Skin is the mirror of the body¹. Skin of infants, children, adults and the elderly, with its anatomic and physiologic characteristics, acts as a barrier for different environmental insults, and undergoes certain changes in each period during human life². Apart from that it is the largest organ in the human body, with a surface area of about 2m2 and a total weight in adults of about 3 kg. It consists of 3 layers: outermost epidermis, dermis and the hypodermis. It plays an essential role in protecting the body against external threats ³.It is thin and more delicate in children therefore; they are more prone to develop skin disorders⁴.Particularly School going children are more frequently exposed to various risk factors since they are ignorant of the risk factors and maintain close contact with other children⁵.

Although skin disease is rarely lethal⁶, in delayed diagnosis or inadequate treatment some infections, for example bacterial infections, have the potential for serious sequelae such as nephritis, carditis, arthritis, and septicemia⁷.On the other hand, skin diseases particularly in children may result in considerable discomfort, parental anxiety, and embarrassment to the child and unnecessary absence from school. This in turn leads to loss of confidence and disruption of social relations, feeling of stigmatization and major changes in lifestyle⁵.

The pattern of skin diseases in any community is influenced by genetic constitution, climate condition, socioeconomic status, occupation, educational background, personal hygiene, customs, quality of medical care, family size, family history and overcrowding in school or household^8,9. Such factors give each community its unique pattern and account for the wide variation reported from different regions of the world and even in the same country⁸. For instance, eczema being the most common skin disorder in developed countries, while infections and infestations in the developing countries¹⁰. Children present a higher prevalence rate than adults for pyoderma (especially under 5 years of age), certain mycoses (tinea capitis) and, to a lesser extent, scabies¹¹ which contribute for 77.7% of the total burden of skin diseases¹³.

Objectives: To know the spectrum of paediatric dermatosis among patients and its age wise distribution presenting to OPD in tertiary care hospital

MATERIALS AND METHODS

Source of data: Children younger than 18 years presenting with new skin conditions in Department of Paediatric Kamineni Institute of medical sciences and Research Centre, Telangana was included in this study.

Type of study: Cross-sectional observational study

Sample size: 2000 was taken for the study

Incidence rate is 9%, P=0.09, q=1-p=0.9, L=allowable error is 15%

Sample size formula is n=4p(1-p) /L2

n=4(0.009)(0.91)/(0.09 x 0.15)2 = 1797.5

n=1798

Therefore, sample size of 2000 is considered for the study.12

Study subjects: Children younger than 18 years presenting with new skin conditions was considered. Diagnosis was mainly done clinically, but if the diagnosis are clinically unclear, further investigations was undertaken accordingly.

Study setting: Department of Pediatrics, Kamineni Institute Of Medical Sciences,Telangana.

Inclusion criteria:

All children between 0-18 completed years and ready to participate in study after consent from parents

Exclusion criteria:

Skin manifestations secondary to trauma, burns, scalds, abuse & assaults. The diagnosis was based on detailed history, clinical features and appropriate investigations such as KOH examination, Tzanck test, Grams-stained smear, hematological and biochemical investigations, skia grams, VDRL test, skin biopsy etc. if required investigations:  

If the diagnosis is not clear after thorough examination one or more diagnostic procedures may be indicated ex Biopsy of skin, Wood lamp, Tzanck smear, immunoflourance studies etc.

Statistically analysis: Data was entered into MS excel sheet and applied to SPSS software 19.0 IBM USA version for statistical analysis. Results were expressed in terms of qualitative data by percentage, frequencies and associations was done by Pearson’s chi square test. A ‘P’ value of<0.05 was considered significant.

RESULTS

Table 1: Distribution according to age

In our study we included 2000 paediatric subjects. Out of all, majority were from 10-18 years age group i.e. 1268 (63.4%) followed by 360(18%) from 6-10 years age group, 306 from 1-5 years age group (15.3%).

Table 2: Distribution according to sex

Out of 2000 subjects, 1105 i.e. 55.2% were males and 895 (44.8%) were females.

Table 3: Distribution according to prevalence of dermatological manifestations

Bacterial infections were the most common, with 258 cases (12.9%), indicating that bacterial etiology contributed the highest proportion among all categories. Fungal infections were the second most frequent, accounting for 201 cases (10.05%), showing a considerable burden of fungal infections in the study population. Parasitic infections constituted 138 cases (6.9%), reflecting a moderate prevalence compared to bacterial and fungal causes. Viral infections were the least common, with only 72 cases (3.6%), suggesting a relatively lower occurrence of viral etiology in the presented dataset.

Table 4: Age wise distribution of bacterial infection amongst study population

Chi square-89.28, p-0.0001, Highly significant

Proportions of bacterial infections were more in 10-18 years age (37.2%) compared to 6-10 (30.2%) and 1-5 i.e. 25.6%. There is statistically significant association found between age and bacterial infection (p<0.001).

Table 5: Age wise distribution of viral infection amongst study population

Chi square-58.49, p-0.0001, Highly significant

Proportions of viral infections were more in 6-10- and 10-18-years age (36.0%) each as compared to other age groups. There is statistically significant association found between age and bacterial infection (p<0.001).

Table 6: Age wise distribution of fungal infection amongst study population

Chi square- 48.74, p-0.0001, Highly significant

Proportions of fungal infections were more in 10-18 years age 112(35.9%) as compared to 54(17.3%) from 1-5 years age group. There is statistically significant association found between age and fungal infection (p<0.001).

Table 7: Age wise distribution of parasitic infection amongst study population

Chi square-5.42, p-0.14, Not significant

Proportions of parasitic infections were more in 10-18 years age 90(65.2%) as compared to 24(17.4%) each from 1-5- and 6-10-years age group. There is no statistically significant association found between age and fungal infection (p<0.001).

DISCUSSION

In our study we included 2000 paediatric subjects. Out of all, majority were from 10-18 years age group i.e. 1268 (63.4%) followed by 360(18%) from 6-10 years age group, 306 from 1-5 years age group (15.3%). Mean age of study population was found to be 12.3± 5.59 years. Out of 2000 subjects, 1105 i.e. 55.2% were males and 895 (44.8%) were females.

Out of 1105 males studied, majority i.e.685 (62%) were from 10-18 years age group followed by 222(20.1%) from 6-10 years age group and 162 from 1-5 years age group. Out of 895 females studied, majority i.e.583(65.1%) were from 10-18 years age group followed by 144(16.1%) from 1-5 years age group and 138(15.4%) were from 1-5 years age group.

Reddy VS¹⁴ in his study from Kerala found that out of 500 pediatric patients of age 18 and below, 243 (48.6%) were males and 257 (51.4%) females. Adolescent group constituted highest percentage (48%) followed by school age group, which constitutes 27.6% of total pediatric patients. A. O. Ogunbiyi et al¹⁵ Studied questionnaire for assessing factors associated with the prevalence of diseases was completed, and a complete physical examination was carried out on 1066 students. The study included 529 (49.6%) boys and 537 (50.4%) girls with a mean age of 8.8 ± 2.5 years. Sacchidanand et al¹⁶ observed 5–11 years is the common age group followed by adolescents with 33.21% and 29.81%, respectively. Sharma et al¹⁷ reported that pediatric dermatoses are more common in adolescent age group.

Spectrum of dermatitis with its prevalence:

Out of 2000 subjects examined, 1414 i.e. 70.7% had infective dermatosis and remaining had noninfective dermatoses. So, our findings are comparable with Jose G. et al ¹⁸ (68.2%), Rao et al¹⁹ (76.65%) and Valia et al²⁰ (53.6%). However, in Dogra and Kumar et al²¹ and Sharma et al.¹⁷ study, the prevalence of dermatoses was 38.80% and 14.30% which is less when compared to our study. This might be because of rural area and low socioeconomic status of the population.

Prevalence of Bacterial infections:

Out of 2000 subjects studied, 258 i.e. 12.9% had bacterial infection.  So, prevalence of bacterial infection was found to be 12.9%. Mean age of study population was found to be 9.51 ± 5.3 years. Out of all 258 subjects with bacterial infections, 102 subjects had impetigo i.e. 39.5% followed by 84 (32.6%) with pyoderma, 48(18.6%) with Folliculitis and 2.3% each having acne and furuncle. Proportions of bacterial infections were more in 10-18 years age (37.2%) compared to 6-10 (30.2%) and 1-5 i.e. 25.6%. There is statistically significant association found between age and bacterial infection (p<0.001). Balai M. et al²² observed that the prevalence of bacterial infection was found to be 13.7%. Out of bacterial infections, impetigo (84; 59.57%) was the commonest entity followed by secondary pyoderma (38; 26.95%). Commonly observed infection was pyoderma i.e. 59.5% followed by secondary pyoderma in 26.9%, Folliculitis in 9.22% and furuncles in 2.13%. Ajit Singh et al²³ observed that highest number of cases was seen in patients up to 10 years of age (109; 21.8%).

Prevalence of fungal infections:

Out of 2000 subjects studied, 201 i.e. 10.05% had fungal infection. So prevalence of bacterial infection was found to be 10.05%.

Out of 201 subjects with fungal infections, 72 had T. cruris (35.8%) followed by 66 (32.8%) each T. corporus and versicolor. 48 subjects (23.9%) had T. capitis. T. facia was seen in 18(9%) subjects.

Reddy VS et al¹⁴ observed in his study that fungal infections of the skin constituted 44.59% of the total infections and 13.2% of total dermatoses. Dermatophytic infections were the most common among these infections making up to 48.5%. Tinea corporis was found in a significant number of children forming 53.12% of dermatophytic infections and 3.4% of all dermatoses followed by tinea cruris. Tinea versicolor was seen in 39.4% of total fungal infections and 5.2% of the total dermatoses.

Prevalence of viral infections:

Out of 2000 subjects studied, 72 i.e. 3.6% had viral infection. So prevalence of bacterial infection was found to be 3.6%.

Viral warts were observed in 48 subjects (66.7%) followed by 12 (16.7%) had enanthemas. Herper labialis, Herpes simplex, Herpes zoster and P. Rosea were seen in 6 subjects with prevalence of 8.3%. Balai M. et al²²observed that molluscum contagiosum (21; 60%) was the commonest viral infection followed by warts (7; 20%).

In our study, we observed that proportions of viral infections were more in 6-10- and 10-18-years age (36.0%) each as compared to other age groups. There was statistically significant association found between age and bacterial infection (p<0.001). Proportions of males having viral infections were 58.3% as compared to 41.7% females. There is no statistically significant association found between gender and viral infection (p>0.05).

Jose G. et al ¹⁸ stated that prevalence of skin disease in their study has been found to be little bit common in boys (34.7%) than girls (33.5%) but its not statistically significant as P value is more than 0.05.

CONCLUSION

• The overall prevalence of dermatoses in the children in our study is 70.7% which is because of rural area and low socioeconomic status of the population in our area. Infectious dermatoses were seen in 35.25% of subjects. Noninfectious dermatoses were seen in 35.45% of subjects.
• Impetigo (39.5%) and pyoderma (32.6%) were most common bacterial dermatosis. Viral warts (66.7%) were commonly observed viral dermatosis. T. cruris (35.8%) and T. corporus and versicolor 66 (32.8%) each were commonest fungal infections.
• There is statistically significant association found between age and bacterial and fungal infection (p<0.05).

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