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ORIGINAL ARTICLE
Year : 2015  |  Volume : 16  |  Issue : 4  |  Page : 198-202

Pattern of dermatoses in preschool children in a teaching hospital in Uttarakhand, India


1 Department of DVL, SGRRIM and HS and Associated Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India
2 Department of Pediatrics, SGRRIM and HS and Associated Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India

Date of Web Publication24-Sep-2015

Correspondence Address:
Prof. (Col) S K Rana
20, A Kalidas Road, P. O. Hathibarakala, Dehradun - 248 001, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.165612

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  Abstract 

Introduction: Dermatoses are a common occurrence in preschool paediatric population in Uttarakhand.
Objective: The present study was conducted, to document prevalence and the type of skin disorders prevalent in preschool age group children, attending dermatology OPD in a medical college in Uttarakhand, India.
Material and Method: A total of 721 children up to 5 years of age, who presented with dermatoses in pediatric dermatology clinic of department of Dermatolgy Venereology and Leprology (DVL), SGRRIM and HS and associated Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India, were selected between 06 Sep 2013 to 05 Sep 2014 in this prospective study. The diagnosis was based upon detailed clinical examination, necessary investigations and dysmorphologic features, if any.
Results: Infections and infestations were commonest disorders contributing to 36.46% of all cases. Major infections/ infestations were viral (9.76%) followed by scabies (9.29%), fungal (9.01%) and bacterial (8.46%). Higher incidence of viral infection was due to outbreak of HFMD in months of Sep and Oct I 2013 in Dehradun. There was significant change in bacterial infections according to season. Bacterial infections were more common in summers and mansoon seasons. Fungal and viral infections did not show this type of seasonal variation. In our study most of parasitic skin infestations were due to scabies (9.43 %).Other important groups of dermatological disorders were dermatitis in 29.63% cases out of which seborrheic dermatitis (10.12%), atopic dermatitis(5.96%), Ptyriasis alba (5.96%), non specific eczema (3.46%) and contact dermatitis (2.77%). Other skin diseases included papular urticaria / insect dermatitis (8.46%), naevi / developmental lesions (4.02%), pigmentary disorders (3.32%), sweat gland disorders (2.08%) and miscellaneous group (6.38%) respectively. Pigmentary lesions prevalence was higher in girls.
Conclusions: Infections and infestations were commonest cause of dermatoses in preschool children (36.46%), followed by dermatitis (29.63%). Bacterial infection showed seasonal variation and pigmentary lesions were more prevalent in female children.

Keywords: Pediatric atopic dermatitis, pediatric dermatoses, preschool children


How to cite this article:
Bisht J S, Rana S K, Kumari N, Aggarwal B, Mehta A, Singh R. Pattern of dermatoses in preschool children in a teaching hospital in Uttarakhand, India. Indian J Paediatr Dermatol 2015;16:198-202

How to cite this URL:
Bisht J S, Rana S K, Kumari N, Aggarwal B, Mehta A, Singh R. Pattern of dermatoses in preschool children in a teaching hospital in Uttarakhand, India. Indian J Paediatr Dermatol [serial online] 2015 [cited 2020 Nov 25];16:198-202. Available from: https://www.ijpd.in/text.asp?2015/16/4/198/165612


  Introduction Top


One encounters dermatological disorders in children frequently. There is variation in the pattern of dermatoses, with eczemas being the most common skin disorder in developed countries and infections and infestations in the developing countries. Most of the skin diseases were seen in the 1-5 years age group (44.94%), followed by school children (29.60%) and infants (25.46%) except birth marks and common genetic disorders (hemangiomas, vascular malformation, nevi, ichthyosis, palmoplanter keratoderma, tuberous sclerosis, and neurofibromatosis) which were more common in infants. [1] The incidence of pediatric dermatoses is showing upward trend gradually and need exists to pay more attention to this problem. There is variation in the pattern and presentation of dermatoses in different age groups, climate, seasons, geographical locations and developing and developed countries. Usually, there is higher prevalence in rural as compared to urban areas due to poor socioeconomic status, overcrowded families, poor personal hygiene, lack of general awareness and education. Lack of public sanitary facilities, water supply and health facilities in rural areas in developing nations results in higher dermatological complaints due to infectious/infestation origins.

Skin diseases in the pediatric age group can be transitory, chronic or recurrent. Primary or secondary dermatological complaints constitute about 30% of all outpatient visit to a Paediatric Clinic and Dermatological Outpatient Department visits. [2],[3],[4] One study in West Nepal reported the prevalence of skin diseases as 13.46%. [5]


  Subjects and methods Top


Objective

The objective of the study was to investigate the pattern of dermatoses in the preschool pediatric population of Uttarakhand and check whether it was different from similar studies from other regions.

Materials and Methods

This prospective study was designed to evaluate the pattern of pediatric dermatoses in preschool children of Uttarakhand, India. It was conducted for a period of 1-year between 06 September 2013 and 05 September 2014.The setting was Pediatric Dermatology Clinic of Department of DVL in a Tertiary Care Facility in Uttarakhand (SGRRIM and HS and Associated Shri Mahant Indiresh Hospital, Dehradun).

A total of 721 infants and toddlers with dermatological complaints were included in this study. The diagnosis was made by detailed history, clinical examination, and investigations like hemogram, skin biopsy, Tzank smear, Gram's staining, wood lamp examination, KOH examination, Venereal Disease Research Laboratory and urine examination etc., were carried out on need basis. The diseases were tabulated based on etiology and results were analyzed.

Statistical Analysis Used

Data were coded checked entered and analyzed using IBM SPSS Statistics 20. Data were represented as number and percentage. P <0.05 was considered statistically significant. P <0.001 means highly significant.


  Results Top


A total of 721 children up to age of 5 years were included in this study in out of these 408 (56.58%) were males and 313 (43.41%) females with boys to girl ratio being 1.29:1. Majority of children were of preschool age with infants constituting 234 (32.45%) [Table 1]. It was similar to other study. [5],[6] The spectrum of skin disorders based on etiology was tabulated [Table 2]. The most common form of dermatoses in this age group in our study was infectious and infestations in origin constituting 36.46% of all cases. Of which infectious dermatoses were etiology in 195 (27.04%), and parasitic infestations constituted 68 (9.42%) cases. Of all infectious cases, 9.57% were of viral etiology, 9.01% of fungal and 8.46% bacterial etiology. Among viral infections, hand foot mouth disease (HFMD) was the most common viral infection 32 cases (46.37% of viral dematoses) in our study. Higher incidence of HFMD was due to an outbreak of HFMD in Uttarakhand during months of September 2013-October 2013 [Table 3]. Other common viral infection was molluscum contagiosum 18 cases (26.08% of viral infections). Fungal infections constituted 65 (9.01%) of skin manifestations. There was a significant change in bacterial infections according to season. Bacterial infections were more common in summers and monsoon seasons (P < 0.05) [Table 4]. Fungal and viral infections did not show this type of seasonal variation. There was no statistically significant difference (P > 0.05) in male and female children as far as infections were concerned (P > 0.05).
Table 6: Prevalence of dermatitis in preschool children


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Table 1: Age and sex wise distribution of studied group


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Table 2: Pattern of dermatoses in preschool children


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Table 3: Age and distribution of HMFD patients


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Our study showed Scabies was the most common infestation (9.29%) followed by pediculosis (0.13%) in this age group. There was no statistically significant difference (P > 0.05) in male and female children as far as parasitic infestations were concerned [Table 5].
Table 4: Seasonal variations in prevalence of infections


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Next important cause of dermatoses in this age group was dermatitis 194 (26.9%) cases. No significant difference was found in prevalence among male and female children (P > 0.05). Atopic dermatitis also had a similar prevalence of 43 cases (5.96%) cases. The range of atopic dermatitis was from 3% to 28%, in various other studies [Table 6]. [7],[8],[9],[10],[11],[12]
Table 5: Prevalence of parasitic infestations in preschool children


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Other causes of skin lesions included pigmentary lesions and naevi 29 (4.02%) keratinization disorders 13 (1.8%), nail and hair disorders 10 (1.38%), drug reactions in 6 (0.83%), and nutritional disorders (0.27%). The pigmentary disorders in our study group had a higher prevalence in female patients (P < 0.01) [Table 7]. There was a lower incidence of reporting of nutritional dermatological lesions and exanthematous/enanthematous febrile infections in our study which is likely to be due to handling of such patients by pediatricians.
Table 7: Prevalence of pigmentary lesions in preschool children


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  Discussion Top


Pediatric dermatoses differ from adult dermatoses from presentation, treatment, and prognosis point of view. It is influenced by environmental, nutritional, climatic conditions, socioeconomic/cultural factors, and genetic influences also play an important role in the prevalence of pediatric dermatoses. Preschool group has highest prevalence of pediatric dermatoses that is why this group was selected for this study.

In our study, the most common dermatoses were found to be of infectious/infestation in origin among preschool children (36.46%). Of which infectious dermatoses were etiology in 195 (27.04%) and parasitic infestations constituted 68 (9.42%) cases. Among infections, viral, fungal, and bacterial infections were common. Similar findings were reported in other studies. [13],[14] There was significant rise of bacterial infections during summer and rainy season in our study (P > 0.05). In our study, HFMD was the most common viral cause of dermatoses followed by molluscum contagiosum. [14],[15] High incidence of HFMD was due to outbreak in months of September-October 2013.

Scabies was the most common infestation. Pediculosis incidence was lower in other studies. [7],[16],[17] Our study showed Scabies was the most common infestation (9.29%) followed by pediculosis (0.13%) in this age group. Rotti et al. and Sharma et al. showed the incidence of scabies of about 11% in their studies which was similar in our study. [7],[18] Pediculosis incidence was lower in our study compared to the incidence of 1.1% and 0.5% reported by Rao et al. and Sharma et al. [7],[16],[17] There was no statistically significant difference (P > 0.05) in male and female children as far as parasitic infestations were concerned.

The incidence of dermatitis was 29.63%. This incidence was similar to one reported by Sharma et al., Hon et al. and Hom, and other studies which was ranging from 3% to 28%. [7],[8],[10],[19],[20] The range of atopic dermatitis also varied between 3% and 28%, in various other studies. [7],[8],[9],[10],[11],[12] Seborrheic dermatitis was a major cause of dermatitis in our study with 79 (10.11%) cases. Pityriasis alba occurred in 43 cases (5.96%) compared to the incidence of 4.9% and 5.2% in other studies by Sharma et al. and Nanda et al. [7],[21]

Atopic dermatitis and seborrheic dermatitis had an incidence of 5.96% and 10.11%, respectively. There was no statically significant difference in prevalence according to gender [Table 6].

Pigmentary lesions constituted 3.32% of all cases, and prevalence was statistically significantly higher in female children in our study (P > 0.01) [Table 7].

Other dermatoses included drug reactions, insect bites, and urticaria/angioedema. Prevalence of acne in this age group was five cases (0.69%) only that too all cases were limited to neonatal age group while preschool children are spared from this lesion. [5],[17],[22]


  Conclusions Top


In Uttarakhand, the pattern of skin disorders in preschool children is not much different from other regions. Bacterial infections were more common during summer and rainy seasons. Viral infections are also common problems besides fungal and bacterial infections. Scabies is the most common infestation. Atopic dermatitis and seborrheic dermatitis are also resulting in considerable morbidity in preschool children. Pigmentary disorders, papular urticaria, insect bites reactions are also common problems. Pigmentary disorders had a higher prevalence among girl children in our study.

Dermatoses in children are thus a widespread problems, which though are not responsible for significant mortality but considerable morbidity. Skin of young children is more prone to develop skin diseases.

There is a need to ensure that the training of pediatric dermatologists and pediatricians should have a focus on accurate recognition, diagnosis and management of dermatological problems of children. Dermatologists should also be more aware of nutritional and genetic etiologies of pediatric dermatoses.

The parents and teachers also need to be aware of identification, etiology and spread of pediatric dermal diseases. This will lead to better awareness among them as well as children about good nutrition, hygiene practices, and proper hydration of skin. This in turn will result in relative freedom from majority of pediatric dermatoses.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
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    Tables

  [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 1], [Table 7]



 

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