Distribution of the most common skin diseases according to age, sex, residence, social class, and season
The most common dermatoses can be categorized according to Bolognia et al.4 into infectious and noninfectious skin diseases. Infectious skin diseases included bacterial diseases such as impetigo (13.37%) and furunculosis (6.2%); fungal diseases such as tinea capitis (7.47%), tinea corporis (4.55%), pityriasis versicolor (1.95%), and candidiasis (1.37%); viral diseases such as chicken pox (9.15%) and warts (2.75%); and infestations such as pediculosis capitis (3.57%) and scabies (2.37%). Noninfectious skin diseases included eczematous dermatoses such as atopic dermatitis (5.17%), napkin dermatitis (3.85%), contact dermatitis (3.45%), pityriasis alba (2.65%), and cradle cap (1.72%), bites and stings in the form of papular urticaria (16.62%), adnexal diseases such as miliaria rubra (4.4%); papulosquamous dermatoses such as pityriasis rosea (1.6%); hair disorders such as alopecia areata (1.22%); and urticarias, erythemas, and purpura in the form of urticaria (1.07%).
The most common dermatoses in the first 2 years of life (group 1) were papular urticaria, followed by impetigo, napkin dermatitis, miliaria rubra, and furunculosis. Among children from 2.1 to 6 years of age (group 2), the most frequent diagnoses were papular urticaria, followed by impetigo, chicken pox, tinea capitis, and furunculosis. In primary school-aged children (group 3), chicken pox was the most common presentation, followed by tinea capitis, impetigo, pediculosis capitis, and warts (Table 2).
The male group had a higher frequency of papular urticaria, tinea capitis, atopic dermatitis, and pityriasis alba. The female group had a higher frequency of impetigo, pediculosis capitis, and pityriasis versicolor. The frequency of some dermatoses was almost equal in both sexes, for example, chicken pox, tinea corporis, and warts (Table 2 and Fig. 4).
In terms of the distribution of the most common dermatoses according to residence and social score, papular urticaria, contact dermatitis, napkin dermatitis, and warts were significantly higher among urban children, whereas impetigo, tinea capitis, and tinea corporis were significantly higher among rural children. Impetigo, tinea capitis, and pediculosis were significantly higher among children from a low social class, whereas papular urticaria, cradle cap, and candidiasis were significantly higher among children from a higher social class (Table 3).
The most common skin diseases detected in winter were papular urticaria, followed by impetigo and chicken pox, whereas the most prevalent ones in summer were impetigo, followed by furunculosis and miliaria rubra. However, in spring, the most common dermatoses were papular urticaria, followed by chicken pox and atopic dermatitis, whereas the most frequent dermatoses in autumn were impetigo, followed by papular urticaria, tinea capitis, pityriasis versicolor, and pityriasis rosea (Table 4).
In 1974, the first large epidemiologic survey of skin diseases in children was conducted in South Africa, with an analysis of 10 000 patients 7. A few similar studies were carried out later in other regions as Kuwait 8, India 9,10, Turkey 11,12, and Saudi Arabia 13.
In our study, bacterial infections were the most frequent (21.5%) in the category of infections and infestations. These results were similar to the findings of previous investigators 10,14. In the current study, among the bacterial infections, impetigo (13.37%) and furunculosis (6.2%) were the most common. Impetigo was common in rural areas with lower hygiene than urban areas and was also common in children with a low social score. Further, impetigo affected females more than males, which may be attributed to the highly significant concomitant infestation with pediculosis capitis.
Fungal infections were the second most common infection, constituting 15.35% of the cases. Among the fungal infections, tinea capitis (7.47%) and tinea corporis (4.55%) were common. A lower frequency was reported in previous studies 8,11,14. In the current study, tinea capitis affected males more than females, those in rural areas more than those in urban areas, children more than 6–12 years more than others as well as those from a low social class more than those from a high social class. These results are similar to those obtained by Al Samarai 15. The high rate of tinea capitis in males may be attributed to the easy implantation of spores because of short hair 16.
In the current study, viral infections constituted 13.5% of the cases. The most common presentation was chicken pox (9.15%), followed by warts (2.75%). A similar frequency had been observed in previous studies 8,11,13. As regards chicken pox, we reported an equal sex affection but with higher age predisposition (>6–12 years). These results are in agreement with those of other investigators who reported that viral infection was more frequent in school children, which could be related to frequent close contact among them and an increase in outdoor and sports activities 13. Also, in this study, there was a significant statistical relation between chicken pox and season (spring followed by winter), and this is in agreement with Deguen et al.17, who reported that transmission rates increased during school terms.
In the current study, parasitic skin infestations constituted 5.95% of the cases, among which pediculosis capitis (3.57%) and scabies (2.37%) were the most common presentations. A similar frequency was observed by Nanda et al.8. However, lower frequency was observed by others 10,12. In the present study, pediculosis capitis affected females more than males, with a ratio of 16 : 1. This can be attributed to longer hair among females and is in agreement with the results of other investigators 18,19. Also, children of school age more than 6–12 years were more affected and this is in agreement with the result of Aydemir et al.20. Moreover, children were more affected in autumn and winter, which emphasizes that transmission rates increase during school terms. Also, patients with a low social score were more affected and this is in agreement with previous studies 19,21.
The present study showed that eczematous dermatoses were common presentations and were found in 19.77% of the cases. Among eczematous dermatoses, atopic dermatitis (5.17%), napkin dermatitis (3.85%), contact dermatitis (3.45%), and pityriasis alba (2.65%) were common. A similar frequency was reported by Gul et al.11, whereas other studies reported higher frequencies 8,10,13,22,23. The discrepancy between the low figures in developing countries and the high figures in developed countries can be attributed to the difference in industrialization, the ‘hygiene-hypothesis’, and climate 9,24.
Papular urticaria was found in 16.62% of the cases, thus being the most common dermatologic disease reported in the current study. A lower frequency was reported by other investigators 9,10. This discrepancy between the different values of frequency of papular urticaria in different studies may be attributed to the difference in climate and biting habits of the insects 25. In our study, papular urticaria was more common in spring and this is in agreement with the results of other investigators 26,27, whereas Banerjee et al.28 reported higher frequency in the rainy season.
Miliaria rubra was found in 4.4% of the cases. It was more common in summer and in a younger age group (0–2 years) and this is in agreement with the result of Banerjee et al.28, who reported that the decrease in the prevalence of miliaria as children reach preschool age may be because of the development of some degree of tolerance to environmental factors.
Papulosquamous dermatoses were found in 2.52% of the cases including mainly pityriasis rosea (1.6%) and psoriasis (0.75%). A higher frequency was reported by other investigators 11,13,29. Similar to other studies, pityriasis rosea was more common in females 7, in older age groups (>6–12) 30, and in autumn 12.
Alopecia areata was found in 1.22% of the cases whereas a higher frequency was reported in other studies 8,11.
Urticaria was found in 1.07% of the cases. A similar frequency was reported by Nanda et al.8, whereas higher frequencies were reported by others 9,10,12,13.
In conclusion, the present study sheds light on the most frequent dermatoses encountered in Damietta Hospital, and provides the basis for better health services in this hospital. Infectious skin diseases represented a large proportion of the cases analyzed. Community-based studies need to be carried out to confirm and explore our findings to determine the magnitude and pattern of different types of dermatoses in Damietta affecting that age group, which could be a basis for future health plans.
Conflicts of interest
There are no conflicts of interest.
1. Jain N, Khandpur S. Pediatric dermatoses in India. Indian J Dermatol Venereol Leprol 2010; 76:451–454.
2. Dos Santos JB, De Barros Guimarães P, Oliveira Cordeiro L, Rodrigues De B, Corrêa PM, Oliveira Cordeiro L, Da Costa Carvalho S. Pediatric dermatoses at the Clinicas Hospital, Federal University of Pernambuco. An Bras Dermatol 2004; 79:289–294.
4. Bolognia JL, Jorizzo JL, Rapini RP.Dermatology 2008: 2nd ed.. USA: Mosby.
5. Fahmy S, El Sherbini AF. Determining simple parameters for social classifications for health research. Bull High Inst Public Health 1983; 13:95–108.
6. World Medical Association Declaration of Helsinki.Ethical principles for medical research involving human subjects. Revised by the 52nd WMA General Assembly, Edinburgh, Scotland. Available at: http://www.wma.net/e/policy/b3.htm
[Accessed 3 December 2012].
7. Findlay GH, Vismer HF, Sophianos T. The spectrum of pediatric dermatology: analysis of 10 000 cases. Br J Dermatol 1974; 91:379–387.
8. Nanda A, Al Hasawi F, Alsaleh QA. A prospective survey of pediatric dermatology clinic patients in Kuwait: an analysis of 10 000 cases. Pediatr Dermatol 1999; 16:6–11.
9. Karthikeyan K, Thappa DM, Jeevankumar B. Pattern of pediatric dermatoses in a referral center in south India. Indian Pediatr 2004; 41:373–377.
10. Sardana K, Mahajan S, Sarkar R, Mendiratta V, Bhushan P, Koranne RV, Garg VK. The spectrum of skin disease among Indian children. Pediatr Dermatol 2009; 26:6–13.
11. Gül U, Çakmak SK, Gönül M, Kiliç A, Bilgili S. Pediatric skin disorders encountered in a dermatology outpatient clinic in Turkey. Pediatr Dermatol 2008; 25:277–278.
12. Tamer E, Ilhan MN, Polat M, Lenk N, Alli N. Prevalence of skin diseases among pediatric patients in Turkey. J Dermatol 2008; 35:413–418.
13. Ben Saif GA, Al Shehab SA. Pattern of childhood dermatoses at a teaching hospital of Saudi Arabia. Int J Health Sci 2008; 2:63–74.
14. Shrestha R, Shrestha D, Dhakal AK, Shakya A, Shah SC, Shakya H. Spectrum of pediatric dermatoses in tertiary care center in Nepal. Nepal Med Col J 2012; 14:146–148.
15. Al Samarai AGM. Tinea capitis among Iraqi children: public health implication. J Clin Diagn Res 2007; 1:476–482.
16. Sehgal VN, Saxena AK, Kumari S. Tinea capitis. A clinicoetiologic correlation. Int J Dermatol 1985; 24:116–119.
17. Deguen S, Thomas G, Chau NP. Estimation of the contact rate in a seasonal SEIR model: application to chickenpox incidence in France. Stat Med 2000; 19:1207–1216.
18. Inanir I, Turhan Şahin M, Gündüz K, Dinç G, Türel A, Serap Öztürkcan D. Prevalence of skin conditions in primary school children
in Turkey: differences based on socioeconomic factors. Pediatr Dermatol 2002; 19:307–311.
19. Kamiabi F, Nakhaei FH. Prevalence of pediculosis capitis and determination of risk factors in primary-school children in Kerman. East Mediterr Health J 2005; 115–6988–992.
20. Aydemir EH, Unal G, Kutlar M, Onsun N. Pediculosis capitis in Istanbul. Int J Dermatol 1993; 32:30–32.
21. Dogra S, Kumar B. Epidemiology of skin diseases in school children: a study from northern India. Pediatr Dermatol 2003; 20:470–473.
22. Wenk C, Itin PH. Epidemiology of pediatric dermatology and allergology in the region of Aargau, Switzerland. Pediatr Dermatol 2003; 20:482–487.
23. Afsar FS. Pediatric dermatology in practice: spectrum of skin diseases and approach to patients at a Turkish pediatric dermatology center. Cutan Ocul Toxicol 2011; 30:138–146.
24. Henderson CA. The prevalence of atopic eczema in two different villages in rural Tanzania. Br J Dermatol 1995; 133Suppl 4550–53.
25. Nair BKH, Nair TVGValia RG, Valia AR. Diseases caused by arthopods. IADVL textbook and atlas of dermatology 2001: 2nd ed.. Mumbai, India: Bhalani; 323–355.
26. Stibich AS, Schwartz RA. Papular urticaria. Cutis 2001; 68:89–91.
27. Demain JG. Papular urticaria and things that bite in the night. Curr Allergy Asthma Rep 2003; 3:291–303.
28. Banerjee S, Gangopadhyay DN, Jana S, Chanda M. Seasonal variation in pediatric dermatoses. Indian J Dermatol 2010; 55:44–46.
29. Al Mendalawi MD, Ibrahim JG. Pattern of dermatoses in Iraqi children. East Mediterr Health J 2012; 18:365–371.
30. Chuh A, Lee A, Zawar V, Sciallis G, Kempf W. Pityriasis rosea – an update. Indian J Dermatol Venereol Leprol 2005; 71:311–315.
Keywords:© 2014 Egyptian Women's Dermatologic Society
Damietta Hospital; pattern of skin diseases; preschool children; primary school children