|Year : 2020 | Volume
| Issue : 2 | Page : 119-125
Clinicoepidemiological study of prevalence and pattern of dermatoses among patients of pediatric age group in southeast region of Rajasthan
Shivani Saini, Devendra Yadav, Ramesh Kumar
Department of Skin and VD, Government Medical College, Kota, Rajasthan, India
|Date of Submission||23-Dec-2018|
|Date of Decision||22-Nov-2019|
|Date of Acceptance||24-Dec-2019|
|Date of Web Publication||01-Apr-2020|
KR 207, MBS Hospital Campus, Opposite, Circuit House, Nayapura, Kota, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: Pediatric dermatoses present as one of the most common clinical entities in dermatology clinics. They differ in clinical presentation and management from adults. Their prevalence and pattern differ from region to region due to several factors such as environmental, social, genetic, and cultural. Aims and Objective: The aim of the study was to determine the prevalence and pattern of various dermatoses among children of the age group 0–18 years in Southeast region of Rajasthan. Materials and Methods: Our study included 1000 cases of 0–18 years age group attending the dermatology outpatient and inpatient department of Government Medical College and attached group of hospitals, Kota. It was carried out from December 2017 to September 2018 (10 months). Appropriate history was taken, and a complete thorough examination was done as required. Relevant investigations were done, and all the findings were recorded in predesigned pro forma. Results: Our study included 560 males and 440 females of 1000 with the male-to-female ratio of 1.272:1. There were 553 urban and 447 rural participants. The patients were subgrouped in the age group of 0–1 year, 1–7 years, 8–12 years, and 13–18 years. The most prevalent dermatoses in 0–1 year age group were eczematous disorders (31.91%). Viral infections were predominant in 26.08% and 23.47% in the age groups of 1–7 years and 8–12 years, respectively. The most common dermatoses in the age group of 13–18 years were disorders of sweat and sebaceous glands (20.15%). Conclusion: Our study demonstrates variability of dermatoses among pediatric patients according to their age groups. This information should contribute to raising the awareness of pediatricians and dermatologists regarding the most common dermatological diagnosis in those patient populations.
Keywords: Pattern, pediatric dermatoses, prevalence, Southeast
|How to cite this article:|
Saini S, Yadav D, Kumar R. Clinicoepidemiological study of prevalence and pattern of dermatoses among patients of pediatric age group in southeast region of Rajasthan. Indian J Paediatr Dermatol 2020;21:119-25
|How to cite this URL:|
Saini S, Yadav D, Kumar R. Clinicoepidemiological study of prevalence and pattern of dermatoses among patients of pediatric age group in southeast region of Rajasthan. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 Jun 1];21:119-25. Available from: http://www.ijpd.in/text.asp?2020/21/2/119/281730
| Introduction|| |
Skin diseases in the pediatric age group reflect a major health problem with significant morbidity and mortality. Pediatrician faces 30% of patients with skin diseases of all outpatient department (OPD) attending children, whereas dermatologist faces 30% cases of pediatric dermatoses of all patients attending OPD., Various dermatoses of pediatric population are reported with the incidence from 9% to 37% all over the world. They should be evaluated separately because they differ in clinical presentation, prognosis, and treatment from adults. Skin diseases in children depend on various factors such as socioeconomic status, seasonal variation, dietary habits, and cultures, so they are associated with significant morbidity.,,, Psychological impact may be associated with the chronic and severe diseases.
The spectrum of skin diseases in children varies in different regions; so, our aim is to determine its pattern in the Southeast region of Rajasthan.
| Materials and Methods|| |
The cross-sectional study was carried out in the Department of Dermatology, Venereology, and Leprosy of Government Medical College, Kota. The duration was from December 2017 to September 2018. Thousand consecutive children of the age 0–18 years attending the OPD and inpatient department were included. Guardian's written consent and an assent were taken from children of 7 years of age or more. All the necessary general, cutaneous, and systemic examination with routine laboratory investigations were done. Skin biopsy was taken wherever it was needed. Ethical permission was duly obtained from the institutional research and ethical committee. Patients were divided into four subgroups:
- 0–1 year – Birth to infant
- 1–7 years – Mid-childhood
- 8–12 years – Preadolescent
- 13–18 years – Adolescent.
We categorized pediatric dermatoses into 18 groups of diseases, and data were recorded on predesigned pro forma as follows: dermatoses (bacterial, viral, fungal, parasitic, eczematous, papulosquamous, vesiculobullous, sweat and sebaceous, nutritional, nevoid and developmental, keratinization, connective tissue/collagen vascular, pigmentary hair, nail, hypersensitivity, vascular malformation, and miscellaneous). Observed data were subjected to descriptive analysis using SPSS software, version 22.0, Chicago, USA. The mean and standard deviation were calculated for quantitative data. Anova test was applied for qualitative data.
| Results|| |
Regarding the frequency of pediatric dermatosis in the 0-18 years of age, overall, noninfectious diseases (53.7%) were more common than infectious diseases (46.3%) [Chart 1] and [Chart 2]. Viral infections were more common in the infectious diseases, and eczematous disorders were maximum in the noninfectious diseases [Table 1].
Overall, in the infectious diseases, scabies (6.7%) was the most common, which was followed by molluscum contagiosum (6.6%), tinea cruris (4.9%), common wart (3.3%), plantar wart (3.3%), and plane wart (3.2%). Of the noninfectious diseases, acne vulgaris (7.0%) was the most common, which was followed by atopic dermatitis (4.1%), milia (3.0%), keratoderma (1.7%), miliaria (1.7%), and psoriasis (1.6%) [Table 2] and [Table 3].
In the 0–1 year age group, most common dermatoses were eczematous disorders, followed by fungal infections, bacterial infections, parasitic infections, viral infections, miscellaneous disorders, hypersensitivity disorders, pigmentary disorders, connective tissue/collagen vascular disorder, and nevoid and developmental disorders.
In the age group of 1–7 years, maximum cases were reported from viral infections, then followed by eczematous disorders, parasitic infections, fungal infections, bacterial infections, sweat and sebaceous disorders, hypersensitivity disorders, nevoid and developmental disorders, keratinization disorders, connective tissue/collagen vascular disorders, miscellaneous, hair disorders, nutritional disorders, papulosquamous disorders, pigmentary disorders, and vesiculobullous disorders.
In the age group of 8–12 years, most common dermatoses were viral infections and then followed by eczematous disorders, parasitic infections, sweat and sebaceous disorders, fungal infections, bacterial infections, papulosquamous disorders, hypersensitivity disorders, miscellaneous disorders, pigmentary disorders, nevoid and developmental disorders, hair disorders, connective tissue disorders, keratinization disorders, nutritional disorders, and vesiculobullous disorders.
The most predominant dermatoses in the age group of 13–18 years were sweat and sebaceous disorders, followed by viral infections, fungal infections, eczematous disorders, hair disorders, parasitic infections, papulosquamous disorders, miscellaneous disorders, bacterial infections, hypersensitivity disorders, pigmentary disorders, vesiculobullous disorders, keratinization disorders, connective tissue/collagen vascular disorders, nevoid and developmental disorders, nutritional disorders, vascular disorders, and nail disorders.
Miscellaneous group included keloid, granuloma annulare, intertrigo, erythema annulare centrifugum, erythema toxicum neonatorum, erythromelanosis follicularis faciei et colli, collodion baby, mucosal cyst, trichoepithelioma, seborrheic keratosis, skin tags, dermatitis artefacta, and transient neonatal pustular melanosis [Table 4], [Figure 1], [Figure 2] and [Figure 3].
| Discussion|| |
Skin manifestations in the pediatric age group cause significant morbidity, thus forming major health problems. It can be transitory, recurrent, or chronic. The pattern of pediatric dermatoses varies by place and depends on various factors such as climate, culture, and environment. Infants are mostly restricted to their place only, whereas another age group of mid-childhood remains in the contact of surroundings and neighborhood. Environmental, cultural, and social factors influence to the adolescent mainly.
In our study, most of the dermatoses contributed to the infections (463, 46.3%), followed by eczematous disorders (134, 13.4%), and then disorders of sweat and sebaceous disease (132, 13.2%). Some studies such as Hayden showed somewhat similar pattern in which infections were the most common but followed by eczema and hypersensitivity disorders.,, In a study by Sacchidanand et al., the pattern was similar for infectious diseases, in which viral infections were the most common, followed by bacterial infections, whereas Balai et al. showed bacterial infections to be the most common. The total number of patients taken was different in other mentioned studies. The number of OPD attending patients may vary in each age group. Hence, the final outcome may vary.
Out of the infectious dermatoses, viral infections were predominant, (213, 21.3%) followed by fungal (114, 11.4%), parasitic (79, 7.9%), and bacterial infections (57, 5.7%). Bacterial infections were the most common in the study conducted by Hayden., Viral infections were most common in the study by Wenk and Itin, and Gül et al. These differences among infectious dermatoses could be due to the climatic variations.,
Impetigo (15, 1.5%) was the most common in the bacterial infections similar to some studies such as Javed and Jairamani., Out of the viral infections, molluscum contagiosum (66, 6.6%) was predominant followed by warts, similar findings were found in the study done by Karthikeyan et al., Al-Tawara et al., and Kacar et al. stated wart to be the most common viral infection, followed by molluscum contagiosum. Tinea cruris (49, 4.9%) was the most common fungal infection, observed in our study, followed by tinea corporis and tinea capitis. Other study showed predominancy of tinea capitis. In our study, pityriasis versicolor was 1% of total dermatoses, which was less than the study done by Saurabh et al. Scabies incidence was in similar range as it was in the study of Balai et al. Balai et al. showed similarity with our study in the pattern of parasitic infestations, in which scabies was the most common (68, 6.8%). Dissimilarity may be due to differences in the regions, cultural habits, and environmental factors. Similarity may be explained in scabies incidence as it is contagious dermatoses.
Among the eczematous group of diseases, atopic dermatitis (41, 4.1%) was found to be predominant, followed by keratoderma (17, 1.7%) and seborrheic dermatitis (11, 1.1%). The pattern was not similar in the study of Wenk and Itin in which atopic dermatitis, followed by seborrheic dermatitis and pityriasis alba were found to be common. These variations could be linked to genetic factors.,
Out of the nutritional disorders, angular cheilitis (3, 0.3%) and pellagra (3, 0.3%) were the most common, whereas the study by Javed and Jairamani showed predominancy of acrodermatitis enteropathica [Figure 4]. These differences could be due to socioeconomic habits as government hospital of Kota covers patients from tribal area. Urticaria (18, 1.8%) was the most common hypersensitivity disorder found, followed by papular urticaria (11, 1.1%) and insect bite (8, 0.8%). It was similar to study done by Karthikeyan et al. showed papular urticaria to be more common than urticaria.
Out of the papulosquamous disorders, psoriasis (16, 1.6%) was the most common dermatoses found, followed by lichen planus (10, 1.0%). The frequency of psoriasis was more than the study done by Rao et al. Mostafa et al. showed a higher incidence of papulosquamous disorders comparative to our study. This can be explained as different total number of patients attending OPD may affect the outcome [Figure 5], [Figure 6] and [Figure 7].
Our study duration covered almost all seasons, so we could include variation in dermatoses. Papular urticaria was common in rainy season, whereas dermatophytosis and miliaria were common during the transition period between winter and summer. Atopic dermatitis was predominantly found in winter [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13].
|Figure 10: Male child presenting with progressive white hairs and white patches over the body (vitiligo vulgaris)|
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|Figure 12: A 16-year-old female was diagnosed with systemic lupus erythematosus, presenting with malar rash, oral ulceration in this picture. Other diagnostic criteria were also fulfilled|
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| Conclusion|| |
It was known about the spectrum of pediatric dermatoses reflecting influencing factors and their association with social, environmental, and hygienic life. In our study, we evaluated the pattern and distribution of pediatric dermatoses according to different age groups (0–18 years) in our region, which was lacking.
Written consent from the guardians and assent was taken from children of ≥7 years of age.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Thappa DM. Common skin problems. Indian J Pediatr 2002;69:701-6.
Federman DG, Reid M, Feldman SR, Greenhoe J, Kirsner RS. The primary care provider and the care of skin disease: The patient's perspective. Arch Dermatol 2001;137:25-9.
Hassan I, Ahmad K, Yaseen A. Pattern of pediatric dermatoses in Kashmir valley: A study from a tertiary care center. Indian J Dermatol Venereol Leprol 2014;80:448-51.
] [Full text]
Centers for Disease Control and Prevention. Epidemiology & Risk Factors”. Centers for Disease Control and Prevention; 2010.
Dhar S, Banerjee R, Dutta AK, Gupta AB. Comparison between the severity of atopic dermatitis in Indian Children born and brought up in UK and USA and that of Indian children born and brought up in India. Indian J Dermatol 2003;48:200-2. [Full text]
Patki A. Eat dirt and avoid atopy: The hygiene hypothesis revisited. Indian J Dermatol Venereol Leprol 2007;73:2-4.
] [Full text]
Al-Tawara M, Odeibat H, Al-Smadi R, Omeish I, Obaidat N. Patterns of skin diseases among pediatric patients attending the pediatric dermatological clinic at King Hussein medical cente. J R Med Serv 2014;21:38-45.
Mitra M, Mitra C, Gangopadhyay DN. Effect of environment on pediatric dermatoses. Indian J Dermatol 2005;50:64-7. [Full text]
Hayden GF. Skin diseases encountered in a pediatric clinic. A one-year prospective study. Am J Dis Child 1985;139:36-8.
Karthikeyan K, Thappa DM, Jeevankumar B. Pattern of pediatric dermatoses in a referral center in South India. Indian Pediatr 2004;41:373-7.
Negi KS, Kandpal SD, Parsad D. Pattern of skin diseases in children in Garhwal region of Uttar Pradesh. Indian Pediatr 2001;38:77-80.
Sacchidanand S, Sahana MS, Asha GS, Shilpa K. Pattern of pediatric dermatoses at a referral centre. Indian J Pediatr 2014;81:375-80.
Balai M, Khare AK, Gupta LK, Mittal A, Kuldeep CM. Pattern of pediatric dermatoses in a tertiary care centre of South West Rajasthan. Indian J Dermatol 2012;57:275-8.
] [Full text]
Wenk C, Itin PH. Epidemiology of pediatric dermatology and allergology in the region of Aargau, Switzerland. Pediatr Dermatol 2003;20:482-7.
Gül U, Cakmak SK, Gönül M, Kiliç A, Bilgili S. Pediatric skin disorders encountered in a dermatology outpatient clinic in Turkey. Pediatr Dermatol 2008;25:277-8.
Nunneley SA. Heat stress in protective clothing. Interactions among physical and physiological factors. Scand J Work Environ Health 1989;15 Suppl 1:52-7.
Kanerva L. Physical causes. In: Adams Occupational Skin Disease. 3. Adams RM, editor. Philadelphia, PA: W.B. Saunders Company: 1999. p. 35-58.
Javed M, Jairamani C. Pediatric dermatology: An audit at Hamdard university hospital, Karachi. J Pak Assoc Dermatol 2006;16:93-6.
Kacar SD, Ozuguz P, Polat S, Manav V, Bukulmez A, Karaca S. Epidemiology of pediatric skin diseases in the mid-Western Anatolian region of Turkey. Arch Argent Pediatr 2014;112:421-7.
Saurabh S, Sahu SK, Sadishkumar A, Kakkanattu JC, Prapath I, Ralte IL, et al
. Screening for skin diseases among primary school children in a rural area of Puducherry. Indian J Dermatol Venereol Leprol 2013;79:268. [Full text]
Schmitt S, Küry S, Giraud M, Dréno B, Kharfi M, Bézieau S. An update on mutations of the SLC39A4 gene in acrodermatitis enteropathica. Hum Mutat 2009;30:926-33.
Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP, et al
. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet 2006;38:441-6.
Rao GS, Kumar SS, Sandhya. Pattern of skin diseases in an Indian village. Indian J Med Sci 2003;57:108-10.
] [Full text]
Mostafa FF, Hassan AA, Soliman MI, Nassar A, Deabes RH. Prevalence of skin diseases among infant and children in Al Sharqia Governorate, Egypt. Egypt Dermatol Online J 2011;8:1-4.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]
[Table 1], [Table 2], [Table 3], [Table 4]