Indian Journal of Paediatric Dermatology

ORIGINAL ARTICLE
Year
: 2017  |  Volume : 18  |  Issue : 4  |  Page : 286--291

Pattern of pediatric dermatoses in Northeast India


Karthick Nagarajan1, Nandakishore Singh Thokchom1, Khaidem Ibochouba2, Kapila Verma1, NA Bishurul Hafi1,  
1 Department of Dermatology, Venereology and Leprology, Regional Institute of Medical Sciences, Imphal, Manipur, India
2 Department of Paediatrics, Regional Institute of Medical Sciences, Imphal, Manipur, India

Correspondence Address:
N A Bishurul Hafi
Department of Dermatology, Venereology and Leprology, Regional Institute of Medical Sciences, Imphal, Manipur
India

Abstract

Background: The prevalence of pediatric skin diseases varies worldwide. Pediatric dermatoses require a separate view from adult dermatoses as there are important differences in clinical presentation, treatment, and prognosis. Aims and Objectives: To study the clinical and etiological presentation of dermatoses in the pediatric population in Northeast India. Materials and Methods: The study was carried out at a tertiary care center in Northeast region for 18 months (from December 2012 to May 2014). Cases under the age of 12 years were selected based on purposive sampling method. Results: Infections (36.25%) were the most common cause of skin diseases in the study group comprising 400 patients. Eczematous diseases (14.5%), pigmentary disorders (14.25%), and infestations (13.25%) were the other common causes. Varicella (6%), impetigo contagiosum (5%), and candidiasis (4.5%) were the most common viral, bacterial, and fungal diseases, respectively. Scabies (12.25%) was the most common individual disease in the present study. The prevalence of hand, foot, and mouth disease was high constituting 4% of the study group. Dyshidrotic eczema (6.5%), pityriasis alba (7.5%), and vitiligo (3.5%) were also common. Miliarial dermatitis and polymorphic light eruption also contributed significantly (5.25%) reflecting the typical pattern of the tropical skin diseases. Atopic dermatitis, genetic disorders, and nutritional deficiency disorders had a very low prevalence. Conclusion: The study finding that the majority of the diseases could be grouped into fewer than 8 disease categories may help in more accurate diagnosis. Significant proportions of the dermatoses are infections followed by eczematous and pigmentary diseases. Age, sex, locality, the income of the parents, family history, and season of presentation have an influential role in the pattern of distribution of the pediatric skin diseases.



How to cite this article:
Nagarajan K, Thokchom NS, Ibochouba K, Verma K, Bishurul Hafi N A. Pattern of pediatric dermatoses in Northeast India.Indian J Paediatr Dermatol 2017;18:286-291


How to cite this URL:
Nagarajan K, Thokchom NS, Ibochouba K, Verma K, Bishurul Hafi N A. Pattern of pediatric dermatoses in Northeast India. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Jul 18 ];18:286-291
Available from: http://www.ijpd.in/text.asp?2017/18/4/286/215798


Full Text



 Introduction



Skin diseases in children are encountered frequently, and their characterization is essential for the preparation of academic, research, and health plans. The prevalence of pediatric skin diseases varies worldwide.[1] Hence, information regarding the local prevalence of the various skin diseases in pediatric age group may help in the better understanding of the sub-specialty and improve the diagnostic and curability rate of the diseases. Pediatric dermatoses require a separate view from adult dermatoses as there are important differences in clinical presentation, treatment, and prognosis. Dermatoses in children are even more influenced by socioeconomic status, climatic exposure, dietary habits, and external environment as compared to adult skin disorders.[2]

Many studies regarding the pattern of pediatric dermatoses have been conducted in other regions of India and other parts of the world.[3],[4],[5],[6] However, little is known about the pattern in North Eastern parts of India. Therefore, the data from this study will help for planning future health care, health education, and research activities and for elucidating the difference from those reported in other regions.

Objectives

To study the clinical and etiological presentation of dermatoses in the pediatric age group.

 Materials and Methods



The study was carried out in the Department of Dermatology in a tertiary hospital in North-East India. Data collection was carried out for 18 months (from December 2012 to May 2014). Cases were selected based on purposive sampling method. All cases under the age of 12 years were included in the study. A detailed analysis of the pattern of the diseases was performed based on the history, morphological presentation, and distribution pattern. Summarization and presentation of qualitative data were done using proportions and percentage and quantitative data with mean. Ethics Committee approval and informed consent were obtained from the Institute ethics committee and the parents of the patients, respectively.

 Results



A total of 400 children were enrolled into the study. There was a slight predominance of males (n = 210; 52.5%) with a male:female ratio of 1:0.9. Patients in the age group of 5–12 years (n = 203) constituted the majority (50.75%) followed by 1–5 year age group (n = 136; 34%) and 0–1 year age group (n = 61; 15.25%) [Table 1]. Sixty-two percent (n = 248) of the study population belonged to the urban locality.{Table 1}

Infections (n = 145; 36.25%) were the most common cause of skin diseases in the study group. Eczematous diseases (n = 58; 14.5%), pigmentary disorders (n = 57; 14.25%), and infestations (n = 53; 13.25%) were also common [Table 1].

Among the infective dermatoses, viral infections (n = 66; 16.5%) were the most common followed by bacterial infections (n = 45; 11.25%) and fungal infections (n = 34; 8.50%). Varicella (n = 24; 6%) molluscum contagiosum (n = 16; 4%) and hand, foot, and mouth disease (HFMD) (n = 16; 4%) were the most common viral diseases. Among the bacterial infections, impetigo contagiosum (n = 20; 5%), folliculitis (n = 15; 3.75%), and bullous impetigo (n = 6; 1.5%) were the most common diseases. Among fungal infections, candidiasis contributed to majority (n = 18; 4.5%) with maximum incidence in infants (100%), followed by dermatophytoses (n = 10; 2.5%), and pityriasis versicolor (n = 6; 1.5%) which was observed only in few cases.

Among eczematous diseases, dyshidrotic dermatitis was the most common (n = 26; 6.5%) followed by seborrheic dermatitis (n = 12; 3%) and contact dermatitis (n = 12; 3%). There were only 2 classical cases of atopic dermatitis, which accounted for <1% of the study group.

Miliarial dermatitis (n = 11; 2.7%) and polymorphic light eruption (PMLE) (n = 10; 2.5%) contributed to a significant percentage. This study had only 3 cases of psoriasis and 1 case of lichen planus. The three leading causes for consultation were scabies (n = 49; 12.2%), followed by pyoderma (n = 45; 11.2%) and pityriasis alba (n = 30; 7.5%). Genetic disorders and nutritional deficiency disorders had a very low prevalence (n = 4; 1% each).

Other common diseases in the study were verruca vulgaris (n = 10; 2.5%), postinflammatory hyperpigmentation (n = 8; 2%), milia (n = 7; 1.75%), nummular dermatitis (n = 6; 1.5%), viral exanthemas (n = 6; 1.5%), lichen striatus (n = 6; 1.5%), postinflammatory hypopigmenation (n = 5; 1.25%), acne vulgaris (n = 4; 1%), alopecia areata (n = 4; 1%), lichen nitidus (n = 4; 1%), nevus sebaceous (n = 2; 0.5%), nevus depigmentosus (n = 2; 0.5%), atopic dermatitis (n = 2; 0.5%), hemangioma (n = 2; 0.5%), epidermal nevi (n = 2; 0.5%), neurofibromatosis (n = 1; 0.25%), and tuberous sclerosis (n = 1; 0.25%).

Seborrheic dermatitits, diaper dermatitis, and candidiasis were exclusively seen only in the infantile age group. Diseases such as verruca vulgaris (100%) and pediculosis capitis (100%) were seen only in the 5–12 years age group [Table 2]. There was less gender disparity in the pattern of the diseases except that female children had increased prevalence of pityriasis alba and pediculosis capitis, whereas male children had increased prevalence of PMLE (80%), miliarial dermatitis (72.7%), and candidiasis (72.7%). Among the school-going children, there was a predominance of communicable skin diseases such as verruca vulgaris (100%), dermatophytosis (90%), varicella (75%), PMLE (70%) molluscum contagiosum (62.5%), and scabies (61.2%).{Table 2}

Miliarial dermatitis (81.8%), PMLE (80%), dermatophytosis (60%), candidiasis (55.5%), varicella (50%), and pyoderma (35.5%) were more common in the summer season (March to May). Dyshidrotic eczema (53.8%), pityriasis alba (46.6%), and exanthemas (40%) had increased prevalence in the winter season (November and December) [Table 3].{Table 3}

 Discussion



The study group included 400 patients with a male:female ratio of 1:0.9. Patients belonging to the age group of 5–12 years (n = 203) constituted the majority (50.75%). It is known that skin diseases are more common in the age group of 5–12 years which could be explained by increased environmental exposure, whereas Sharma et al. showed a higher prevalence in younger ages.[6]

The most common type of dermatoses seen was infections followed by eczematous and pigmentary disorders. This pattern of distribution has been observed in studies made by Karthikeyan et al. and Sayal et al.[7],[8] Reports from outside India have demonstrated eczematous diseases contributing the majority [Table 4].[9],[10],[11] Developed countries are also known to show a higher prevalence of eczematous diseases due to external factors like lifestyle differences, dietary habits, environmental allergens, and climatic conditions.{Table 4}

Viral infections were the most common infective dermatosis followed by bacterial and fungal infections. A similar pattern was observed in studies by Gül et al. and Casanova et al.[9],[12] However, bacterial and fungal infections were the most common infections in studies done by Sharma et al. and Sayal et al.[Table 5].[6],[8] This difference in the pattern of distribution of infective dermatoses can be attributed to the type of population studied, hygiene practices, nutritional status, and the regions were the studies were conducted.{Table 5}

In the present study, scabies was most prevalent among infestations (n = 49; 12.25%) which is comparable with the study conducted by Sharma et al.[13] However, low prevalence of scabies were reported in studies done at Uttar Pradesh by Negi et al. and Central India by Bhatia.[14],[15] Pediculosis capitis (1%) was a rare disease. Two studies conducted at Himachal Pradesh and Pondicherry by Sharma and Sharma and Kumar et al., respectively, had found pediculosis capitis to be the most common dermatological disorder in children.[16],[17] The decreased frequency of pediculosis capitis in this study could be due to increase awareness about hair care and scalp hygiene with locally made herbal preparations among people in this part of the country.

Eczematous diseases have varying distribution patterns in different regions. This can be due to the genetic predisposition and environmental allergens in the locality. Among eczematous diseases, dyshidrotic dermatitis was the most common disease followed by seborrheic dermatitis and contact dermatitis. This observation was different from reports of Balai et al. and Hayden where atopic dermatitis and diaper dermatitis was the most common eczema respectively [Table 6].[18],[19] Another interesting observation is the rarity of atopic dermatitis in this study group. There were only two classical cases of atopic dermatitis, which accounted for <1% of the study group. In contrast, studies from developed countries have been found to have a higher incidence ranging from 3.1% to 28% as reported by Foley et al.[20]{Table 6}

Miliarial dermatitis (n = 11; 2.7%) and PMLE (n = 10; 2.5%) contributed significantly in the present study. A similar observation was made by Balai et al. and Ghosh et al. in their study.[18],[21] This pattern is typical of tropical skin diseases. Only 3 cases of psoriasis and 1 case of lichen planus were found in this study. Similarly, study by Balai et al. also had very few cases of papulosquamous diseases.[18]

In the present study, acrodermatitis enteropathica was seen only in 2 cases, whereas, a high incidence (3.6%) has been reported in a study from Karachi by Javed and Jairamani.[22] Such a low prevalence of nutritional disorders in a developing nation like India is a rare occurrence. However, this could be because of very low percentage of people below poverty line in this part of the country.

Genetic disorders like neurofibromatosis were rarely encountered in the present study similar to study by Porter et al.[23] Only one case each of tuberous sclerosis, neurofibromatosis, and Darier's disease were seen in the present study group. The rare occurrence of genetic disorders in this population can be explained by the low incidence of consanguineous marriages in this region.

Sixteen cases of HFMD also constituted a part of this study. There were very few epidemics reported in Indian literature. Although this disease is very common in other parts of the world, especially China, Singapore, Indonesia, and Thailand as reported by Zhi-Chao et al.[24] the prevalence of this disease in India is very low and cases have been reported only during epidemics. Since then few epidemics of very small scale have been reported. One such epidemic might be the cause of the cases being reported here. In this study, only 16 cases are being reported due to the sampling technique being followed. There was history of fever in (n = 13), sore throat (n = 3), diarrhea (n = 5), and vomiting (n = 1). These findings were indicative of viral enteric infections (like Enterovirus and Coxsackie virus) as the cause of HFMD. There were no complications such as herpangina, meningitis, paralysis, or myocarditis. The cause of this epidemic and the strains of the organisms involved are yet to be investigated.

Among the 49 patients with scabies, 27 patients had papules, 2 patients had papulovesicular lesions, and 20 patients (40.8%) had papulonodular lesions. All the 20 patients had papulonodular lesions, especially in the genitalia. This proportion of nodular pattern (40.8%) among the scabies patients is significantly high compared to other study done by Jackson et al.[25]

Seborrheic dermatitits, diaper dermatitis, and candidiasis were exclusively seen only in the infantile age group. Diseases such as verruca vulgaris (100%) and pediculosis capitis (100%) were seen only in the age of 5–12 years. This could be related to the increased environmental exposure. These findings were comparable to studies by Sayal et al., Bhatia and Ghosh et al.[8],[15],[21]

There was less gender disparity in the pattern of the diseases except that female children had increased prevalence of pityriasis alba and pediculosis capitis (due to increased atopic tendency and longer hairs, respectively). Sardana et al. and Sharma et al. also reported similar findings in their studies.[1],[6]

Patients from the rural areas had a higher prevalence of communicable skin diseases like scabies (67.3%), pyoderma (64.4%), and dermatophytoses (60%), whereas patients from the urban areas had increased prevalence of eczematous diseases such as pityriasis alba (86.6%) and pompholyx (76.9%). This difference in the distribution pattern signifies the importance of increasing the awareness on local hygiene among the rural population and the role of food habits and lifestyle measures in the pathogenesis of eczematous skin conditions. These findings were similar to those reported by Banerjee et al. in their studies on the role of environmental factors in the pathogenesis of pediatric skin diseases.[26]

The same pattern of distribution was also observed in the patients with parents earning low monthly income (<Rs 5000) compared to patients with parents earning a better income (<Rs 15000) [Table 7].{Table 7}

There was a wide range of individual diseases (n = 46) in this study which contributed to the difficulty in diagnosing skin diseases. It emphasizes the need for proper dermatological teaching among pediatricians and physicians. However, majority (75%) of the diseases could be classified among the 8 common groups. Hence, dermatological teaching oriented to these 8 groups of diseases may increase the diagnostic capabilities of future doctors.

This study was a tertiary hospital outpatient department based cross-sectional study with known limitations. We believe that the pattern observed represents a rough estimate of the pattern of pediatric skin diseases in dermatology clinics and the community of North East India.

 Conclusion



This study identifies the pattern of distribution of pediatric skin diseases in North East India. Childhood dermatoses showed varied pattern. The majority of the diseases could be grouped into fewer than 8 disease categories. This knowledge will help in narrowing down the differential diagnosis and help in the prompt management of the patients. The differences observed in the pattern between different studies on pediatric dermatoses probably represent the importance of intrinsic and extrinsic factors such as the type of study population, environmental, socioeconomic, and genetic factors in the pathogenesis of pediatric skin diseases.[27]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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