A Clinical Study of the Pattern of Dermatoses among Schoolgoing Children Attending a Tertiary Care Center in North Karnataka : Indian Journal of Paediatric Dermatology

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Original Article

A Clinical Study of the Pattern of Dermatoses among Schoolgoing Children Attending a Tertiary Care Center in North Karnataka

Chitapur, Umamaheshwari G.; Athanikar, Sharatchandra B.1; Kikkeri, Naveen Narayanshetty1; Prabhu, Sweta R.1

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Indian Journal of Paediatric Dermatology 23(3):p 225-229, Jul–Sep 2022. | DOI: 10.4103/ijpd.ijpd_6_22
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Abstract

Introduction

Pediatric dermatoses are a distinct group of disorders, comprising skin problems encountered during childhood and adolescence.[1] Pediatric dermatoses require a separate view from adult dermatoses as children are not merely “small adults,” and there are important differences in clinical presentation, treatment, and prognosis of various dermatoses.[2]

Dermatological problems constitute at least 30% of all outpatient visits to a pediatrician and a similar number of visits to a dermatologist involve children.[34] The prevalence of skin diseases among children in various parts of India ranges from 8.7% to 35%.[25]

Skin diseases are common in schoolgoing children and can spread easily due to close contact with each other and these can be prevented by providing effective health education to the children, parents, and teachers. We have taken up this study to assess the clinical pattern and prevalence of various dermatoses among schoolgoing children (5–14 years) at our tertiary care center.

Materials and Methods

This hospital-based descriptive study was conducted in the department of dermatology at a tertiary care center in North Karnataka over a period of 1 year from November 2018 to October 2019. Ethical permission was duly obtained from the institutional ethics and research board (Approval number: SDMIEC/PG/0183/12-11-2018).

Inclusion criteria

Schoolgoing children in the 5–14 years age group with dermatological disorders attending the dermatology outpatient department were enrolled for the study.

Exclusion criteria

Children <5 years and more than 14 years of age were excluded from the study.

A predesigned pro forma was used for all cases. After obtaining informed written consent from the parents or guardians, detailed history was taken which included onset, progression, duration of the skin lesions, past history, family history, associated dermatoses, systemic manifestations, and treatment history. Clinical examination and relevant laboratory investigations such as the scraping of a lesion for potassium hydroxide wet mount, Gram stain, pus culture and sensitivity, Wood's lamp evaluation, skin biopsy, and other relevant hematological and biochemical investigations were done to confirm the diagnosis in doubtful cases. The obtained data were analyzed by descriptive statistics such as frequencies and percentages using SPSS 23.0 (Released 2015. Armonk, NY: IBM Corp.).

Results

A total number of 550 patients belonging to the age group of 5–14 years were evaluated for the pattern of skin disease in this study. The number of children <10 years of age was 335 (60.9%) and 215 (39.1%) were more than 10 years. Two hundred ninety-one (52.9%) were male and 259 (47.1%) were female and an overall male preponderance was seen with a male: female ratio of 1.12:1.

Most common pattern of dermatoses observed were infections and infestations constituting 40.5% (223 cases), followed by eczema/dermatitis constituting 14.4% (79 cases) [Table 1].

T1-7
Table 1:
Distribution according to the pattern of dermatoses (n=550)

Of the total of 223 (40.5%) children with infections and infestations, fungal infections were predominant affecting 77 children (14%) closely, followed by parasitic infestations seen in 76 children (13.8%) [Table 2].

T2-7
Table 2:
Distribution of infections and infestations (n=223)

Among the bacterial infections, impetigo and folliculitis were the most common constituting 40.91% (9 cases) each, followed by furuncle 13.63% (3) [Figure 1]. Among the fungal infections, tinea corporis constituted the highest percentage of 27.3% (21), followed by tinea corporis with tinea cruris at 22.1% (17) [Figure 2]. Among the viral infections, verruca/viral wart (palmar wart – 12, facial wart – 9, plantar wart – 6) was the most common constituting 56.2% (27), followed by varicella constituting 25% (12) [Figure 3]. Scabies was the most common parasitic infestation constituting 93.4% (71) of the infestation group and pediculosis constituted 6.6% (5) [Figure 4].

F1-7
Figure 1:
Distribution of bacterial infections (n = 22)
F2-7
Figure 2:
Distribution of fungal infections (n = 77)
F3-7
Figure 3:
Distribution of viral infections (n = 48). HFMD: Hand–foot–mouth disease
F4-7
Figure 4:
Distribution of parasitic infestations (n = 76)

Among the eczematous diseases, endogenous eczema (46 cases) was more common than exogenous eczema (33 cases). Pityriasis alba (27 cases) was the most common endogenous eczematous disease, followed by atopic dermatitis (15 cases). Irritant contact dermatitis (15 cases) was the most common exogenous eczematous disease [Figure 5].

F5-7
Figure 5:
Distribution of eczematous diseases (n = 79). AD – Atopic dermatitis; SD – Seborrheic dermatitis; ACD – Allergic contact dermatitis; ICD – Irritant contact dermatitis

Among the papulosquamous disorders, psoriasis was the most common disease constituting 31.6% (12), followed by lichen planus constituting 28.9% (11) and pityriasis rosea 26.3% (10). Lichenoid disorders constituted 10.5% (4) and pityriasis rubra pilaris 2.6% (1).

Among the pigmentary disorders, vitiligo (25 cases) was the most common disease seen in children. Vitiligo vulgaris (16) was the most common presentation, followed by mucosal vitiligo (5), localized vitiligo (3), and acral vitiligo (1). Three patients were diagnosed to have previtiligo or early vitiligo.

Among the hypersensitivity disorders, acute urticaria (17 cases) was most common followed by papular urticaria (14), chronic urticaria (2), and dermographism (1).

Keratinization disorders constituted 4% (22) of all the dermatoses in this study. Palmoplantar keratoderma (11) was the most common disease, followed by keratolysis exfoliativa (7). Other diseases seen were ichthyosis (2; one case each of ichthyosis vulgaris and lamellar ichthyosis), pachyonychia congenita (1), and keratosis pilaris (1).

Hair disorders constituted 4.4% (24) of all the disorders. Fourteen cases of alopecia areata, six cases of premature canities, two cases of chronic telogen effluvium, and one case each of traction alopecia and female pattern hair loss were seen.

Phrynoderma (13 cases) was the most common disease seen among nutritional disorders. Nevi constituted 0.9% of all dermatoses. Nevus depigmentosus, epidermal nevus, congenital melanocytic nevus, linear and whorled nevoid hypermelanosis, and nevoid sebaceous hyperplasia constituted one case each.

Among the sebaceous gland disorders, 19 cases of acne vulgaris and one case of truncal acne were seen. Among photodermatoses, 18 cases of polymorphic light eruption were seen.

Other dermatoses such as connective tissue diseases (5 cases: morphea – 4, Parry–Romberg syndrome – 1), sweat gland disorders (6 cases: palmoplantar hyperhidrosis – 4, miliaria crystallina – 2), perforating diseases (2 cases of reactive perforating collagenosis), vesiculobullous disease (one case of chronic bullous dermatosis of childhood), developmental defects (2 cases of aplasia cutis), necrobiotic disorder (one case of granuloma annulare), disorder of lymphatics (one case of lymphangioma circumscriptum), acanthosis nigricans (4 cases), adverse drug reaction (5 cases: erythema multiforme – 2, Stevens–Johnson syndrome – 3), keloid and hypertrophic scar (5), xerosis (7), and prurigo simplex (6) were also observed.

Discussion

In the present study, of 550 children aged 5–14 years, majority belonged to <10 years age group constituting 60.9% (335 children), followed by more than 10 years age group constituting 39.1% (215 children). This is in accordance with similar kinds of studies done by Gupta et al.,[6] wherein the highest number of children belonged to the 7–8 years age group and Gupta.[7] in which the highest number of children were 5–10 years old.

The number of male children was 291 constituting 52.9% and female children were 259 (47.1%) with a male: female ratio of 1.12:1. These findings were similar to other studies conducted by Jose et al.[8] and Nagarajan et al.[9] in which males outnumbered females.

In the present study, the most common pattern of dermatoses was infections and infestations constituting 40.5% (223 cases). The next most common was eczema/dermatitis constituting 14.4% (79 cases). This was in accordance with similar studies conducted by Gupta et al.,[6] Reddy et al.,[10] Kiprono et al.,[11] and Nagarajan et al.[9] The school environment makes children vulnerable to the cross-transmission of communicable skin diseases among themselves.

Among 223 (40.5%) children with infections and infestations in the present study, fungal infections were most commonly observed (14%). This was followed by parasitic infestations, viral infections, and bacterial infections which constituted 13.8%, 8.7%, and 4%, respectively. The results were comparable to other studies conducted by Baskaran et al.,[12] Sangameshwara and Venkatesh,[13] Poudyal et al.,[14] Reddy and Narasimha Rao,[15] Gupta et al.,[6] and Kiprono et al.[11] In all these studies, fungal infection was the most common infection. Parasitic was the second most common in studies conducted by Baskaran et al.,[12] Poudyal et al.,[14] Reddy and Narasimha Rao.,[15] and Gupta et al.,[6] as noted in our study. The higher prevalence of fungal infection seen in the elderly could be one of the reasons for the similar higher prevalence in children.

In the present study, impetigo and folliculitis were the most common bacterial infections. In studies conducted by Baskaran et al.,[12] Gupta et al.,[6] Kiprono et al.,[11] Reddy and Narasimha Rao,[15] and Sangameshwara and Venkatesh,[13] impetigo was the most common bacterial infection.

Tinea corporis was the most common fungal infection in our study, followed by tinea cruris with corporis. Similar results were seen in Gupta et al.[6] and Reddy et al.[10]

Among the viral infections, viral wart/verruca was found to be most common, followed by varicella. Verruca was also the most common viral infection in similar other studies conducted by Gupta et al.,[6] Poudyal et al.,[14] Kiprono et al.,[11] and Sangameshwara and Venkatesh.[13]

Scabies was the most common parasitic infestation in our study, followed by pediculosis. These results were comparable to studies done by Baskaran et al.,[12] Gupta et al.,[6] and Reddy and Narasimha Rao.[15]

Eczematous diseases were the second most common group of dermatoses in the present study. Among the eczemas, pityriasis alba was found to be the most common disease. This was in concordance with other studies conducted by Gupta et al.[6] and Hassan et al.,[16] while in another study conducted by Sacchidanand et al., atopic dermatitis was the most common eczematous dermatitis.[2]

Among the papulosquamous disorders which constituted 6.9% of total dermatoses in this study, psoriasis was the most common disease. Similar results were seen in studies conducted by Sacchidanand et al.[2] and Karthikeyan et al.[17] Palmoplantar keratoderma was the most common disease among keratinization disorders in our study, while in a study conducted by Thappa et al., ichthyoses and palmoplantar keratoderma were the most common diseases.[3]

Pigmentary disorders constituted 5.1% of total dermatoses in the present study and vitiligo was the most common disease. Similar prevalence was noted in studies conducted by Sacchidanand et al.[2] and Karthikeyan et al.[17]

In the present study, alopecia areata was the most common disease among hair disorders. This was in concordance with the study conducted by Vora et al.[18] Nutritional dermatoses constituted 2.5% of all the dermatoses in this study and phrynoderma was the most common disease. A similar prevalence was seen in the study conducted by Karthikeyan et al.[17] Acne vulgaris was the most common disease among sebaceous gland disorders in our study. This was in concordance with the study conducted by Gupta et al.[6]

The highest number of infections and infestations seen in our study can be attributed to lack of awareness among children, overcrowding, malnutrition, and poor hygiene. Hence, these dermatoses can be prevented by effective health education among children and their parents and by stressing upon the importance of improving sanitation, nutrition, and personal hygiene.

Furthermore, conducting camps in schools at regular intervals might help in the early diagnosis and treatment of skin disease and hence decrease the transmission of communicable skin diseases.

The limitation of our study was that it was conducted in a single center and the sample size was small. A large, prospective multicentric study is needed to know more about the clinical pattern and prevalence of pediatric dermatoses.

Conclusion

The present study was undertaken to determine the clinical pattern and prevalence of various dermatoses among schoolgoing children. A higher frequency of skin diseases was seen in children <10 years of age with a slight male preponderance. Infections and infestations were more prevalent compared to noninfectious diseases. Fungal infections were most common among infections and infestations, followed by parasitic, viral, and bacterial infections. Eczematous disorders were more prevalent among noninfectious diseases, followed by papulosquamous, hypersensitivity, and pigmentary disorders.

A detailed knowledge about the pattern of dermatoses among children of schoolgoing age group in each geographic area will help us in implementing essential changes in health education and disease control strategies in the area concerned.

Declaration of consent

The authors certify that they have obtained all appropriate consent forms, duly signed by the parents/guardians of the patient. In the form, the parents/guardians have given their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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Keywords:

Child; pediatric dermatoses; the pattern of dermatoses; schoolgoing children; skin diseases

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