NIH Pediatric Dermatology Spending Misaligned With Disease Burden

The pediatric dermatology conditions that win funding from the National Institutes of Health (NIH) are not necessarily the conditions that lead to the greatest health burden for patients, a new report has found. The study, which was published in Pediatric Dermatology, suggests that the agency could do a better job of prioritizing diseases that have a major burden on patients.¹

The NIH is a major funder of biomedical research in the United States, but the limitations of government funding mean the agency must make tough choices about which studies—and which medical conditions—deserve funding. One way to make those decisions is by considering the burden of the disease, noted co-author Babar Rao, MD, of the Rutgers Robert Wood Johnson Medical School, and colleagues. Yet, NIH funding does not always align with disease burden. For instance, a 2015 study of NIH dermatology spending suggested that, based on disease burden, the agency was over-funding melanoma and under-funding dermatitis and acne vulgaris.² 

Rao and colleagues wanted to see how well NIH funding priorities aligned with disease burden in pediatric dermatology specifically.¹ They used the framework from the 2015 study to compare NIH funding in 2024 and 2025 with disease burden rankings for the 10 most burdensome dermatological diseases in patient populations under 20 years of age.

The investigators pulled US-specific data from the 2021 Global Burden of Disease study, which measures disease burden in terms of disability-adjusted life years (DALYs). The investigators calculated the disease burdens of 18 skin conditions as a percentage of the total US DALYs in the global study and then adjusted them for a pediatric population. They found that acne vulgaris, atopic dermatitis, contact dermatitis, cellulitis, pruritus, psoriasis, urticaria, fungal skin diseases, viral skin diseases, and “other skin and subcutaneous diseases” represented the 10 most burdensome skin conditions.

They then searched an NIH database to find NIH-funded studies from 2024 and 2025 that were specifically focused on one of the identified conditions and which mentioned a pediatric population. They found a total of 307 grants that met their criteria. The total funding for those grants was $388 million, representing just less than 1% of the total NIH-issued grants.

Next, the team looked at how well the spending on the 10 conditions matched the disease burdens associated with each condition. Atopic dermatitis was found to be the most burdensome disease, with a burden of 2.15 absolute DALYs in the 2021 Global Burden study. It also earned the highest number of NIH grants (98), and the highest amount of grant funding ($62.99 million). Approximately half of the grants were explicitly focused on pediatric patients.

However, the correlation between disease burden and NIH funding deteriorated as the investigators went down the list of burdensome diseases. For instance, the second-most burdensome disease was viral skin diseases, which measured 1.93 DALYs. Yet, such diseases were the subject of just 2 NIH grants, totaling just $2.35 million. Neither of those 2 studies was specifically focused on pediatric populations.

Instead, psoriasis received the second-highest amount of funding (71 grants totaling $29.95 million), even though it ranked fifth in terms of disease burden. Just 3 of those 71 grants were specifically focused on pediatric patients.

“Overall, given the long-term physical, psychological, and social implications of pediatric skin disease, findings from this study underscore the urgent need for more research explicitly designed for pediatric patients,” Rao and colleagues concluded.

The investigators also noted that their source data might be limited by a lack of focus on pediatric patients. They explained that some studies that did not specifically mention children might still have implications that benefit children. In addition, variability in how grants are categorized and in which keywords are used could potentially limit the completeness of searches of the NIH database, the authors said.

Rao and colleagues also noted that NIH funding priorities are influenced by a number of factors, including broader sociopolitical factors, which could drive some of the mismatches identified in the study.

However, they argued that the Global Burden of Disease framework should play a bigger role to more closely align NIH funding with disease burden, “and stakeholders should advocate for increased transparency and targeted pediatric dermatology grants.”

References

1. Mackenzie E, Amancharla N, Casagrande S, et al. Comparing pediatric dermatology research funded by the US National Institutes of Health (NIH) with the US skin disease burden in patients under 20 years old. Pediatr Dermatol. Published online August 17, 2025. doi:10.1111/pde.70007

2. Hagstrom EL, Patel S, Karimkhani C, et al. Comparing cutaneous research funded by the US National Institutes of Health (NIH) with the US skin disease burden. J Am Acad Dermatol. 2015;73(3):383-91.e1. doi:10.1016/j.jaad.2015.04.039