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ORIGINAL ARTICLE
Year : 2017  |  Volume : 18  |  Issue : 3  |  Page : 202-208

Prevalence of common dermatoses in school children of rural areas of Salem; a region of South India


Department of Skin and STD, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India

Date of Web Publication7-Jun-2017

Correspondence Address:
Seethalakshmi Ganga Vellaisamy
11, Mullai Nagar, Near Chandra Mahal, Seelanaickenpatti, Salem - 636 201, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.206090

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  Abstract 

Introduction: Skin diseases are a major health problem in children, which is associated with significant morbidity. Its prevalence ranges from 4.3% to 49.1% in various parts of India in school-based surveys.
Objective: The present study was conducted to know the prevalence, epidemiology of various dermatoses, and the factors contributing to those dermatoses among school children of rural areas of Salem.
Materials and Methods: A cross-sectional prospective study was conducted in two schools of rural Salem between September 2014 and September 2015. A total of 1000 children between the age group of 5 and 14 years were examined for diseases of the skin and appendages. Data were coded and analyzed.
Results: The overall prevalence of skin diseases was 68.2%. Almost 53 types of skin lesions were identified among the students; of these, 15 were infectious, 35 were noninfectious, and three were nutritional dermatoses. Infectious dermatoses were seen in 346 (50.73%), noninfectious in 253 (37.10%), and nutritional deficiency dermatoses in 83 (12.17%) children. The top three conditions, i.e.. pediculosis capitis (21%), scabies (11%), and bacterial infections (8.52%) contributed 40.52% of the total burden of skin diseases.
Conclusion: The prevalence of skin disorders, especially infectious dermatoses, was high among the school children in our study area which is a reflection of the prevalence in the overall population of that area. It is mainly attributed to a lack of proper hygienic measures and health awareness which has to be addressed promptly for the improvement of that area.

Keywords: Pediatric dermatoses, pediculosis capitis, school children, South India


How to cite this article:
Jose G, Vellaisamy SG, Govindarajan N, Gopalan K. Prevalence of common dermatoses in school children of rural areas of Salem; a region of South India. Indian J Paediatr Dermatol 2017;18:202-8

How to cite this URL:
Jose G, Vellaisamy SG, Govindarajan N, Gopalan K. Prevalence of common dermatoses in school children of rural areas of Salem; a region of South India. Indian J Paediatr Dermatol [serial online] 2017 [cited 2017 Nov 23];18:202-8. Available from: http://www.ijpd.in/text.asp?2017/18/3/202/206090


  Introduction Top


Skin diseases are a major health problem in all age groups, especially in the pediatric age group. They are associated with significant morbidity. The prevalence of pediatric dermatoses in various parts of India ranges from 4.3% to 49.1% in school-based surveys.[1] Status of health, hygiene, and personal cleanliness of a society can be judged from the prevalence of certain skin diseases in the children of the community.[2]

Pediatric dermatoses vary in clinical features, treatment, and prognosis from adult dermatoses so that they have to be addressed in a different way. A variety of skin disorders are seen during childhood. The pattern of skin diseases varies from country to country with infections, infestations, and malnutrition being more prevalent in developing countries, while eczemas are more common in developed countries. This can be attributed to differing climatic, cultural, and socioeconomic factors.[3]

School survey is a useful method to screen a large number of children of the particular age group for the presence of diseases at a time. The purpose of studying the prevalence of pediatric dermatoses is to assess the level of health awareness and availability of health-care services which is useful to build child health-care strategies that cope with actual community requirements.[4] Many studies which were conducted in urban areas do not reflect the true state of diseases in the community. 78% of Indian population stay in rural areas and children below 14 years constitute about 38% of the total population.[5] Therefore, the present study was conducted to find the prevalence and pattern of skin diseases among school-going children of age 5–14 years in our rural service area.

Objectives

The objective of the study was to know the spectrum of skin disorders among school-going children of age 5–14 years in the rural Salem and also to look for the factors contributing to those dermatoses among them.


  Materials and Methods Top


This was a prospective cross-sectional study conducted in two schools (government schools) of rural Salem, a northern region of Tamil Nadu, after getting approval from the Ethical Committee of our institution. The study population included the students aging between 5 and 14 years from the two schools. School visits were scheduled twice weekly in coordination with school's principal after getting informed consent from them. The study was conducted during September 2014–September 2015.

Each child was interviewed for age, residence, and any specific complaint related to skin. Then, the student was evaluated for hygiene status. Each child was then subjected to a complete dermatological examination including skin, nail, and mucosa in adequate daylight. The diagnosis was made based on clinical features and appropriate investigations (KOH examination, Gram's stain, Wood's lamp). Digital photographs were taken after obtaining the consent.

After examination, skin diseases were classified into three broad categories for the purpose of analysis: (1) infectious dermatoses, (2) noninfectious dermatoses, (3) nutritional deficiency dermatoses. The findings were recorded in a pro forma for analysis and interpretation of data. The data gathered using the questionnaire and clinical examination were compiled, coded, and entered in Excel Spreadsheets. Statistical analysis was performed using SPSS Version 16 [SPSS, Inc., Chicago, IL, USA]. Chi-square test was used to compare categorical variables. P< 0.05 was considered to indicate statistical significance.


  Results Top


A total of 1000 students of age 5–14 years were included in the study. Of these, 528 (52.8%) were males and 472 (47.2%) were females. The majority of the study subjects were in the age group of 9–12 years (40.3%), and the mean age of the study population is 11.2 years. About 49.9% of the students belonged to middle class according to modified Kuppuswamy classification (Grade 1 - Upper class, Grade 2 - Upper middle, Grade 3 – Middle class, Grade 4 – Lower middle, and Grade 5 – Lower class). Of 1000 study subjects, only 318 (31.8%) were totally normal without any skin lesion and the remaining 682 children had any one of the skin lesions, which makes the prevalence of dermatoses was almost 68.2%.

[Table 1] shows distribution of total dermatoses among the boys and girls from which we can infer that prevalence of skin disease in our study has been found to be little bit common in boys (34.7%) than girls (33.5%) but its not statistically significant as P value is more than 0.05.
Table 1: Distribution of total dermatoses among boys and girls

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[Table 2] shows category-wise distribution of total dermatoses among boys and girls. It shows 346 (50.73%) students had infectious dermatoses, 253 (37.10%) students had noninfectious dermatoses, and only 83 (12.17%) had nutritional deficiency dermatoses. Almost 53 types of skin lesions were identified among the children; of these, 15 were infectious, 35 were noninfectious, and 3 were nutritional dermatoses. Fifty-four children had more than one type of skin disease. Infectious dermatoses were more common among girls (29.77%) and the P< 0.0001 which is statistically significant. Noninfectious dermatoses were more common among boys and the P- 0.0002 which is statistically significant. Nutritional dermatoses were more common among boys, but it is not statistically significant.
Table 2: Category-wise distribution of total dermatoses among boys and girls

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Infectious Dermatoses

In infectious dermatoses [Table 3], more than one-third of the students were suffering from pediculosis capitis (21%), followed by scabies (11%) and impetigo (5%). Pediculosis capitis was more common among girls (17.30%) than boys (3.67%) and the P< 0.0001 which is statistically significant. Scabies [Figure 1] was the second most common dermatoses in our study which was more common among boys. Herpes labialis [Figure 2] was seen in one female student (0.14%).
Table 3: Distribution of infectious dermatoses among boys and girls

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Figure 1: Scabies

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Figure 2: Herpes simplex labialis

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Noninfectious Dermatoses

Among the noninfectious dermatoses [Table 4], pityriasis alba was the common dermatoses seen in 9.23% (27) of the study population, and it is more common in males (5.13%) which is statistically significant. Pityriasis alba [Figure 3] was the third most common skin condition seen in our study population. Atopic dermatitis is seen only in 0.58% of the study population and it is because atopic eczema is not so common in developing countries like India. Among the papulosquamous disorders, psoriasis vulgaris [Figure 4] was seen in two female students (0.28%).
Table 4: Distribution of noninfectious dermatoses among boys and girls

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Figure 3: Pityriasis alba

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Figure 4: Psoriasis vulgaris

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Nutritional Dermatoses

Of nutritional dermatoses [Table 5], xerosis was seen in 8.21% of the students and phrynoderma was seen in 3.07% of the study population.
Table 5: Distribution of nutritional dermatoses among boys and girls

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  Discussion Top


Dermatological problems, especially infectious dermatoses, affect a high proportion of school children in developing countries like India. Skin disorders in children may result in considerable discomfort, parental anxiety, and embarrassment to the child and unnecessary absence from school and work. This, in turn, leads to loss of confidence and disruption of social relations, feeling of stigmatization, and major changes in lifestyle.[6]

Sociodemographic factors such as age, gender, economic status, and overcrowding play a crucial role in determining the pattern of skin disorders in this age group.[7] Dermato-epidemiological data from population-based studies are important in planning public health strategies intended to control skin diseases. Information on the epidemiological characteristics and economic constraints in a particular area is required to formulate standardized recommendations for treating the common skin diseases prevalent there.[8]

The common problem in interpreting the data from different studies is variation in the classification of disease categories. Thus, population-based prevalence studies are essential to estimate the true burden of skin disorders among children.[8] The incidence of these diseases appears to be increasing and is influenced by social, economic, public health, nutritional, environmental, and climatic factors, as well as the genetic make-up of the population studied.[9]

We have compared our study with other studies done by Dogra and Kumar,[10] Rao et al.,[11] Valia et al.,[12] and Sharma et al.[13] In our study, skin disorders were found in 68.2% which is comparable to Rao et al. (76.65%) and Valia et al. (53.6%). However, in Dogra and Kumar and Sharma et al.'s study, the prevalence of dermatoses was 38.80% and 14.30% which is less when compared to our study. This might be because of rural area and low socioeconomic status of the population in our area. In our study, infectious dermatoses were present in 50.73% which is comparable to Negi et al.[14] (50.69%) and Valia et al.[12] (43%). Noninfectious dermatoses were present in 37.10% in our study while it was 31.6% in Negi's study. In our study, nutritional deficiency dermatoses were present in 12.17% which is comparable to Negi's study (17.5%) and less when compared to Rao's study (6.71%).

Infectious Dermatoses

Infectious dermatoses constituted 50.73% of all dermatoses in the study. Similar results were reported in the study conducted by Patodi et al.[15] and Badame.[16] The reasons for the high prevalence of infectious dermatoses are attributed to high illiteracy rate, poor hygienic and sanitary conditions, lack of awareness, and services for the skin diseases. In majority of the studies, infections and infestations were the main groups of dermatoses like our study.

Among the infectious dermatoses, pediculosis capitis was the leading presentation found in 21% of children. Few studies done by Chouela et al.[17] and Figueroa et al.[18] have yielded similar results. However, Valia et al.[12] showed a low prevalence of pediculosis capitis. It was followed by scabies in 11% and bacterial infections in 8.52% of our study population. Infectious dermatoses were more common among girls and the P< 0.0001 which is statistically significant. This is because pediculosis capitis was the common infectious dermatoses, which is more prevalent in girls. That could be the reason why infectious dermatoses are common among girls.

Pediculosis was more common in girls (17.30%) as compared to boys (3.67%), which has been attributed to long hair and infrequent head bath in girls. Other studies done by Khokhar [19] and Wu et al.[20] also substantiated these findings. The majority of parents did not consider pediculosis infestation seriously. Thus, children, parents, and teachers should be educated regarding timely detection and treatment of pediculosis infestation.

In our study, pediculosis capitis was more common among the 9–12 years age group and it is statistically significant which implies an association between age and pediculosis capitis. It may be due to the reason that the school children are exposed to newer risk factors as they grow older. Parental care also decreases as the child becomes independent. As a result, hygienic practices by the child may be insufficient in maintaining good skin hygiene, in turn leading to increase in transmissible skin disease.

Parasitic infestations, bacterial infections, and fungal infections shared 46.95% of all skin diseases. The warm climate in our region may contribute to the higher percentage. With control and preventive measures against this triad, the burden of skin diseases can be reduced by half in the community. Hansen's disease was detected in only 0.29% of the population which is less compared to Sharma et al.,[13] where it was found to be 5.10%. This is probably because the incidence of leprosy is lesser than what it was a decade ago.

In a study conducted in rural Pakistan, pyoderma was the most common disorder in the children.[21] However, in our study, pyoderma [Figure 5] constituted 5.73% of total study population. In most other studies, pyodermas are the single most common dermatoses.[5],[14],[21],[22] The presence or absence of biting flies is important in determining the amount of pyoderma, for the irritation and subsequent infection of insect bites appeared to underlie the largest number of cases in the Porter et al.'s study.[21]
Figure 5: Pyoderma

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Noninfectious Dermatoses

Among the noninfectious dermatoses eczema (11.86%) like pityriasis alba (9.23%), pigmentary disorders such as postinflammatory pigmentation (3.81%), scars (3.95%), miliaria rubra (3.22%), ichthyosis vulgaris (2.78%), papular urticaria (2.63%), and dermatitis neglecta (2.49%) were the main problems. However, on the whole, the prevalence was low for these diseases.

Like Valia et al.'s [12] study, pityriasis alba was the most common noninfectious dermatoses in our study. The presence of atopic dermatitis in only four children (0.58%) in our study is consistent with its low prevalence in developing countries.[18] Miliaria is another disorder peculiar to hot and humid tropics and was seen in 3.22% of the children. Acquired melanocytic nevus was seen in 1.17% of study population. According to recent studies in children, nevi are the leading cause of dermatology referrals in Spain and the second leading cause in Switzerland and China but not in our country because of darker skin complexion.[23]

Papular urticaria contributed to 2.63% of the study population. Ghosh et al.[22] observed a frequency of 4% in their study which is comparable to our study. It was explained by the fact that most of the children in our study belong to rural areas and wear scanty clothing due to climatic conditions and thus being exposed to insect bites. Genodermatoses and papulosquamous diseases (1.17%) demonstrated low prevalence.

Nutritional Dermatoses

Among the nutritional deficiencies, xerosis (8.21%), phrynoderma (3.07%), and angular cheilitis (0.87%) were the main problems. Phrynoderma was seen in 3.07% of students which is less compared to the previous studies done by Rao et al.,[11] and Sharma et al.,[13] where it was found to be 6.28% and 10.96%. respectively.

Seasonal dermatoses like chicken pox was seen only in 0.29% of our study population and this low prevalence is attributed to the cross sectional nature of our study.


  Conclusion Top


The overall prevalence of dermatoses in the school-going children in our study is 68.2% which is because of rural area and low socioeconomic status of the population in our area. Infectious dermatoses were seen in 50.73% of students, noninfectious dermatoses were seen in 37.10% of students, and nutritional deficiency dermatoses in 12.17% of students. The top three conditions, i.e., pediculosis capitis (21%), scabies (11%), and bacterial infections (8.52%), contributed 40.52% of the total burden of skin diseases. Thus, simple approaches on promoting hygiene, sanitation, improving awareness regarding dermatoses, and provision of commonly required drugs at the grass-root level may bring down the burden of skin diseases drastically.

The prevalence of skin disorders was high among the primary school children in the study area. This might be a reflection of the prevalence in the overall population of the area. Skin diseases, especially infestations, are not given due attention. Similar population-based studies are required to estimate the burden of skin disorders and formulate appropriate strategies to prevent and treat them. Regular community-based studies are necessary to trace community changes, assess the influence of healthcare services, and follow up trends in pediatric dermatoses.

Regular examination of school children by experienced doctors with the help of school authorities will help in reducing the prevalence of skin disorders in children and society. Health education and good personal hygiene will definitely help improve the health status of school children. Even though most of the dermatoses were asymptomatic, routine school survey should be carried out every year for the early diagnosis and treatment of communicable and nutritional diseases. Because India is a developing country, it still shows a relatively high prevalence of infections as a result of relatively low standards of hygiene, as well as ignorance, poverty, and overcrowding. We would like to highlight the fact that many of these dermatoses can be controlled by proper sanitation, improving nutrition and environment.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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