The evolution of dermatology: dermatological workload in southeast Scotland 1921-2010

Sequential audits over a recent 30-year period from 1981 to 2010 have documented dermatological activity data for the same region of southeast Scotland approximately every 5 years, allowing demonstration of trends in workload.

To undertake similar assessments of outpatient dermatological activity using historical documentation from 1921 to 1965, and to compare trends with modern data.

Historical records held in the libraries of the Department of Dermatology, Royal Infirmary, Edinburgh and in the University of Edinburgh were audited. Details of new dermatological outpatients were recorded for the months of September, October and November from 1921, and at 5-year intervals from 1925 to 1965. Patient age, sex and primary diagnosis were documented. Data were analysed and compared with those of previous audits of the same geographical population from 1981 to 2010.

Details of 11 225 new patients were analysed during the period 1921-1965, in conjunction with 7755 patients from the period 1981-2010, giving a total of 18 980 patients included in the study. The monthly number of patients increased by over 3000%, from 74 patients in 1921-2882 patients in 2010. Trends were seen in the following diagnostic categories. Between 1921 and 2010, benign tumours increased from 1% to 36% of workload and malignant tumours from 2% to 11%. Over the same time period, dermatitis decreased from 32% to 13%, and infections from 24% to 2%. Infestations referrals peaked at 12% in the 1940s, but declined to 1% in the 1950s. Viral warts peaked at 49% of patients in 1960 and fell to 3% in 2010.

Over a 90-year period, there has been a dramatic rise in new patient dermatological workload. We have found trends in presentations of common dermatological conditions. Outpatient dermatology now appears to be increasingly involved in the detection and treatment of skin malignancy. Although many inflammatory dermatoses remain important, infectious dermatoses are less commonly encountered, compared with historical activity.