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Skin Health Australia Report Card
2016 SHARC Report
Table of contentsForeword 3
Executive summary 4
About the 2016 SHARC Report 8
What do you think about your skin? 10
What problems do you have with your skin? 14
Focus on psoriasis 17
How do you treat your skin conditions? 23
Do you check your skin? 25
Do you understand the risk of skin cancer? 27
How do you maintain healthy skin? 30
Does your skin affect your quality of life? 32
Comments from survey participants 34
About Galderma 35
About the Skin & Cancer Foundation Inc 36
2
Foreword The 2016 Skin Health Australia Report Card – the 2016 SHARC Report – provides a valuable reference for Australians. In a nation where skin health issues are particularly important, the SHARC report delivers revealing evidence of the health of our skin, what we think about our skin, and how we are caring for and protecting our skin.
This is the third year that we
have commissioned a
national population survey.
The survey tracks attitudinal
and behavioural changes
related to the skin health of
the Australian population, and
the results are analysed and
published as the SHARC Report.
This year’s report is exciting. It
allows a comparison of data
over three years, so we can
now know whether a result
seen last year was a change
from an average, or the start
of a trend. Some interesting
trends have been identified.
The third iteration of the
SHARC Report has once
again illustrated that the
methodology and analysis
of our survey remain rigorous.
It is clear that the SHARC Report,
and the data which underpins
it, is becoming an increasingly
valuable resource for our key
stakeholders including
policymakers, dermatologists,
general practitioners, allied
health professionals, and of
course, individual Australians.
This year’s SHARC Report shows
that the incidence of psoriasis
is increasing in Australia. We
would like to highlight the
situation in Australia where
those with severe psoriasis are
disadvantaged in comparison
to those in other developed
countries. Australian patients
need to endure a greater
degree of severity of psoriasis
to access advanced treatments
compared to patients in
other countries.
Our focus on psoriasis should
not, however, detract from
other skin health issues of
concern. For instance, Australia
has the highest rate of
melanoma in the world, a
situation that needs continued
awareness and action. The
SHARC report shows there is
room to improve our attitudes
towards and knowledge of
skin and skin health. By doing
so, we can take better care of
ourselves as individuals,
families and communities in
relation to skin health.
The Skin & Cancer Foundation
Inc is Australia’s leading centre
for the specialist treatment of,
and research into, skin disease.
Established in 1987, we are a
not-for-profit organisation that
provides specialist clinical
treatment, education and
research for a wide variety of
skin diseases, skin cancer and
melanoma.
If you took part in the survey,
we thank you. If you’re reading
this report, we also thank you.
And we welcome you to join
us in our mission to improve
the skin health of our nation.
Associate Professor Chris Baker
Immediate Past President, Skin & Cancer Foundation Inc
President, Australasian College of Dermatologists
3
Executive summary 2016 HighlightsAs the 2016 Skin Health Australia Report Card is our third SHARC Report, we are seeing a number of concerning trends which lead us to believe that Australians could be doing a whole lot better to look after their skin health.
We are particularly
concerned that:
• There’s a clear trend over
the three years of the
report of a rise in those
reporting a skin condition
(from 41% in 2014 to 43% in
2015 and 46% in 2016).
• Skin cancer was the skin
condition of highest
concern to participants
(41%), yet a surprising 49%
say they have no concerns
about skin cancer or sun
spots at all.
• Sunburn is an important risk
factor for melanoma (a
person’s risk for melanoma
doubles if they have had
more than five sunburns
at any age), but 66%
of respondents were
unexpectedly sunburned
in the last two years (the
figure rises to 76% within the
25- to 34-year-old age
group).
• 36% of respondents do not
currently protect themselves
from the sun by wearing a
hat or using sunscreen.
• Many Australians still
believe that sunburn mostly
happens on hot, sunny
summer days during the
hottest time of day,
dismissing risks associated
with sunburn that happens
on cloudy, cool days. They
do not understand UV risk.
• When asked when sun
protection is important, many
respondents did not indicate
key factors: 31% did not
identify a high UV as a
factor to take into account
for sun protection; 41% did
not identify when it is sunny,
and 49% the time of day.
4
• Although 56% of those
surveyed work sometimes,
regularly or always outdoors,
the provision of protection
measures by their employers
is still patchy. Only 48%
of employers provide
sunscreen, 35% protective
clothing, 26% sunglasses
and 25% gloves.
• Unhealthy skin and
common skin problems
may be signs of other, more
significant health problems.
But of those who have skin
problems, 35% consider
them cosmetic only, and
20% don’t know if they see
these as medical or
cosmetic problems.
• Nearly one in five
respondents (19%) say
they experience itchy skin,
equivalent to just over
3.7 million Australians
adults. More than 20% of
the population don’t seek
any treatment for it and
14% work out their own
treatment, rather than see
a healthcare professional.
• Itchy skin can be a sign
of skin disease and
inflammatory skin disease
can often disguise other
underlying health factors
that need a professional
medical opinion and
diagnosis. For example,
itchy skin could be a sign of
allergies or associated with
asthma. If your skin is itchy
or inflamed, it’s important
to get it checked out by a
healthcare professional.
• There is an upward trend in
the reported incidence of
psoriasis, from 5% in 2014 to
6% in 2015 and 8% in 2016.
On the other hand, we are
encouraged that:
• 68% of respondents
personally check their skin
for signs of skin disease
• The large majority of
Australians have a good
understanding of how to
maintain skin health. For
example, 80% believe in
drinking water to maintain
skin health, 79% in protecting
themselves from the sun,
75% in ensuring they have
good nutrition and 70% in
using a moisturiser.
• Just over 7 in 10 Australians
moisturise (with more
women moisturising, 90%,
than men, 54%).
• While employers' provision
of sun protection measures
could be better, the
percentage of those whose
employers provided them
with no protection from the
sun at all shrunk from 44% in
2014 to 39% in 2015 and 30%
in 2016.
• It was also reported that
employers are providing
sunscreen and moisturiser
more often.
Here are other highlights
of the results from the 2016
SHARC Report.
What we think of our skin
• Unhealthy skin is an
important concern for
Australia, rating fourth in a
list of nine general health
conditions.
• Yet, 84% of respondents
consider their skin ‘very
healthy’ or ‘healthy’.
• 56% are happy with the
way their skin looks.
• 71% of respondents
describe their skin as very
fair or fair.
• 67% of respondents say
they burn ‘always’, ‘easily’
or ‘moderately’.
There is an upward trend in the
reported incidence of psoriasis,
from 5% in 2014 to 6% in 2015
and 8% in 2016.
‘’
5
6
7
8
%201620152014
REPORTED INCIDENCE OF PSORIASIS
5
6
8
5
• 9% say they never tan and
always burn, but this figure
jumps to 19% among the
18 to 24 age group.
• Most respondents (74%)
describe their skin as
‘moderately marked’
by moles, freckles
and sunspots.
• The top three current skin
concerns of respondents
are signs of ageing, dry skin
and signs of sun damage.
• People worry about
different skin issues at
different times of their
lives; younger people are
concerned about acne,
and people start to worry
about signs of ageing in
their skin when they enter
the 45–54 age group.
• Men are twice as likely than
women to say they don’t
have concerns about their
skin’s appearance.
Skin cancer monitoring and
prevention
• 68% of respondents
personally check their skin
for signs of skin disease
(meaning that 32% of the
adult population do not
do this).
• 44% also have someone
else check their skin.
• 68% were either very
confident or confident they
can identify possible skin
cancer.
• While many Australians know
that drinking water (80%),
protecting themselves from
the sun (79%), ensuring they
have good nutrition (75%)
and using a moisturiser
(70%) are good ways to
maintain skin health, only a
smaller number put that
into action with 67%
drinking water, 64%
protecting themselves from
the sun and 58% using a
moisturiser.
• 53% identify that minimising
alcohol consumption
contributes to healthy skin,
but only 32% do this.
Skin conditions
• The most common current
skin condition is itchy skin
(19%) with acne and
eczema/dermatitis tied in
second place (12%) and 10%
of participants reporting
skin cancer/sun spots.
• Most skin conditions are
longstanding with the
largest share of those with
skin conditions reporting
having them for over
five years.
• 45% of respondents have a
skin allergy or sensitivity. The
most common reported
allergy is to nickel, as found
in cheap jewellery.
• The most common specific
skin problem is dry or scaly
legs or hands.
• To treat conditions, most
respondents, 54%, see their
GP, 31% see a skin specialist
or dermatologist and 30%
see their pharmacist; 37%
either did not seek treatment
or worked out their
treatment on their own.
Skin health affects the quality
of life of Australians
• Issues with the skin can
affect socialising, playing
sport, wearing clothes,
sexual activities, and
relations with partners, close
friends and relatives. Skin
affects our quality of life.
• In the week before the
survey, 41% of respondents
were embarrassed or
self-conscious because
of their skin health. The
share of those who were
‘a lot’ embarrassed, or
self-conscious, was 9%,
considerably higher than
reported in previous years.
• 42% found their skin itchy,
sore, painful or stinging.
• 20% said their skin had an
effect on their social and
leisure activities, made it
difficult to play sport (15%),
created problems with a
partner, close friend or
relative (14%), or caused
sexual difficulties (12%).
6
Skin health is a workplace issue
• More and more Australians
consider skin conditions in
terms of choosing their
occupation (31%, up from
27% last year and 19% the
year before).
• 55% are employed in jobs
that sometimes, regularly or
always require them to be
outdoors, yet 52% of
employers do not provide
sunscreen, 65% do not
provide protective clothing,
74% do not provide
sunglasses and 75% do not
provide gloves.
• Yet it was reported that
employers are providing
sunscreen more often (rising
from 35% in 2014 to 38% in
2015 and 48% in 2016) as
well as moisturiser (from
10% in 2014 to 13% in 2015
and 19% in 2016).
Psoriasis
SHARC illustrates a consistent upward trend in the prevalence
of psoriasis, from 5% to 2014 to 6% in 2015 and 8% in 2016. This
indicates that nearly 1.6 million Australian adults have some
form of psoriasis. This is important information as previous studies
on the prevalence of psoriasis have been done only in certain
locations, and many years ago. This increase is statistically
significant. Possible reasons for this change include increases
in incidence, awareness or diagnosis.
Men and women are affected
about equally by psoriasis. Of
those who have psoriasis, 33%
report having no effect on the
Dermatology Life Quality Index
(a measure of quality of life),
28% report a small effect, 17%
a moderate effect, and 18% a
very large effect. 78% of those
reporting having psoriasis
consider their skin healthy,
possibly because it
is being treated.
Despite the higher numbers of
respondents with psoriasis
reporting their skin as healthy,
most adults with psoriasis try to
hide their condition, and it
causes not only physical
discomfort and pain but
emotional trauma. This year’s
SHARC Report provides further
information on living with
psoriasis, its effects on the
quality of life, and how it
affects work life.
For Australians who suffer from
serious psoriasis, biologics
treatments offer fast and
comprehensive relief. Yet,
access to these new drugs is
restricted by having to score
higher on the Psoriasis Area
and Severity Index than
overseas counterparts. The
Skin & Cancer Foundation Inc
believes this situation should
change and will continue to
raise awareness of this issue,
arguing the case for change.
Nearly 1.6 million Australian adults
have some form of psoriasis.‘ ’7
About the 2016 SHARC ReportAs with previous SHARC
Reports, the main issues that
our third SHARC Report
examined by the population
survey are:
• Perceptions: What do
Australians think about
their skin?
• Awareness: What are
Australians’ awareness
of and problems with
skin health?
• Attitudes and knowledge:
What are Australians
attitudes towards skin
conditions? What is their
knowledge of how to keep
skin healthy?
• Actions: How do Australians
treat skin conditions? If they
seek help, who do they go
to? How do they check the
health of their skin and
how often? How do they
keep their skin healthy?
• Prevention: How do
Australians prevent skin
conditions, problems
and disease?
• Quality of life: How do
skin health issues affect
Australians’ quality of life.
The SHARC Report is based on
the results of a national
population survey that tracks
changes in attitude and
behaviour in the Australian
population regarding skin
health, conducted by the
professional research and
advisory firm, StollzNow
Research. The survey was
carried out in August 2016
and was commissioned by the
Skin & Cancer Foundation Inc
and funded by an untied
education grant from
Galderma Australia.
About the Skin & Cancer Foundation IncThe 2016 SHARC Report was commissioned by the Skin &
Cancer Foundation Inc (the Foundation), a Melbourne-based,
not-for-profit organisation that provides specialist clinical
treatment, education and research for a wide variety of skin
diseases, skin cancer and melanoma.
8
About those surveyedFor a representative snapshot
of Australians and skin health,
over 1,000 people participated
in the survey from across the
country, with an even number
of males and females
responding. The mix of
participants (gender, age,
location, income, employment
status and household
composition) is very similar
to last year.
Survey respondents come
from all age groups, with more
participants in the three age
groups between the ages of
25 and 54 (25 to 34; 35 to 44
and 45 to 54). This year, we will
be able to learn more about
the skin issues of older people:
7% of responses are from
those 75 years old and over
compared to last year’s report
with only 1% from this age group.
All of Australia was represented, although with only 2 of 1,002
participants from the Northern Territory, they don’t show up in
the chart. »
Figure 1: Age range of survey participants
55 to 64
15%
45 to 54
18%
25 to 34
18%
18 to 24
13%
65 to 74
10%
75 & over
7%
35 to 44
19%
Figure 2: Geographical representation of participants
SA
8%
Qld
18%WA
10%
Tas
3%
NSW
34%
Vic
25%
ACT
2%
NT
0%
9
Other survey questions
asked about participants’
employment, living situation
and income. Those who took
the survey are mostly employed
full-time (38%) with a significant
number employed part-time
(22%) or retired (21%). Students
make up 5% of participants,
slightly down from 7% in 2014
and 2015. Most participants
live as part of a couple without
dependants (35%) or with
dependants (29%) and a
smaller number (17%) live
alone. A small number, 8%,
live with their parents or in a
shared household, 6%, and 5%
are single parents.
The household incomes of
participants were divided into
23% making from $20,000 to
$50,000, and 30% from $50,000
to $100,000. Reporting under
$20,000 are 6%, 21% make over
$100,000, 10% over $150,000
and 11% prefer not to say.
What do you think about
your skin?Survey respondents were asked to indicate which of nine health conditions they were concerned about. Unhealthy skin rates fourth out of nine concerns, after back pain, dental health and blood pressure.
In all three years of the survey, back pain is the
highest concern followed by dental health;
allergies are the lowest concern with bowel
health the second to last. Concern about the
other five conditions fluctuates. Unhealthy skin
was the sixth highest concern in 2014, the third
highest in 2015, and this year is fourth.
Table 1: Which of these health
conditions are you concerned about?
Back pain 36%
Dental health 32%
Blood pressure 30%
Unhealthy skin 28%
Cholesterol 27%
Headaches 25%
Arthritis 24%
Bowel health 22%
Allergies 21%
I do not have any concerns 16%
Survey respondents were also asked to think
about their skin and then describe it according
to skin pigment, type and sensitivity, response
to sunlight and blemishes.
10
The survey asked Australians to describe their skin
pigment. 71% of our survey respondents described
their skin pigment as ‘fair’ or ‘very fair’. The
majority of Australians get sunburnt easily and
need to check for skin disease. The number of
those who describe their skin pigment as ‘black’
doubled to 2%, from 1% in both 2014 and 2015.
Most respondents describe their skin type as
‘normal’ (48%) with similar proportions describing
opposite problems: ‘dry’ (31%) and ‘oily’ (21%).
Figure 3: Skin pigment
Olive
27%
Very fair
10%
Black
2%
Fair
61%
Figure 4: Skin type
Normal
48%
Oily
21%
Dry
31%
11
Do you think of yourself as having sensitive skin? While 55% of
survey respondents describe their skin sensitivity as normal, 31%
describe their skin as sensitive to the sun and 22% as sensitive to
products. Participants could answer yes to more than one
category so the shares don’t add up to 100%.
A very common issue in Australia is worrying about getting
burned by the sun. A total of 67% of respondents say they burn
‘always’, ‘easily’ or ‘moderately’; of those, 9% ‘never tan’ and
‘always burn’. However, among the age group from 18 to 24, this
figure of 9% jumps to 19%! A total of 7% of respondents say they
rarely burn and 2% say they never burn.
A very common issue in Australia is
worrying about getting burned by the sun.‘ ’
0 10 20 30 40 50 60
Figure 5: Skin sensitivity
Normal
Sensitive to the sun
55%
31%
22%Sensitive to products
0 5 10 15 20 25 30 35
In the sun, I rarely burn and tan profusely
In the sun, I burn minimally and tan well
In the sun, I burn easily and tan minimally
In the sun, I burn moderately and tan uniformly
In the sun, I never burn
In the sun, I never tan and always burn
Figure 6: Response to sunlight
33%25%24%9%7%2%
12
Finally, it’s interesting to read how survey respondents describe
their various moles, freckles and sunspots. The vast majority
consider themselves right in the middle, with 74% ‘moderately
marked’. Those rating their skin as clear were 20%. Those who
consider themselves ‘very marked’ were 6%. These figures are
about the same as in 2014; in 2015, 4% more respondents
considered their skin clear rather than moderately marked.
There were differences in descriptions of skin by age. Those 75
and over have the highest percentage of skin that is ‘very
marked’ (12% compared to an average of 6%), while
the percentage of those who consider themselves
‘moderately marked’ is highest among the 35
to 44 year age group (79%). Those in New
South Wales and Queensland have the
highest percentage of ‘very marked’
skin (8%) compared to only 3% in
South Australia.
Figure 7: Blemishes
Clear – no molesor markings
20%
Very marked –moles, freckles,
sunspots
6%
Moderately marked – moles, freckles, sunspots
74%
13
What problems do you have with your skin?Our survey participants think they have healthy skin. 84% of the respondents this year consider their skin ‘very healthy’ and ‘healthy’ and only 15% consider their skin unhealthy. This indicates that nearly 3 million adult Australians believe they have unhealthy skin.
More men (89%) than women (79%) consider their skin healthy,
and those 18 to 24 have the highest proportion of those who think
their skin is unhealthy (20%, much higher than the 15% average).
Interestingly, while over half of the respondents say they have a
problem with skin health (54%), it’s evident from the results that
people can consider their skin healthy, even with a skin problem.
This may be because they are treating the problem.
56% of respondents are happy with the way their skin looks (32%
said they aren’t happy and 12% say they didn’t know). More
women than men are not happy with the way their skin looks
(38% vs 26%) but people seem more at peace with their skin in
older age groups: between 58% and 63% were happy with how
it looks between the ages of 45 and 74; higher than the younger
age groups (and higher than those age 75 and over).
What makes skin unhealthy?
The survey asked participants both whether they have a problem
with skin health and if they have skin conditions. The top three
skin problems that respondents believe make their skin unhealthy
are acne/pimples/blackheads (36%), dryness (30%) and skin
cancer/sun spots (19%).
Table 2: The most common
specific problems for those
with skin health problems
Dry or scaly hands 28%
Dry or scaly legs 27%
Roughness on hands 19%
Pimples on the face 19%
Dry or scaly face 18%
Sun-damaged face 18%
Wrinkled on the face 18%
Dry or scaly arms 15%
Pimples on back 14%
One of the biggest
misconceptions is that skin
health is a cosmetic problem
and therefore does not require
medical attention. Just over
one-third of respondents (35%)
consider their skin problems
'cosmetic' only; over one-
quarter (27%) consider them
'both medical and cosmetic';
about one-fifth (18%) think of
them as only ‘medical’
problems; and 20% ‘don’t know’.
There’s a clear trend over the
three years of the report of a
rise in those reporting a skin
condition (from 41% in 2014 to
43% in 2015 and 46% in 2016).
14
The following skin conditions were reported as a current
concern (respondents could choose more than one):
Percentages ranged from 40% of respondents who are concerned
about signs of ageing to 27% who worry about signs of sun
damage. 14% worry about skin cancer or growth and 12% say
they do not have any concerns about the appearance of their
skin. Concern for other conditions ranges from 10% to 13% of
participants saying they are concerned about dull skin, rashes,
too much hair and prominent blood vessels.
Women are more concerned than men about most skin
conditions, including signs of ageing, dry skin, signs of sun
damage, acne, dull skin and redness; men are more concerned
about hair loss and thinning, and skin cancer or growth. Men
are twice as likely as women to say they don’t have concerns
about their skin’s appearance.
Different concerns at different stages of life see 18- to 24-year-
olds extremely worried about acne (61%), with that figure
dropping to 39% by the next age group (25 to 34). People don’t
really start to worry about signs of ageing in their skin until they
hit the 45 to 54 age group; 50% start to worry, then this figure
rises to 60% and above in the older age groups.
Worrying about a skin
condition is not the same as
having one. Presented with
a list of 10 skin conditions, a
large majority of participants
had no concerns about any
of them: 88% had no worries
about hives and urticaria, 84%
had none about rosacea and
82% none about psoriasis.
The largest share of worried
participants was related to
skin cancer and sun spots
(41%), itchy skin (22%), skin
infections and eczema/
dermatitis (17%) and acne
(16%). Psoriasis rated of less
concern with 11% of survey
respondents worried about it.
Skin cancer is the highest
concern for SHARC participants,
and so it should be, considering
the prevalence of melanoma in
Australia and the consequences
of late diagnosis.
However, 49% said they have
no concerns about skin cancer
and sun spots at all, which is
concerning! Since almost 1 in
10 participants (or 2.4 million
Australians) have skin cancer
or sun spots, it’s a condition
that should have high visibility
and high concern among
all Australians.
0 5 10 15 20 25 30 35 40
Figure 8: Top 11 skin conditions
40%38%27%24%23%19%17%15%15%14%14%
Signs of ageing
Dry skin
Signs of sun damage
Hair loss or thinning
Pimples/acne/blackheads
Dandruff
Finger or toenail problems
Discolouration
Large pores
Redness
Skin cancer or growth
15
The most common current skin
condition was itchy skin (19%),
followed by acne and eczema/
dermatitis (12% each) and 10%
with skin cancer/sun spots.
These skin conditions make up
more than half of the identified
current conditions by those
who have a skin condition.
While last year’s survey
showed younger age groups
had skin conditions more
frequently, this year’s survey
shows a higher share only
among those in the 18 to 24
age group (55% compared
to the average of 46%).
The skin conditions are mostly
longstanding. Of the ten
conditions used in the
questionnaire – eczema/
dermatitis, psoriasis, skin
infection, warts, tinea, hives or
urticaria, skin cancer/sun spots,
itchy skin, acne and rosacea –
the largest group in most
categories have had the
condition for over five years
(with about 50% or over of those
with acne, eczema/dermatitis,
and psoriasis having these
conditions for over five years).
Only skin infections and tinea
are generally short lasting, up
to six months.
A significant minority of survey
participants (45%) have some
sort of skin allergy to different
materials, or it causes some
irritation. For those that have
skin allergies, the most
commonly reported issue, by
17%, is nickel, such as found
in cheap jewellery. Between
12% to 16% reported allergies
to clothes washing powder,
sticking plaster, bandaids and
tapes; cleaning products
including dishwashing liquid;
and fragrances.
More women report being
irritated or allergic than men
(66% vs 44%). Older people are
much higher than the average
in being not affected by skin
allergies and irritations: 70% of
those 65 to 74 and 77% of those
75 and over are not affected.
Could they be tougher? Less
aware? Or have allergies and
skin irritation been on the rise
in the last century?
The most reactive materials,
those reported as causing either
significant or severe problems
are oral medications
recommended by pharmacies
(42%), nickel (37%), topical
medications suggested by
pharmacies (35%) and
fragrances (25%).
1 Quirk CJ. Skin disease in the Busselton population survey. Med J Aust. 1979; 1(12):569–70.
2 Kilkenny M, Stathakis V, Jolley D, Marks R. Maryborough skin health survey: prevalence and sources of advice for skin conditions. Australas J Dermatol. 1998; 39(4):233–7.
3 Plunkett A, Merlin K, Gill D, Zuo Y, Jolley D, Marks R. The frequency of common non-malignant skin conditions in adults in central Victoria, Australia. Int J Dermatol 1999; 38:901–8.
4 Plunkett A, Marks R. A review of the epidemiology of psoriasis vulgaris in the community. Australas J Dermatol. 1998; 39(4):225–32.
People worry about
being shunned and
can be subject to
misconceptions.
‘’
40
50
%201620152014
4143
46
PEOPLE WITH A SKIN CONDITION16
Focus on psoriasisPsoriasis is a common chronic skin condition that is not well understood and needs more attention from policymakers as well as a higher level of public awareness.
Caused by a dysregulated
immune system, psoriasis
affects women, men and
children of all ages, from
newborn babies to the aged.
Psoriasis is driven by an
overactive immune system
and most commonly causes
skin cells to multiply too quickly,
resulting in thick, scaly and
inflamed areas of skin.
Gaps in global data on
psoriasis make prevalence
difficult to estimate, though
one source proposes over
125 million people are affected.
In Australia, the estimates of
prevalence
have varied widely for many
years, so the SHARC Report
providing a consistent and
reliable measure is a welcome
service. A 1979 review of 1,037
adults in Busselton, WA showed
a prevalence of 2.3%, a figure
which has since been used
widely.1 A 1996 survey of 416
adults in Central Victoria
showed a prevalence of 4.5%.2
A 1997–98 study of 1,457 adults
in the same location showed
a prevalence of 6.6% (4.5%
among women and 8.9%
among men).3 A 1998 systemic
review of incidence and
prevalence reported a range
from 0.3% to 2.5%.4
The 2016 SHARC Report shows
self-reported prevalence
increasing over the last three
years from 5% to 6% and this
year to 8%, which is the
equivalent of nearly 1.6 million
adult Australians.
The condition onset usually
occurs in people in their early
twenties; with a smaller peak
onset in people between 55
and 60 years of age. Many
cases of psoriasis are mild, but
for some, the consequences
are severe. Immense physical
discomfort from cracked and
bleeding skin can lead to
psychological suffering,
including depression,
loneliness and thoughts of
suicide. The condition can
interfere with social and work
life, relationships, sport or a day
at the beach or even simple
actions like choosing what to
wear. People worry about
being shunned and can be
subject to misconceptions –
including that psoriasis is
contagious, caused by poor
hygiene, is the fault of the
person suffering it, or is related
to leprosy. » 17
But there is a brighter outlook, as there are many
drugs in the pipeline to treat psoriasis including
injectables, tablets and biologics, which are
drugs that come from living cells cultured in a
laboratory. This offers the possibility for people
to participate in clinical trials.
For those who suffer from serious psoriasis,
biologic treatments offer fast and comprehensive
relief but there is, however, a problem in Australia.
To be eligible for subsidy or reimbursement of
these drugs under the Pharmaceutical Benefits
Scheme, those with psoriasis must have tried
3 out of 4 common drugs (UV, cyclosporine,
methotrexate and acitretin) and found them
ineffective or had significant side effects; and
they must score greater than 15 on the Psoriasis
Area and Severity Index (PASI), a tool which
allows assessment of the degree of psoriasis
and how much of the body is affected.
And yet, an expert panel convened in Australia
in 2012 recommended that moderate and severe
psoriasis be defined as a PASI score greater than
10. In New Zealand and the United Kingdom,
eligibility for biologics is available to those who
score 10 and above. In other words, the Australian
Government requires Australians to suffer much
more than their overseas counterparts before
they can get the treatment they deserve.
The Skin & Cancer Foundation Inc believes that this situation should change.
Survey results on psoriasisThere is a consistent upward trend in the
number of respondents reporting having
psoriasis, from 5% in 2014 to 6% in 2015 and
8% in 2016, equivalent to 78 people of the
1,002 survey respondents. This indicates that
nearly 1.6 million adult Australians have
some form of psoriasis. This rise is statistically
significant. Possible reasons for this change
include an increase in incidence, awareness
or diagnosis.
The largest proportion of people reporting
psoriasis were from New South Wales (37%) and
Victoria (29%). Those with psoriasis describe
their skin as fairer than those without psoriasis
(68% vs 60%) and more frequently sensitive
to products applied to the skin (31% vs 22%).
They are more likely to have drier skin (41% vs
30%), but sensitivity to sunlight (in terms of
burning and tanning) is not significantly
different to those without psoriasis.
Men and women are affected about equally
by psoriasis. Of those who have psoriasis, 33%
report having no effect on the Dermatology
Life Quality Index (DLQI), 28% report a small
effect, 17% a moderate effect, and 18% a very
large effect. In most cases, current psoriasis
activity is classified as quite mild; those who
experience a very large DLQI effect are in the
minority. On the other hand, this represents
a large number of people: about
285,000 Australians.
The mean DLQI score for those with psoriasis
of 6.1 was more than twice that of those
without psoriasis (2.9), indicating that the
adverse effect on quality of life for those
with psoriasis is to a much greater degree.
Of those who report having psoriasis, 78%
consider their skin healthy, possibly because it
is being treated (85% of those without psoriasis
consider their skin health as healthy or very 18
healthy). At the same time,
42% of those with psoriasis
report they are unhappy with
the way their skin looks,
compared to 31% of the
population without psoriasis.
About 60% seek treatment
from their GP, 29% from a skin
specialist, and 24% from
pharmacists. A proportion
of those with psoriasis use
microdermabrasion and
alpahydroxy acid containing
preparations for skin care, at
three to four times the rate of
those without psoriasis.
Half of those surveyed with
psoriasis have had the condition
for more than five years,
although the remainder were
evenly spread from those
recently aware of their condition
(less than three months) to
having the condition up to five
years. Of all the skin conditions
listed in the SHARC survey, those
with psoriasis had it for the
longest duration.
Some people with psoriasis
report other skin conditions, for
example eczema/dermatitis
(41%), itchy skin (37%), skin
cancer/sun spots (22%) and
acne (21%).
Those with psoriasis are affected
by skin allergies and irritations
(71%) more than those without
psoriasis (43%). Sticking plaster,
bandaids and tapes (28%) and
perfume (26%) are problems
for those with psoriasis, and
cause problems more than
twice as frequently than for
people without psoriasis.
5
6
7
8
%201520152014
PSORIASIS UP CLOSE
SEEKING TREATMENT
0
10
20
30
40
50
60
70
80
71%
43%
Those with PSORIASIS
are affected by SKIN ALLERGIES &IRRITATIONS MORE than those without PSORIASIS
Psoriasis’ affects QUALITY OF LIFE
SMALL EFFECT
MODERATEEFFECT
Peop
le w
ith
psor
iasi
s
Peop
le w
itho
ut
psor
iasi
s
Prevalence of skin allergies & irritations
31%WITHOUT
PSORIASIS
42%WITH
PSORIASIS
HALF
>5YRS
of those surveyedwith psoriasishave had it
60%29%24%
see a skin specialist
speak to a pharmacist
see a
GP
Are people unhappy with how their skin looks?
37%
29%
34%
WHERE DO MOST AUSTRALIANS WITH PSORIASIS LIVE?
NSW
VIC
OTHER
2011-2016
18%
17%
28%
VERYLARGEEFFECT
Reporting of psoriasis has increased This may be because
increase in incidence, awareness or diagnosis5
6
8of an
19
The results of the 2016 SHARC survey confirm what
we know about psoriasis. It negatively impacts
one’s quality of life and causes problems in all
aspects of one’s life. The DLQI was used to ask
whether a respondent’s skin caused any problems
over the preceding week. The results show that
psoriasis has an effect, ranging from ‘a little’ to
‘very much’ in the answers to all ten questions
on the index, with greater levels of problems
than people without psoriasis.
Psoriasis is particularly a problem at work or
studying. It interferes with daily activities like
shopping or looking after the home or garden,
as well as social and leisure activities, and
influences the choice of clothes worn. Psoriasis
also creates problems with close friends and
family and can cause sexual difficulties.
The survey also hinted at the stigma experienced
by people with psoriasis. People with psoriasis
consider themselves less at risk of sunburn. This
may be because they are more careful with their
skin, and may skirt these activities, such as being
outside in summer or going to the beach, just
to avoid revealing their skin condition to others.
Psoriasis negatively effects work life. People with
psoriasis reported a skin condition had some
degree of influence on their profession, 46%
compared with 28% without psoriasis. Time off
work because of a skin condition was reported
by 17% of those with psoriasis compared to 10%
without psoriasis.
Why talk about psoriasis?• Psoriasis is a common condition but may go
undiagnosed due to a lack of awareness.
• It can have severe emotional and
psychological effects, along with
the physical discomfort and pain.
• Psoriasis has a genetic predisposition, and
is related to the body’s immune system but
the exact cause is unknown. There’s no cure.
For these reasons, psoriasis research needs
more funding.
• Psoriasis can come out of the blue. Triggers
can include stress and illness, and dry or
cold weather, obesity, alcohol, smoking
and some medications.
• Yet the symptoms can be treated.
Treatments include moisturisers, creams,
vitamin D and UV therapy, though patients
need to be diligent about following through.
But psoriasis is complex, and treatment likely
will need to be different for each person.
• The 2010 Psoriasis Uncovered study showed
that 71% of Australian adults with psoriasis try
to hide their condition, mostly because of
embarrassment and fear of stigma.
• People with psoriasis should be involved in
developing policy and programmes related
to the condition, and have their voices
heard for raising awareness about psoriasis
and contributing to effective advocacy.
Australians with severe
psoriasis cannot access
effective treatments as
easily as their counterparts in
countries like New Zealand
and the United Kingdom.
20
Profile: Josh Nguyen At age 25, Josh was diagnosed with psoriasis. At its worst, Josh’s psoriasis covered nearly 85% of his body. The condition has had a heavy physical and psychological impact on his life. Now, ten years later, with successful biologics treatment, and the birth last year of his son, Jacob, Josh describes being ‘in a really good place’ where ‘every day is normal’ and he’s ‘busy and happy.’
It wasn’t always this way. He was self-conscious at first, and tried to cover up his condition. ‘For years, my closest friends didn’t know that I had psoriasis,” Josh recounts. ‘Eventually, they started asking questions and I could see the looks on their faces when they learnt what it is I have and what it’s like to live with psoriasis. I could see them realise what a big deal it is.’
Life was made worse because stress was the biggest trigger of psoriasis, so that when it came on, Josh would end up having to juggle multiple stressful events, which could be ‘overwhelming’.
But Josh actively sought treatment, as well as seeking out support groups, including on social media. He receives a lot of support from his family as well as from his physicians. He recommends talking about psoriasis with others – it helped him to start to cope with his condition – as well as to not give up on finding a treatment option and to see a dermatologist as soon as possible.
‘Please seek help straight away,’ he advises, ‘and don’t let psoriasis run your life.’
‘Don’t let psoriasis run your life.’
21
Profile: Margaret Colquhoun Margaret is 65 years old, and lives in a small country town in Victoria called Coleraine. She keeps up an active and busy lifestyle, visiting family members in Melbourne and Ballarat, including three grandkids, and studying at a distance for a Master of Arts degree.
Psoriasis has been a huge part of her life, since she was 11 years old. She’s been through times in her life when she said she ‘couldn’t put a 20 cent piece on my skin without it touching some psoriasis’. Margaret explained that she felt ashamed of the condition for many years and it caused terrible issues for her self-esteem as a child and teenager.
She also told us how uncomfortable psoriasis has been. At one time, she had a period of constant itching that led her to be suicidal. Margaret points out that psoriasis affects multiple areas of health – skin and psychological health – but also that other health issues are more prevalent in people with psoriasis.
But Margaret never gave up. She just kept trying until she found something, and after going through many, many different treatments, she participated in a clinical trial of biologic injections that were successful in reducing psoriasis coverage to only 1% to 2% of her body. She continues the same treatment today.
From her experience of living with psoriasis for over 50 years, Margaret would like to see greater awareness so people understand how difficult psoriasis is to manage as a condition, that it costs money and takes time, and yet it’s not contagious nor something to be ashamed of.
‘It’s just skin that peels off’, she explains. At the same time, she feels psoriasis is ‘a condition that still doesn’t receive the attention it deserves’.
‘Psoriasis still doesn’t receive
the attention it deserves.’
22
How do you treat your skin conditions?While most skin disease can be effectively managed with medical treatment, avoiding things that irritate the skin and minimising stress, it’s also important to seek professional advice.
To treat skin conditions, survey respondents seek help from
various healthcare professionals depending on the condition.
For most skin conditions, people primarily see their GP, though may
seek multiple sources of treatment. For skin cancer/sun spots, about
the same number of people see a skin specialist as a GP. For
conditions including warts and tinea, people are as likely to see
a pharmacist as a GP. The highest number of those who worked
out their own treatment was in relation to itchy skin and acne; those
with itchy skin were the most likely of people with any condition
to not seek treatment at all. This year, there was a higher share
of those seeking treatment for acne from GPs than in the two
previous years.
0 10 20 30 40 50 60
Figure 9: Seeking treatment for skin conditions
54%31%30%21%16%11%9%8%
GP
Dermatologist/skin specialist
Pharmacist
No treatment
I worked it out myself
Internet
Surgeon
Beauty therapist/health food store
23
As for the treatments
themselves, the most popular
was a non-prescription (49%)
or prescription (48%) cream or
ointment, though other
significant interventions include
freezing (18%), prescription
tablets (17%), surgery (16%)
and modification of diet (15%).
A small number of people, 34
of the over 1,000 participants,
have tried a complementary
or alternative therapy for their
skin condition, such as cupping.
Prescription treatments were
generally recommended by
medical practitioners. For
over-the-counter treatments,
half or more of those who used
them chose the product
themselves. Similarly, of the 14
respondents who modified
their diet to address a
skin
condition, 9 of them chose to
do this themselves without
recommendations from
healthcare professionals.
Table 3: Have you received
any of the following treatments
for your condition?
Treatment %
Cream/ointment/
lotion/gel – non-
prescription/over-the-
counter
49
Cream/ointment/
lotion/gel – prescription
48
Freezing 18
Tablets – prescription 17
Surgery, e.g. biopsy or
removal
16
Diet modification 15
No treatment 13
Tablets – non-
prescription/over-the-
counter
9
Laser 5
Complementary/
alternative therapy
2
The Foundation is worried about
the large number of Australians
who are not treating skin
conditions or who are not
seeking professional advice.
As described above, 41% of
respondents worry about skin
cancer and sun spots, and some
of them are self-checking and
having second opinions;
however, more common skin
problems are being overlooked.
Inflammatory skin disease
comes in various forms, from
rashes, itchy skin and redness
that occur on occasion to
chronic conditions like
psoriasis, rosacea and
eczema or dermatitis.
Nearly one in five respondents,
19%, say they experience itchy
skin, equivalent to just over 3.7
million Australian adults. Itchy
skin can be a sign of skin
disease and inflammatory skin
disease can often disguise
other underlying health factors
that need a professional
medical opinion and diagnosis.
Yet over 20% don’t seek any
treatment for it, and another
14% work out their own
treatment. If your skin is itchy
or inflamed, it’s important
to get it checked out by
professionals. Most people
don’t realise that it might be a
sign of more serious health
problems. For example, itchy
skin could be a sign of asthma
or allergies.
24
Do you check your skin?Of those surveyed, 68% personally check or monitor their skin for signs of skin disease such as moles, skin cancer or rashes – we call this ‘skin-checking’. We actively encourage Australians to be aware of their skin health and to do skin-checking but it needs to be followed up with a visit to the doctor to get a professional opinion. Only 44% also have someone else check or monitor their skin for signs of skin disease.
The survey found that women (70%) were a little
more diligent than men (67%) when it comes to
self-checking. About 3 in 10 respondents check
weekly and just less than this check monthly.
About 2 in 10 check daily! One in ten check
every three months; 6% check every six months
and the same amount check annually.
Although on average, 77% of those who self-
check do so either daily, weekly or monthly, this
ranges from the most diligent (87% of those 75
and over and 82% of 18 to 24 year olds) to the
least diligent (69% of those 25 to 34 years old).
Last year, it was the 35- to 44-years-olds who
were least diligent, but they’ve increased their
share this year from 68% to 78% who self-check
daily, weekly or monthly.
Respondents check their skin where it’s easiest
to see, with the highest shares checking arms
(82%) and legs (74%). But they also check their
necks (70%), head (63%) and back (51%); 42%
check under their arms, 26% the soles of their
feet, and 24% their buttocks. It is essential to
check every part of your body.
According to this year’s SHARC survey, 44% get
someone else to check or monitor their skin for
signs of skin disease such as moles, skin cancers
and rashes. This was the same share as in 2014,
though the share dipped last year down to 38%.
When respondents had other people check their
skin, it was usually their GP (55%) and often their
partner (40%) though many also went to skin
cancer clinics (27%) and dermatologists (14%).
25
When it comes to other people checking one’s skin, the
frequency is less. While 93% of those who self-check do so every
six months or more frequently, this figure drops to 40% for having
someone else check your skin at this same frequency. An
additional 37% have someone check their skin every six to
twelve months.
The reasons people do not have skin checks vary. The biggest
share of respondents, 37%, say it’s because their skin does not
have anything that looks suspicious, while 30% say that it's never
occurred to them to do that; 21% report that they do it themselves;
19% say they limit their sun exposure or don’t go out in the sun,
and 18% lay the blame on their doctors who don’t do these skin
checks when they are visited by patients. Interestingly, cost is a
factor for 12% of respondents.
0 10 20 30 40 50 60
Figure 10: Who else checks your skin?
55%
40%
27%
14%
GP
Partner
Skin Cancer Clinic
Dermatologist
26
Do you understand the risk of skin cancer?The early detection of skin cancer means that it can nearly always be successfully treated, and it is great to see that most people are now regularly checking their skin. We would love to move the 68% figure of Australians who check their skin to 100%.
Melanoma has been called Australia’s national
cancer with the highest incidence in the world.
Australians experience 12 times the global
average rate of melanoma. Queensland’s
incidence rate is higher than anywhere else
in the world. More than 13,000 Australians were
expected to be diagnosed with melanoma
in 2016, and the number increases slightly
each year.
KPMG reported in ‘Advanced Melanoma –
The real cost of Australia’s national cancer’
that the estimated cost to the nation of
advanced melanoma in 2014 was $422 million.5
The Australian Institute of Health and Welfare
estimates that over 1,700 people (1,210 men
and 530 women) will die of melanoma in 2016.
It is the third most commonly diagnosed
cancer for both men and women.
Another question in the SHARC survey was
that if people are checking their skin, are they
confident that they can identify possible skin
cancer? This was positive, with 68% either very
confident or confident (higher than last year’s
63%), though with 29% not confident and 3%
with ‘no idea’, some public and self-education
about suspicious lesions or spots would be useful.
There was no clear trend in terms of confidence
among age groups. While the average of those
who were confident or very confident in
identifying skin cancer was near the overall
average of 68% in most age groups, only those
aged 65 to 74 were particularly confident (78%).
On the other hand, more education, awareness
or experience is leading people to be more
confident at a younger age. While last year,
confidence rose from the age of 45, this year,
all age groups had similar confidence levels.
When asked at what age respondents think
people are at the highest risk of getting skin
cancer, the majority said ‘any age’ (41%) while a
roughly equal share (12 to 13%) guessed between
the age groups of 25 to 34, 35 to 44 and 45 to 54.
Skin cancer and melanoma occur at any age,
though the common cause of UV exposure has
a cumulative effect.
Another key result of the survey is that Australians
need to understand sunburn risk during everyday
activities. While 54% answered ‘every day’ was
the most important time to protect oneself from
the sun, 38% said the period between September
and April. These results are much the same as in
the previous two years.
In fact, those in northern Australia must protect
themselves every day of the year, while those
in southern Australia must protect themselves
between September and April.
5 KPMG (2014) ‘Advanced Melanoma – The real cost of Australia’s national cancer’, http://www.melanomapatients.org.au/wp-content/uploads/MPA_the_real_cost.pdf, accessed 20 October 2016 27
Skin cancer risk isn’t confined to hot, sunny
summer days. Sunburn can occur where and
when you least expect it and there is still
significant threat of UV rays during the cooler,
non-summer months of the year in southern
Australia. Tasmanians often underestimate the
rate of being sunburnt because it is cooler there.
While some might think that the risk of sunburn
depends on whether your skin pigment is light
or dark, what is most relevant is the amount of
time in the sun, the date and time of day, and
your location in Australia.
Respondents correctly identified factors that
should be taken into account when trying to
protect themselves from the sun, noting in order
of most importance the UV index, how sunny it
is, and the time of day.
Still, the Foundation is concerned that most
Australians still don’t understand UV and
generally believe that skin cancer risk is
confined to hot, sunny summer days.
Table 4: Which of the following should you
take into account when you are trying to
protect yourself from the sun? (Multiple
answers were allowed)
%
When the UV index is high 69
When it is sunny 59
Time of day 51
When it is hot – over 30 degrees 51
Time of year/season 45
When it is warm – 20 to 29 degrees 36
When it is cloudy 35
When the UV index is low 15
When it is cool – under 20 degrees 14
Sunburn is a known risk factor for melanoma
and skin cancer. You are vulnerable to the sun
at different times of day and in different seasons,
even when it is cloudy. People often spend longer
outside than they initially anticipate, especially
when gardening.
Know your facts about melanoma• Detect it and treat it early!
Melanoma causes the most
deaths of any skin cancers,
but if it’s recognised at an
early stage, with treatment,
it can almost always be
treated successfully.
• Know your risk factors!
A person’s risk for
melanoma doubles if he or
she has had more than five
sunburns at any age. And
one or more blistering
sunburns in childhood or
adolescence more than
double a person’s chances
of developing melanoma
later in life. Melanoma is
particularly deadly for
young Australians, though
incidence in people over
60 is also very high and
increasing. It is the most
common cancer in young
Australians aged 15 to 39
years old and in 20 to
34-year-olds, melanoma
kills more young Australians
than any other single cancer.
• It’s a serious issue!
In Australia, an average of
30 people will be diagnosed
with melanoma every day,
and 1 in 17 Australians will
be diagnosed with
melanoma before age 85.
28
Yet the number of people who did not choose
the factors above indicates a need for more
awareness education: 31% did not identity a
high UV as a factor to take into account for sun
protection; 41% did not identify when it is sunny,
and 65% when it is cloudy.
Interestingly, women identified the time of day and
the time of year as factors more than men (57%
vs 46% for the former; 50% vs 39% for the latter).
While the 2016 SHARC results show that 31% of
participants did NOT identify a high UV index
as a reason to protect yourself from the sun, this
lack of knowledge seems endemic in Australia.
With similar results to the SHARC surveys, a 2014
report6 in the Australasian Journal of Dermatology
noted that in Melbourne, UV is theoretically
highest at the time of the summer solstice
(21–22 December) and the months of December
and January have the highest UV radiation. Yet
only 12% of 668 participants knew the former
and 38% knew the latter. Further, 25% answered
May–August, when UVR is negligible in
Melbourne, or they had no idea.
It’s also important to raise knowledge of this
issue for Australians residing in cooler parts of
southern Australia, where UV radiation levels
may be high even when the temperature is
relatively cool. Any time the UV index is above
a moderate level of 3 requires people to
undertake some sun protection.
Table 5: Which of these are places/situations
where you consider yourself at risk of sunburn?
%
At the beach 84
Being outside in summer 82
Playing sport 67
At a BBQ on a cloudy day in summer 61
Driving 46
At a BBQ on a clear day in winter 42
Being outside in winter 30
Sitting in the shade in summer 21
Similarly, all of these situations above can place
people at risk of sunburn, even though the ones
at the top of the list are the most likely.
Who is getting sunburnt and how? Perhaps
younger people are more active and spend more
time outdoors, as those 25 to 34 were most likely
to be sunburnt unexpectedly (76%) and once
participants hit the age of 55, they reported being
unexpectedly sunburnt less. An average of 66%
of participants were sunburnt unexpectedly in
the last two years.
Awareness of the risk of these situations declined
slightly from 2014 to 2015 and again to 2016. Is
this lack of knowledge the reason why 66% of
those surveyed reported being unexpectedly
sunburnt in the last two years? Respondents
reported getting sunburnt while gardening (27%),
going for walks (26%), at the beach (24%),
driving (17%) and watching an event (16%).
6 Wong CC, Liu W, Gies P and Nixon R (2014) ‘Think UV, not heat!’ Australasian Journal of Dermatology. 2014 Dec 12. doi: 10.1111/ajd.12272 29
How do you maintain healthy skin? The 2016 SHARC Report asked if Australians know how to protect themselves from skin damage, and then whether they turn that knowledge into action. The results? The SHARC Report revealed Australians have a good understanding of steps needed to maintain healthy skin, yet struggle to implement these steps in daily routines.
Respondents showed a good understanding of
how to maintain skin health.
Table 6: Which of these items do you believe
will help maintain skin health?
%
Drink water 80
Protect from sun, e.g. Wear a hat,
use sunscreen
79
Good nutrition 75
Treat dryness, e.g. use a moisturiser 70
Don’t smoke 66
Minimise alcohol 53
Minimise exposure to irritants, e.g. soap,
detergents, irritating chemicals at home
or work
51
A slightly smaller number of participants each
year identified the actions above to maintain
skin health. For example, minimising alcohol
consumption was identified by 60% in 2014, 58%
in 2015 and 53% this year.
Similarly, less respondents are taking these
actions. While there was always a difference
between identifying actions to maintain skin
health and then actually doing them, our
participants this year are not as active in
maintaining their skin health. Those who drink
water for skin health declined from 74% in 2014
to 67% in 2016; those who minimise drinking
alcohol declined from 40% in 2014 to 36% in
2015 and to 32% in 2016.
Table 7: Which of these do you currently do
to maintain your skin health?
%
Drink water 67
Protect from sun, e.g. Wear a hat,
use sunscreen
64
Treat dryness, e.g. use a moisturiser 58
Don’t smoke 54
Good nutrition 53
Minimise exposure to irritants 34
Minimise alcohol 32
It seems that with age comes wisdom. Those in
the age range from 45–64 appear to drink the
most water on a daily basis (70% to 74%). The
survey also finds that respondents aged 55 and
over are the most active in protecting
themselves from the sun by using a hat and
regularly applying sunscreen (77% and up).
In contrast, the percentage of younger adults
(18 to 24) that wear a hat and use sunscreen
to maintain skin health is only 49%.
Most Australians (over 7 in 10) use a moisturiser,
which hasn’t changed over the last two surveys.
There is a higher share of 25- to 34-year-olds who
moisturise than other age groups (80%). There
was a significant difference between women
(90% who moisturise) and men (only 54%).
30
Most respondents moisturise
daily (59%) or every other day
(22%) or once a week (15%).
A minority (43%) use other skin
care products with the most
common one being sunscreen.
Of this minority, 59% who
moisturise also use sunscreen
and 58% also use a cleanser.
Of those who use moisturiser
on their bodies, they use it
especially on their face (85%),
arms (67%), legs (61%) and
neck (55%). Perhaps the chest
being covered most of the
time is the reason it receives
less attention (33%) and the
back is hard to reach (21%)
though the head received the
same share (21%) as the back.
Table 8: Top 5 skin care products
used other than moisturiser
%
Sunscreen 59
Cleanser 58
Day cream 45
Facial scrubs 45
Make-up 43
Unsurprisingly, not as many
men use facial scrubs (25%) as
women (53%), or use cleanser
(25% vs 72%) and day cream
(22% vs 55%) though 4%
use make-up of some sort
(compared with 59% of women).
Roughly one-fifth of participants
don’t spend any money on
skin products or services each
month; 11% spend $1–5; 17%
spend $5–10, and the biggest
share spend $11–20 (21%). 17%
spend $21–50 and 16% spend
over $50 a month including
1% who spend over $200.
Most respondents, 56%, are
happy with the way their skin
looks, of which 60% of men are
happy and 51% of women.
Very few have sought
cosmetic
treatments to change the
appearance of their skin in
the previous 12 months.
Facial peels were done by
7% of respondents, 5% tried
dermabrasion and laser
treatment, 3% of respondents
had body or hand peels,
botox or dermal fillers.
On the other hand, these
approaches are becoming
less popular every year; the
share of those who had done
none of these increased from
11% in 2014 to 14% in 2015 and
17% in 2016. These approaches
are most popular among those
ages 25 to 34, and more
popular in New South Wales
than any other state or territory.
10
15
20
%201620152014
11
1417
PEOPLE WHO HAVE NOT HAD COSMETIC TREATMENTS
31
Does your skin affect your quality of life?The SHARC survey asks if issues with your skin affect your quality of life. The survey used the Dermatology Life Quality Index (DLQI)7 to understand how your skin affects your quality of life. The DLQI finds the effect of skin issues, ranging from no effect or a small effect to a moderate, very large or extremely large effect, on different areas of a person's life.
These are important results. Your skin health is
important to you, and it affects a significant
number of Australians while they work, study and
socialise. Using the DLQI, survey participants
were asked to think about the week previous to
the survey. During this week:
• About 41% of survey respondents were
embarrassed or self-conscious because of
their skin (up from 38% last year and 30%
the year before). Those who were ‘a lot’
embarrassed or self-conscious was 9%,
considerably higher than previous years.
• 18% said their skin health interfered with
shopping or looking after their home
or garden.
• 42% found their skin itchy, sore, painful
or stinging (the same share as in last
year’s survey).
• 20% said it had an effect on their social and
leisure activities. This figure was higher for the
younger age groups: 31% of 18- to 24- year-
olds, and 33% of 25- to 34-year-olds.
• A skin issue made it difficult for 15% to
participate in sport.
• 50% more people reported sexual difficulties
in the last week caused by their skin health
this year compared to last year (12% of those
surveyed, up from 8%).
• A skin issue created problems with a partner,
close friend or relative for 14%, up from 10%
last year.
• Skin health prevented just 4% from working
or studying in the previous week to the survey
though it was a ‘little’ or ‘a lot’ of a problem
for 13% at work or studying.
• About 28% said their skin influenced the
clothes they wore (much higher than last
year’s 18%). This figure was higher for the
younger age groups: 31% of those ages
18 to 24, and 39% for those ages 25 to 34.
• 17% of respondents found it a problem to
treat skin issues (for example, by making
their home messy or taking up time).
It’s obvious that skin health issues are affecting
a large number of people. In fact, the DLQI results
over the last three surveys show a clear trend
that in all nearly all aspects of life, respondents
report the effect of skin conditions on their quality
of life as larger. A skin condition interfered with
shopping or looking after the home or garden,
influenced what clothes were worn, affected
social and leisure activities, made it more
difficult to play sport, prevented or had been a
7 © Dermatology Life Quality Index. Finlay, AY and Khan GK, April 1992 www.dermatology.org.uk. The DLQI must not be copied without the permission of the authors.
30
40
50
%201620152014
30
3841
PEOPLE WHO ARE SELF-CONSCIOUS OF THEIR SKIN32
problem at work or studying,
created problems with a
partner or close friends or
relatives, or caused sexual
difficulties. Only the DLQI score
for treatment of skin causing a
problem remained about the
same from year to year.
As reported above, while most
people with skin conditions are
not extremely or moderately
affected, overall, respondents
reported a slightly larger
effect each year.
How skin conditions relate to
work is an interesting issue. 31%
of respondents chose their
occupation based on an issue
related to a skin condition
(higher than last year’s response
of 27% which was much higher
than the previous year’s
response of 19%).
Of these, 4% were extremely
influenced and 5% moderately.
Men were more likely than
women to say their choice of
occupation was influenced by a
skin condition (34% vs. 29%). 11%
of respondents had to miss work
in the last 12 months because
of a skin condition. About one-
third missed two to five days,
and 30% six to ten days.
Awareness about the skin
condition of someone else in
their workplace has risen, from
12% of respondents in both
2014 and 2015 to 16% in 2016.
Respondents believe that
these colleagues would suffer
embarrassment (47%), the
condition would have an
effect socially (32%), they
would be absent from work
more often than others (9%),
and the condition would affect
their capacity to work (9%).
Australia is a country where
people sometimes have to
work outdoors.
Table 9: Does your
employment require you to
work outdoors?
%
Never 44
Sometimes 40
Regularly 11
All the time 4
This is a different profile of
participants than previous years,
where 53–54% never had to
work outside, and 30–31%
sometimes had to. Those who
have to work outdoors all the
time dropped from 6–7% to 4%.
A much higher percentage of
men sometimes, regularly or all
the time work outdoors (about
63%) than women (47%). Those
from South Australia work the
most outdoors (67% working
outdoors at least sometimes)
of the states and territories;
those from ACT (38%) and
Victoria and Tasmania (46%
each) work the least outdoors
(never working outdoors).
If people do have to work
outside, their employers
generally do not provide them
with protection, although
there are improvements over
previous years.
Table 10: Does your employer
provide you with any of the
following?
%
Sunscreen 48
Protective clothing, e.g.
hats, sun-protective shirts
35
Sunglasses 26
Gloves 25
Moisturisers 19
Skin checks 10
None of these 30
48% of employers (compared
to 38% last year) provided
sunscreen (which was 3% higher
than the year before) and 19%
compared with 13% provided
them with moisturisers (which
was 3% higher than the year
before). Those whose employers
provide them with no protection
at all dropped from 44% in 2014
to 39% in 2015 and 30% in 2016.
These statistics demonstrate a
very favourable trend.
The Skin & Cancer Foundation
Inc is already working with
a range of employers and
sporting groups to raise
awareness about both skin
health and responsibilities if
their workers are required to be
outside; however, it remains an
issue that requires attention.
33
Comments from survey participantsIt was great to get comments from so many respondents. About 80 of our over 1,000 survey respondents had comments on the survey, up from 50 last year. Many found the survey ‘good’, ‘very good’ and ‘great’, and even ‘enjoyable’. Participants also commented on the professionalism of the survey and that it was ‘expert’.
A number commented on the way survey
helped raise awareness of skin health among
the Australian population. ‘I feel there is not
enough awareness about skin health and having
regular skin checks,’ said one participant, while
others said that the survey reminded them of
‘the importance of checking my skin more
regularly for any changes’ and ‘reminded me
about looking after my skin’.
Some interesting comments were that one
person found it embarrassing and difficult to
talk to health professionals about skin problems
because of being a man, while another reminded
us that skin care is not always easy; they’d ‘like
to do more for my skin but money and time are
huge factors’.
A few comments were that the survey was
‘thought provoking’ and ‘a good reminder to
look after my skin, particularly with summer
approaching.’ Another found the survey a good
way to raise awareness that some people may
suffer from their skin.
Two different people spoke of the need for
care, empathy and self-confidence, to be
happy with who you are and not to judge
others based on their appearance.
Two responses highlighted the need for attention
in the workplace, including skin protection in
occupational health and safety, and the damage
to skin caused by chemicals in the workplace.
One notable comment came from an older
participant who said ‘My skin problems are all
age-related, and at 78, I can live with them.’
Our sincere thanks to all our survey participants,
and all those who gave us extra comments.
We’re grateful to you for contributing to our
national understanding of skin health issues.
My skin problems are
all age-related, and
at 78, I can live with them.‘ ’34
About Galderma For the third year, the SHARC Report has been commissioned with the support of an untied education grant to the Skin & Cancer Foundation Inc from Galderma.
Galderma is a global
dermatology company, part
of Nestle Skin Health, which
is focused on developing
medical solutions for the skin.
Galderma has a particular
focus on acne, rosacea,
psoriasis and other steroid-
responsive dermatoses,
onychomycosis (fungal nail
infections), skin cancer, sun
protection, and medical
aesthetic and corrective
solutions for skin senescence.
The company has 36 wholly
owned affiliates, over 6,500
employees and is present
in over 100 countries.
Today, Galderma is a global
leader in the research and
development of scientifically
defined and medically proven
solutions for the skin, hair and
nails, partnering with healthcare
professionals around the world
to meet the needs of people
throughout their lifetime.
35
About the Skin & Cancer Foundation Inc The Skin & Cancer Foundation Inc (the Foundation) is Australia’s leading centre for the specialist treatment of and research into skin disease. Established in 1987, we are a not-for-profit organisation that provides highly specialised clinical treatment and care, education and research for a wide variety of skin diseases, skin cancer and melanoma.
Diseases of the skin are one
of Australia’s major public
health problems. Every day,
dermatologists see people with
a wide range of skin conditions;
some are debilitating and
profoundly affect their self-
esteem and the ability to
socialise and work. The
Foundation is proud to help
these Australians achieve their
full potential through better
skin health.
Headquartered in Melbourne,
the Foundation has become
Australia’s largest centre of
excellence in dermatology.
Our core activities are:
1. To provide patient-focused,
world-class dermatological
treatment and care
2. To lead the promotion of skin
health in the community
through education in
dermatology including
dermatologists, registrars,
GPs and other healthcare
professionals
3. To achieve global
outcomes by conducting
and contributing to world-
class dermatology research
The Foundation conducts
clinical trials and world-class
research that are published
and presented internationally.
This allows us to make significant
advancements in skin disease
treatments and patient care.
We also provide education and
updates to dermatologists,
specialist trainees, medical
students, general practitioners,
other healthcare professionals
and the community.
You can always visit our
website or contact us for more
information about skin health
and sun protection:
www.skincancer.asn.au
Skin & Cancer Foundation Inc
80 Drummond Street
Carlton VIC 3053
t: 03 9623 9400
www.skincancer.asn.auPublished October 2016
