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ORIGINAL ARTICLE
Year : 2020  |  Volume : 21  |  Issue : 4  |  Page : 275-278

Pattern of common skin diseases among school going children in Semi-Urban Area of Jaipur: A cross-sectional study


1 Department of Dermatology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
2 Department of Gastroenterology, SMS Hospital, Jaipur, Rajasthan, India

Date of Submission28-Nov-2019
Date of Decision01-Jan-2020
Date of Acceptance26-Apr-2020
Date of Web Publication30-Sep-2020

Correspondence Address:
Dr. Manmohan Bagri
Department of Dermatology, Mahatma Gandhi Medical College and Hospital, Jaipur - 302 022, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_119_19

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  Abstract 


Aims: Skin disorders are a common health problem in pediatric age group, and a school-based survey seems to be a good screening tool for estimating the prevalence of cutaneous disorders among children. Subjects and Methods: A cross-sectional prospective study was conducted in three schools of semi-urban area of Jaipur. A total of 576 children including 218 boys and 358 girls of age group 4–18 years were examined for the study, and laboratory investigations were also done for all the children. Results: Out of 576 students, 349 students were found to have a skin disorder. Of all the affected children, 69.7% (370) had noninfectious dermatoses, 19.8% (105) had infectious dermatoses, and 10.5% (56) had nutritional dermatoses. Conclusions: In our study, the prevalence of skin infection was found to be associated with low socioeconomic status and poor personal hygiene. Hence, awareness regarding skin-related health problems in children as well as in their parents seems to be of utmost importance.

Keywords: Pediatric dermatosis, school children, various dermatoses


How to cite this article:
Nijhawan M, Bagri M, Nijhawan S, Bishnoi S, Agarwal S, Nijhawan S. Pattern of common skin diseases among school going children in Semi-Urban Area of Jaipur: A cross-sectional study. Indian J Paediatr Dermatol 2020;21:275-8

How to cite this URL:
Nijhawan M, Bagri M, Nijhawan S, Bishnoi S, Agarwal S, Nijhawan S. Pattern of common skin diseases among school going children in Semi-Urban Area of Jaipur: A cross-sectional study. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 Oct 25];21:275-8. Available from: https://www.ijpd.in/text.asp?2020/21/4/275/296843




  Introduction Top


Skin diseases are a common health problem in pediatric age group.[1] The prevalence of skin diseases depends on the health status, hygiene, and nutrition of the children in the society.[1] The pattern of skin diseases in the children varies from country to country due to different climate, cultural, and socioeconomic status.[2] In India, the prevalence of skin disorders among the school-going children ranged from 4.3% to 49.1% during various surveys.[3] The most common dermatoses observed in India are infections, infestations, and malnutrition.[3],[4] School survey is a very useful method to assess the health status of a community and to upgrade the health-care services accordingly.[5],[6],[7],[8] We conducted this study in school-going children of semi-urban area of Jaipur to assess the pattern of skin diseases and correlated them with laboratory investigations wherever required.


  Subjects and Methods Top


This was an observational cross-sectional study of children of government school located in semi-urban area of Jaipur in 2019.

The study population included students between 4 and 18 years of age after approved by the institutional ethics committee before undertaking the present study. Randomly selected schools of urban and rural area of Jaipur district of Rajasthan, North India, were included. Written informed consent was taken from parents and school principal.

Sample size – sample was calculated by the formula: N = 4PQ/L2.

where N = Sample size

P = Prevalence

Q = 100 − P

L = Allowable error.

From the reference article, the prevalence of skin manifestation among school children was 69%.[1] Hence, taking 6% dropout rate, it come to be 566, and in our study, a total of 576 children including 218 boys and 358 girls of age group 4–18 years were examined for the study, and laboratory investigations were also done for all the children.

The detailed history and cutaneous finding including mucosal and appendageal structure were recorded in a pro forma for interpretation of the data. Digital photographs were taken.

Inclusion criteria

  1. Students aged 4–18 years
  2. All students who were willing to participate after written informed consent.


Exclusion criteria

  1. Those not willing to participate
  2. Those not ready to give written informed consent.


The diagnosis was based on clinical features; examination; and appropriate investigations such as blood investigations, KOH mount, Gram's stain, and Wood's lamp examination. Skin diseases were classified in three broad categories for further analysis: (1) infectious, (2) noninfectious, and (3) nutritional deficiency.


  Results Top


A total of 576 children in the age group of 4–18 years were included in the study. 60.59% of the children were found to be affected by one or other dermatosis [Table 1]. Of these, 37.8% were male and 62.1% were female. Majority of the cases were in the age group of 11–15 years, followed by 6–10 years [Table 2]. Among 349 total affected children, there were 105 cases of infectious dermatoses (19.8%) and 370 cases of noninfectious dermatoses (69.7%), and nutritional dermatosis was found in 56 children (10.5%) [Table 3]. The prevalence of infectious and noninfectious dermatoses and nutritional dermatoses was more common among girls than boys.
Table 1: Distribution of total dermatomes among boys and girls

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Table 2: Age and sex distribution

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Table 3: Category.wise distribution of total dermatoses among boys and girls

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In infectious dermatoses, 25.7% were suffering from scabies, followed by pyoderma in 23.8%, pediculosis capitis in 21%, dermatophytosis in 11.5% [Figure 1]a, pityriasis versicolor in 7.6%, Molluscum contagiosum in 4.8% [Figure 1]b, verruca vulgaris in 3.8%, herpes simplex in 0.9%, and chickenpox in 0.9% [Table 4]. Similarly, in noninfectious dermatoses, most of the cases were of seborrheic capitis (24.1%), acne vulgaris in 18.6% [Figure 2]a, and pityriasis alba in 15.4% [Figure 2]b, followed by leukonychia in 6.2%, milia in 4.3%, diffuse hair loss in 3.7%, papular urticaria in 3.8%, atopic dermatitis in 3.2%, miliaria rubra in 3.2%, congenital melanocytic nevus in 2.2%, melanonychia in 1.3%, freckles in 1.3%, aphthous ulcer in 1.3%, vitiligo vulgaris in 1.1%, acanthosis nigricans in 1.1%, allergic contact dermatitis in 1.35, chronic urticaria in 1.1%, congenital ichthyosis in 0.3%, and plantar hyperkeratosis in 0.3% [Table 5]. In nutritional dermatosis section, xerosis was the most common finding and was seen in 55.3% of cases, followed by phrynoderma in 17.9%, canities in 16.1%, and Angular cheilitis in 10.7% [Table 6].
Figure 1: (a) Tinea capitis-multiple erythematous patchy hair loss with fine scaling seen over scalp. (b) Molluscum contagiosum - multiple pearly white papule seen over right cheek

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Table 4: Distribution of Infectious dermatoses among boys and girls

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Figure 2: (a) Pityriasis alba- well defined hypopigmented patch seen over right mandibular area. (b) Acne vulgaris - comedons and erythematous papules seen over forehead, bilateral cheeks and nose

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Table 5: Distribution of noninfectious dermatoses among boys and girls

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Table 6: Distribution of nutritional dermatoses among boys and girls

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A total of 576 school children were screened for laboratory investigations to find any abnormal parameters. In these parameters, low hemoglobin (Hb <11) was present in 36 children who presented with pityriasis alba (61%), xerosis (30.5%), cheilitis (5.6%), and atopic dermatitis (2.8%). SGOT/SGPT were deranged in 50 children who presented with noninfectious dermatosis such as pityriasis alba (32%) and xerosis (18%) and infectious finding included seborrheic capitis (28%), pediculosis (14%), and acne vulgaris (8%). HbsAg was positive in 6 children showing pediculosis, acanthosis nigricans, acne vulgaris, and pityriasis alba.

Tissue transglutaminase assay (IgA-tTG) was positive in 5 children showing leukonychia (60%) and pediculosis (40%). Similarly, low albumin was seen in 42 children having xerosis (38%), pityriasis alba (35.7%), acne vulgaris (12%), pediculosis (9.5%), and freckles (4.7%).


  Discussion Top


There are various patterns of cutaneous dermatoses seen in school-going children and it is different in each state and each country due to different economic status, literacy rate, sanitation, and disease awareness.[5],[6],[7]

Out of 576 total students, 349 children had skin dermatosis with the prevalence of 60.5%, which was similar to the study done by Komba and Mgonda, with a prevalence of 57%.[9]

In our study, age group of 11–15 years constituted the maximum (50%) numbers, followed by age group of 6–10 years, whereas a study conducted by Sacchidanand et al. showed 5–11 years as the common age group.[10]

In our study, out of 349 affected patients, female patients outnumbered the male patients (62%) similar to the study done by Ferreira et al. where female predominance (57.2%) was seen.[11]

In our study, noninfectious dermatosis was the most common dermatosis encountered seen in 69.7% of the total cases, followed by infectious dermatosis in 19.8% of cases and nutritional deficiency in 10.5% of cases only. Similar observation of more noninfectious dermatosis was seen in a study done by Yaseen and Hassan where they found infectious disorder in 5.3% of cases.[12] In a study done by Rita et al., noninfectious dermatosis was the most common dermatosis seen in 79.6% cases, whereas infectious dermatoses in 18.14% cases.[2] This finding was similar to our study.

In our study, among the infectious dermatoses, the most common infection was scabies seen in 27 cases, followed by pyoderma in 25 cases and pediculosis capitis in 22 cases. In the study done by Reddy et al., scabies alone constituted the majority of infestation making 3.6% of the total dermatoses followed by pediculosis capitis.[13]

Among noninfectious dermatoses, the most common dermatosis seen was seborrheic capitis in 89 cases, followed by acne in 65 cases and pityriasis alba in 57 cases.

In the study done by Upendra et al., among noninfectious dermatoses, the most common finding was pityriasis alba seen in 18.9% of cases, whereas seborrheic capitis was seen in 1.6% of cases and acne in 8.6% of cases.[14]

The prevalence of nutritional dermatosis in our study was 10.5%. Xerosis was seen in 55.3% of students followed by phrynoderma 18%, canities 16% and angular chelitis in 10.7% as compared to Jose et al.[3] study where xerosis seen in 8.21%, phrynoderma in 3.07% and angular chelitis in 0.87%. The prevalence of nutritional dermatosis in our study is more than the study done by Rita et al.[2] (2.26%) and Yasha et al.[14] (1.7%), it may be because of low socio economic status in their area. There is a paucity of studies in literature conducted in schools along with laboratory investigation.


  Conclusions Top


In our study, the prevalence of skin infection was found to be associated with low socioeconomic status and poor personal hygiene. Hence, awareness regarding skin related health problems in children as well as in their parents seems to be of utmost importance. Thus, for estimating cutaneous disorders among children, other population based prevalence studies are required. such studies can help in spreading awareness, early prevention and diagnosis of various cutaneous disorders, and lowering down rate.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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.  Back to cited text no. 1
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2.
Rita V, Nishit B, Shivang P. Prevalence of various dermatoses in school children of Anand District. Natl J Community Med 2012;3:100-3.  Back to cited text no. 2
    
3.
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.  Back to cited text no. 3
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Kumar AS, Devi BN, Jahnavi K, Varma P. A study on prevalence of skin infections among school children in Hyderabad, Telangana state. Int J Contemp Med Res 2016;3:1862-4.  Back to cited text no. 4
    
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Bisht JS, Rana SK, 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.  Back to cited text no. 5
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Jain S, Barambhe MS, Jain J, Jajoo UN, Pandey N. Prevalence of skin diseases in rural Central India: A community-based, cross-sectional, observational study. J Mahatma Gandhi Inst Med Sci 2016;21:111-5.  Back to cited text no. 6
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Godara SK, Thappa DM, Pottakkatt B, Hamide A, Barath J, Munisamy M, et al. Cutaneous manifestations in disorders of hepatobiliary system. Indian Dermatol Online J 2017;8:9-15.  Back to cited text no. 7
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8.
Medasani V, Oudeacoumar P*, Chitralekhya R, Misra SR. Prevalence of paediatric dermatoses among patients attending dermatology outpatient department in a tertiary care hospital in Puducherry. Int J Res Dermatol 2018;4:368-75.  Back to cited text no. 8
    
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Komba EV, Mgonda YM. The spectrum of dermatological disorders among primary school children in Dar es Salaam. BMC Public Health 2010;10:765.  Back to cited text no. 9
    
10.
Sacchidanand S, Sahana MS, Asha GS, Shilpa K. Pattern of pediatric dermatoses at a referral centre. Indian J Pediatr 2014;81:375-80.  Back to cited text no. 10
    
11.
Ferreira FR, Nascimento LF, Cirvidiu DC. Prevalence of pediatric dermatoses in a university hospital in southeastern Brazil. An Bras Dermatol 2011;86:477-82.  Back to cited text no. 11
    
12.
Yaseen U, Hassan I. Prevalence of various skin disorders in school going children of Kashmir valley of North India: A cross-sectional study. Indian J Paediatr Dermatol 2013;14:67-72.  Back to cited text no. 12
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13.
Reddy VS, Anoop T, Ajayakumar S, Bindurani S, Rajiv S, Bifi J. Study of clinical spectrum of pediatric dermatoses in patients attending a Tertiary Care Center in North Kerala. Indian J Paediatr Dermatol 2016;17:267-72.  Back to cited text no. 13
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14.
Upendra Y, Sendur S, Keswani N, Pallava A. Prevalence of dermatoses among the tribal children studying in residential schools of South Chhattisgarh, India. Indian J Paediatr Dermatol 2018;19:15-20.  Back to cited text no. 14
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

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



 

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