ratio–

100X com

plaints/significant

skin

pathology

Number

of

examinees

173.6

587.4

262.8

88.9

53.9

153.9

699.3

138.1

751.0

619.6

272.5

416.6

396.8

18.7

900.2

447.3

218.7

295.3

139.3

80.1

230.4

411.7

229.6

245.2

628.1

269.6

347.4

98.8

655.7

64.2

563.3

111.3

442.4

541.4

504.5

222.2

84.2

293.2

344:1

195.6

512.8

12.4

71.6

450.8

364.7

222.5

248.0

541.3

37.5

625.1

539.0

Rate per 1,000 famales

0.0

587.5

18.1

57.2

36.8

313.0

6.9

11.3

151.5

253.6

189.4

209.0

371.2

827.4

21.8

26.1

111.1

139.8

98.2

52.6

241.2

2.7

14.3

229.8

196.9

130.9

214.2

0.0

28.4

0.0

563.3

260.4

32.6

122.8

109.7

34,5

233.0

440.4

246.2

258.4

88.3

44.1

384.5

490,5

777.5

195.6

22.1

35.5

181.1

476.7

0.0

100.0

6.9

64.3

68.3

203.4

1.0

8.2

20.2

40.9

69.5

50.2

93.5

4,424.6

2.4

5.8

50.8

47.3

70.5

65.7

104.7

0.7

6.2

9.4

31.3

48.6

61.7

0.0

5.1

0.0

100.0

234.0

7.4

24.3

49.4

41,0

79.5

71.5

132.1

17.2

3.6

85.3

134.5

349.4

78.9

4.1

84.7

29.0

88.4

39

48

58

60

64

22

84

85

121

23

40

28

104

4

129

162

141

77

82

165

81

347

122

223

88

113

70

212

37

31

15

52

113

67

33

40

183

54

15

95

70

61

117

142

64

27

2

41

121

128

30

89

...

,.,, ?=.

59
APPENDIX II

THE DERMATOLOGY EXAMINATION FORM

r > . .

HE AL THAN DNu TRIT I ON EXAMINATIONS URVEY

DE RMATO LO GY EXAM IN AT ION

Deck No. 151

(USE RED PENCIL TO FILL FORM)

NAME (Last, First, Middle) “SAMPZE NUMBER EXAMINER NO.

I

STATE OR FOREIGN COUNTRY OF LONGEST

RESIDENCE

——. —— __ m

OCCUPATIONAL EXPOSURE la Yes

m——=

2R No EX=URE TO LIGHT

IF YES: (CHECK ALL THAT APPLY) ~ (by history)

~ In Chemicalq f.me$or vapors ~ lU Immersion (hands or feet)

~ In Oils ~ la Other(SPECIFY)

In Unimpressive

~ 10 Insecticides

2D Moderate

3Q Considerable

SIGNIFICANTDESMATOLOGICAL DIAGNOSIS FROM THIS EXAMINATION

Clinical Impression Code Biopsy

1.

~ Cm 1 Done l~Refusesl

—.-— ——— Not done+ 2

mn

2.

~ ;U Done ~ 10 Ref.sed

2U Not done+ 2mOther reason

3.

ma 10 Done mla Refused

—-—— —— 2m Not done+ 2n Other reason

FINDINGS RELATING TO NUTRITION

.,, ,

SIGNIFICANT DERMATOLOGICAL DIAGNOSIS MADE PKEVIOUSL~ PHOTOGRAPHY OF SKIN: Frame No.

NOW SUPPRESSED OR IN REMISSION Lesion diagnosis code ~

Code Certain

~

Probable Doubtful

1. a ~=.—.—. — !lQL ~ 1 J 2 3n

:.~d----

GENERAL APPEARANCE (1 - 3)

~Age at first

1. Jipircolor (Natural) graying-- years

(CHECK 1 BOX)

m%’ ::; 4:: ~

- ,. ..

03cj

04/g

05Q

06D

070

08D

090

10U

----

Whi~e - I

Medium to ii~h~ ~r~;__ _ _ _

Chestnut or auburn

Red (titian, carro~,-e;c~)- --

Dark blonde

---- .

Light blond;---- ---- -

Previous Hair

Color if Gray

or Whi

Black ---- --- ---- __ 04m

Dark b;o-m. ----- ___ 05m

n ,--- 06C]

07C1 - —-

08c]

----- -— p~~

----- -——~ vu

te

---- ----- ----- _____ ____ ___ - -- -.

CHECK “YES OR ‘NO“ FOR EACH

Dyed, tinted or bleached? ~ llZ Yes

2C] No ---------------------------------------

Flag signs?

~-irJ.y:;-.--.-.

2r] No

2. Eye Color -(CHECK 1 BOX)

la Dark brown SD Dark blue

20 Light brown 6D Light blue

3D Gray,green, 7U Mismatch

hazel 8a Other(SPECIF$

40 Speckled

---- ____ ____ ____ ____ ____ _

Nevus of Iris - (CHECK 1 Box)

m ;~ M;:t

3n Both

m 2 “-12’(?age 1)

7-W

.Iumllii-l I 2rl I 3U,

3. Skin Texture

Surface 10 NO FINDINGS

~ ~U Coarse 2U Fine

~ ~D-5ii~------ZB-E;:5 miE;EG5”-E;EG--” ~ ~u-i;:sE--..------...--. ---------------

---------------------------------,--------.

m Dry 1n Senile 20 Winter

30 Both Lo Atopic Ury

Complexion

Skin Color

Code

Abdomen ~ _ _

Foream ~

,---------

~-i~-iiorid 2~-~;Iz~&’ ------

—----- --—

-----------------------------------------------

~ la Erythematous

2U Sallow

Form Approved

o .M.B. NO. 68-R1184

60
4. PIGMENT ABERRATIONS

Items 4-6+ ~ 10 NO FINDINGS (GO TO ITEM 7)

1vpe I Impression

DE51

m

ma

la Melanin general-hyper

I

-------------- -----.-- -------------.---=---

la Melanin ~eneral-hypo ------.------- -------- ---------------------

In Melanin general-cosmetically disfiguring

---------- ---------------- . ------- ------------ I I

Melanin localized

In Face

la Body

la Extremities -- ------------------------------------.......

~o Melanin localized - hyper

I?E

~U--fi;i&::-i:& ii;;:d-:-&p; ----------------

lU--fi; i;:l;-i:::ii;;~-:6;~;1;;iij-~1 ;Zifi;1

~~_. ---- Sen~lg -dgp-ig~egt~tion -— --- ---- -—.

Icterus

‘--------:EZZXE-------------------”---- -------------------------------

Q --;

~n Tatoo - ar

lu--?i;;;-:-i;aumatic

20 Tatoo - traumatic - cosmetically disfig.

In Addison’s disease -------------------------------------------.-

In Albinism - Total

2n Albinism - Partial --------------------------------.----.-------

:D Pella~oid pigmentation ------ ------- --------------------------

In Vitiligo - Total

~U Vitili&o - Partial ------: ----------------------------------

~u ------,.--------- Peat Inflammatory~F$Fzij----------------

Iu Chronically ill

iU-W&:-W%c~FYj-------------------------

Significant Trau- Surgi- *oth Herbie

Scars matic cal Zoster

Hypertrophic lU 2U 3U 4U

Atrophic lU 2U 3U 4U

Keloids ll_J 21.._l 31-I 4U

Senile Lentigenes ~ 10 Many (10+) ------------ -------------------------- ---------- -.----

EphiIidee ~ ~ 10 Many (10+)

6. Vascular

—

VASCULAR CHANGSS OTHRR TNAN NBVI (7 - 10)

ITEMs 7-10-+@ I&l NO FINDINGS @-Tc)~T&KL~ ~--g-..----.---..-.-------.---..------....--.....--.L---

---‘-‘~~~~1 ~-~~fiM%Oti- -------

7. . VASCUL4R CHANGES OTNSR THAN NSVI

Source (CHSCK ONE) Location (CHECK ONE)

~ 10 Observed UIQ 11=1 Hands

~ 10 Furpura-senile ~ :U --------- Coldness

Other purpura(CHECK ONE) ~ ~B Qanosis

2D BY history 20 Feet ~ In Traumatic

-. ------

~ In Sdema

3~ Both 3U Both 21=1 Med. induced

-------------

Duration

Sdema, chronic

3D Dis. related ~ lU Persistent

——

years f+m Idiopathic 20 Recurrent

SD Etiology obscure ~ lD-~;;~;-----

mermorsta

HSM 425-12 (Page 2)

7-72

Form Approved

O.M.B. No. 68-R1184

61
9. ACTINIC DAMAGE j

Minimal

! ~

Moderate Severe

Overall impression 123 In 2 3

Fine telangiectasia 124 In 2 3rSenile Elaetoais 125 lU ~ 3q-1

Actinic keratoses .126 lU 2 3

10. OTHER TELANGIECTASIA

Location

Face ~ lr~ Extremities

Scalp and neck

Face, scalp,

and neck

Weber Osler Rondou

Peat irradiation

Sclerodactyly

2[3 Trunk

3D Trunk and

extremities

~ in Idiopathic

familial

~ 10 Poikiloderrna

vasculare

atrophicans

~ ID Other (SP13CIlQ_—._.

——

Family history

~ la Mother 20 Father 30 Both

~ 10 Paternal 2m Paternal 3D Both

male female

~ In Maternal 2U Maternal 3m Both

male female

12. NEOPLASTIC CWANGE

~ lm NO FINDINGS (GO TO ITEM 13)

Superficial

Squamous Ce11

BCE

Carcinoma

--------‘-

- - m6

l!=%

Bowen’s disease_ _ _ _ - - 67 II

Lymphoma, leukemia_ _ _ _ . 70 1U1

Metastatic__ _ _ _ _ . 73 1[

L MISCELLANEOUS LESIONS OF COLOR AND TEXTO’RE

~ 10 NO FINDINGS(GO TO Few Many

ITEM 12) d5 5+

Clams (feet) ---------------- ~ In in

Seborrheic keratoses

Face and scalp 141 In 2n ---------------

Back and cheat---.----------- 142 la zn

Nasolabial or other

body folda 143 10 -------------------

Papuloaa nigra---------------- 144 10 g

Epithelial tags--------------- 145 lU

Neurofibromata --------------- 146 IU [1

Dermatofibromata-------------- 147 1u +

Epidermal Levi---------------- K lrl _

Warts-hands ------------------.% m 2

Warts-feet-------------------- 150 lrl 2[

Warts-genital---------------m- 351 In !2

Warta-other(SPECIFY) 152 1[-J 2n

Tophi------------------------- 153 lU

Xanthomta -------------------- 154 lu _ –+

Acanthosis nigracanS---------- 155 lU

Lichen atriatus 156 lU 21-1

I

—1

I

~

I

I

I

I

I

(Lr

Lipoma----- m—_

Ganglioma-..~

Sebaceoua

—

Size of lirgeat

‘-->9, codeto 9)

——cm.

cm.

ademoma___ ~ cm.

Benign neoplasm of

aweat glands

and ducts cm.

Other fib;;:

j mt..--_-.~ cm.

ECTODERML APPENDAGES

13. Ectodermal glands ~ ~ lU NO FINDINGS (GO TO ITEM 14)

Eccrine

Locati“,x

Activity Forehead I Hands IFeet

Marked

---- la

Minimal- --

k .7, !

-----------

Dishydrotic. I /\ U, r-l W,rl I

--- 1/ -4 .L , I *A4J

1[_l Anhydrotid

Apocrine (Poat pubertal)

Mammary gland developmen~ Fox Fordyce disease

la Absent !3D Marked ~1~ Axillary m la

2a Deficient ~ 10 Para-areolar

Sebaceous glands:

Sebum production ~ 1 n Increaaed

i;:iG:i:;-:;;EG-7i::~ -i-U-Z-L--------? -D-:5 -?---

Genital

La;gest ~ cm. (9 or > code to 9)

Location of cysts :~ ~ lU Chest ~ 10 Face

mm In Back lD Other (SPECIFY)+

HSM 425-12 (Page 3)

7-72

Form Approved

O.M,B. No. 68-R1184

62
14. NAILS - ~ ~ 1D NO FINDINGS (GO TO ITEM 15)

Fingernails (TOTAL NIJMBSR) ~ _ _

Abnormsliti.es(RECORD NUMBER OF NAILS INVOLVED. IF LESS THAN ~ PRECEDE

Color m— — whit’; ~ ye;::: m91_

Quality — — soft;

Contour

——

~~ Raised; ~ ~~dd

Surface — — Ridged; .—

Other ~] Thickened; ~ Clubbed

Complete absence of nails, not traumatic ~ 10

B●nds White,cross;~~ pigmented 10ng —.

NUMBER WITH ())

_ Green, brown or black

Clinical impression of abnormalities noted above:

~ 1U Fungus ~ In Trauma @ lU Alopecia areata

~ la Lichen plan.a ~ la Nevus ~~ 1U Psoriasis

~ In Other (SpECIFY)

-----------------------------------------------------------------------------------------------------------

Toenails

Abnormalities

~ In Thickened ~ la Discolored ~ la Pigmented bands

Clinical impression of abnormalities noted above:

~ lU Fungus ~ 10 Psoriasis ~ 1[~ Nevw7

~ 1U Trauma ~ la Other (SPECIFY)

15. HAIR —> ~ la NO FINDINGS

~: Alopecia Min. Mod . Severe

Male

Pattern--- m lrl 2n 30

>

Localized m lrl 2n 30

Diffuse-- m lrl 21-I 3n

Impression

of etiology

~ 1n Areata ~ 10 Infection

H la Anti meta- ~ 10 Trauma

bolites

~ 10 POstcli- ~ la Familial

macteric

Texture:

~ lC]Fj.ne 2CI COarse

UZZl lUDry staring Za Easily plucked 30 Both

,Eyebrows:

~ lnSparse 2U Absent

Evelashes:

~ laSParse 20 Absent

Facial Hair (post pubertal)

Males

~ luSparse 2U Absent

Females >

~ l~cessive 1

~ 10 Alopecia @ In Genetically

Areata determined

~ In Post infec- ~ la Post trauma

tion

~ la Endocrine ~ 1n Other (SPECIFY)

Axillar~

~ lnsparae 2H Absent

Pubic

~ l[~Sparse 2~ Absent (not shaved)

Body Weir

m 10 Inappropriate -xutch-n

Location ‘None Minimal Marked Excessive

Anterior Thorax

Posterior Thora~~ 262 1

Arms

..........

H;M7$?5-12 (Page 4) Form Approved

. O.M.B. No. 68-R1184

63
REGIONAL EXAMINATION

16. H?L4DAND NECK

m la NO FINDINGS (GO TO ITEM 17)

‘% Scalin$. .ZQ-.EEY!L%E---?-Q--!?!! . 7 --------- --

-Impressions: —

l.@ la Seborrheic dermatitis

~ In Trauma

LLu j In Psoriasis

~ 10 Other

Q-=@-lz:=:d!.:~=t!!kt,!w?& Family Histor

Ears

Deform~

~ 10 Acquired 2a Congenital

@ la Chondodermatitia helicis nod.laris

Nose

Deform~

~ la Acquired Zu Congenital (saddle, etc.)

Mouth Bucca

Observ= LiPs lf.ucos Gingiv Tongue

Fissuring-------

Pigmented les. 30

Leukoplakia ‘- -----

Lichen Planus

Tumor---

Angular

scars -,

Cheilosis------- 132011r

L?!2.8w (-t’,. ) General ma-wzlossia

Mal developed generally

~ In Forked ~ la Partial atrophy 20 Fu11 atrophy

Papillae

~ 10 AtrOphic ~ 10 Geographic 30 Pyramidal

Zn Black hairy 4n Scrotal

Palate

~ In Smok=s 2~Glandular hypertrophy ~ ;~ .kr;h~d

(non-smokers)

----------

Color

30 Bc}th

= lU Beefy red Za Magenta

Other findings:

~81 In Serrations 2U Swelling(marginal 3[Z Bc,th

(marginal bilateral) bilateral)

18. THIGHS AND BUTTOCKS

~1 la NO FINDINGS (Go To ITEM 19)

[~ ~D Veno.a stars

~ l~-F1i;il~;i-Zj; i;:d’li~i:-------

20 Pilonidal cysts-drainage

3D Pilonidal cysts-no drainage

AU Pilonidal cysts-repaired

~ l~-~~~~~i-~~~~; i;---------------

Za Rectal fissure and ulceration

~a Both

~ lU-Y;;;;:Gi:E:Si-E:; ::i:---’-----

l& G~o

E3?a 10

20

3U

~ lU

I

3ii Both

4U Uncertain

2(?. EXTREMITIES

~] la NO FINDINGS(W TO ITEM 21)

NO FINDINGS (GO TO ITEM 20)

Chancre I

Redness and scaling due to:

Other VD ~ l~Posriasis

Both 2a Seborrheic dermatitis

Ulcers CQiKl itg-&&~:a:----A----

1 2D Parasites

Clubbing

acquired

Clubbing------

familial------

Deformity,

acquired------

Deformity,

familial------

----------------’.---- ‘----------------------- k-----

Varicoaities bin. jMod. ISever

Right 13581 1C112CI 30

Left-~z4 13591I lrllzcl I 3LI

----------------------------------- -------- --------

N3 color Peri-’foll.

Follicular hyperkeratosis change redness

Upper-outer arm 36~ 1n 2CI ---------

Rest of upper extrem. m m 2D ---

Entire arm m In 2rl -------.------

Upper-outer legs m 1c1 2Kl --------

Rest of lower extrem---- m ~ 20

Entire leg m 1n 20

--------------

Upper back ---- ------ =~ la 2L

Abdotnen_ -- _ ..- -,--- .m . la 2U

Buttocks ----- - ._.- _ -- .= 13.CI 2m-:,

,

17, THORAX AND ABDOMEN —m la NO FINDINGS(GO% ITEM 18)

Supernumerary areolaeL.= number with glandular tissue

lJ.31J number yithout glandular tissue

Gynecomastia:----------~=Minimal

F

Etiolo

2~Marked 10 Medication

2~ Liver dysfunction

3m Both

Striae: - --.------------~ lEI purple ~ 1n White

~ In Draining fistulae or other lesions

= lD Pigmented

m Congenital malformations

HSM 425-12 (Page 5) Form Approved

7-72 O.M.’B.No. 6B-R1184

64
DISEASE ORIENTE D EXAMINATION

[3691 1[ 1 NO DISEASE [(ITE?JB21-31) SKIP TO EVALUATION ON NEXT PAGE-]

21. ACNE VULGARIS 26. cent.’d Cause of Urticaria (CIDICKALL TK4T APPLY)

~ lU Inactive

b~’

Min. I Mod. ISever =~~U-F~od ~n Inhalant

20 Active

.:.--:---

711 11 JI 2EI 3 m 1~ fi~dzcat.on m lD-56;:G;:-:;-: EF:;-----

--------------------- ---------------------------------

A.-o ..Vct.

(SPECIFY)

--s-t lx! ---------------------- 2UL.%’2’LL’L?

---IQ ------------ Plt scarrln~---

IQ ~stic scarring -------- --- ------------ ----------------------------

Extent of acne

.=

~ 1 -Face

II

!27. CONTACT DERMATITIS (CHSCK ALL THAT APPLY)

~ la Plant ~ In Rubber

~ 10 Medication ~ la Leather

~ la Chemical ~ In Cosmetics

~ 10 Metal ~ 10 Obscure

in Fabrics

.-

22. SECONDARY ACNE (CHECK ONE)

~ lD Steriod

11----

30 Anovulatory p]

2U Halogen tions .--------

4Cl Oil ------------------------------------------------------ Feet

L

~ ---------

ACNE ROSACSA

la Minimal 30 Severe Hands 1’0 2CI11[ 1

I

repara+

w

SEBORRHEIC DERMATITIS (CHBCK ALL THAT APPLY)

Culture taken for Candida? ~ la Yes 2UN0 Feet: ~~ ;= ~jj------~-u--Gii;E i-;Eifi

24. PSORIASIS

4[ --~--=-----------

~ lU Inactive

—--:--r.-::------:.

2D Active ~F

---------------------- --------------------------------11=

~ Combination

Sever

nanas: WJ LQ Nal L crimi---------

IL]I 2

2~ Glabrous skin

m -~ Groin

Il@ 1 -m;----------------------------------------

Location

~ 10 Scalp only ~~ 10 Trunk

2U Extremities only 2r2 SebOrrheic 11— .–

Viral Vesi

/12’.‘lM:lNFE::~@xcE~wARTs)

: Diagnostic Impression

3a Both areas only W 11-J H. Simplex 3U M. Contagiosum

3~ Both 2D H. Zoster 4D Primary Varicella

------------------------------------------------------.

--------------------------------- ---------------

Tzanck smear

-II Description/Severity I

Family History Furuncles ~

~ la Parent 20 Sibs 30Parents and sibs Min. Ii-l In

~ i~-~~~~-;;l;~~;; ;--------------------------- Mod . 20 2n

------------------------------------------------------- Severe >1 J 5( I I SI J15

Did joint problem precede psoriasis? Folliculitis M mlwy

~ lU Yes 2U No Min. la lm ‘m ‘

Mod.

25. ATOPIC DERMATITIS

20 2nl .q

Severe r “- ‘ --

Severity Impetigo

~ la Minimal 2Q Moderate 3U Severe Min. 1r] In

Distribution

Mod . 20 20

H la Flex.ral areas only TBC

2U Flexural areas and other (SPECIFY) Min.

3U Generalized

Mod . 2

Severe 31 1 I-1,

Family History Hansen’s ml rh-1[

EEH El

Ato~ Disease Min. lrl 11--I

.-=.----

‘~;~icarla and?~~-~;~~;------------ Mod . 2m 2m,-4 ----------- ------------------------------ Severe 3 31--I 31_J JI

Personal History Swim. Pool

~ la Urticaria and/or asthma Gran. Min. 1

Mod . 2

26. URTICARIA (CHRCK ALL THAT APPLY)

Joint Involved

~ ~D Fi.~ers 2U Toes

~ in Positive 2D Negative 3n Not done

30 Both ~ ~n.~;in:---------------------------- on BACTERIAL INFECTIONS

m Ln-6iR6i-I:IiE7EFEEiH j-------------

--------------------- --------------------------

~ ~U Cholin&gic ~ lnAn@o-ne”roticede !=

@19~nczi;;--- ‘--- IIEE ----------------- t3E3 lnb;~ifi;;~-;;;icaria -------------------------------------- miCl&.lZ --------------- m

I

lD Yes

ARTKROPOD AND PROTOZOAN INFECTIONS

~ l~%rimmer ‘a itch

~ lCIMites

~ la Leiahmaniaais

] la Pedic.losis capitis ~

] 10 Pediculosis pubis ~

Q la Pediculosis corporis ~. _

IJ= 1~ Creeping _ __.._.——– eruption I

RSM 425-12 (Page 6)

7-72

Form Approved

CJ.M.B. No. 68-R1184

65
EVALUATIONOFD ERMATOLOGICAL COMPLAINT

w 10 NO CONDITIONS (END OF EKAM)

LOCATION

I

-—

I OTHER (SPECIFY

EvALuATION HAND FOOT

filO~’-l

EVALUATION

148.sl

32. Diagnostic Code

————-——- —-- - .——. -

Recurrent? 4L9Ql ruul 1

1 D Yes 1 D Yes 1 mYe

2DN0 2 m No 2 No

IF YES-Months

active in past 12

months

.— ._ ~s X

m TOTAL

SKIN

Years duration--.--.- .—— —— —— COMPLAINT

w] XL2.1

Percent limitation

of activity----------

33. Handicap to Gainful Employment or

Housework w w

Total 10 -----------

In

Part-severe Zn 2[7 ----- / 2rl !21-J

Part-minimal 3r] 30 -----

30 3~

None 4n -------------

---------------------

Precludes prefe

occupation

‘--”’+

lUYes

34. Handicap to Social

Relations

UIJ u M

Severe ---------- Ir] 1rl in In

Minimal Zr--l Zn ---------

2[~ z~

None 3U 3-rl ------------

or] 3J-1

35. Care So”~htiCHECK

ALL THAT APPLY )

m

11 I

Pharmacy---------

M.D.-------------

Fodiatrist ------

Osteopath--------

Dermatologist----

36. Presently Under

Current Best Care

-----------------

IF NO :With expertare

a. Woulcicondition

be improved? --------- -----------

b. Would condition

permit Full Gain7.

3.

?..

b.

Disfigurement

(examiner eval.)

Hand m

Foot m

Other m

SEVERITY

‘w

lr-1 21--J 3r-J 41-1

lr) Zrl 3n 4CI

In 2rl 3n L

Discomfort(Patient evaluation )

Fain or

BurningHand

Foot

Other

Itching

Hand

Foot

Other

c. Limitation of

MotionHand

Foot

Other

d. overall

Discomfort

Hand

Foot

Other

9. OBSTACLE TO IMPROVEMENT OF CONDITION (CHECK ALL

TH4T APPLY)

= lo NO medical advice sowht

~D Inadequate medical ad;ice .- -----..-.-7----------------

l~Pattent cooperation

1

E

- - ‘iiiEiGGi-??ii-iiZZEii-GGi;”- -------- ~------- ----.------- ~

~ Availablllty of transportation

~u-FIi:&;----------------------

lrY-6E&---------- ”-----”--”-----

Emp. or W ------In in ! 1[1 I

Part. Emp. or I-W Zn Zn 1 2n

No change 3r-1 i 3n 3n I

I

-------

HSM 425 12 (Page 7)

?-72

Form Approved

O.M.B. NO. 68-R1184

66
APPENDIX Ill

SKIN PATHOLOGY CLASSIFICATION

AND GLOSSARY OF SELECTED TERMS

Classification

Inclusions in the groupings of conditions

from the Code of Skin Diseases of the Department of Dermatology, New York University

School of Medicine (February 1968 edition)8

as used in this report are as follows:

NYU

Codes

020-029

030-039

050-059

070-074

080-096

096

100-108

120-130

131

Condition

Syphilis-Congenital, Early, Late,

Latent, and Unqualified

Other Venereal Diseases

Bacterial Diseases–Scarlet Fever,

Erysipelas, Diphtheria, Meningococcal Infection, Plague, Tularemia

Spriochetal Diseases (excluding

syphilis)

Diseases due to Viruses-SmalIpox, Rubeola, Rubella, Chicken

Pox, VariceIla, Herpes Zoster,

Trachoma, Herpes Simplex, Foot

and Mouth Disease, etc.

Herpes Simplex, Foot and Mouth

Disease, etc.

Rickettsial Diseases – Typhus,

Rocky Mountain Spotted Fever,

Q Fever, etc.

Leishmaniasis and other Parasitic

Diseases–including Trypanosomiasis, Toxoplasinosis, Trichinosis, Pin Worm, etc.

Dermatophytoses–including Athlete’s Foot, Tinea Pedis, Tinea

Manuum, Tinea Capitis, Tlnea

Barbae, Tinea Unguium, OnychoNOTE: A list of references follows the text.

13100-

1312--

13131-

131910

132-134

135-137

138

19X

19X0

19X1

19X14X

mycosis, Paronychia, Tinea Cruris, Tinea Corporis, Favus, Trichophytids, Tines Versicolor,

Tinea Nigra Palmaria, etc. (exchding Monilial)

Dermatophytoses of Foot, Athlete’s Foot, Tinea Pedis (excluding Nails)

Dermatophytoses of Nails, Tinea

Unguium, Onychia due to Dermatophytes, Onychomycosis, Paronychia (excluding Bacterial and

Monilial)

Dermatophytoses-Crura.I, Tinea

Cruris (excluding Monilial and

Erythrasma)

Tinea Versicolor, Pityriasis Versicolor

Deep Fungus Infections-Actinomycosis, Coccidioidomycosis,

Blastomycosis, Paracoccidiomycosis, Histoplasmosis, Cryptococcosis, Nocardiosis, Moniliasis,

(Candidiasis), etc.

Zoonoses – including Scabies,

Mites, Pedictdosis, Chiggers, Tick

Bites, etc.

Sarcoidosis and other Infective

and Parasitic Diseases

MaIignant Tumors

Malignant Tumors–Bowen’s Disease, Erythroplasia, Paget’s Disease (Breast and Extra-Mammary)

Malignant Tumors–Fibroepithelial

Tumor, Basal-Ceil Epithelioma

Malignant Tumors–Basal-Ceil Epithelioma, Nodtdo-Ulcerative or

Solid

67
19X18X

19X2

19X6

19X8

19X9

19XX

20X

22x

22X44X

22X959

23X

23X081

23Y

242-243

244

245

Malignant Tumors–Basal-Cell Epithelioma, NOS

Malignant Tumors – Base-Squamous Epithelioma, Base-Squamous Carcinoma, Intermediary

Metatypical Epitheliorna or Carcinoma, Mixed Metatypical Epithelioma or Carcinoma, PrickleCell Epithelioma and Basal-Cell

Epithelioma, and Intraepidermal

Epithelioma

Malignant Tumors–Malignant M,elanoma, Lentigomaligna

Malignant Tumors–Squamous-Cell

Carcinoma

Malignant Tumors–Adenocanthoma, Adenocarcinoma, Cutaneous

Metastasis, Fibrosarcoma, Neurosarcoma, etc.

Malignant Tumors–on Skin NOS

or NEC

Lymphomas and Leukemias

Benign Tumors–including Nevus:,

Hemangioma, Cafe au Lait Spot,,

etc. (excludes 22X44X–Sebor

rheic Keratosis )

Seborrheic Keratosis, NOS or NEC

Benign Tumors–Lipoma

Precancels–including Actinic Keratosis, Burn (X-ray), Senile Kera.

tosis, etc.

Actinic Keratosis

Tumor–Malignancy not stated

Urticaria-including Angioneurotic

Edema, Nettle Rash, Lichen

Urticatus, Telangiectasia MacuIaris Eruptiva Perstans, Mastocystosis, Hives

Allergic Eczema or Dermatitis due

to extermd agent–Eczema, Allergic Eczema, Drug Eruption,,

“Auto-immune Syndrome,” Dermatitis Medicamentosa

Other Allergic Disorders–Allergic

Conjunctivitis, Allergic Disorders

of Skin

—

NOTE: NOS = not otherwise specified; NEC = not

elsewhere classi~lable.

250-254

260

270-277

280-286

288-289

290-293

294-299

320-324

360-369

370-389

390-398

400-402

450-456

460-466

467468

Diseases of Thyroid Gland–Thyrotoxicosis, Myxedema, Cretinism

Diabetes Mellitus

Other Endocrine Disorders–Pancreatic Disorders, Acromegaly,

Gigantism, Hyperthyroidism,

Dwarfism, Addison’s Disease,

Cushing’s Syndrome, etc.

Avitaminosis and Nutritional Deficiency States–including Beriberi, Pellagra, Scurvy, Rickets,

Alopecia, Vitamin Deficiencies,

etc.

Lipoidoses and Other Metabolic

Diseases–including Gout, Xanthelasma, etc.

Anemias-including Pernicious,

Iron-Deficiency, SickIe-Cell, etc.

Other Blood Dyscrasias–iricluding

Polycythemia, Hemophilia, Pur- ,

pura, etc.

Psychophysiologic, Mental PsychoNeurotic, and Personality Disorders

Diseases of Nerve-including Bell’s

Palsy, Erythredema Polyneurotica, Meralgia Paresthetic,

Diseases of Eye–including Conjunctivitis (nonallergic), Blephari-,

tis, Sty(e), Chalazion, E@ropion,

Entropion, Ptosis, etc.

Disease of Ear–includir~g Otitis

Externa, Chondrodermatitis Nodularis Chronica Helicus

Rheumatic Fever–with or’ without

Heart Involvement

Diseases of Arteries and Connective Tissue—including Gangrene,

Arterial Embolism, Arterial

Thrombosis, Lupus Erythematosus, Vasculitis, etc.

Diseases of Veins–includihg Statis

Ulcer or Dermatitis, Varicose

Veins, Hemorrhoids, Phlebitis,

etc.

Other Diseases of Circula~ory System–including Osler-Weber’s Disease, Telangiectasis (h&editary

or NEC), Lymphedema, etc.

68
530-587

600-637

690-698

696030

700

700010

701

701000

701010

701030

703

704

705

706

706090

707

708

708300

708310

708320

709

710

Diseases of the Digestive System–

Buccal Cavity, Salivary GIands,

Lips, Anus, Pancreas

Diseases of the Breast and GenitoUrinary System

Infections of the Skin and Subcutaneous Tissue–including Boils,

Carbuncles, Cellulitis, Impetigo,

Infectious Warts, and other local

infections

Infectious Warts-Verruca Vulgaris

(includes Periungua.1)

Seborrheic Dermatitis

Seborrheic Dermatitis, NOS or

NEC

Eczema

Hand Eczema or Dermatitis

Nummular Eczema

Dyshidrotic Eczema

Other Dermatitides – including

Contact Dermatitis due to Plants,

Oils and Grease, Solvents, Drugs,

other Chemicals, Radiation, Cosmetic, other Agents (such as

Dyes, Furs, C1othes, Dress, WOOI,

Clothing Finishes, Shoes, Leather,

Rubber), DDT, Pyrethrum, Paint,

Varnish, Cement, Photographic

Agents, Wood, etc.

Pemphigus, Erythema Perstans

Group, Dermatitis Herpetiforrnis

Erythemas–including Toxic Erythema, Erythema Simplex, Acne

Rosacea, Rhinophyma, etc.

Psoriasis including Parapsoriasis

and other and unspecified types

of Pityriasis

Psoriasis (all types, NOS or NEC)

Lichen Planus and some other

Lichenoid Dermatoses

Pruritusand related conditions

Infantile Atopic Dermatitis

Neurodermatitis Disseminate and

Atopic Dermatitis, NOS or NEC

Lichen Simplex Chronicus, Circumscribed Neurodermatitis

Corns and Callosities

Other Hypertrophic and Atrophic

Conditions of the Skin-including

Scleroderma, Elastosis Seni.lis,

etc.

710130

710150

712

713

713908

714

7141-7149

714150

714180

714190

714930

715

716

716210

740-744

751-759

766-780

781-795

850-999

Glossary

Ichthyosis

Keratosis Pilaris

Diseases of Nails-including Ingrowing Nail, Hangnails, Discolorations, etc.

Diseases of Hairand Hair Follicles–

including Alopecia, Folliculitis,

Dull Hair, etc.

Folliculitis

Diseases of Sweat

Sebaceous Glands

Diseases invohing

Glands

Acne Vulgaris

Acne. Cvstic

Glands and

Sebaceous

Acne: S&rs or NOS or NEC

Xerosis

Chronic Ulcers of Skin

Diseases of Skin, NEC–including

Acne Scaring, Chickenpox Scarring, Smallpox Scarring, Cicatrix,

Tattoo, Freckle, etc.

Vitiligo, Albinism, Piebaldism

Diseases of Bones and Organs of

Movement–including Bunion,

Tenosynovitis, Dupuytren’s Contracture

Congenital Malformation

Certain Diseases of Early Infancy–

including Ritter’s Disease, Scleroderma Neonatorum, Impetigo

Neonatorum, etc.

Symptoms, Senility and Ill-Defined

Conditions

hjuries and Adverse Effects of

Chemical and Other External

Causes

For those who are not familiar with the dermatological terminology in the tables and examination form a glossary is included to identify

and explain certain clinical observations. For

fi.u-therclarification and discussion, the reader is

referred to a standard text of dermatology;

three are cited:

MoscheIla, S. L., Pillsbury, D. M., and Hurley,

H. J., Jr.: Dermatology, Vol. 2. Philadelphia.

W. B. Saunders, Nov. 1975.

69
Fitzpatrick, T. B., et al.: Dermatology in Gerzeral Medicine, New York. McGraw-Hill, 1971.

Rook, A., Wilkinson, D. S., and Ebling, F. J. G.:

Textbook of Dermatology, 2d ed. Oxford and

Edinburgh. BlackweU Scientific Publications,

1968.

A canthosis niqicans. —A warty velvety

change in the skin of the axillae, groin, and

about the neck that can be associated with

obesity, endocrine disturbances, and in adults

with visceral malignancy.

A ctinic keratosis. –Adherent yellow to brown

scale on a red-tinged base associated with solar

da*age) a Pre*~iwancY of the epiderfis.

Addison’s disease. *Primary adrenal cortical

insufficiency. It can have secondary hyperpigmentation in the skin from an outpouring of

pituitary hormones responding to the adrenal

cortical failure,

Albinism. –The result of an inherited failure

of the melanocyte to produce normal amounts

of pigment in the skin, or eye, or both. Partial

albinism (piebaldism), an autosomal dominant

trait, involves only the skin and hair. All forms

of albinism are present from birth.

Apocrine glands. –Developmentally associated with hair and sebaceous glands, they

atrophy during fetal Iife but persist in the axillae

and genital area to secrete at puberty an oily,

colorless, odorless substance that undergoes

bacterial decomposition to produce body odor.

A topic dermatitis. –An inflammatory condition of the skin characterized by itching, redness, and occasionally vesiculation and weeping,

that is found in individuals with the inherited

diathesis called atopy. The patient may present

one or several manifestations of the atopic state

such as hay fever, allergic rhinitis, asthma, and

urticaria or hives.

Basal-cell epithelioma. –An epithelial carcinoma arising in the basal cells of the surface

epidermis. It may be further characterized as

superficial eryth,ematous or nodular, and may be

pigmented or not.

Bowen’s disease. -A precancerous dermatosis

presenting as a defined brownish-red plaque

without eIevated border single or multiple,

which may have an historical association with

arsenic ingestion.

Callus. –Hyperkeratosis of the epidermis adjacent to thinner skin and the apparent rdspcmse

to constant rubbing or pressure. A corn is similar

but has a sharply demarcated translucetit core.

Neither lesion is vascularized.

Candida. –A yeast genus of which the species

Albicans is the most common pathogen for man.

It infects the mucous membranes of mouth and

vagina most commonly but also body foIds and

can be widespread in the immune deficient

patient.

Dermatofibromata. –Firm circumscribed .

papules of a half centimeter or so, in the skin,

usually on legs and often hyperpigmented. They

may represent a cellular reaction to injury.

Dermatophytosis. –Infection of the skin

with fungus.

Eccrine glands. –Sweat glands that produce

and transport to the skin surface a hypotonic,

clear, odor-free solution (eccrine sweat) in response to heat or psychological factors.

Eczema.–See eczematous dermatitis, ~

Eczematotis dermatitis. -Not a condition but

an inflammatory resptmse of the skin to a number of stimuli from within and without, ~Poison

ivy can produce a characteristic weeping dermatitis that is eczematous, so too can surdight in

certain sensitive individuals, Ingested dtiugs, as

well as the patient’s own host response to a

superficial infection as with fungus, can evoke

a similar eruption. Because atopic dermatitis

in children is often eczematous, it has been commonly called “eczema” with consequent cow

fusion of the reaction pattern with the disease.

“Atopic dermatitis. “ “ is the term to be preferred

and shouId designate the active atopic condition

whether in adults or children.

Ephelides. –Freckles, those circumscribed

tan-brown macules scattered over Iight-qxposed

skin.

Epithelial tags, –Hyperplasia of the skin resulting in soft polypoid lesions less than a centimeter in diameter that are skin colored and

multiple around neck, upper chest, and inner

surface of the arms.

Herpes simplex. –A virus that inddces an

infection characterized by small vesicles on a red

base (fever blisters or “cold sores”) anld recurrence. It can occur on head or neck, in the genital area, over the buttocks, and more rarely on

the extremities.

70
Ich.thyosis. –Accumulation of polygomd scale

that gives a fishlike appearance to the skin. It

may be congenital or acquired and in its sudden

appearance can be associated with occult malignancy.

Lichen planus. –A papuIosquamous eruption

of violaceous polygonal lesions and characteristic histology that is often pruritic, can last 1 to

2 years, and is of obscure etiology.

Lichen striatus. –A self-limiting Iinear dermatitis of unknown etiology that appears inflammatory and occurs more often in children.

Moniliasis. –Infection with Candida.

Mycosis fungoides. –A chronic fatal disease,

a T-cell Iymphoma of the reticuloendothelial

system, initially invoIving the skin, with a name

descriptive of the large fungating lesions that can

occur and should not impIy fungal infection.

The disease can be limited to the skin, but may

also involve lymph nodes and viscera.

Neurofibromata. –An overgrowth of

Schwann cells and endoneuria that resuIts in a

smooth soft to firm skin-colored papule that can

be inva~nated. In size they can range from a few

millimeters to several centimeters in diameter.

These lesions are found in large numbers in

neurofibromatosis (Von Recklinghausen’s disease).

Nevus. –The Latin for birthmark, is used

most commonly for the clinical evidence of

aggregates of normal melanocytes or pigment

cells in the skin. In color they range from tan,

brown to black, in size from millimeters to an

entire trunk (giant hairy nevus). By histological

level of mektnocytes, they are divided into (1) a

junctional nevus that histologically has aII the

melanocytes above the basement membrane,

(2) a dermal nevus with all melanocytes in the

dermis, and (3) a compound nevus with melanocytes in the dermis and epidermis.

Onychomycosis. –A fungous infection of the

nails.

Papulosa nigra. –The hyperpigmented seborrheic keratoses of the more pigmented races

occurring usually on the face.

Pityriasis versicolor. –See tinea versicolor.

Psort”asis.–An inherited disease of the skin

characterized by circumscribed red scaling

patches with silvery scale that may be few in

number or may extend to involve the skin

totalI y. It can be associated with arthritis.

Seborrheic dermatitis. –A persistent erythematous, scaling dermatitis, more greasy than

dry, that involves the scaJp, eyebrows, anterior

chest, and the areas about the nose and behind

the ears. It can be extremeIy bard as in miId

dandruff or proceed to generalized redness and

scaIing.

Seborrheic keratoses. –Raised, greasy, warty

lesions that appear tacked on, vary in pigment

content from pale yellow to black, and in size

from a millimeter to centimeters in diameter.

They are found mostIy on the trunk or face but

may appear on the extremities.

Senile keratosis. –See actinic keratosis.

Squamous-cell carcinoma. –A tumor of the

epidermis which in its invasive form has all the

characteristics of malignancy including the

ability to metastasize, but which usually has a

more beni~ course when arising on sun-exposed

skin.

Sweat glands. –hlay be eccrine or apocrine

(see both).

Telangz”ectasia. –Dilated superficial vessels

that appear as coarse or fine vascular threads

on the skin. They can be a response to solar

damage and are characteristic of the lesions of

certain dermatological diagnoses.

Tinea. –A superficial infection with fungus.

The term is usually further modified by anatomical site: T. capitis, of the scalp; T. corporis,

of the body; T. pedis, of the foot; T. manuum,

of the hand; T. umguium, of the nail; T. cruris,

of the groin.

Tines nigra palmart”a.-A superficial fungous

infection of the palms leaving residual pigmented macules seen largely in tropical climates.

Tinea versicolor. –A superficial fungous infection of the skin with Malassezia furfur.

Tophi. –Subcutaneous, firm to hard nodules

of a salmon-pink color that occur most commonly on the helix of the ear, over the bursae

of the elbow, and about the digits of the hands

and feet. They consist of urate deposits from

elevated uric acid levels of the blood and are

seen in gout.

Trichoph ytids. –A generalized or Iocalized

skin reaction in individuals allergic to the fungus, Trz”chophyton.

Tumors. –Cellular aggregates that are clinically apparent in the skin.

Urticarib. -Hives or wheals.
Verruca. –Warts are epidermal responses to

the human papilloma virus that appear on the

skin as circumscribe ed elevated, rough-surfaced

papules (verruca vulgaris or common warts);

as threadlike polypoid growths (verruca fili.-

formis, the filiform or digitate wart); as ia

smooth flat or slightly elevated skin-colored

or gray-yellow papule (verruca plana, the plane

wart); on the sole of the foot as a horny papule,

(verruca plantaris or plantar wart); in the genitaI

area as the venereally transmitted pink, elongated, occasionally filiform or peduncuIated

warts (cond ylomata acuminata or acuminate

warts).

Vitiligo. –A spontaneous loss of pigment

with disappearance of the melanin-producing

cells of the hair bulbs, skin, and mucous membranes but not other parts of the me~anocyte

system such as those in the eyes and brain.

It is probably an inherited defect and is more

commonly found in those with diseasq associated with autoimmune mechanisms, pernicious

anemia, hyperth yroidism, Addison’s disease, and

idiopathic hypoparathyroidism.

Xanthomata. –Erythematous papules with a

yellow cast that appear singly or diffusely and

are associated with abnormal concentrations or

composition of pIasma lipids.

Xerosk -Dry skin.

72

.
Series 1.

Series 2.

Series 3.

Sem”es4.

Series 10.

Series 11.

VITAL AND HEALTH STATISTICS Series

Programs and Collection Pro cedures. –Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions and data collection methods used and include

definitions and other material necessary for understanding the data.

Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental tests of new survey methods, studies of vital statistics collection methods, new analytical

techniques, objective evaluations of reliability of collected data, and contributions to statistical theory.

Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the analysis further than the expository types of reports in the other series.

Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistics and documents such as recommended model vital registration laws and revised birth

and death certificates.

Data Fro m the Health Interview Suroey. –Statistics on illness, accidental injuries, disability, use of

hospital, medical, dental, and other services, and other health-related topics, all based on data collected

in a continuing national household interview survey.

Data From the Health Examination Survey and the Health and Nutrition Examination Survey. –Data

from direct examination, testing, and measurement of national samples of the civilian noninstitutionalized population provide the basis for two types of reports: (1) estimates of the medically defined

prevalence of specific diseases in the United States and the distributions of the population with respect

to physical, physiological, and .psychological .characteristics and (2) analysis of relationships among the

various measurements without reference to an explicit finite universe of persons.

Series 12. Data From the Institutionalized Population Surveys. –Discontinued effective 1975. Future reports from

these surveys will be in Series 13.

Series 13. Data on Health Resources Utilization. –Statistics on the utilization of health manpower and facilities

providing long-term care, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health

occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly

reports. Specizd analyses by cause of death, age, and other demographic variables; geographic and time

series analyses; and statistics on characteristics of deaths not available from the vital records based on

sample surveys of those records.

Series 21. Data on Natality, Marriage, and Divorce. –Various statistics on natality, marriage, and divorce other

than as included in regular annual or monthly reports. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics of births not

available from the vital records based on sample surveys of those records.

Series 22. Data From the National Mortality and Natality Surveys. –Discontinued effective 1975. Future reports

from these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Data From the National Survey of Family Growth. –Statistics on fertility, family formation and dissolution, family planning, and related maternal and infant health topics derived from a biennial survey

of a nationwide probability sample of ever-married women 15-44 years of age.

For a list of titles of reports published in these series, write to: Scientific and Technical Information Branch

National Center for Health Statistics

Public Health Service

Hyattsville, Md. 20782