Assessing the impact of skin disease on the quality of life in comparison with that of chronic non-dermatological diseases is difficult; however, the study by Marlon and others (1999), which was not carried out in a developing country, compares the common skin disease acne with chronic disorders such as asthma, diabetes, and arthritis and finds comparable deficits in objective measurements of life quality. Skin disease related to HIV, which may constitute an important component of the skin disease burden in developing countries, particularly in Sub-Saharan Africa, leads to a similar impact on life quality compared with non-HIV-related skin problems, although the use of antiretroviral therapy significantly improves quality of life (Marian and others 2002). Those findings indicate that skin diseases have a significant impact on quality of life.

 Although mortality rates are generally lower than for other conditions, people's needs for effective remedies for skin conditions should be met for a number of important reasons.

•  First, skin diseases are so common and patients present in such large numbers in primary care settings that ignoring them is not a viable option. Children, in particular, tend to be affected, adding to the burden of disease among an already vulnerable group.
•  Second, morbidity is significant through disfigurement, disability, or symptoms such as intractable itch, as is the reduction in quality of life. For instance, the morbidity from secondary cellulitis in lymphatic filariasis, which may lead to progressive limb enlargement, is severe, and subsequent immobility contributes to social isolation.
•  Third, the relative economic cost to families of treating even trivial skin complaints limits the uptake of therapies. Generally, families must meet such costs from an overstretched household budget, and such expenses in turn reduce the capacity to purchase such items as essential foods (Hay and others, 1994).
•  Fourth, screening the skin for signs of disease is an important strategy for a wide range of illnesses, such as leprosy, yet a basic knowledge of the simple features of disease whose presenting signs occur in the skin is often lacking at the primary care level.

 A shortage of elementary skills in the management of skin diseases is a further confounding problem. A number of studies assessing success in the management of skin diseases in primary care settings in the developing world find that treatment failure rates of more than 80 percent are common (Figueroa and others, 1998; Piecework, 1998). An additional point, often overlooked, is that skin diseases in the developing world are often transmissible and contagious but are readily treatable (Mahé, Thin N'Di aye, and Bob in 1997).

  A number of common diseases account for the vast majority of the skin disease burden; therefore, implementing effective treatments targeted at those conditions results in significant gains for both personal and public health. Even where eradication is impossible, control measures may be important in reducing the burden of illness; yet few systematic attempts have been made to validate control programs for skin diseases as public health interventions