|Year : 2021 | Volume
| Issue : 1 | Page : 29-36
Pattern of Dermatoses in Small Children in a Tertiary Care Hospital
Ritu Gujarati1, Siva Rami Reddy2, T Naresh Babu2, B Janardhan2
1 Department of Dermatology, Venereology and Leprosy, Osmania Medical College, Hyderabad, Telangana, India
2 Department of Dermatology, Venereology and Leprosy, Bhaskar Medical College, Hyderabad, Telangana, India
|Date of Submission||21-Dec-2019|
|Date of Decision||20-Jan-2020|
|Date of Acceptance||26-Apr-2020|
|Date of Web Publication||31-Dec-2020|
Flat No. 203, Venkataramana Residency, 2nd Cross, Road No 2, Rocktown Colony, Nagole, Hyderabad - 500 068, Telangana
Source of Support: None, Conflict of Interest: None
Aims: The aim of the study was to study the pattern of dermatoses in children up to 5 years of age. Settings and Design: It is an observational study done in a tertiary care hospital. Subjects and Methods: A total of 505 patients, aged up to 5 years, attending the department of dermatology, venereology, and leprosy for a duration of 18 months from January 2017 to June 2018 were included in the study. Statistical Analysis Used: All results were statistically analyzed by IBM SPSS software and Chi-square test was used to compare the associations. Results: Preschoolchildren (75.44%) formed the majority. Males (54.65%) outnumbered females. Infections constituted the most (45.94%) followed by eczema (21.98%), hypersensitivity disorders (14.25%), nevi (4.55%), papulosquamous (3.76%), pigmentary (3.76%), physiological and transient noninfective neonatal conditions (3.56%), sweat gland (2.97%), hair disorders (0.59%), and other dermatoses (2.97%). Conclusions: Infections/infestations constituted the most among the dermatoses in children up to 5 years of age. As they are preventable, educating the parents, guardian, care takers, and teachers in the preschool about communicable diseases can limit their transmission and improve the well-being of children.
Keywords: Pediatric dermatoses, pattern, up to 5 years
|How to cite this article:|
Gujarati R, Reddy SR, Babu T N, Janardhan B. Pattern of Dermatoses in Small Children in a Tertiary Care Hospital. Indian J Paediatr Dermatol 2021;22:29-36
|How to cite this URL:|
Gujarati R, Reddy SR, Babu T N, Janardhan B. Pattern of Dermatoses in Small Children in a Tertiary Care Hospital. Indian J Paediatr Dermatol [serial online] 2021 [cited 2021 May 6];22:29-36. Available from: https://www.ijpd.in/text.asp?2021/22/1/29/305800
| Introduction|| |
Skin lesions are common in children and are influenced by diet, external environment, socioeconomic status, malnutrition, overcrowding, and personal hygiene, especially in the developing countries. Infections/infestations are more common in preschool and school-going children. Nutritional dermatoses need attention. Chronic dermatoses can have a psychological impact. Most of the genetic diseases with skin manifestations have their onset in early childhood.
Early recognition and identification of these skin lesions is necessary. Inflammatory and infectious lesions need prompt treatment to prevent more serious sequelae of progressive infection and scarring.
Skin lesions in children form an area of apprehension to the parents. Hence, they are very important for us to identify them. Counseling, explaining about the condition to the parents/guardian and reassurance, plays a very important role in pediatric patients.
Children form a major group among our outpatients. This study was done to assess the pattern of dermatoses in children up to 5 years of age in a tertiary care hospital.
| Subjects and Methods|| |
It is an observational study done in a tertiary care hospital at Bhaskar Medical college/ Bhaskar General Hospital, Moinabad, Telangana. Permission was granted by the ethical committee for undertaking the study. Patients aged up to 5 years attending the department of dermatology, venereology, and leprosy (outpatients, inpatients, and referral cases) for a duration of 18 months from January 2017 to June 2018 were included in the study. A total of 505 patients were studied. Patients unwilling to participate in the study were excluded.
Informed consent was obtained from parents/guardian of all patients. A detailed history was taken, and thorough general, systemic, and cutaneous examination was conducted and recorded. Photographs of cutaneous lesions in every patient were taken with consent. Relevant investigations were done whenever needed.
All results were statistically analyzed by IBM SPSS software (IBM SPSS Inc., Chicago, Illinois, USA) and Chi-square test was used to compare the associations.
| Results|| |
A total of 505 patients were studied
A maximum number of patients were preschoolchildren (75.44%), followed by infants (20.99%) and neonates (3.56%). Males, 276 (54.65%), outnumbered females 229 (45.34%). A maximum number of parents/guardians were farmers (20%), followed by laborers (19.20%), drivers (9.90%), and others. Majority of the patients were from rural area. Most of the children were delivered by normal vaginal delivery (72.87%), followed by elective cesarian section (25.74%), emergency cesarian section (0.99%), and forceps (0.39%). Majority of the children were term (94.85%), followed by preterm (4.95%) and postterm (0.19%). Good number of the children were weighing 2.5 kg or more at birth (74.65%), followed by low birth weight (25.34%). Atopy was present in 24.35% of the patients. Papular urticaria constituted the most (14.63%), followed by atopic eczema (13.82%), pityriasis alba (11.38), and others. Majority of the patients were single child at home (47.92%). A total of 36 cases had a history of consanguinity (7.12%). First-degree consanguinity was seen among 1.18% of the patients. Atopic eczema constituted the most among them. Second-degree consanguinity was seen in 5.94% of the cases. Pityriasis alba and nummular eczema constituted the maximum among them.
There were a total of 85 types of dermatoses seen in the study. Infections constituted the most (45.94%) followed by eczema (21.98%), hypersensitivity disorders (14.25%), nevi (4.55%), papulosquamous disorders (3.76%), pigmentary disorders (3.76%), physiological and transient noninfective neonatal conditions (3.56%), sweat gland disorders (2.97%), hair disorders (0.59%), and others (2.97%) [Table 1].
|Figure 1: (a) Tinea corporis, (b) KOH × 100 – fungal hyphae, (c) tinea capitis, (d) lupus vulgaris|
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|Figure 4: (a) Epidermal nevus, (b) nevus depigmentosus, (c) hemangioma, (d) lichen sclerosus et atrophicus|
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Among infections, bacterial infections were maximum (42.67%), followed by scabies (22.84%), fungal (19.36%), and viral (15.08%) infections. Among bacterial infections, the most common was impetigo (59.59%), followed by scalp folliculitis (13.13%), folliculitis (12.12%), furunculosis (7.07%), and others. Among fungal infections, tinea capitis was most common (44.44%), followed by tinea corporis (33.33%), candidal intertrigo (13.33%), and others. Hand–foot–mouth disease was most prevalent (45.71%) among viral infections followed by molluscum contagiosum (20%), varicella (8.57%), and others.
Eczema was the second most prevalent condition (21.98%) after infections. A total of nine types of eczema were observed. Among them, pityriasis alba was most common (31.53%), followed by atopic eczema, seborrheic dermatitis (20.72% each), nummular eczema (12.61%), and others. Least common was pompholyx (0.90%).
Hypersensitivity disorders were seen in 14.25% of the patients. Papular urticaria was most common (65.27%) followed by urticaria (27.77%) and insect bite reactions (6.94%) among them. Urticaria constituted 27.77% of all hypersensitivity cases. Four types of urticaria were seen. Among them, acute urticaria constituted 80% of the cases, followed by acute urticaria with angioedema (10%), pressure urticaria (5%), and chronic spontaneous urticaria (5%).
Nevi constituted 4.55% of all the cases. Of them, most common was hemangioma (34.78%), followed by mongolian spot (26.08%), nevus depigmentosus (21.7%), nevus of Ota, nevus of Ito, nevus spilus, and epidermal nevus (4.34% each).
Papulosquamous disorders were seen in 3.76% of the cases. Lichen spinulosus was most common (47.36%), followed by lichen striatus (26.31%), lichen nitidus (15.78%), and psoriasis the least (10.52%) of the patients. Lichen planus was not seen.
Pigmentary disorders constituted 3.76% of the cases. Among them, vitiligo was most common, seen in 63.15% of the cases, followed by cafe au lait macule (15.78%), post-inflammatory hypopigmentation (10.52%), pigmentary demarcation line (5.26%), and linear and whorled nevoid hypermelanosis (5.26%). Of the total vitiligo cases, vitiligo vulgaris was most common (50%), followed by focal (25%), lip tip (16.66%), and acral vitiligo constituting the least.
Physiological and transient noninfective neonatal dermatoses constituted 3.56% of all the cases. Among them, erythema toxicum neonatorum was seen in 72.22% of the patients, followed by occipital alopecia (16.66%), transient pustular melanosis, and neonatal acne (5.55% each).
Sweat gland disorders constituted 15 (2.97%) cases. Miliaria crystallina (46.66), miliaria rubra (46.66), and apocrine hidrocystoma (6.66%) were among them.
Hair disorders were seen in a total of 3 (0.59%) cases. These included canities (33.33%), alopecia areata (33.33%), and trichoepithelioma (33.33%).
Other dermatoses constituted 2.97% of the cases. Minor aphthae, dermatofibroma, lichen sclerosus et atrophicus, keratosis circumscripta, milia, acanthosis nigricans, polymorphic light eruption, ichthyosis vulgaris, Henoch–Schonlein purpura, burns, pruritus ani, phrynoderma, and perianal fistula were the cases among them.
Majority of the conditions were common in males such as erythema toxicum neonatorum (61.53%), nummular eczema (71.42%), atopic eczema (60.8%), seborrheic dermatitis (52.17%), impetigo (52.54%), scalp folliculitis (76.92%), hand–foot–mouth disease (75%), tinea corporis (66.66%), tinea capitis (71.42%), scabies (62.26%), and papular urticaria (51.06%). Pityriasis alba (54.28%) and mongolian spot (66.66%) were seen more common in females. Preschoolchildren constituted most of the cases of nummular eczema, atopic eczema, seborrheic dermatitis, impetigo, folliculitis, scalp folliculitis, hand foot mouth disease, tinea corporis, tinea capitis, scabies, and papular urticaria. Seborrheic dermatitis (78.26%) and mongolian spot (83.33%) were more common in infants. Erythema toxicum neonatorum (53.84%) was seen most commonly in the 1st week of life.
There was more than one dermatological condition in 22 patients (4.35%).
| Discussion|| |
Skin diseases are a major cause of morbidity in pediatric population. They require a separate view from adult dermatoses due to important differences in clinical presentation, treatment, and prognosis. Due to different anatomical, physilogical and biochemical nature of skin, most pediatric dermatoses are attributable to physical factors, infections, and allergens. Most of the genodermatoses, congenital, and nevoid disorders, also manifest during early childhood. Among pediatric patients, the prevalence of dermatoses varies in different age groups, with children of preschool age showing higher prevalence of skin diseases compared to other age groups. The disease pattern differs from region to region, within the same country, due to different ecological factors.,
A retrospective study from a large pediatric hospital in Delhi, a referral center of North India, compared the pattern of dermatoses in different age groups within the pediatric population. They were grouped into three categories based on their age at first visit: Infants (<1 year), pre-schoolchildren (1–5 years), and school-children (5–12 years). Most of the skin diseases were seen in the 1–5 years of age group (44.94%).
This study was undertaken to know the prevalence of skin diseases among the pre-schoolchildren including infants and neonates who presented to the department of dermatology, venereology, and leprosy in a tertiary care center.
A total 505 cases were studied which included neonates, infants, and preschoolchildren. Majority of the cases were preschoolchildren (75.44%) which was as that of Jain and Khandpur, Rawat (P = 0.052) [Table 2], Sardana et al., and Hassan et al.
Males outnumbered females (54.65%) which was like studies done by Awal et al. (56.6%) (P = 0.4), Rawat (59.11%) (P = 0.07), Sardana et al., Bisht et al. (56.58%) (P = 0.5), Balai et al. (55.15%) (P = 0.85) [Table 2], Jawade et al., Patel et al., and Sacchidanand et al. This contrasted with Karthikeyan et al. where females constituted majority of cases.
When coming into the pattern of dermatoses, infection and infestations were most common constituting to 45.94% like that of Awal et al. (41.1%) (P = 0.07), Rawat (50.29%) (P = 0.08) [Table 2], Patel et al. (38.43%), Sacchidanand et al. (32.47%), Karthikeyan et al. (54.5%), Nagarajan et al. (36.25%), Bhatia (63.5%), Negi et al., (50.9%), Sayal et al., (31%), and Reddy et al. (33.8%) but contrasted with Vora et al. where noninfectious conditions were majority (79.60%) because of proper hygienic condition.
Bacterial infections were most common (19.60%) in this study like in Awal et al., (14.5%), Balai et al. (13.72%)(in higher percentages [P value being significant]) [Table 2], Sharma et al. (37.5%), Ghosh et al. (35.6%), and Solanki et al. (23.52%).
Only scabies was seen among parasitic infestations and constituted 10.49% of the cases as that of Balai et al. Unlike this study, scabies was most common of all infections and infestations in a study done by Jawade et al. (24.49%) and Sharma and Mendiratta (46.44%). Pediculosis capitis constituted the maximum in a study done by Bhatia (20.4%) and Negi et al. (22.6%). Fungal infections were seen in 8.91%. Unlike this study, fungal infections were most common among infections and infestations in a study done by Sangameshwara and Venkatesh. Viral infections were seen in 6.93%. Hand–foot–mouth disease was the most common as that of Bisht et al.
Dermatitis was the next common condition seen in 21.98% like 26.9% in Bisht et al. Pityriasis alba was most common in this study in contrast to atopic dermatitis (or Atopic Eczema (AE)) in Awal et al., Rawat, and Balai et al. Papulosquamous, pigmentary, and nutritional disorders are compared in [Table 2].
- Sample size was small when compared to other studies
- Most of the patients lost for follow-up
- Most of the parents did not reveal their monthly income. Socioeconomic status could not be corelated
- Only one biopsy could be done (lupus vulgaris case) as rest of the parents did not consent for it.
| Conclusion|| |
Infections/infestations were most common (45.94%) among all cases. Early diagnosis and prompt treatment can prevent complications. Educating the parents, guardian, caretakers, and teachers in the preschool about communicable diseases can limit their transmission. Maintenance of good personal hygiene can be helpful. This study shows the pattern of dermatoses in children up to 5 years of age in a tertiary care hospital.
- We acknowledge all the patients
- Professor and Head, Department of Pediatrics, Bhaskar Medical college, Moinabad, Telangana.
- Professor and Head, Department of Obstetrics and Gynecology, Bhaskar Medical College, Moinabad, Telangana.
- Dr. N Balakrishna, Scientist E (Retired), Division of Biostatistics, National Institute of Nutrition, Hyderabad.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jain N, Khandpur S. Paediatric dermatoses in India. Indian J Dermatol Venereol Leprol 2010;76:451-4.
] [Full text]
Awal G, Singh SP, Sharma S, Kaur J. Spectrum and pattern of paediatric dermatoses in under five population in a tertiary care center. Int J Res Dermatol 2016;2:69-76.
Rawat SD. A study of dermatoses in preschool children at a tertiary care hospital in Uttarakhand. Int J Appl Res 2016;2:879-82.
Sardana K, Mahajan S, Sarkar R, Mendiratta V, Bhushan P, Koranne RV, et al
. The spectrum of skin disease among Indian children. Pediatr Dermatol 2009;26:6-13.
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]
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. [Full text]
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]
Jawade SA, Chugh VS, Gohil SK, Mistry AS, Umrigar DD. A clinico-etiological study of dermatoses in paediatric age group in tertiary health care center in South Gujarat region. Indian J Dermatol 2015;60:635.
] [Full text]
Patel JK, Vyas AP, Berman B, Vierra M. Incidence of childhood dermatosis in India. Skinmed 2010;8:136-42.
Sacchidanand S, Sahana MS, Asha GS, Shilpa K. Pattern of pediatric dermatoses at a referral centre. Indian J Pediatr 2014;81:375-80.
Karthikeyan K, Thappa DM, Jeevankumar B. Pattern of paediatric dermatoses in a referral center in South India. Paediatrics 2004;41:373-7.
Nagarajan K, Thokchom NS, Ibochouba K, Verma K, Hafi NA. Pattern of paediatric dermatoses in Northeast India. Indian J Paediatr Dermatol 2017;18:286-91. [Full text]
Bhatia V. Extent and pattern of paediatric dermatoses in rural areas of central India. Indian J Dermatol Venereol Leprol 1997;63:22-5.
] [Full text]
Negi KS, Kandpal SD, Parsad D. Pattern of skin diseases in children in Garhwal region of Uttar Pradesh. Indian Pediatr 2001;38:77-80.
Sayal SK, Bal AS, Gupta CM. Pattern of skin diseases in paediatric age group and adolescents. Indian J Dermatol Venereol Leprol 1998;64:117-9.
] [Full text]
Reddy VS, Anoop T, Ajayakumar S, Bindurani S, Rajiv S, Bifi J. Study of clinical spectrum of paediatric dermatoses in patients attending a Tertiary Care Center in North Kerala. Indian J Paediatr Dermatol 2016;17:267-72. [Full text]
Vora R, Bodiwala N, Patel S. Prevalence of various dermatoses in school children of Anand district. Natl J Community Med 2012;3:100-3.
Sharma R, Rathore BS, Krishna A. Clinical pattern of cutaneous infections and infestations in paediatric age. Indian J Paediatr Dermatol 2016;17:263-6. [Full text]
Ghosh SK, Saha DK, Roy AK. A clinico-aetiological study of dermatoses in paediatric age group. Indian J Dermatol 1995;40:29-31. [Full text]
Solanki A, Chauhan A. Clinicohistopathological profile of 85 paediatric patients attending skin outpatient department: A retrospective analysis at a municipal hospital of middle-east region of Ahmedabad. Indian J Paediatr Dermatol 2016;17:258-62. [Full text]
Sharma RC, Mendiratta V. Clinical profile of cutaneous infections and infestations in paediatric age group. Indian J Dermatol 1999;44:174-8. [Full text]
Sangameshwara GM, Venkatesh U. Clinical study of cutaneous infection in children: Changing trends. Indian J Paediatr Dermatol 2015;16:136-8. [Full text]
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]