|Year : 2017 | Volume
| Issue : 4 | Page : 281-285
The clinico-epidemiological profile of atopic dermatitis in residential schoolchildren: A study from South Chhattisgarh, India
Yasha Upendra1, Naveen Keswani1, Sampreeti Sendur1, Abhishek Pallava2
1 Department of Dermatology, Government Medical College, Rajnandgaon, India
2 Indian Police Service, Chhattisgarh Cadre, Chhattisgarh, India
|Date of Web Publication||29-Sep-2017|
Department of Dermatology, Government Medical College, Rajnandgaon - 491 441, Chhattisgarh
Source of Support: None, Conflict of Interest: None
Introduction: Atopic dermatitis is a chronic, inflammatory, relapsing skin disorder with early age of onset in infancy and early childhood.
Objective: The present study was conducted to study the clinico-epidemiological profile of atopic dermatitis among children of residential schools of naxal-infested South Chhattisgarh.
Materials and Methods: Ninety children (4.6%) of atopic dermatitis were pooled out from a previous study by the same authors on 1943 children of eight residential schools. The various clinico-epidemiological factors were studied and analyzed using relevant statistical tools.
Results: Out of ninety children having atopic dermatitis, boys:girls ratio was 1:1.73. The mean age of onset was 2.14 ± 0.52 years, and the mean duration of illness was 1.71 ± 0.38 years. The personal history of atopy was present in 34 (37.8%) children whereas a family history of atopy was seen in 47 (52.2%) children. Among clinical presentation, chronic type (n = 56, 62.2%) was most common, followed by subacute (n = 24, 26.2%) and acute (n = 10. 11.1%). Flexor (n = 42, 46.7%) was the most common site affected followed by extensor and face (n = 24, 26.7%) each. Mild severity was seen in 76 (84.4%) children followed by moderate severity (n = 12, 13.4%) and severe (n = 2, 2.2%) children. Sweating (n = 53, 58.9%) was the most common aggravating factor followed by seasonal (n = 51, 56.7%), wool (n = 24, 26.7%), stress (n = 15, 16.7%), dust (n = 10, 11.1%), physical exercise (n = 8, 8.9%), and food (n = 2, 2.2%).
Conclusions: Atopic dermatitis of chronic type with mild in severity is more common in community.
Keywords: Atopic dermatitis, clinico-epidemiological profile, tribal schoolchildren
|How to cite this article:|
Upendra Y, Keswani N, Sendur S, Pallava A. The clinico-epidemiological profile of atopic dermatitis in residential schoolchildren: A study from South Chhattisgarh, India. Indian J Paediatr Dermatol 2017;18:281-5
|How to cite this URL:|
Upendra Y, Keswani N, Sendur S, Pallava A. The clinico-epidemiological profile of atopic dermatitis in residential schoolchildren: A study from South Chhattisgarh, India. Indian J Paediatr Dermatol [serial online] 2017 [cited 2018 Jan 20];18:281-5. Available from: http://www.ijpd.in/text.asp?2017/18/4/281/215796
| Introduction|| |
Atopic dermatitis is a chronic, inflammatory, pruritic, relapsing and remitting skin disorder with early age of onset, commonly running in families with a history of atopy. The diagnosis is made clinically based on Hanifin and Rajka criteria. Atopic dermatitis is common dermatoses affecting pediatric population with prevalence ranging from 15% to 23%.,, Both the prevalence and severity of atopic dermatitis have been found to be lower in Indian children.,,, There are few studies on epidemiology and clinical pattern of atopic dermatitis in Indian children done in hospital settings, but no study has been conducted in the community setting and more so, in remote insurgency/naxal-infested tribal children. Hence, this study was conducted to study epidemiology and clinical presentation of atopic dermatitis in residential schoolchildren of naxal-infested remote tribal areas.
| Materials and Methods|| |
A study by the same authors had been conducted to find the prevalence of various dermatoses in 1943 children (aged 6–16 years) of eight residential schools of Dantewada district, Chhattisgarh, in which a total of ninety (4.6%) children were clinically diagnosed as atopic dermatitis based on Hanifin and Rajka criteria. Ninety children diagnosed as atopic dermatitis in the previous study were recruited as particcints in our present study. The parents of the children were contacted and called to the school next day for detailed evaluation. Informed consent was obtained from the principal of the school and parents of the children who were enrolled in the study. The detailed history regarding the age of onset, duration of illness, personal and family history of atopy, seasonal variation, aggravating factors, and past history of treatment for atopic dermatitis were recorded in the study pro forma. The children were clinically examined for the type of dermatitis (acute/sub-acute/chronic), predominant site of involvement, and severity of atopic dermatitis. The severity was assessed using SCORAD index. Data were tabulated, and analysis of categorical variables was done by Chi-square test. A criterion of significance used was P < 0.05 (two tailed). The ethical clearance for the study was obtained from the Institutional Ethical Committee before commencing the study.
| Results|| |
A total of ninety children studying in eight residential schools clinically diagnosed with atopic dermatitis were examined, of which 38 (42.2%) were boys and 52 (57.8%) were girls with boys:girls ratio of 1:1.73. Fifty-one (56.6%) children were from primary schools (age: 6–10) while 39 (43.4%) children were from high schools (age: 10–16). There were 22 (24.4%) boys compared to 29 (32.2%) girls in primary school, whereas there were 16 (17.8%) boys compared to 23 (25.6%) girls in high schools [Table 1].
The mean age of onset of atopic dermatitis was 2.14 ± 0.52 years with infantile onset (n = 30; 33.3%) being most common. Most of the children (n = 77, 85.6%) had onset within first 5 years of life. The mean duration of illness was 1.71 ± 0.38 years [Table 2].
|Table 2: Age of onset and duration of the disease in children with atopic dermatitis|
Click here to view
Twenty-five (27.8%) children had comorbid allergic rhinitis, whereas 12 (13.3%) had comorbid bronchial asthma. About one-third of the children (n = 34; 37.8%) had either allergic rhinitis or bronchial asthma. Thirty-eight children (42.2%) had a family history of atopic dermatitis whereas a family history of allergic rhinitis and bronchial asthma was positive in 9 (10.0%) and 5 (5.6%) children, respectively. About half of children (n = 47; 52.2%) had a family history of atopic dermatitis, allergic rhinitis, or bronchial asthma [Table 3].
There were no significant differences between primary schoolchildren (age: 6–10 years) and secondary schoolchildren (age: 10–16 years) in the clinical presentation (type, predominant site involved, and severity) of atopic dermatitis. Most common type of atopic dermatitis seen was chronic in both age groups affecting thirty (58.8%) of primary schoolchildren (age: 6–10 years) and 26 (66.7%) of secondary schoolchildren (age: 10–16 years) followed by subacute type affecting 15 (29.4%) of primary schoolchildren (age: 6–10 years) and 9 (23.1%) of secondary schoolchildren (age: 10–16 years). Least common type was acute which was seen in 6 (11.8%) of primary schoolchildren (age: 6–10 years) and 4 (10.3%) of secondary schoolchildren (age: 10–16 years). The predominant site of involvement in primary schoolchildren (age: 6–10 years) was flexor surface in 21 (41.2%), face in 15 (29.4%), extensor in 13 (25.5%), and mixed in 2 (3.9%) children whereas, in secondary schoolchildren (age: 10–16 years), flexor surface was involved in 21 (53.8%) followed by extensor in 9 (23.1%), face in 7 (18.0%), and mixed in 2 (5.1%) children. More than 80% of the children (n = 42; 82.4% in primary schoolchildren and n = 34; 87.2% in secondary schoolchildren) had mild severity followed by moderate severity (n = 8; 15.7% in primary schoolchildren and n = 4; 10.3% in secondary schoolchildren). Least common was severe type seen in only one child each from both age groups. Only one (1.9%) child from primary school and two (5.1%) children from secondary schools had sought treatment for atopic dermatitis previously [Table 4].
Among the aggravating factors for atopic dermatitis, sweating was most commonly reported by 53 (58.9%) of the children. Seasonal aggravation of symptoms was seen in 51 (56.7%) of children (winter [n = 30, 33.33%], summer [n = 8.9%], and rainy [n = 5, 5.6%]). Other common aggravating factors were wool (n = 24, 26.7%), stress (n = 15, 16.7%), dust (n = 10, 11.1%), physical exercise (n = 8, 8.9%), and food (n = 2, 2.2%) [Table 5].
| Discussion|| |
Our study sample of atopic dermatitis had population prevalence of 4.6% among school-going children. The prevalence is lower compared to Western population where it ranges from 15% to 23%.,, The lower prevalence could be due to predominant rural population, higher rates of infection leading to the development of immunity, and lesser pollution due to lack of industrialization and dense forests. There was a female preponderance of atopic dermatitis in our sample (boys:girls ratio: 1:1.73). Majority of Western community studies have shown a higher prevalence in females.,, The male preponderance seen in hospital-based Indian epidemiological studies could be due to more treatment-seeking behavior for boys compared to girls.,
The mean age of onset in our study was about 2 years with more than 70% children developing symptoms before first 5 years of age. This is in consonance with earlier studies which have shown infantile and early childhood onset of atopic dermatitis.,,,,,,,,, Personal history of atopy has been seen in 37.8% of children in our study whereas Western studies have shown personal history of atopy ranging from 50% to 70%., Family history of atopy has been seen in 52.2% of the children in our study whereas most of the Western studies have shown a higher prevalence in the range 60%–70%. As personal/family history of atopy is known to be associated with severe form of atopic dermatitis and about 85% of the children in our study suffered from mild atopic dermatitis., Thus, lower personal/family history of atopy could be a reason for mild presentation. In majority of hospital-based studies, acute presentation of atopic dermatitis is common,, whereas, in our study, chronic presentation was the most common followed by subacute and acute type which could be due to our study being done in community settings. More than 80% of schoolchildren had mild severity of atopic dermatitis; this could be due to study sample directly taken from community and sample being predominantly rural with prolonged breastfeeding and low personal and family history of atopy.,, Among late childhood children (age: 6–10 years), flexors were most commonly affected followed by face and extensors whereas, in adolescent children, flexor was again most common followed by extensor and face, these findings are consonant with previous studies. In our study, sweating (59%) was the most common aggravating factor which could be related to hot and humid weather of the area and poor infrastructure of the schools. Stress was another important aggravating factor in about 17% children. High-stress levels in children could be due to separation from home and examination stress. The seasonal exacerbations of symptoms were seen in about 60% of children with a maximum in winter months (about 33%). This could be related to decreased levels of moisturization and direct wearing of woolen clothes by tribal children.
| Conclusions|| |
As most of the research regarding epidemiological factors has been done in hospital settings in our country, there has been a scarcity of knowledge regarding true epidemiology of atopic dermatitis in the community. There are epidemiological differences from region to region; thus, our study has a utility in being the first community study from remote tribal areas of our country. The prevalence of atopic dermatitis was less compared to Western studies, presentation was mostly chronic, and severity of illness was predominantly mild. There was extremely low treatment seeking for atopic dermatitis which could be due to poor disease awareness or lack of access to health care. There is a need to make teachers, caregivers, and children in schools aware of the symptoms of atopic dermatitis so that timely diagnosis and prompt treatment could be done. Our study was a cross-sectional study; a longitudinal follow-up study with bigger sample size would give a clearer picture of various epidemiological factors affecting atopic dermatitis. There was also possibility of recall bias in view of predominantly chronic presentation of atopic dermatitis in our study and poor educational status of parents and linguistic difficulties.
This study received full support and cooperation from Dantewada police and district administration to provide logistic support and requisite security in view of naxalite problem.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Friedmann PS, Ardern-Jones MR, Holden CA. Atopic dermatitis. In: Burns T, Breathnach S, Cox N, Griffith C, editors. Rook's Textbook of Dermatology. 8th
ed. West Sussex: Wiley-Blackwell; 2010. p. 24.1-24.33.
Hanifin JM, Rajka RG. Diagnostic features of atopic dermatitis. Acta Derm Venereol 1980;92:44-7.
Kay J, Gawkrodger DJ, Mortimer MJ, Jaron AG. The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol 1994;30:35-9.
Dotterud LK, Kvammen B, Bolle R, Falk ES. A survey of atopic diseases among school children in Sør-Varanger community. Possible effects of subarctic climate and industrial pollution from Russia. Acta Derm Venereol 1994;74:124-8.
Schultz Larsen F, Diepgen T, Svensson A. The occurrence of atopic dermatitis in North Europe: An international questionnaire study. J Am Acad Dermatol 1996;34:760-4.
Dhar S, Mandal B, Ghosh A. Epidemiology and clinical pattern of atopic dermatitis in 100 children seen in a city hospital. Indian J Dermatol 2002;47:202-4. [Full text]
Dhar S, Kanwar AJ. Epidemiology and clinical pattern of atopic dermatitis in a North Indian pediatric population. Pediatr Dermatol 1998;15:347-51.
Sehgal VN, Srivastava G, Aggarwal AK, Saxena D, Chatterjee K, Khurana A, et al.
Atopic dermatitis: A cross-sectional (descriptive) study of 100 cases. Indian J Dermatol 2015;60:519.
Kanwar AJ, Dhar S. Severity of atopic dermatitis in India. Br J Dermatol 1994;131:733-4.
Upendra Y, Sendur S, Keswani N, Pallava A. Prevalence of dermatoses among the tribal children studying in residential schools of naxal infested South Chhattisgarh, India. Indian J Paediatr Dermatol; doi: 10.4103/ijpd. IJPD_128_16.
Kunz B, Oranje AP, Labrèze L, Stalder JF, Ring J, Taïeb A, et al.
Clinical validation and guidelines for the SCORAD index: Consensus report of the European task force on atopic dermatitis. Dermatology 1997;195:10-9.
Dhar S, Banerjee R. Atopic dermatitis in infants and children in India. Indian J Dermatol Venereol Leprol 2010;76:504-13.
] [Full text]
Tay YK, Kong KH, Khoo L, Goh CL, Giam YC. The prevalence and descriptive epidemiology of atopic dermatitis in Singapore school children. Br J Dermatol 2002;146:101-6.
Girolomoni G, Abeni D, Masini C, Sera F, Ayala F, Belloni-Fortina A. et al
. The epidemiology of atopic dermatitis in Italian school children. Allergy 2002; 58:420-5.
Kuhnyar A, Egyud K, Szabo I, Hunyadi J, Kosa L. Prevalence of Atopic Dermatitis Among Children Under 19 in an East-Hungarian Agricultural County. Clinical and Developmental Immunology 2006; 13:395-399.
Sarkar R, Kanwar AJ. Clinico-epidemiological profile and factors affecting severity of atopic dermatitis in north Indian children. Indian J Dermatol 2004; 49:117-22. [Full text]
Roth HL, Kierland RR. The natural history of atopic dermatitis. A 20-year follow-up study. Arch Dermatol 1964; 89:209-14.
Rystedt I. Prognostic factors in atopic dermatitis. Acta Derm Venereol 1985; 65:206-13.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]