FROM VITAL & HEALTH STATISTICS OF THE NATIONAL CENTER FOR HEALTH STATISTICS 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE I No. 4 Jan uary 26, 1977 I Public Health Service. Health Resources Administration 

Prevalence of Dermatological Disease Among Persons 

1-74 Years of Age: United States a 

This report presents national estimates of 

the prevalence of skh pathology, or dermatological disease, among the civilian noninstitutionalized population 1-74 years of age in the United 

States, based on examination findings from the 

Health and Nutrition Examination Survey of 

1971-74. 

The Health and Nutrition Examination Survey program in which these data were obtained 

was desi~ed to measure the nutritional status of 

the U.S.-population as well as certain aspects of 

general health status and medical care needs in 

the U.S. population. This is the fourth of the 

Health Ex;m-ination Survey programs authorized 

by the 84th Congress under the National Health 

Survey Act of 1956. These programs secure information on the prevalence of medicalIy defined illness, including previously unrecognized 

and undiagnosed conditions, as well as on a variety of physical, physiological, and psychological 

measures within the population through direct 

examinations, tests, and measurements, as described in previous publications.1’4 

� 

The dermatology component of the Health 

and Nutrition Examination Survey (HANES) 

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. Mane-Louise T. 

Johnson, Chairman of the Data Collection Unit 

for the National Program, was primarily responsible for planning the content of the examination, 

recruiting the dermatologists, and training them 

aPrepared by Marie-Louise T. Johnson, M.D., Ph.D., 

New York University School of Medicine, and Jean 

Roberts, Divi>ion of Health Examination Statistics. 

in the examination methodology so as to minimize interobserver variation. This part o’f the 

HANES examination included a complete clinical examination of the skin and surrounding tissue that considered normal variations in texture 

and color, certain manifestations of aging, and 

all pathological changes. Significant diagnoses 

were documented by tissue biopsy to determine 

malignancy or culture to identify fungi whenever possible. Estimates were made of actinic exposure experienced, as welI as actinic damage 

sustained, and of occupational risk from irritant 

and allergic contractants. For an examinee with 

a sigriificant hand, foot, or generalized problem, 

the dermatologist made a judgment about the 

burden to the examinee in terms of discomfort 

or disability, about care sought, and about the 

effect expected from current best care possible. 

The examinations of persons in this HANES 

sample were made at 65 preselected locations 

throughout the country. Of the 28,043 sample 

persons selected to represent the 194 million 

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

there were 20,749, or 74.0 percent, examined. 

This corresponds to an effective response rate of 

75.2 percent after adjustment is made for the 

effect of oversampling among the poor, preschool children, women of childbearing age 

(20-44 years), and the elderly. 

This summary is limited to national estimates by age and sex of the prevalence of skin 

disorders and the principal types of skin disease. 

The Code of Skin Diseases of the Department of 

Dermatology, New York University (NYU) 

School of Medicine5 was used for identifying 

and classifying skin disorders. Further information on the geographic and socioeconomic 

distribution of skin pathology, the extent of dis-
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2 acimncedata 

ability or handicap caused by skin conditions, — and the extent “to which medical care has been 

sought or needed among the U.S. population Figure 2- PREVALENCE RATES FOR THE FOUR LEADING TYPES 

OF SIGNIFICANT SKIN PATHOLOGY AMONG PERSONS 1-74 

will be presented in a forthcoming Series 11 re- YEARS BY AGE: UNITED STATES, 1971-74. 

port in the Vital and Health Statistics series.6 300 

— Diseasesof sebwseou$glands 

TRENDS	

I 250 

r . . . . . . . . . Dermatophytoses 

Tumors 

Seborrheic dermatitis 

Among persons 1-74 years of age in the Unit- 200 

ed States, nearly one-third (31.2 percent), or an 

estimated 60.6 million, have one or more signif- 150 

icant skin conditions (table 1). These include 

3.2 percent, or an estimated 6.1 million, who 100 

have three different types of skin conditions; 6.4 

percent, or 12.4 million, with two; and 21.6 per: 50 

cent, or 42.0 million, with only one condition. 

Since the examiner was limited to the identifica- 10 20 30 40 50 60 

I 

70 

tion of no more than three conditions, only the 

three most serious were recorded. Hence the es- AGE IN YEARS 

timates obtained may somewhat underestimate 

the true prevalence of specific skin conditions in


the population. The most frequently occurring groups of


The pattern of increase in skin pathology skin conditions are those affecting the sebace~us 

with age is shown in figures 1 and 2 and table 2. glands (84.8 per 1,000 persons); dermatophy -

The prevalence rates are 10 west among children, toses, or fungzd diseases (81.1 per 1,000); maligmore than double by ages 12-24 years, decrease nant or benign tumors (56.5 per 1,000); and sebslightly by 25-34 years, then steadily increase orrheic dermatitis (28.2 per 1,000). Among the 

Wi;h age to a maximum at 65-74 years. individual conditions diagnosed, the most prevalent is acne vulgaris (68.1 per 1,000); followed 

by benign tumors (38.2 per 1,000); fungal conFigure 1. PREVALENCE RATES FOR SIGNIFICANT SKIN PA- ditions of the feet, tinea pedis (38.7 per 1,000); THOLOGY AND PREVALENCE RATES OF SIGNIFICANT 

SKIN CONDITIONS AMONG PERSONS 1-74 YEARS BY seborrheic dermatitis (28.2 per 1,000); fungal 

AGE: UNITED STATES, 1971-74, conditions of the nails, tinea unguium (21.8 per 

700 r 1,000); precancerous and unspecified tumors 

.. (12.4 per 1,000); folliculitis (8.0 per 1,000); ver­ ...’” 600 ...” ruca vulgaris (8.5 per 1,000); and atopic dermati­ ...”” .. . .. . . .. . tis (6.9 per 1,000). ... ... . z

~ 500 . .. .. .. .... One-third of those persons with significant ... ... .. 

....$ . . . ...-” : ; skin pathology (36.4 percent, or an estimated 

; 400 – j 22.0 miIIion persons 1-74 years of age) are con­ =. ~. 

u cerned about their skin problem, and 3.4 per­ & 300 – cent, or an estimated 2.1 million persons, have a E ; ~ disability severe enough to be a handicap to 200 — Persons with significant skin pathology gainful employment or housework. The princi­ .. . . . . . . . Significant skin conditions pal skin conditions of concern are those affect- 100 ing the sebaceous glands (28.2 per 1,000); dert matophytoses, or fungzd diseases (21.6 per 

1,000); the atopic dermatitis/eczema group 

(10.8 per 1,000); and tumors (8.1 per 1,000) AGE IN YEARS (table 3). However, among those with significant 

skin pathology diagnosed, persons are most 
� 

ZKkancedata 3 

Figure 3. PREVALENCE RATES FOR THE SIX LEADING TYPES 

OF SKIN PATHOLOGY AMONG PERSONS 1-74 YEARS OF AGE 

BY SEX: UNITED STATES, 1971-74. 

140� 

oimaws Dermato. Tumors Seborrheic Atopic Ichthwsisl 

of Phytoses dermatitis dermatitis{ keratosis 

Sebaceous eczema 

glands 

likely to be concerned if they have psoriasis (69 

percent of those with this diagnosis), atopic dermatitis/eczema (58 percent), diseases of the sebaceous gk.nds (33 percent), vitiligo (28 percent), and funga.1 conditions (dermatophytoses, 

27 percent). 

Skin pathology is more prevalent among 

males than among fema.Ies (34 percent compared 

with 29 percent), and the proportion with the 

major types of skin conditions is generally 

greater arnon~ males than among females (fi,gure 

3). Of the most frequently occurring skin conclitions, males are substantiality more likely than 

females to have a fungal condition or folliculitis, 

the prevalence being about three times as great 

in males. 

REFERENCES 

1National Center for Health Statistics: Plan and initial program of the HeaIth Examination Survey. Vital 

and Health Statistics. PHS Pub. No. 1000-Senes l-No. 4. 

Public Health Service. Washington. U.S. Government 

Printing Office, July 1965. 

2National Center for Health Statistics: Plan, operation, and response results of a program of children’s examinations. Vital and Health Statistics. PHS Pub. No. 

1000-Senes l-No. 5. Public Health Service. Washington. 

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

3National 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. 

4NationaI Center for Health Statistics: Plan and operation of the Health and Nutrition Examination Survey, 

United States, 1971-73. Vital and Health Statistics. Series 1-Nos. 10a and 10b. DHEW Pub. Nos. (HRA) 

76-1310 (lOa) and (HSM) 73-1310 (lOb). Health Resources Administration- Washington. U.S. Government 

Printing Office, Feb. 1973. 

5The Department of Dermatology, New York University School of Medicine: Code of Skin Diseases, 1st 

rev. New York. New York University, Feb. 1968. 

6NationaI Center for Health Statistics: Skin conditions and need for medical care among persons 1-74 

years of age, United States; 1971-74. Vital and Health 

Statistics. Series 11. Health Resources Administration, 

DHEW, Rockville, Md. To be published. 
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4 acklncedata 

Table 1. Prevalence of significant skin patholo , all types and the most frequently occurring types of con­
 ditions, among persons 1-7$“years, by sex: United States, 1971-74


BO th I Both Condition and NYU code Male Female IIMale I

Female sexes II sexes 

Rate per 1,000 Number in thousands persons 

Persons with one or more significant skin conditions 312.4 339.8 286.6 60’6011131’988 28,613 

All types of significant skin conditions 439.7 499.4 383.4 85,2871147,018 38,269 

Diseases of sebaceous glands----------------------7l4l-7l49 84.8 87.9 81.9 16,465 8,279 8,186 Acne wlgaris--------------------------------------7l4l5O 68.1 70.5 65.9 13,217 6,638 6,579 

Cystic acne----------------------------------------7l4l8O 1.9 0.6 375 312 Acne scars-----------------------------------------7l4l9O ::; 1.3 321 192 1:; Xerosis --------------------------------------------7l493o ::; 5.3 7.7 1,260 497 763 

Demtophytoses-----------------------------------------l3l 81.1 131.4 33.7 15,733 12,372 3,361 

Tinea pedis----------------------------------------l3lOO- 38.7 68.4 10.7 7,509 6,438 1,071 

Tines unguium 1312-- 21.8 30.3 13.9 4,232 2,856 1,376 

Tines versicolor-----------------------------------l3l9lO ;.: 10.9 6.0 1,623 1,022 601 Tines cnris---------------------------------------l3l3l- . 12.9 0.9 1,301 1,214 87 

Tumors 19x,22x, 23x,23y 56.5 59.6 53,7 10,968 5,606 5,362 

Mali~ant---------------------------------------------l9x 5.9 6.4 :,; 1,136 602 5:.3 Basal cell (nodular-ulcerative- solid) l9xl4x 0.6 0.6 . 119 Basal cell epithelioma---------------------------l9xl8x 247 1:; 100 Benignl -----------------------------------------------22x 3::: 3;:: 4;:; 7,412 3,372 42040 Lipom-------------------------------------------22x959 . 401 244 157 Precancerous and not specified--------------------23x,23y l;:i 1;:: 2,420 1,632 788 Actinic keratosis--------------------------------23xO8l 9.6 13.9 ;:: 1,858 1,306 552 

Seborrheic dermatitis--------------------------------7OOOlO 28.2 26.4 29.9 5,476112,490 2,986


Atopic dermatitis leczema 701,708300,708310,708320 18.4 19.5 17.4 3,575 1,837 1,738 

Atopic 

Lichen 

Hand eczem----------------------------------------7OlOOO 

dermatitis----------------------------------7O83lO 

simplex chronicus---------------------------7O832O 6.9 

4.5 

1.6 ~:: $; 

1,332 

882 

311 441 

771 

105 

561 

!!dl.1 

206 

� Numnular -------------------------------------------7ololo 1.7 1:0 2:4 332 240 Dyshidrotic----------------------------------------7OlO3O 2.1 3.1 1.2 405 2% 117 

Ichthyosis/keratos is--------------------------7lOl3O,7lOl5O 9.5 1,835 880 955 Folliculitis-----------------------------------------7l39O8 :.: 1;:: ;:: 1,553 1,;;+ 399 Verruca wlgaris-------------------------------------696O3O 10.3 1,684 717 Psoriasis--------------------------------------------7O6O9O 5;5 5.9 ;:: 1,070 556 514 Seborrheic keratosis---------------------------------22x.44x 5.2 4.6 5.8 1,010 ;:; 579 Vitiligo---------------------------------------------7l62lO 4.9 3.6 957 616 Herpes si~lex----------------------------,--------------O96 ::; 824 376 448 All other skin conditions 12$:: 12$:: 124.4 I

24,137 11,729 12,408 

1Excludes seborrhe ic kerat~s is (22.x44x), which in the NYU classification is grouped with benign t~ors.

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� Table 2. Prevalence of significantskin pathology, all type
 persons 1-74 years, by a


Conditionand NYU code


Fersons with one or more significantskin conditions


All types of significantskin conditions


and the most frequently occurring types of conditions,among
 : United States, 1971-74


1-5 6-11 12-17 18-24 25-34 35-44 45-54 55-64 65-74
 years years years years years years years years years


Rate per 1,000 persons


142.3 174.2 362.0 365.1 318.0 32S.2


166.4 195.4 46S.5 499.9 452.9 475.2


Diseases of sebaceous glands------------------------7l4l-7l49 6.3 21.4 249.9 191.1 99.6 44.1 Acne mlgaris----------------------------------------7l4l5O 0.4 11.9 23; .; 172.2 83.6 25.4 

Cystic acne------------------------------------------7l4l8O 5.2 2.6 Acne scars-------------------------------------------7l4l9O 4:5 ;:; 1.7 

Xer0sis----------------------------------------------7l493OZ.i 6.; 3.9 . R 6..! 

Demtoph~oses-------------------------------------------l3l 3.4 :.; 33.2 61.7 87.7 121.5 

Tinea pedis------------------------------------------l3lOO- 0.4 if.; 24.9 49.1 62.C 

Tines mmim----------------------------------------l3l2-- 0:9 1;.$ 24.9 

Tinea versicolor-------------------------------------l3l9lO 1.; 1.5 1::; 1;:: 13.C 

Tines cmris-----------------------------------------l3l3l- - . 6.7 10:2 7-1.7 

Tumors 19x,2.2x,23x,23y 21.7 1s.9 3;.; 43.0 39.6 46.8 

Wli~nt-----------------------------------------------l9x - . 0.1 0.1 3.2 Basal cell (nodular-ulcerative-solid) 19x14x 0.2 Basal cell epithelioma-----------------------------l9xl8x 

Benignl --------------------------------------------22X21.; 18.; 30.; 40.; 3s.; 3::! 

Lipm---------------------------------------------22x959 0.8 0.9 0.6 Precancerousand not specified----------------------23x,23y o.i 2.2 0.6 M 

Actinic keratosis----------------------------------23xO8l 1.5 

Seborrheic dermtitis----------------------------------7OOOlO 9.6 6.7 18.5 38.7 41.9 41.1 

Atopic dermatitis/eczema-------------7Ol,7O83OO, 708310,708320 24.9 20,0 17.0 15.4 28.0 14.1

Atopic demtitis------------------------------------7O83lO 19.3 13.8 10.7 5.1 

Lichen simplex chronicus-----------------------------7OS32O 1.7 4.1 1.2 ;:: H Hand eczem------------------------------------------7OlOOO 0.2 4.9 3.7 Nmular---------------------------------------------7OlOlO 1.; 1.; 0.6 H 2.5 0.1 

~shi&otic------------------------------------------7OlO3O 1.9 0.4 2.6 5.9 1.3 

Ichthyosis/keratosis----------------------------7lOl3O,7lOl5O8.6 15.5 

Folliculitis-------------------------------------------7139O8 

Verruca mlgaris---------------------------------------696O3O i:: 1;:: 

Psoriasis----------------------------------------------7O6O9O3.1 1.9 

Seborrheickeratosis-----------------------------------22x44x 0.2 

Vitiligo-----------------------------------------------7l62lO0.6 5.; 

Herpes simplex--------------------------------------------096 3.4 All other skin conditions 78.7 7H 

356.8 361.9 409.5 

529.7 563.9 654.8 4
 21.5 25.5 8.7 0.7 

0.1 

0.9 

5.4 14.; 

155.7 126.8 

SO.9 59.6 

46.2 54.7 

2.3 

1::: 1.3 

S4.9 184.1 

9.5 36.4 

1.1 3.8 

52:: 6;:; 

22:: 79:6 

15.9 65.1 

31.9 36.3 

18.3 

1::: 

0.9 

3.2 

0.4 

1.5 

::: 

2::: 

13.6 

zo::~ 

1Excludes seborrheickeratosis (22x44x), which in the NW classificationis grouped with benign tumors.


Datanot 

Category 

Quantity 

Quantity 

I 

SYMBOLS 

available 

notapplicabIe . . . I zero ­

morethan Obutless than0.05----- 0.0 

Figure does not meet standards of 

reliability or precision * 
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� 

6 adwncedata 

Table 3. Prevalence of skin conditions of concern, all types and the most frequently occurring types of conditions, among persons
 1-74 years, by part of body affected and sex: United States, 1971-74


Both sexes Male Female


Condition and NYU code


rotal Hand Foot Other Total Wand Foot Other Total Hand Foot Other


Rate per 1,000 persons


All types of skin conditions of concern--- 113.6] .0.8 17.9 84.9 127.7 12.6 27.61 87.51 100.3 9.0 8.8 82.5 

1 & Diseases of sebaceous glands-----------7l4l-7l49 28.2 0.1 0.1 28.0 29.0 - 0.0 29.0 27.5 0.2 0.2 27.1 Acne vulgaris---------------------------7l4l5O 23.6 0.1 23.4 23.1 - 23.1 24.1 0.2 0.1 23.8 Cystic acne-----------------------------7l4l8O 1.7 M 3.1 - 0.; 3.1 0.3 Acne scars------------------------------7l4l9O 0.3 ;:; ::? 0.7 XerOsis---------------------------------714930 0.9 o.; o.i 0.8 0.: : 0.6 0.; 0.9 o.iJ o.i 0.8 

Dermatophytoses------------------------------l3l 21.6 12.5 8.0 35.9 21.3 12.8 8.2 0.4 ;.: Tines pedis-----------------------------l3100- 9.7 ::: 9.3 0.3 17.8 ::; 17.1 0.5 0.0 ::: 

Tines versicOlOr------------------------l3l9lO 2.7 3.5 - 3.5 2.0 - -

Tines cmris----------------------------l3l3l- 3.2 3:2 6.3 - 6.3 0.2 - - ::: 

Tumors 19x,22x,23x,23Y 8.1 0.6 0.4 ;.; S.3 0.5 0.2 7.6 8.1 0.8 0.5 Malignant----------------------------------l9x 

solid)-19x14x 3:! 0.0 0.1 0:3 2.3 

0.3 -- 0.2 2.1 

0.3 1.8 

0.3 0.1 - -

-

Tinea unguium---------------------------1312-- 4.5 0.2 3.1 ;.$ 5.7 0.3 3.8 1.6 ::!! 0.2 2:3 0.7 

Basal cell (nodular-ulcerative-
 Basal cell epithelioma----------------l9xl8x 0.8 0.8 1.3 - 1.3 0.3
 Benignl------------------------------------22x 2.4 0.; 0.; 1.5 - 1.5 0.; :,j
 Lip~~----
 ----------------------------22x959 0.1 0.0 M :.; - 0.2 ~:;
 Precancerous and not specified 23x,23y 3.7 0.; 0:1 3.1 4.0 (&j 0:1
 Actinic keratosis---------------------23xO8l 3.1 0.5 Tnl 2.6 3:8 ::; 3.3 2;4


Seborrheic dermatitis---------------------7OOOlO 5.4 0.1 0.0 5.3 4.8 0.2 0.1 4.5 5.9 - - 5.9 

Atopic 

7Ol,7O83OO,708310,70S320 10.8 1.3 ;.; 11.7 3.4 6.4 10.0 0.6 6.4 Atopic demtitis-----------------------7O83lO 

Lichen simplex chronicus----------------7O832O 

Hand eczema-----------------------------701000 

:.; 

1:1 

::} 

0.1 0.1 

0.2 1:6 ;.; 

1:0 

0.8 

1.6 

;:? 

0.4 4.2 

1.7 3.8 

1.8 

1.2 

::8 

0.1 

1.2 

:.: 

. 

- H 

Ntmmlar--------------------------------7OlOlO 0.8 M 0.; 0.8 0.3 0.; 0.; 0.8 o.; Oyshidrotic-----------------------------7OlO3O 1.6 1.0 0.5 ::! 2.1 1.0 1.1 1.2 0.2 

is---------------710130,710150 1.3 1.3 1.3 1.3 

dema.titis/
 eczema-----------------


Ichthyosis/keratos


Folliculitis------------------------------7l39O8 1.s ($::
 Verruca vulgaris--------------------------696030 R 0.; 0.; 0.4 o.i ::; 1.8 1.; 0.; j::
 Psoriasis---------------------------------7O6O9O 3.8 0.5 0.0 3.3 3.8 0.2 0.1
 Seborrheic keratosis----------------------22x44x 0.7 M 1.1 1:1
 Vitiligo----------------------------------7l62lO ;:: 0.; 0.; I

::; o.i 0.5 2.0 0.6 0.6 Heqes simplex-------------------------------O96
 8:: All other skin conditions 28.3 4.i 1 3.; 28::
 3.; 1::: 2::: 3,i 

I 2.; 22.9 

1Excludes seborrheic keratosis (22x44x),which in the NYU classification is grouped with benign tumors.

� 

acivancedata 7 

TECHNICAL NOTES 

The sampling plan for the 65 examination 

locations in the Health and Nutrition Examination Survey from April 1971 through June 1974 

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. 

The sample was stratified by geographic region, 

population density, and rate of population 

change between 1960 and 1970. Within each 

stratum, cluster-type sampling was used for selecting households and sample persons to be included in each examination location. The sample 

design provided for oversamplin~ among persons 

living in poverty areas, preschool-age children, 

and women 20-44 years of age. 

Previous issues of Advance Data from 

Prevalence rates of skin conditions are 

shown as population estimates; that is, the examination findings for each individual have been 

“weighted” by the reciprocal of the probability 

of selecting the person. An adjustment for persons in the sample who were not examined and a 

poststratified ratio adjustment were also made 

so that the finaI sample estimates of the population size agree exactly with independent U.S. 

Bureau of the Census estimates for the civilian 

noninstitutionalized population of the United 

States as of November 1, 1972, by color, sex, 

and age. 

Vital and Health Statistics 

No. 1	 Blood Pressure of Persons 6-74 Years of Age in the United States 

(Issued: October 18, 1976) 

No. 2 Hypertension: United States, 1974 (Issued: November 8, 1976) 

No. 3	 Height and Weight of Adults 18-74 Years of Age in the United States 

(Issued: November 19, 1976) 

GPO 913-165