1. Dermatitis, melanoma, nonmelanoma skin cancer, viral skin disease, and fungal skin disease were all adequately studied by the Cochrane Database of Systematic Reviews relative to their disease burden.
2. Oppositely, decubitus ulcer, psoriasis, and leprosy were over-studied, while acne vulgaris, bacterial skin disease, urticaria, pruritus, scabies, cellulitis, and alopecia areata were under-studied relative to disease burden.
Evidence Rating Level: 3 (Average)
Study Rundown: Systematic reviews are crucial to evidence based medicine. The Cochrane Database of Systematic Reviews (CDSR) produces rigorous systematic reviews on a vast number of medical topics as well as protocols. The authors aimed to assess whether CDSR coverage accurately reflected disease burden in dermatology, i.e. if the systematic reviews were appropriately focused on the skin diseases causing the most morbidity and disability. The disease burden of 15 prevalent skin conditions were calculated in disability-adjusted life years (DALYs) by the Global Burden of Disease (GBD) Project in 2010. The authors correlated each disease’s DALY with its representation in the CDSR, finding that 5 out of the 15 skin diseases were well represented in reviews/protocols per their DALY score, while 3 diseases were overrepresented and 7 underrepresented. However, this study utilized minimal statistical methods to demonstrate the correlation between CDSR representation and DALYs. Future studies may expand upon this study by employing more rigorous statistical testing.
Relevant Reading: Global Burden of Skin Disease (GBD) – Cochrane Project
In-Depth [cross-sectional study]: The CSDR was searched to identify the reviews and protocols pertaining to each of 15 skin diseases: dermatitis, melanoma, nonmelanoma skin cancer, viral skin disease, fungal skin disease, decubitus ulcer, psoriasis, and leprosy, acne vulgaris, bacterial skin disease, urticaria, pruritus, scabies, cellulitis, and alopecia areata. Any reviews or protocols with the disease name in the title were included, as well as any additional discovered in an official publication report published by the Cochrane Skin Group. The number of reviews and protocols pertaining to each skin disease was compared to the DALY for each skin disease. The study found that at least one systematic review had studied each of the 15 skin diseases, and one protocol had been published for 13 diseases. While dermatitis, melanoma, nonmelanoma skin cancer, viral skin disease, and fungal skin disease (5/15) were all adequately studied by the CDSR per their disease burden, decubitus ulcer, psoriasis, and leprosy (3/5) were overrepresented in the number of reviews and protocols while acne vulgaris, bacterial skin disease, urticaria, pruritus, scabies, cellulitis, and alopecia areata (7/15) were all underrepresented. This data suggests that resources may be better allocated toward the study of the more burdensome skin diseases.
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