Skin Health Australia Report Card 2017

Skin issues: a lack of awareness and a big impact on quality of life

Supported by

Foreword 3

Executive summary 4

SHARC 2017 10

About those surveyed 10

How do you describe your skin? 12

Do you get sunburned? 15

Expect the unexpected… sunburn 16

What do you think of your skin health? 18

What are you allergic to? 19

What are your problems with skin health? 20

What are you concerned about? 22

How do you treat skin conditions? 26

Please see a doctor 28

Do you check your skin? 29

Do you understand the risk of skin cancer? 31

How do you maintain healthy skin? 34

Was your choice of occupation influenced by a skin condition? 34

Are you happy with the way your skin looks? 37

Comments from survey participants’ 37

Skin issues affect the quality of life of many Australians 38

About the Skin & Cancer Foundation Inc. 44

About Galderma 44

Contents

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Foreword Skin health issues have a high impact on the quality of life of Australians, a fact that is not often recognised. The 2017 Skin Health Australia Report Card – the 2017 SHARC Report – helps to highlight the ways that skin issues can have an affect on people’s social life, relationships, work and well-being.

At the same time, the SHARC Report aims to increase the knowledge and awareness of skin issues of Australians with a goal of Australians taking better care of their skin, including by avoiding the unexpected sunburns that the survey found so prevalent, by regularly checking their skin, and by using protective measures such as sunscreen.

Skin health issues are particularly important in Australia. The SHARC Report reveals 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 fourth year that we have commissioned a national population survey that tracks attitudinal and behavioural changes related to the skin health of the Australian population, with the results analysed and published as the SHARC Report.

Another of our aims is for the SHARC Report and the data upon which it is based to serve as a valuable resource for our key stakeholders including policymakers, dermatologists, general practitioners, allied health professionals, and individual Australians.

The SHARC Report shows a strong need 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.

We would like to thank all those who took part in the survey and all of the readers of this Report, as we join together to improve Australia’s skin health, making us a healthier and happier nation.

Associate Professor, Chris Baker,Skin & Cancer Foundation Inc. Melbourne

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SHARC examines these key issues:

• What Australians think about their skin

• Australians’ awareness of and problems with skin health

• Attitudes towards and treatment of skin conditions

• Actions for checking skin health

• Prevention of skin issues

• Quality of life issues related to skin health.

The 2017 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.

Key findingsThe key findings of the 2017 SHARC Report are on the importance of skin issues to the quality of life of Australians, and the importance of skin care, in particular, avoiding sunburns.

Skin issues and problems have a high impact on the quality of life of Australians and this is often not recognised. Issues related to our skin affect many aspects of our quality of life, including socialising, playing sport, wearing clothes, sexual activities, and relations with partners, close friends and relatives. The survey told us that in the week previous to the survey, 43% of respondents, the equivalent of 8.6 million Australians, had a skin issue that had an effect on their life.

Executive SummaryThe 2017 Skin Health Australia Report Card is our fourth SHARC Report. It is based on the results of a national population survey that focused on tracking the Australian population’s attitudinal and behavioural changes regarding skin health.

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A similar number in this year’s survey, 45%, equal to just over 9 million Australians, stated that they had a specific skin condition, and that 71% of them said these conditions have some negative effect on their quality of life – the equivalent of 6.4 million people.

So skin issues are common, ranging from specific conditions such as eczema and acne, to more general concerns, such as signs of ageing and itchiness. Yet their impact is underestimated, particularly the effect they can have on someone’s social life, relationships, work and well-being.

The following findings show the range and degree of impact of skin issues on the quality of life of Australians.

• In the week before the survey, 42% were embarrassed or self-conscious because of their skin health, with a steady upwards trend over the four years of the survey from 30% in 2014. 13% were ‘very much’ or ‘a lot’ embarrassed or self-conscious.

• 18% said their skin interfered with shopping or looking after their home or garden.

• 45% found their skin itchy, sore, painful or stinging.

• 20% said it had an effect on their social and leisure activities, making it difficult to do

sport (15%) and causing sexual difficulties (11%) or creating problems with a partner, close friend or relative (15%).

• A skin issue prevented 4% from working or studying, or just over 800,000 Australian adults.

• About 28% said their skin influenced the clothes they wore.

• 18% of respondents found it a small or big problem to treat skin issues.

The other key finding is that Australians don’t care enough for their skin. This

is demonstrated in the finding that 68% of people had unexpected sunburns in the previous two years, a figure slightly higher than the four-year average of 65%.

This has a range of consequences. 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. 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.

Awareness needs to be raised. But while skin cancer was the skin condition of highest concern to participants (44%), a surprising 47%

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and avoid sunburn and protect yourself from the sun. This will help improve early diagnoses of melanoma, but it also recognises the earlier important finding of how skin issues have a big impact on the quality of life of Australians.

Other key findingsHere are other highlights of the results from SHARC 2017:

What we think of our skin• Unhealthy skin is an important concern for

Australia, rating third in a list of nine general health conditions.

• Yet, 84% of respondents consider their skin ‘very healthy’ or ‘healthy’.

• 53% are happy with the way their skin looks.

• The top three current skin concerns of respondents are signs of ageing (43%), dry skin (38%) and signs of sun damage (28%).

• 45% of participants reported a current skin condition.

• People worry about different skin issues at different times of their lives: people are concerned about acne up until the age of 34, and people start to worry about signs of ageing on their skin when they enter the 45–54 age group.

How we describe our skin• 70% of respondents describe their skin as

very fair or fair; 29% as olive and 1% as black.

• 71% of respondents say they burn ‘always’, ‘easily’ or ‘moderately’; 12% say they never tan and always burn.

• Among the age group from 18 to 24, 6% say they never burn, a much higher figure than any other age group (ranging from 1% to 3%).

• Most respondents (72%) describe their skin as ‘moderately marked’ by moles, freckles and sunspots; 8% as very marked; and 20% as clear.

say they have no concerns about skin cancer or sun spots at all. Australians are concerned about the effects of the sun: signs of ageing was the most common skin condition of concern (43%) and signs of sun damage was also a high concern.

These concerns need to be leveraged into action and awareness, for example, 37% of survey respondents do not currently protect themselves from the sun by wearing a hat or using sunscreen.

Knowledge is also important. Many Australians do not understand UV risk, and believe that sunburn mostly happens on hot, sunny summer days during the hottest time of day, dismissing the risk of sunburn happening on cloudy, cool days.

A final action that should come out of Australians’ concern about sun damage on their skin is checking one’s skin for signs of skin disease. About one-third of the Australian adult population do not do this. It’s also worrying that less than 40% are not confident that they could identify a possible skin cancer.

Considering the results of the SHARC Report 2017 and from previous years, the need for a range of public health messages is clear: check your skin; learn how to identify unhealthy skin;

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• 41% also have someone else check their skin.

• 62% were either very confident or confident they can identify possible skin cancer.

• Many Australians believe that drinking water (79%), protecting themselves from the sun (76%), using a moisturiser (73%), ensuring they have good nutrition (72%) and not smoking (67%) are good ways to maintain skin health.

• However, only a smaller number put that into action with, for example, 68% drinking water, 63% protecting themselves from the sun and 61% using a moisturiser.

• 54% believe that minimising alcohol helps skin health but only 33% do this, indicating that 21% do not practise what they believe.

Skin conditions• The most common current skin condition

is itchy skin (20%), followed by acne (13%), eczema/dermatitis (12%), skin cancer/sun spots (9%) and psoriasis (7%).

• Most skin conditions are long-standing with the largest share of those with most skin conditions reporting having them for over five years. Skin infections are short lasting. Tinea can be both short-term and long-term.

• 48% of respondents have a skin allergy or sensitivity. The most common reported

Skin cancer risk• 68% of 2017 respondents were

unexpectedly sunburned in the last two years. This is higher than the average over four years of 65%.

• This figure rises to 82% within the 25 to 34 year old age group.

• Respondents reported getting unexpectedly sunburned while going for walks (30%), gardening (29%), at the beach (26%), watching an event (19%) and driving (18%).

• It seems that in their mid-forties, people trade beach towels for garden trowels: gardening was the most common situation for getting sunburned for those 45 to 54 (37%), and 55 to 64 (36%).

• When asked when sun protection is important, many respondents did not indicate key factors: 31% did not identity a high UV as a factor to take into account for sun protection; 40% did not identify when it is sunny, and 46% the time of day.

Skin cancer monitoring and prevention• 67% of respondents personally check their

skin for signs of skin disease (meaning that about one-third of the adult population do not do this).

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allergy is to nickel, as found in cheap jewelry (19%) though 16% report problems with clothes washing powder and 14% to sticking plaster, band aid and tapes and 14% to cleaning products.

• The most common specific skin problem is dry or scaly hands or legs.

• To treat conditions, the most respondents, 53%, see their GP, 31% each see their pharmacist; and a skin specialist or dermatologists, 23% work out their treatment on their own; and 18% do not seek treatment.

• Unhealthy skin and common skin problems may be signs of other, more significant health problems. But of those who have skin problems, 33% consider them cosmetic only, the same numbers think of them as both medical and cosmetic, 17% as medical problems and 18% don’t know.

• And while 20% of respondents with a current skin condition say they experience itchy skin, which can be a sign of asthma or allergies, 9% don’t seek any treatment for it, or work out their own treatment (6%), rather than see a healthcare professional.

Skin health is a workplace issue• More and more Australians consider skin

conditions in terms of choosing their occupation (33%, with an upwards trend over four years from 19% in 2014)

• 45% are employed in jobs that sometimes, regularly or always require them to be outdoors.

• Yet most employers do not provide protective measures such as sunscreen, protective clothing, sunglasses or gloves. For those who work outside, 43% of their employers provided sunscreen, 34% provide protective clothing and 20% each provided sunglasses or gloves.

• In the last two years, more employers provided moisturisers (18% in 2017 and 19% in 2016) than previously (13% in 2015 and 10% in 2014).

About the Skin Health Australia Report CardThe main issues examined by the fourth SHARC Report 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 have healthy skin?

Actions: How do Australians treat skin conditions? If they seek help, who do they go to? How do they check their skin health 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 the quality of life of Australians?

About the Skin & Cancer Foundation IncThe Foundation is a Melbourne-based, not-for-profit organisation that provides highly specialised clinical treatment, education and research for a wide variety of skin diseases, skin cancer and melanoma.

The Skin Health Australia Report Card (SHARC) has been published annually since 2014. SHARC is based on the results of a national population survey carried out by StollzNow Research, the professional research and advisory firm.

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This survey was completed in September 2017, commissioned by the Skin & Cancer Foundation Inc., funded by an untied education grant from Galderma Australia.

Every year, SHARC looks at how Australians understand skin health, what they think of their skin, and whether they have any skin problems. The survey asks whether Australians are checking the health of their skin themselves or by others and, if they seek help, where do they go.

SHARC also explores whether skin health affects their quality of life, and what their knowledge of and routines are for keeping their skin healthy.

Each successive year of the survey allows understanding the issues in a new way.

The second year of the survey allowed a comparison to the first year. The third year of the survey allowed an identification of trends over the three years. Now in the fourth year of the survey, the data has an interesting message for us. In terms of what Australians think of their skin and how they treat it, there is little significant difference from year to year. Occasionally, in one year of the four years, there will be a different figure in a category, but by the next year, that figure has usually returned to the average.

In this year’s Report, very few trends have emerged. However, if the data for 2017 is significantly different than other years, or shows that data in a previous year was an anomaly or part of a trend, this will be highlighted in the Report.

SHARC 2017

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About those surveyedOver 1,000 people participated in the survey from across the country, giving us a representative picture of Australians and skin health.

In this year’s survey, as previously, slightly more women (53%) than men (47%) participated. The mix of participants (gender, age, location, income, employment status and household composition) is similar over the four years of the survey.

Survey respondents are over 18 years of age, and divided into 7 age groups. There are more participants in the three age groups between the ages of 25 and 54 (25 to 34; 35 to 44 and 45 to 54). 70% of the respondents are from metro areas and 30% from regional Australia.

Figure 1:

Figure 2:

Where participants liveNSW 33%VIC 26%QLD 19%WA 10%SA 8%TAS 3%ACT 1% Other survey questions sought information on participants’ employment, living situation and income. Those who took the survey are mostly employed full-time (39%) with a significant number employed part-time (19%) or retired (23%). Students make up 5% of participants, the same as in 2016 but slightly down from 7% in both 2014 and 2015. 10% of survey participants were on home duties, and 6% were unemployed.

Most participants live as part of a couple without dependents (36%) or with dependents (27%) and a smaller number (18%) live alone. A smaller number, 5%, live with a parent or parents or in a shared household, 8%, and 5% are single parents.

The household incomes of participants were divided into: 25% making from $20,000 to $50,000; and 31% from $50,000 to $100,000. Reporting under $20,000 are 6%, 17% make from $100,000 to $150,000, 10% over $150,000 and 11% preferred not to say.

n 18 to 24n 25 to 34n 35 to 44n 45 to 54n 55 to 64n 65 to 74n 75 & over

Age range of survey participants

Most participants are from New South Wales, followed by Victoria and Queensland. Each Australian State and Territory was represented, although with only 2 of 1,007 participants from the Northern Territory, they are not reflected in the figure.

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How do you describe your skin?Survey respondents were asked to think about their skin and describe it according to blemishes, skin pigment, sensitivity, type and response to sunlight.

They were requested to describe the level of blemishes on their skin in terms of moles, freckles and sunspots. The great majority consider themselves in the middle, with 72% ‘moderately marked.’ Those rating their skin as clear were 20%. Those who consider themselves ‘very marked’ compared to a national average of 8%.

Figure 3:

n Very marked – moles, freckles, sunspots

n Clear – no moles or markingsn Moderately marked – moles,

freckles, sunspots

Describing blemishes

There were differences in descriptions of skin by age. Those 75 and over have the highest percentage of skin that is ‘very marked’ (11% compared to an average of 8%), while those who consider themselves ‘moderately marked’ is highest among those 55 to 64 (77%). Those in Queensland (12%) and South Australia (13%) have the highest percentage of ‘very marked’ (8% average) compared to only 4% in Tasmania.

The survey asked Australians to think about their skin and describe it according to four categories of skin pigment. Of survey respondents, 70% describe their skin pigment as ‘fair’ or ‘very fair’, which reflects that the majority of Australians get sunburned easily and need to check for skin disease. The number of those who describe their skin pigment as ‘black’ was 1% and olive was 29%.

Figure 4:

Describing skin type

n Oilyn Dryn Normal

Survey respondents were also asked to think about their skin in terms of its sensitivity to the sun and to products: 51% of survey respondents describe their skin sensitivity as normal, 37% describe their skin as sensitive to the sun and 23% as sensitive to products.

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Figure 5: This year’s responses describing skin type represent a change from the previous three years where 48% of participants considered their skin normal (compared to this year’s 44%) and 29% to 31% considered it dry (compared to 35%). The share of oily skin was the same as over the previous years. We don’t have an explanation for this change. While dry skin is a problem in winter, and the survey was done in September following the June to August winter period in Australia’s temperate zone, this year’s winter was generally hotter and drier than usual.

Do you get sunburned? Dorothea Mackellar’s famous poem ‘My Country’ called Australia a ‘sunburnt country’. How our skin responds to the sun is an important issue in Australia. A total of 71% of respondents say they burn ‘always’, ‘easily’ or ‘moderately’; of those, 27% ‘burn easily and tan minimally’ and 12% ‘never tan and always burn’.

That is the equivalent of about 12.5 million adult Australians who need to take extra care with sun protection.

In describing their skin type most respondents called their skin ‘normal’ (44%) with 35% calling it ‘dry’ and 21% ‘oily.’

Survey participants in regional Australia are more likely to describe their skin as normal (50%) compared to metro participants (42%) and fewer describe their skin as oily (15% vs 23%).

Figure 6:

n Very Fairn Fairn Oliven Black

Describing skin pigment

Skin sensitivity

NORMAL SENSITIVE TO THE SUN

SENSITIVE TO PRODUCTS

60

50

40

30

20

10

0

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Figure 7:

Among the age group from 18 to 24, 6% say they never burn, a much higher figure than any other age group (ranging from 1% to 3%). How did this younger age group get less sensitive skin? Or do they just perceive themselves as never burning when some of them actually do: the bravado of youth? It certainly isn’t because this age group is protecting themselves from sunburn. On the contrary, only 38% of them currently protect themselves from the sun with sunscreen or wearing a hat; a far lower number than the average for all age groups (68%).

The survey identified some common factors for those who were burned unexpectedly in the last two years. Those who were burned unexpectedly reported more often being employed full-time and less often retired; more often to be couples with dependents and less often to be couples without dependents or those who live alone.

They were moderately or much more marked than those with clear skin, and had fair skin more often than those with olive skin. They had dry skin; less of those with ‘normal’ skin reported burns; oily skin seemed not to make a difference.

As expected, those who burned unexpectedly were more likely to say they ‘always’ or ‘easily’ burn; the opposite was true for those who say they burn ‘minimally’ or ‘rarely’. Those who were burned unexpectedly had more problems with skin health and more acne.

Those who reported less unexpected sunburns believe that it’s important to protect yourself every day from the sun; those who reported unexpected sunburns more often believe it’s important from September to April or August to May.

Those who reported being burned unexpectedly less were in general much happier with the way their skin looks, and maintain their skin health by drinking water, good nutrition, minimising alcohol, and minimising exposure to irritants. A big share of this group, 74%, didn’t feel that skin issues affected their quality of life.

In contrast, those who reported being sunburned unexpectedly in the last two years were divided pretty much equally into two with half feeling that skin issues do affect their quality of life and the other half not.

Your skin in the sun

In the sun I...n never burnn rarely burn and tan profuselyn never tan and always burnn burn minimally and tan well n burn easily and tan minimallyn burn moderately and tan uniformly

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differences by age group. Perhaps younger people are more active and spend more time outdoors, as those 25 to 34 were most likely to be sunburned unexpectedly (82%) and once participants hit the age of 55, they reported being unexpectedly sunburned less, although the figure was still 60% for those 55 to 64.

However, 10 percentage points fewer of the youngest age group, 18 to 24, (72%) got unexpectedly burned compared to those in the next older group (82%), so younger years are not a conclusive factor.

Respondents reported getting unexpectedly sunburned while going for walks (30%), gardening (29%), at the beach (26%), watching an event (19%) and driving (18%).

The youngest (18 to 24) were most often unexpectedly sunburned on walks (28%) and

ARTICLE

One of the key findings of the SHARC Report is that a majority of Australians have been unexpectedly sunburned during the last two years. This tells us that much more education is needed to raise awareness of Australians to convince them to avoid unexpected sunburns.

The average over four years is 65% though this year’s survey has particularly bad results with 68% who were unexpectedly sunburned. At a population level, this is equivalent to about 13.6 million Australians.

Considering this information with the number of adult Australians whose skin burns always indicates that only a very small number of people susceptible to sunburns are managing to avoid them.

There is little difference between men (48%) and women (52%) in the results, but there are

Expect the unexpected… sunburn It could put you at risk of melanoma.

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the next older groups were at the beach (39% for 25- to 34-year-olds and 35% for 35- to 44-year-olds).

It seems that people in their mid-forties trade beach towels for garden trowels: gardening was the most common situation for getting sunburned for those 45 to 54 (37%), and 55 to 64 (36%).

Those in regional Australia are less likely to get burned while playing sport (8% compared to 16% in metro areas), but more likely to get sunburned while driving (21% vs 16%).

The implications of sunburn are very serious.

A person’s risk for melanoma doubles if they have had more than five sunburns at any age. And one or more blistering sunburns in childhood or adolescence more than doubles a person’s chances of developing melanoma later in life.

Melanoma has been called Australia’s national cancer and, as noted by the Australian Institute of Health and Welfare (AIHW), Australia has the second highest incidence rates of melanoma in the world (second only to New Zealand). Australians experience 12 times the global average rate of melanoma. On top of that, the incidence in Queensland is higher than anywhere else in the world.

• Nearly 14,000 Australians were estimated to be diagnosed with melanoma in 2017, 8,392 males and 5,549 females. The number increases slightly each year.

• It is estimated to be the fourth most commonly diagnosed cancer in 2017.

• Skin cancers, including melanoma, account for the largest number of cancers diagnosed in Australia each year.

• It is estimated that over 1,700 people will die of melanoma in 2017, the equivalent of 5 people a day.

• 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.

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.

There is some good news. AIHW noted in their 2016 report, Skin Cancer in Australia, that while the rate of melanoma has doubled in the population since 1982, from 27 to 49 cases per 100,000 people, the rate has dropped for people under the age of 40, from 13 cases per 100,000 in 2002 to about 9 in 2016. They attribute this success possibly to ‘long-running public-education campaigns on the effects of sun exposure.’

The other positive news is that survival from melanoma, compared to other cancers, is relatively high: if you were diagnosed in 2007–2011, you had a 90% chance of surviving at least 5 years, compared to 67% for all cancers combined.

Still, it’s absolutely imperative to detect melanoma and treat it early! If it’s recognised at an early stage, treatment is almost always successful. n

ARTICLE

Expect the unexpected… sunburn

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What do you think of your skin health? When asked to rate their skin health, survey participants were extremely positive: 7% consider their skin ‘very healthy’ and 77% ‘healthy’ with nearly 16% considering their skin health as unhealthy and less than 1% as very unhealthy.

Figure 8:

This was not a list to check off, but an open question. The answers included oiliness, rashes, scars and eczema, with 44% identifying dryness as a skin problem that makes their skin unhealthy (the most common answer) and 11% for the fifth-most identified skin problem, signs of ageing.

Figure 9:

Self-evaluation of skin health

n Very Unhealthyn Very Healthyn Unhealthyn Healthy

DRYNESS

ACNE/PIMPLES/BLACKHEADS

UNEVEN PIGMENTATION/REDNESS

SKIN CANCERS/SUN SPOTS

AGING/AGE SPOTS/GROWTHS

44%

26%

19%

14%

11%

Top five identified skin problems

These perceptions of skin problems are something that tend to vary from year to year more than other areas of the survey, likely because respondents are not choosing from a list but instead writing in the particular problem they have. For example, in 2017, a much larger number were concerned with dryness (44%) and rashes (6%) than last year (30% and 0%); and 10% less were worried about acne (26%, down from 36%) and 5% less were worried about skin cancers and sun spots (14%, down from 19%).

By age group, the most commonly identified issues were acne for those 18 to 24 (57%) and 25 to 34 (58%), then dryness for all older age groups (45 to 54 (57%), 65 to 74 (73%), and 75 and over (57%)).

More men (87%) than women (80%) consider their skin very healthy or healthy. Those aged 65 to 74 are particularly positive (90%) compared to other age groups. This age group has a smaller share of those who consider their skin unhealthy or very unhealthy (10%) and those 35 to 44 also have a lower share (15%) than some age groups.

If participants felt their skin was unhealthy or very unhealthy, they were asked to list what skin problems makes them think their skin is unhealthy.

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This was one of the few areas in the survey where a significant difference was observed between respondents from metropolitan and regional Australia.

Skin cancers and sun spots were identified as a problem for 24% of regional respondents, compared with 10% of metro respondents; similarly, age spots and growths were considered a problem for 20% in regional Australia and only 7% in metropolitan Australia.

The survey was even more specific and asked participants to consider different parts of their body. Rating the health of their skin, when thinking of different body parts, indicates where people see signs of poor skin health. The chest was considered healthiest (86% rated it with good or very good skin health) though neck (85%) and arms (83%) weren’t far behind. Thinking about the hands (28%), face (25%) and legs (24%) made folks think of their skin health as unhealthy, or very unhealthy.

What are your problems with skin health?If survey participants rated the skin health of any body part as poor or very poor (face, hands, arms, neck, back, legs and chest), they were considered to have a skin health problem. According to this classification, 54% had problems with skin health and 46% did not.

This raises an interesting inconsistency. With 85% of participants rating their skin as ‘healthy’ or ‘very healthy’, it would imply most people dismiss skin health as a minor concern, or, as shown elsewhere in the survey that a problem is merely cosmetic. But asked to think more in depth about their skin reveals that a significant number of people consider their skin healthy while identifying specific skin problems.

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More women (58%) than men (49%) listed problems with skin health, and the age group 25 to 34 also had a higher average at 64% than the overall average of 54% who identified skin health problems.

Participants were asked what part of their body was affected and what was the skin problem that affected them. The most common specific problems were:

• Dry or scaly hands (34%) or legs (30%)

• Sun-damaged hands or face (21%)

• Dry or scaly arms (19%)

• Pimples or wrinkles on the face (18%)

• Roughness on the hands (18%)

The survey asked whether respondents believed that their skin problem was a medical or cosmetic issue.

Figure 10:

About one-third of those who have problems with skin health (33%) consider their skin problems ‘both medical and cosmetic’; the same (33%) consider them ‘cosmetic’ problems’ only; less than one-fifth (17%) think of them as only ‘medical’ problems; and 18% ‘don’t know’.

Do you see your skin health problems as medical or cosmetic?

n Medical Problemsn Don't Known Both Medical &

Cosmetic Problemsn Cosmetic Problems

What are you allergic to?Almost half of survey participants (48%) reported that their skin is allergic to or irritated by different materials. The most commonly reported irritant at 19% is nickel, such as found in cheap jewellery, with 16% reporting problems with clothes washing powder, 14% each with sticking plaster, band aid and tapes and with cleaning products including dishwashing liquid; and 12% with fragrances. A sensitivity to rubber and latex was reported by 8%.

Men report not being irritated or allergic more than women (61% vs 43%). Older people are also much higher than the average of those who are not affected by skin allergies and irritations: 61% of those 65 to 74 and 69% of those 75 and over are not affected (the average is 48%).

The most reactive materials, those reported as causing either significant or severe problems, are prescribed topical pharmaceutical medications’ (38%), nickel (38%) and prescribed oral pharmaceutical medications’ (33%).

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What is concerning you?Survey respondents were asked to indicate which of nine health conditions they were concerned about as a way of comparing concern for skin compared to other conditions. They could indicate concern for all nine health conditions or only one, or state that they do not have any concerns.

Unhealthy skin rates third out of nine concerns, after back pain and dental health. In all four years of the survey, the level of concern for the different health conditions is about the same, and doesn’t vary that much (unlike people’s perceptions from year to year of the skin problems that bother them personally, as discussed above).

Back pain was a concern among the highest percentage of respondents, followed by dental health in all four years; allergies were the lowest concern with bowel health the next lowest. Generally, 16% of participants stated they were not concerned about any of these conditions.

Concern about the other five conditions had some small fluctuations. In 2017, unhealthy skin was the highest it has ever been in the life of the survey – at 30% (compared to an average of 27% over four years). Concern about arthritis is up (28%) after two years of lower concern.

Table 1:

Concerns for health conditions varies by age. For example, concern about blood pressure slowly rises to a peak among those 65 to 74 (49%). Worries about cholesterol peaks at ages 55 to 64 (39%).

Interestingly, worries about headaches remained steady (between 31% and 34%) across three age groups, from 18 to 44, and then declines. Concern for dental health was highest among those 18 to 24 (43%) and then steadily declines.

Unhealthy skin was also the biggest concern to those 18 to 24 (39%) with a slow decline to those 65 to 74 (18%) and a sudden jump up for those over 75 years old (27%).

Participants were asked to consider a list of 15 skin appearances and features (they could also specify an ‘other’ concern or that they do not have any concerns with their skin appearance). They indicated which of them is a current concern.

Figure 11:

Which of these health conditions are you concerned about?Back pain 37%

Dental health 37%

Unhealthy skin 30%

Blood pressure 29%

Arthritis 28%

Cholesterol 27%

Headaches 23%

Bowel health 22%

Allergies 20%

I do not have any concerns 16%

For the eight most common skin conditions of concern, percentages ranged from 43% of respondents who are concerned about signs of ageing to 18% who worry about skin cancer or growth, and pigmentation. 12% say they do

Eight most common skin conditions of current concern

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19 18

38

18

25

SIGNS

OFDRY S

KINHAIR

LOSS

OR T

HINNIN

GDIS

COLOURATI

ON OR P

IGMENTA

TION

SKIN

CANCER O

R GROW

TH

SIGNS

OF SU

N DAMAGE

PIMPLE

S/ACNE/B

LACKHEADS

DANDRUFF

AGEING

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not have any concerns about the appearance of their skin. Concern for other conditions ranges from 11% to 17% of participants saying they are concerned about nail problems, redness, large pores, dull skin, rashes, prominent blood vessels and too much hair. Individual participants wrote in additional current concerns that were not provided on the list: psoriasis, eczema, scarring and wrinkles.

Women are more concerned than men about most skin appearances and features, 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 and rashes.

Men were three times more likely (18%) than women (6%) to say they don’t have concerns about their skin’s appearance.

Different concerns at different stages of life see the younger age groups – 18- to 24-year-olds (47%) and 25- to - 34-year-olds (48%) –concerned about acne, with that figure dropping to 27% by the next age group (35 to 44). This matches up with the finding above on concern for general health conditions with the

highest concern about unhealthy skin among the youngest survey respondents.

People start to be concerned about signs of ageing in their skin when they enter the 45 to 54 age group; 53% start to worry, then this figure rises to 61% for those over 75. Signs of ageing is the top concern for those aged 65 to 74, and over 75 .

Moving from skin appearance and features, participants were asked whether they currently have, worry about, or have no concerns about nine specific skin conditions. These were the five most common conditions that participants currently have:

Figure 12:

Five most common current skin conditions

ITCHY S

KIN

ACNEECZEM

A/DERM

ATITIS

SKIN

CANCER/S

UN SPOTS

PSORIA

SIS

20

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The other four conditions were warts, tinea, skin infections, rosacea and hives or urticaria.

Last year’s SHARC Report showed a clear trend in those reporting a skin condition from 2014 to 2016. However, this year’s statistics are nearly the same as last year’s. Those who reported having a skin condition were 45% and 55% did not have any.

More women (48%) than men (42%) reported a specific skin condition, with a higher share among those 18 to 24 (50%), 25 to 34 (55%) and 75 years and over (52%).

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As described earlier, for this question, participants were asked to indicate if they had the condition, were worried about it or had no concerns. The results below are interesting to compare to the ones above, the differences between the skin conditions that people have, and the ones they worry about.

Figure 13:

an average of 73% do not have concerns at all about these skin conditions.

It is understandable, in Australia, that skin cancer is the main concern of the population. The prevalence of melanoma in Australia is very high; the consequences of late diagnosis are severe.

However, it is of real concern that 47% said they have no worries about skin cancer and sun spots. Since almost one in ten participants have skin cancer or sun spots, this is a condition that should have high visibility and high concern among all Australians, for their own personal health as well as that of friends and family.

For people who indicate they have a skin condition, most have had that condition for many years. 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: 50% or over of those with eczema/dermatitis, psoriasis, skin cancer/sun spots and acne have had these conditions for over 5 years.

The exception are skin infections, which are generally short term (up to six months). Interestingly, those with tinea have had it over varying lengths of time, with about one-quarter having it less than three months and a similar fraction having it for more than five years.

While 9% of survey participants have skin cancer/sun spots, 44% of participants worry about them, the highest share by far. While only 4% currently had a skin infection, many more, 17%, worry about them. In most cases, about twice or more people have concerns about a condition than actually have them. But lest this make Australians seem to unnecessarily worry,

Five skin conditions causing most worry

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23 2118 17

ITCHY S

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ATITIS

SKIN

INFECTIO

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ACNE

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SUN S

POTS

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How do you treat skin conditions?Most skin diseases can be effectively managed with medical treatment, minimising stress and avoiding things that irritate the skin. But it’s important to seek professional advice to make sure you’re on the right track and that any condition is not a serious one.

To treat skin conditions, survey respondents seek help from various healthcare professionals depending on the condition.

Over half, 53%, visited their GP; 31% went to a skin specialist such as a dermatologist; and the same share, 31% saw a pharmacist. Some, 18%, don’t have any treatment; or work out their treatment on their own (23%); 12% seek advice from the internet, 9% asked for guidance at a health food store or from a beauty therapist, and 8% saw a surgeon.

Figure 14:

What treatment source have you used for your skin issue?

GP52%

PHARMACIST 33%

DERMATOLOGIST/SKIN SPECIALIST 32%

NO TREATMENT 22%

I WORKED IT OUT MYSELF

17%

INTERNET 12%

SURGEON

10%

BEAUTY THERAPIST/HEALTH FOOD STORE

8%

0 20 40 60

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For most skin conditions, people primarily see their GP, though may seek multiple treatment methods. 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 more likely to see a pharmacist. The highest number of those who worked out their own treatment was in relation to itchy skin and acne; those with itchy skin (20% of those with a current skin condition) were the most likely of people with any condition to not seek treatment at all (9%) or to work out their own treatment (6%).

As for the treatments themselves, the most popular was non-prescription over-the-counter (46%) cream or ointment or a prescription one (43%), though other significant interventions include freezing (19%), modification of diet (17%), and biopsies or surgical removals (17%). Prescription tablets (15%), and over-the-counter tablets (11%) were less popular; the same small

Have you received any of the following treatments for your condition? Treatment %

Cream/ointment/lotion/gel – over-the-counter non-prescription

46%

Cream/ointment/lotion/gel – prescription

43%

Freezing 19%

Diet modification 17%

Surgery, e.g. biopsy or removal 17%

Tablets – prescription 15%

No treatment 13%

Tablets – non-prescription/over-the-counter

11%

Laser 4%

Complementary/alternative therapy 4%

share of people, 4%, have tried a complementary or alternative therapy for their skin condition, such as cupping, and have tried laser treatments, with 13% having no treatment at all.

Table 2:

Respondents from regional Australia were more likely than metro respondents to have surgery (24% vs 14%) and less likely to modify their diets (12% vs 19%).

Prescription treatments and surgery were recommended by medical practitioners, and survey participants chose over-the-counter treatments themselves. Of those who decided to modify their diets to address a skin condition, 71% made this decision themselves (with the rest doing it as a recommendation from a medical practitioner or other healthcare professional).

Laser treatment was an area recommended by both medical practitioners (58%) and other healthcare professionals (16%), but a significant share (26%) chose it themselves.

For those who did not seek any treatment for their condition, it’s useful to clarify that not all of them made this decision on their own. For about 20% of them, their doctors or other healthcare professionals recommended that no treatment was necessary.

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Australians have a reputation for being an independent people who don’t like being told what to do.

That might be admirable in some circumstances, but in terms of skin health, we’re not so sure. The Foundation has concerns about the many Australians who do not treat skin conditions or who do not seek professional advice.

As described above, 9% of respondents reported skin cancer or sun spots, which is the equivalent of about 1,600,000 Australians over the age of 18. A much larger share (and number), 44% of respondents, worry about skin cancer and sun spots, and some are self-checking and getting second opinions. But 10% of those who have skin cancer or sun sports are not seeking any treatment, 3% went to their beauty therapist or a health food store for advice, 4% worked out treatment on their own and 5% looked to the internet for advice.

We strongly recommend that people always seek professional healthcare advice for such a serious issue that can have severe consequences. If diagnosed early, skin cancers and melanomas can nearly always be treated successfully.

One of the problems is the misconception that skin health is a cosmetic problem and one that does not require medical attention. About one-third of those who have problems with skin health (33%) consider their skin problems ‘both medical and cosmetic’; the same (33%) consider them ‘cosmetic’ problems’ only; less than one-fifth (17%) think of them as only ‘medical’ problems; and 18% ‘don’t know.’

A useful message for the general public would be to convey that skin health is a medical issue, even when it may seem a cosmetic one. Thus, it’s important for people to report any skin health problems to their doctor to see if they are treatable or the sign of another condition.

ARTICLE

The youngest age group, 18 to 24-years-old, had the largest share of those who ‘don’t know’ if the problems are both medical and cosmetic (31% vs an average across all age groups of 18%) and the smallest share of those who see them as both (14% vs an average across all age groups of 33%). So this age group is a particularly important target for public education.

Thinking that skin problems are only cosmetic issues means that they are often overlooked. For example, inflammatory skin disease comes in various forms, from rashes, itchy skin and redness that occur on occasion in relation to chronic conditions like psoriasis, rosacea and eczema, a form of dermatitis. Inflammatory skin disease can often disguise other underlying health factors that need a professional medical opinion and diagnosis.

Over one in five respondents, 23%, say they experience itchy skin, equivalent to approximately 4.6 million Australians over the age of 18. Yet 19% don’t seek any treatment for it, and another 15% work out their own treatment with 8% going to the Internet for answers. Itchy skin could be a sign of asthma or allergies but most people don’t realise that it might be a sign of more serious health problems.

If your skin is itchy or inflamed, it’s important to get it checked out by healthcare professionals. n

Please see a doctor

Do you check your skin?The share of Australians who personally check their skin for signs of skin disease such as moles, skin cancer or rashes has remained consistent over the four years of SHARC Reports: between 66% and 68%; in 2017, it was 67%.

The survey found that women (70%) were a little more diligent than men (64%) when it comes to self-checking. Skin-checking also varies by state, for example, 72% in Queensland do self-checking compared to 61% in Victoria. Nearly two in ten people (17%) check their skin daily, just over three in ten check weekly and just less than three in ten check monthly. 12% check every three months; 6% check every 6 months and 5% check annually.

Although on average, 76% of those who self-check do so either daily, weekly or monthly, this ranges from the most diligent (91% of those 75 and over and 85% of 18- to 24 year olds) to the least diligent (67% of 35- to 44-years-olds). Those in regional Australia are more diligent (80%) than those in metro Australia (74%).

It makes sense to learn that survey participants check their skin where it’s easiest to see, with the highest shares checking arms (87%) and legs (75%). But they also check places hard to see: their necks (69%), head (60%) and back (54%); 43% check under their arms, 26% the soles of their feet, and 24% their buttocks.

According to the 2017 SHARC survey, 41% get someone else to check or monitor their skin for signs of skin disease such as moles, skin cancers and rashes. More people in regional Australia do this (49%) than those in metro Australia (37%). When respondents have other people check their skin, it is usually their GP (62%) and often their partner (40%) though many also went to dermatologists (20%) and skin cancer clinics (19%).

People in regional Australia have their skin checked by GPs (71%) more often than those in metro Australia (57%) and less by dermatologists (14% vs 23%).

Figure 15:

Who else checks your skin?

GP

52%

PARTNER

33%

DERMATOLOGIST

32%

SKIN CANCER CLINIC

22%

When it comes to other people checking one’s skin, the frequency is less. While 94% of those who self-check do so every 6 months or more frequently, this figure drops to 36% for having someone else check your skin at this same frequency. This would make sense that someone may not visit their GP or a dermatologist more frequently, but one would hope that partners are more readily available. 39% of those who have someone check their skin do so every 6 to 12 months.

Why don’t people have regular skin checks? The reasons vary. The biggest share of respondents, 33%, 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% each report that they do it themselves or that they limit their sun exposure or don’t go out in the sun, and 14% each lay the blame on the cost or that their doctors don’t do these skin checks when they are visited by patients. 10% believe they are too young for skin checks and 5% do not think it’s important, with 3% saying they are too busy or they forget to do it.

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NEW GUIDELINES FOR IDENTIFYING MELANOMAThe ABCDE guidance for identifying melanoma has meant checking for asymmetry, border irregularity, colour variegation, a diameter greater than 6 millimetres, and evolution or change in a mole or spot. New research by a Cancer Council Australia multidisciplinary working group will result in updating 2008 guidelines on managing cutaneous melanoma. Researchers found that some thick, life-threatening melanomas may lack the ‘more classical ABCD features’. So, in addition to the ABCDE protocol, other suspicious characteristics need greater attention, with biopsies taken or referred for opinion for any lesion that continues to grow or change in size, shape, colour or elevation over a period of more than one month. Suspicious raised lesions should be cut out immediately rather than monitored. The advice will improve early detection and ultimately save more lives.

Source: Victoria J Mar, Alex J Chamberlain, John W Kelly, William K Murray and John F Thompson, Clinical practice guidelines for the diagnosis and management of melanoma: melanomas that lack classical clinical features. Med J Aust 2017; 207 (8): 348-350.

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 67% figure of Australians who check their skin up to 100%. With nearly a full third of the population not checking their skin, this has negative consequences for public health and could have terrible outcomes for individuals who do not identify melanoma for it to be treated early. This behaviour needs to change.

A question in the SHARC survey was that if people are checking their skin, are they confident that they know what a skin problem looks like, such as skin cancer? This was positive, with 62% either very confident or confident. However, 33% were not confident and 4% had ‘no idea’. These figures indicate people who are willing to check their skin, but could usefully be targeted by education so they know what they are checking for.

Men are slightly more confident than women in knowing what a skin problem like skin cancer might look like (66% very confident or confident vs 60%) with little difference between age groups: those 55 to 64 were slightly less confident (59%) than the average; those 65 to 74 slightly more confident (68%).

Education is needed for everyone, but especially those who need more confidence and knowledge about what lesions or spots look like that might be a sign of skin cancer. Awareness needs to be raised about what healthy skin is, i.e. warm, not hold or cold; smooth and intact, no breaks in the surface; and not flaky or dry.

When asked at what age respondents think people are at the highest risk of getting skin

cancer, the majority said ‘any age’ (42%) while an equal share (12%) guessed between the age groups of 25 to 34, 35 to 44 and 45 to 54.

Skin cancer and melanomas occur at any age, though the common cause of UV exposure has a cumulative effect. Those in regional Australia had a better understanding it could at any age (46%) than those in metro Australia.

Another key result of the survey is that Australians need to understand sunburn risk during everyday activities. While 55% answered ‘every day’ was the most important time to protect oneself from the sun, 36% said the period between September and April.

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themselves from the sun, noting most frequently the UV index, when it is sunny, the time of day and when it is hot.

However, sunburn can happen on cloudy days, which was only identified by 33% of respondents (compared to 60% who identified ‘when it is sunny’ as a factor to take into account for sun protection). This is an example of how most Australians still don’t understand UV and generally believe that skin cancer risk is confined to hot, sunny summer days.

Table 3:

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 60%Time of day 54%When it is hot – over 30o 50%Time of year/season 44%When it is warm – 20o to 29o 37%When it is cloudy 33%When it is cool – under 20o 15%When the UV index is low 14%

Interestingly, women tended to correctly identify multiple factors compared to men, particularly the time of day (58% vs 48%), when it is cloudy (37% vs 28%) and the

These results are much the same across the four years of the survey.

In fact, those in northern Australia must protect themselves every day, while, generally, those in southern Australia must do so between September and April. It all depends on UV ratings.

Skin cancer risk isn’t confined to hot, sunny summer days during the hottest time of day. Sunburn can occur where and when you least expect it. There is a threat of sunburn from UV rays when it is cloudy or cool. Tasmanians often underestimate the rate of being sunburned because it is cooler there. But whenever the UV index is 3 or above, people need to protect themselves.

While some might think that the risk of sunburn depends on whether your skin pigment is light or dark, it’s the UV index that is most important, and how that relates to the amount of time in the sun, the date and time of day, and your location in Australia.

While in northern Australia, people should be aware of UV every day of the year, in southern Australia, people should be aware of the UV index between September and April.

Most websites reporting on weather, as well as weather apps on smart devices, report on the UV index, though it is information that should be highlighted more prominently, for example by the Bureau of Meteorology. Still, the information is easy to find so awareness is needed about the importance of the UV index, how to use it, and where to find it.

Respondents identified factors that should be taken into account when trying to protect

UV INDEX: HOW TO USE IT AND WHERE TO FIND ITAs 31% of respondents did not identify a high UV index as a reason to protect yourself from the sun, action is needed. Education is necessary so people know that anytime the UV index is 3 or above, sun protection is needed.

People need to check the UV Index, and find out where on a weather app or website the UV index is reported. It’s a simple piece of knowledge and a simple action that could reduce the rate of unexpected sunburns that has been consistently found to be so high in the SHARC Reports.

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How do you maintain healthy skin? Most Australians, over 7 in 10, use a moisturisers. This has remained consistent over the four years of the survey. There is a higher share of those 25 to 34 and 35 to 44 who moisturise than other age groups (78% each). There was a significant difference between women (88% who moisturise) vs. men (only 52%).

Most respondents moisturise daily (62%) or every other day (19%) or once a week (15%). These figures are also consistent over the years.

Of those who use moisturiser on their bodies, they use it especially on their face (85%), arms (63%), legs (63%) and neck (55%). Perhaps the chest being covered most of the time is the reason it receives less attention (35%) and the back is hard to reach (18%) though the head receives the same share as the back(18%).

time of year (47% vs 41%). Those in regional Australia consistently identified all of these factors more often than those in metropolitan Australia.

Sunburn can occur where and when you least expect it. It can make you vulnerable to the sun at different times of day and in different seasons. People often spend longer outside than they initially anticipate, especially when gardening.

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; 40% did not identify when it is sunny, and 67% when it is cloudy.

This is a worry.

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 protect themselves from sunburn.

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Table 4:

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 62%Driving 47%At a BBQ on a clear day in winter 47%Being outside in winter 34%Sitting in the shade in summer 22%

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.

Some might find it useful to make their morning routine easier by using a product that can be put on in the morning and acts as both a facial moisturiser and sunscreen.

Of those who moisturise, about 4 out of 10 people (41%) use other skin care products with the most common one being sunscreen. Of this group, 62% who moisturise also use sunscreen, 55% also use a cleanser and 49% use make-up.

Table 5:

Top five skin care products used other than moisturiserSunscreen 62%Cleanser 55%Day cream 49%Facial scrubs 45%Make-up 44%Unsurprisingly, not as many men use facial scrubs (27%) as women (51%), or use cleanser (26% vs 66%) and day cream (19% vs 54%) though 5% use make-up of some sort (compared with 65% of women).

The most common belief of how to maintain healthy skin is that drinking water helps skin health. But most people also understand the need for protection from the sun, treating dryness, good nutrition, not smoking and minimising alcohol. A small percentage, 8%, identified going to the beach as healthy for maintaining skin health.

Table 6:

Which of these items do you believe will help maintain skin health?Drink water 79%Protect from sun, e.g. Wear a hat, use sunscreen 76%Treat dryness, e.g. use a moisturiser 73%Good nutrition 72%Don’t smoke 67%Minimise alcohol 54%Minimise exposure to irritants, e.g. soap, detergents, irritating chemicals at home or work 49%

In 2017, a slightly smaller share of participants identified the actions above to maintain skin health, between 1% and 3% less, with a similar decline shown in 2016 from 2015. For example, advocates of drinking water went from 84% in 2014 to 83% in 2015 and 80% in 2016 to 79% in 2017.

Do people’s beliefs translate into doing what they believe? Comparing the tables above and below show an average about a 15% difference between whether you believe an action will maintain your skin health and whether you actually do it or not. People are most diligent about drinking water: 79% who believe it’s good for your skin and 68% who do it. Is it a surprise what the biggest difference is? 54% believe that minimising alcohol helps skin health but only 33% do this, meaning that 21% do not practise what they believe.

SPENDINGSome Australians maintain their healthy skin by using skin care products. 20% 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, 22%, spend $11–20. 19% spend $21–50 and 12% spend over $50 a month including a handful of people who spend over $200. Adding together the categories with the largest shares, nearly 60% respondents spent between $5 and $50 on skin products or services.

The SHARC Report 2017 shows that Australians generally have a good understanding of how to maintain healthy skin, but they may not put this into action.

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Table 7:

Which of these do you currently do to maintain your skin health?Drink water 68%Protect from sun, e.g. Wear a hat, use sunscreen 63%Treat dryness, e.g. use a moisturiser 61%Don’t smoke 54%Good nutrition 54%Minimise alcohol 33%Minimise exposure to irritants 32%

Does wisdom come with age? The percentage of younger adults (18 to 24) that wear a hat and use sunscreen to maintain skin health is only 38%, far lower than any other age group, and also far lower than last year’s share of 49%. But this age group also takes the least actions to maintain their skin health compared to all other age groups in relation to all of the actions listed.

More women than men drink water for skin health (75% to 60%). Protection from the sun (sunscreen, wearing a hat) is practised by half of those 25 to 34, which increases in leaps and bounds to where 89% of those 75 and over are conscientious protectors. If you live in regional Australia, you’re more likely to protect yourself from the sun and minimise your exposure to skin irritants.

Are you happy with the way your skin looks?The SHARC Report draws a difference between what we observe (evidence on different parts of our body of skin problems) and how we feel (whether we are concerned about skin problems or are satisfied with the way our skin looks).

Someone may not be happy with their skin, but this may not be objectively related to whether they have a skin problem or condition.

Some people may undertake procedures to make their skin look better, based on whether they are happy or not with their skin.

As will be discussed below, skin issues and conditions have a tangible effect on the quality of life of Australians. Yet it is also how we think about our skin and our attitudes that have an impact on our quality of life, our well-being and mental health.

With so many people unhappy with the way their skin looks, perhaps a conversation needs to be opened on what are reasonable expectations for how our skin looks, as a way of being a little happier overall. This is a critical message.

The 2017 SHARC Report found that 53% of respondents are happy with the way their skin looks, 11% say they don’t know, and 36% said they are not happy, which is a significant jump when compared to previous years (32% in 2014 & 2016, and 29% in 2015). More women than men are not happy with the way their skin looks (42% vs. 30%). The age group 65 to 74 are particularly happy (66%). Nearly half (46%) of those 25 to 34 are unhappy with the way their skin looks.

For most people, this unhappiness did not translate to action. Just as there is a difference between believing an action is good for skin

HOW TO TAKE CARE OF YOUR SKIN The Skin & Cancer Foundation Inc publishes a wealth of consumer information on caring for your skin.

Visit our website: www.skincancer.asn.au

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health and actually doing it, there is a difference between being unhappy with how your skin looks and taking an approach to change the appearance of your skin: 85% of survey participants have not done anything in the last 12 months (at least). On the other hand, 15% of respondents had tried various procedures for their skin, the equivalent of over 3 million Australians.

What did people do? Facial peels were done by 5% of respondents, 4% each tried dermabrasion and laser treatment, 3% of respondents had laser treatment and dermal fillers and 2% each had body or hand peels, used a radio frequency

device, or underwent cosmetic surgery such as a facelift, eyelid lifts or the removal of bags under the eyes. Some people also had tattoos removed.

Women had tried these approaches (7%) more than men (4%) and the most popular procedures were facial peels among those 25 to 34 and 35 to 44 (8%) and dermabrasion among the 25- to 34-year-olds (7%) with the same share of those 18 to 24 who had laser treatment. Far fewer of those in regional Australia have done Botox or Botox-like treatments than in Metro Australia (1% vs 5%) and laser treatment (1% vs 4%).

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Skin issues affect the quality of life of many Australians Your skin health is important to you, and it affects a significant number of Australians while they work, study and socialise.

The SHARC survey used the Dermatology Life Quality Index (DLQI) to understand how your skin affects your quality of life. The DLQI finds the effect of skin issues on different areas of life, ranging from no effect or a small effect to a moderate, very large or extremely large effect on someone’s life.

Important results were found.

All SHARC participants were asked, using the DLQI, to think about the week previous to the survey. For 56%, a skin issue did not affect any area of their life; for 26%, a skin issue had a small effect and for 17% an effect that was moderate or very to extremely large. Added together, that’s 43% who said a skin issue had an effect on their life, or 8.6 million Australians.

A similar number of Australians in this year’s survey, 45%, equal to just over 9 million, stated that they have at least one of the specific nine skin conditions listed in the survey question, such as sun spots, itchy skin, acne, eczema and psoriasis.

Those with a specific skin condition were asked whether and how big an effect it had on their quality of life, and 71% said these conditions have some negative effect on their quality of life – the equivalent of 6.4 million people.

The DLQI was used to examine impacts of skin issues in different areas of people’s lives. Between 30% and 49% of survey respondents experienced a skin issue as a problem in relation to a range of issues in their professional and personal lives. During the week before the survey:

ARTICLE

• About 42% of survey respondents were embarrassed or self-conscious because of their skin (up from 30% in 2014, 38% in 2015 and 41% in 2015). There has been a steady trend upwards over the four years of the survey. 13% were ‘very much’ or ‘a lot’ embarrassed or self-conscious.

• 18% said their skin interfered with shopping or looking after their home or garden.

• 45% found their skin itchy, sore, painful or stinging.

• 20% said it had an effect on their social and leisure activities. This figure was higher for the younger age groups, 33% of 18- to 24- year-olds, and 37% of 25- to 34-year-olds.

• A skin issue made it difficult for 15% to do sport.

• A skin issue caused sexual difficulties for 11% of those surveyed, similar to last year’s 12% but up from 6% in 2014 and 8% in 2015. At 29%, this was an issue particularly for those 25 to 34 years old.

• A skin issue created problems with a partner, close friend or relative for 15%, a similar figure to last year (14%) but up from 11% the previous year and 8% the year before that.

Was your choice of occupation influenced by a skin condition?How skin conditions relate to work is an interesting issue. For 33% of respondents, their choice of occupation was influenced by a skin condition. An upward trend is indicated over the four years of the survey.

Figure 16:

2014 2015 2016 2017

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2731 33

Of the 33%, 2% were extremely influenced, 7% moderately and 13% somewhat. Men were more likely than women to say their choice of occupation was influenced by a skin condition (39% vs. 28%). Those in regional Australia were less influenced by a skin condition in choosing work, 20% compared to 37% in metropolitan Australia.

12% of respondents (over 2 million adult Australians) had to miss work in the last 12 months because of a skin condition. Nearly 3 in 10 of those missed 11 to 15 days of work.

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 and 17% in 2017. Respondents believe that these colleagues would suffer embarrassment (49%), the condition would have an effect socially (43%), they would be absent from work more often than others (10%), and the condition would affect their capacity to work (18%).

Many people in Australia work outdoors

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ARTICLE

Skin issues affect the quality of life of many Australians• A skin issue prevented 4% from working or

studying in the previous week to the survey, or just over 800,000 Australian adults. Of those who were not prevented from working by a skin issue, it was still a ‘little’ or ‘a lot’ of a problem for 14% of them at work or studying.

• About 28% said their skin influenced the clothes they wore. This figure was particularly high, 44%, for those from 25 to 34 years old.

• 18% of respondents found it a small or big problem to treat skin issues (for example, by making their home messy or taking up time).

• While the same share of people who experience effects on their quality of life from skin conditions is the same between metropolitan and regional Australia, a larger share in regional Australia mention a small effect (31%) than in metropolitan Australia (24%) and a smaller share mention an effect ranging from moderate to extremely large (13% vs 20%). The conclusion is that those from regional Australia feel the effect of skin conditions is smaller than those in Metropolitan Australia.

Skin issues are affecting millions of Australians. In fact, the DLQI results over the last four surveys have indicated a slight upward trend in the intensity of how skin issues affect people’s quality of life, symptoms and feelings, and leisure activities. n

sometimes, regularly or all the time (45%) in all, though the majority, 54%, are never required to work outdoors.

Table 8:

Does your employment require you to work outdoors?Never 54%Sometimes 32%Regularly 9%All the time 4%

A much higher percentage of men sometimes, regularly or all the time work outdoors (about 58%) than women (35%). Those from New South Wales work the most outdoors (51% working outdoors at least sometimes) of States and Territories; though the share is similar, ranging from 42% to 47% for Victoria, Queensland, Western Australian and South Australia.

If people do have to work outside, their employers generally do not provide them with protection. Sunscreen is what is most commonly provided, but even this is only for just over four out of ten of those who work outside.

Table 9:

Does your employer provide you with any of the following?Sunscreen 43%Protective clothing, e.g. hats, sun protective shirts 34%Sunglasses 20%Gloves 20%Moisturisers 18%Skin checks 12%None of these 28%

Comparison between metro and regional Australia in employer provision of skin protection Treatment Net% Metro Regional

Sunscreen 43 39 53

Protective clothing, e.g. hats, sun protective shirts

34 29 45

Sunglasses 20 17 28

Gloves 20 16 32

Moisturisers 18 19 13

Skin checks 12 14 9

None of these 28 31 23

Over the four years of the survey, employers have provided about the same level of sun protection and support, though 2016 appears to have been a good year, with more employers providing sunscreen (48%) and sunglasses (26%) than the average. In the last two years, more employers provided moisturisers (18% in 2017 and 19% in 2016) than previously (13% in 2015 and 10% in 2014).

There is variation by state and territory. The figures for Queensland are clearly better than for other states. For example, 56% of those who worked outdoors were provided with sunscreen, 47% with protective clothing and 33% with gloves. Those from South Australia were most likely to be provided with sunglasses at 44%.

This issue is one of the few areas with significant differences between metropolitan and regional areas.

Table 10:

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Comments from survey participantsOver 80 of our over 1,000 survey respondents had comments on the survey, and it was good to get comments from so many people. Participants shared their own advice for healthy skin, as well as giving more details on their own challenges and issues.

Participants found it ‘good’, ‘very good’, ‘great to do’, ‘nice’, ‘informative’, ‘very interesting’, ‘very enjoyable’, ‘really fun’ and ‘very well written.’ One person found it an enjoyable way to let others know of their problems. A few commented on how the survey raises awareness, including about the effects of the sun and being outdoors, and can be used to measure that awareness.

The survey has had positive benefits on the respondents in being able to personally raise their awareness or motivate them to do better skin care. The survey reminded one person ‘to start wearing sunscreen daily again’ and another to ‘take more care out in the sun, even in the winter, especially in Queensland’. One survey respondent commented ‘I’m thinking I do not look after my skin as much as I could.’ Another proposed seeing a professional about facial age spots instead of just using chemist-bought products and one resolved to make an appointment to see a skin specialist. Another said that they wanted to be a ‘success story’ and had gone to a doctor to consult about their rash and had been prescribed antibiotics.

A fair number of people shared details of their skin conditions, related to different medical conditions or issues, such as cirrhosis of the liver, biopsies, venous insufficiency, and using blood pressure medication. One person had a recent diagnosis of tinea on their feet, another a pimple on their nose that won’t go away, and another a rash and itch from jogging and sweating in their sleep.

A few people had regrets, for example, that cigarette smoking had been a ‘disaster’ for their skin. Another said they hate their skin, ageing and wrinkles and dislike not having a tan and looking older and drawn but feel it is ‘too late now’. One participant hides their stomach, back and shoulders from everybody.

Quite a few shared their advice on skin care: check skin daily for problems, watch for skin cancer, use proper sunscreen and a good moisturisers, wear a hat and sun block, exercise, improve diet, reduce alcohol consumption, use healthy soap and Dettol, use 50+ sunscreen when doing outdoor activities, drink water if your skin is dry and itchy, use appropriate shampoo if your scalp is itchy and flaking, and wash hair less to not aggravate psoriasis. And see a doctor if something seems wrong!

The survey responses often touch on the workplace and clear advice was offered this year to review the harmful side effects and unpleasant results on the skin from work environments that use harsh chemicals to maintain infection control.

Two people commented on the need for GPs to take more interest in checking the skin of their patients, which would help to prevent melanoma. Another two made comments about skin health over time: one was interested

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in finding out the differences in skin over a longer period, and not just from the week preceding the survey; the other advised that when people are young, there should be more external motivation to develop good sun smart habits. As another commented, skin cancer is not only something to watch for but a matter of ‘life (or death!)’. Finally, one comment requested an article on skin care.

The Foundation would like to offer sincere thanks to all of the participants in our survey and all those who provided comments. You are making a valuable contribution to our national understanding of skin health issues. Thank you.

About the Skin & Cancer Foundation Inc. The Skin & Cancer Foundation Inc. is a private, not-for-profit organisation that delivers highly specialised treatment, education and research for skin diseases, skin cancers and melanoma.

We are a fully accredited hospital that now cares for some 30,000 patients each year in our world-class clinical facilities.

The Foundation also delivers professional education for dermatologists and registrars, specialist training for visiting international medical graduates, workshops to upskill GPs and medical students, as well as public education programs aimed at improving skin health in the community.

We conduct clinical trials and world-class research projects that are published and presented internationally. The Foundation makes substantial contributions to the worldwide clinical care and management of skin diseases, skin cancer and melanoma.

Headquartered in Melbourne, the Skin & Cancer Foundation Inc. has become Australia’s centre of excellence in skin health, and home for dermatology.

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 ability to socialise and work. The Foundation is proud to help these Australians achieve their full potential through better skin health.

Visit our website for more information about skin health and sun protection: http://www.skincancer.asn.au/

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About Galderma The SHARC Report has been commissioned each year over the past four years with the support of Galderma in the form of an untied education grant to the Skin & Cancer Foundation Inc.

Galderma is a global dermatology company committed to delivering innovative medical dermatological solutions that meet the needs of patients and physicians. Galderma has a particular focus on acne, rosacea, psoriasis and other steroid-responsive dermatoses, onychomycosis (fungal nail infections), pigmentary disorders, skin cancer and

medical aesthetic and corrective solutions for skin senescence.

The company has 34 wholly owned affiliates and a worldwide network of distributors, over 5,500 employees, and an extensive product portfolio available in 80 countries.

Galderma’s R&D is continually dedicated to finding new medical solutions, offering physicians more options and offering patients a better quality of life. Five state-of-the-art R&D centers and six manufacturing sites are dedicated to providing a wide range of innovative medical solutions which meet the highest standards of safety and efficacy. 

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Supported by

Skin & Cancer Foundation Inc

80 Drummond Street

Carlton VIC 3053

T: 03 9623 9400

E: info@skincancer.asn.au

www.skincancer.asn.au Published November 2017