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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 21  |  Issue : 2  |  Page : 111-115

Prevalence of skin diseases in rural Central India: Acommunity-based, cross-sectional, observational study


1 Department of Skin and VD, MGIMS, Sevagram, Wardha, Maharashtra, India
2 Department of Community Medicine, MGIMS, Sevagram, Wardha, Maharashtra, India
3 Department of Medicine, MGIMS, Sevagram, Wardha, Maharashtra, India

Date of Web Publication31-Aug-2016

Correspondence Address:
Sonia Jain
Department of Skin and VD, MGIMS, Sevagram, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9903.189537

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  Abstract 

Aim: To identify prevalence of skin diseases and to determine the risk factors of skin diseases among the adult population of rural Central India. Materials and Methods: It was a community-based, observational study in which we prospectively recruited general population in and around Wardha beginning October 1, 2011, through March 2012. The main focus was to study population of 10 years and above. Results: Eczema was the most common dermatosis accounting for 22% participants and among them almost 60% sufferers were female. Fungal infection presented in 13.0% of all the affected participants and was found more in male participants (58%) than in female (42%) among those affected with fungal infection. Eczema, benign skin tumors, and pigmentary disorders were more common in participants aged 51 years and above accounting to 52.7%, 9.4%, and 6.3%, respectively. Fungal infection and acne were more in adolescent age group accounting to 17.4% and 30.4%, respectively. Conclusion: Hence, we concluded that of the entire study population prevalence of skin diseases was 60%. Our study brought a higher prevalence of eczema in female and fungal infection in male. Eczema, benign skin tumors, and pigmentary disorders were more common in participants aged 51 years and above, and fungal infection and acne were more in adolescent age group. Adolescents suffered predominantly from fungal infections and acne due to pubertal changes. Various causes such as environment, overcrowding, and poor living conditions are major factors and not only adolescents or old age group but also entire population between 21 and 50 years of age were found to be suffering more commonly from eczema and infective dermatoses.

Keywords: Community, rural Central India, skin diseases


How to cite this article:
Jain S, Barambhe M S, Jain J, Jajoo U N, Pandey N. Prevalence of skin diseases in rural Central India: Acommunity-based, cross-sectional, observational study. J Mahatma Gandhi Inst Med Sci 2016;21:111-5

How to cite this URL:
Jain S, Barambhe M S, Jain J, Jajoo U N, Pandey N. Prevalence of skin diseases in rural Central India: Acommunity-based, cross-sectional, observational study. J Mahatma Gandhi Inst Med Sci [serial online] 2016 [cited 2019 Mar 20];21:111-5. Available from: http://www.jmgims.co.in/text.asp?2016/21/2/111/189537


  Introduction Top


Diseases of skin are becoming increasingly important.[1] The pattern of skin diseases in India is influenced by the developing economy, level of literacy, social backwardness, varied climate, industrialization, access to primary health care, and different religious ritual and cultural factors. Skin changes are affected with aging due to passage of time, photo-aging due to exposure to the sun.[1] The cutaneous signs of skin are xerosis, fine wrinkling, thinning of skin, loss of elasticity, seborrheic keratosis, coarse deep wrinkling, skin tag, etc.[2]

The prevalence of skin diseases in the general population has varied from 7.86% to 11.16% in various studies.[3],[4]

Skin diseases also pose huge financial, psychological burden for the patients and their families. However, there are very minimal data available on the prevalence of the skin disease in this population, especially in central rural India. Improvement in the standard of living, education of the general public, improvement in the environmental sanitation, and good nutritious food may help us to bring down the skin diseases in this area. Therefore, prevention by identifying the risk factor is the most effective approach especially in resource restrained settings of Central India.


  Materials and Methods Top


It was a community-based, observational study in which we prospectively recruited general population in and around Wardha (Pimpadgaon, Kutki, Tadodi, Dindoda, Hiwara, and Takli kite) beginning October 1, 2011, through March 2012. We obtained approval from the institutional review board before we started the study.

We included general population in the above-mentioned villages after a written informed consent was sought from all patients. All the individuals who were aged 10 years and above and who were residents of the above-mentioned villages in were taken for the study. Individuals not willing to provide consent for participation in the study were excluded. The study was divided into four parts: Selection of the study population, history taking and data collection, clinical examination, and relevant biochemical investigation.

All study participants were enquired about the potential risk factors of skin diseases through a questionnaire. The variables in this questionnaire included demographic variables (age, gender, place, or residence); socioeconomic variables (education, material object possession, occupation); and self-reported history of diabetes mellitus, hypertension, and tuberculosis. History of smoking tobacco in the form of active cigarettes or beedi (with quantification) and exposure to passive smoking along with history of alcohol consumption, history of chewable tobacco, and family history of skin diseases were taken.

We examined the entire eligible study participant clinically for height, weight, and body mass index by standard methods. Blood pressure was recorded.

This study was conducted by the author attending various camps in rural areas of Central India in collaboration with the Department of Medicine. The diagnosis was entirely based on clinical assessment of the dermatologists at the field, and no dermatological investigations were conducted.

About 100% patients attending the camps agreed to participate in the study. There were no dropouts. We grouped skin diseases and classified them further as follows:

  • Fungal (pityriasis versicolor, onychomycosis, tinea corporis, tinea cruris, tinea pedis)
  • Bacterial (Pyoderma, paronychia, furunculosis)
  • Acne (nodulocystic acne, postacne scar, senile comedones, rosacea)
  • Benign skin tumors (seborrheic keratosis, cherry angiomas, skin tags, varicose dermatitis, xerosis, Senile xerosis, plantar keratoderma, bindi dermatitis), dentigerous cyst, Sebaceous cyst, dermatosis papulosa nigra, erythema nodosum, lipoma, Milia, syringoma, papular-urticaria)
  • Pigmentary disorders (postinflammatory hyperpigmentation, vitiligo, melasma, melanonychia, idiopathic guttate hypomelanosis, Becker's nevus)
  • Eczema (contact dermatitis, photodermatitis, seborrheic capitis, chronic-dermatitis, lichen simplex chronicus, and asteatotic eczema
  • Oral/mucosal (oral submucous fibrosis, bleeding gums, aphthous stomatitis)
  • Neurological (leprosy, nevus, meralgia paresthetica, peripheral, neuropathy, neurofibromatosis)
  • Miscellaneous (drug reaction, elephantiasis, lichen planus, callosity, Beau's lines, striae albicans, angioedema, and systemic sclerosis). There was also a group of normal individuals who did not suffer from any dermatological condition.


Statistical analysis

All data were abstracted on a standardized data collection form. We used a spreadsheet to enter the data electronically and used statistical software STATA (version 10, Stata Corporation, Texas, USA). We compared means with t-test, medians with Mann–Whitney test, and proportions with Chi-square test. A level of P < 0.05 was used to indicate statistical significance in all analysis.


  Results Top


[Table 1] and [Figure 1] depict the age and sex distribution of surveyed population aged 10 years and above. Among the surveyed population, 55.7% were female and 44.3% were male participants. Almost half (52.8%) of the participants were aged <41 years and 20.4% were aged 60 years and above.
Table 1: Age sex distribution of surveyed population

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Figure 1: Bar diagram showing age and sex distribution

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[Table 2] shows the relationship between diagnosis and gender of the surveyed participants. Eczema was the most common dermatosis accounting for 22% participants and among them, almost 60% sufferer were female participants followed by fungal infection present in 13.0% of the participants. Of the total 81 individuals with fungal infection, male participants (58%) suffered more than the females (42%). Benign skin tumors, pigmentary disorders, and acne were found in 6.1%, 5.1%, and 4.5% participants, respectively.
Table 2: Diagnosis and gender of surveyed population

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[Table 3] exhibits the relationship between diagnosis and age of the participants. Eczema was found in 52.7% study participants aged 51 years and above. Fungal infection was more in adolescent age group (17.4%), and it was declined to 10.2% with the advancement of age. Benign skin tumors and pigmentary disorders were more common in participants aged 51 years and above which was 9.4% and 6.3%, respectively. Acne was found more in adolescent participants (30.4%).
Table 3: Diagnosis in relation to age

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[Table 4] reveals the associated systemic diseases profile of the participants. About 88.8% participants did not report any associated condition related to health during the survey. 10% reported to be hypertensive, >1% was diabetic, and one participant each reported the presence of tuberculosis and thyroid disorder. Gender wise, no statistically significant association (P < 0.05) was found for reported symptoms profile.
Table 4: Associated systemic diseases profile of surveyed population

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  Discussion Top


This study was conducted by carrying out survey in the Central India to document the prevalence of various skin diseases in the population surrounding Kasturba Hospital Sevagram, Wardha.

In a study by Grover et al.,[3] prevalence of skin disorders presented with female preponderance and the largest group of population (50.7%) was in their second and third decades.[3] In our study, although there was female preponderance with skin disorders of 55.7%, the largest group was in the third and fourth decades of life (49.1%), respectively. They found fungal infections in 54.52% and eczemas in 39.2% whereas our study showed eczema as the most common dermatosis accounting for 22% cases with fungal infection accounting for 13% patients respectively.

A study by Rao et al.[4] showed fungal diseases to be the most common infection (22.92%) and eczemas took an upper hand in noninfectious group (32.19%).[4] Likewise, in our study, maximum patients presented with eczema, also being the most common noninfectious dermatosis (22%) and fungal infections as the most common infective dermatoses (13%). Similar to Rao et al.,[4] we also concluded that causes such as environment, overcrowding, poor living conditions, and poor hygiene were found to be the major factors and correction of these conditions shall significantly reduce the occurrence of these dermatoses.

A federal sponsored study in America observed the prevalence of skin diseases as 40% in the aged people between 65 and 74 years.[5] However, in our study, individuals above 60 years of age group accounted for 20.4% of the patients. In a study conducted by Das et al.,[6] infective dermatosis was most common (36.41%) whereas, in our study, eczema was the most common dermatosis (22%).

Kar et al.[7] in his study concluded that pattern of skin diseases mostly depends not only on environmental factors but also on occupation, socioeconomic status, literacy, and age of the patients.[7] It was found that male to female ratio was 1.1:1; whereas in our study, it was 1:1.25. Among all patients, infection was most common (39.54%) whereas in our study eczema was the most common (22%).

Hay et al.[8] studied the global burden of skin disease in 2010 and analyzed the prevalence and impact of skin conditions concluding fungal skin diseases, other skin and subcutaneous diseases, and acne in the top 10 most prevalent diseases worldwide followed by pruritus, eczema, impetigo, scabies, and molluscum contagiosum.

The prevalence of skin diseases was 60%. There was female preponderance 55.7% and 44.3% were male participants. Almost half (52.8%) of the participants were aged >41 years and 20.4% were aged 60 years and above implying that dermatosis is more common in younger age group. Eczema was the most common diagnosis accounting for 22% participants and of which 60% were females and 40% were males. Of the total male participants of the study, 20% suffered from eczema and of all the female participants, 24% were the sufferers from eczema.

Of all the patients suffering from eczema, patients from age group 21 to 50 years suffered from contact dermatitis (7.3%), hand dermatitis (3.6%), seborrheic dermatitis (32.8%), and photodermatitis (26.3%), and those above 50 years of age suffered from Lichen simplex chronicus (19%) and asteatotic eczema (11%). Fungal infection was the next commonly observed dermatosis (13%) of study group of which males were more commonly affected. Elderly participants of age 50 years and above were more susceptible to dermatoses such as benign skin tumors and pigmentary disorders. Adolescents suffered predominantly from fungal infections probably due to lack of hygiene and overcrowding (subjective assessment based on the history given by the patients) and also from acne due to pubertal changes. Various causes such as environment, overcrowding, and poor living conditions are major factors and not only in adolescents or old age group but also entire population between 21 and 50 years of age were found to be suffering more commonly from eczema and infective dermatoses.


  Conclusion Top


Hence, we concluded that the prevalence of skin diseases was 60%. Our study showed a higher prevalence of eczema in female and fungal infection in male. Eczema, benign skin tumors, and pigmentary disorders were more common in participants aged 51 years and above, and fungal infection and acne were more in adolescent age group. Adolescents suffered predominantly from fungal infections and acne due to pubertal changes. Also the lack of hygiene and overcrowding were found to be contributory in the predominance of fungal infections amongst adolescents.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Masoro EJ, editor. Aging. In: Current Concepts in Aging. Oxford: Oxford University Press; 1995. p. 3.  Back to cited text no. 1
    
2.
Borkan GA, Norris AH. Assessment of biological age using a profile of physical parameters. J Gerontol 1980;35:177-84.  Back to cited text no. 2
    
3.
Grover S, Ranyal RK, Bedi MK. A cross section of skin diseases in rural Allahabad. Indian J Dermatol 2008;53:179-81.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.
Rao GS, Kumar SS, Sandhya. Pattern of skin diseases in an Indian village. Indian J Med Sci 2003;57:108-10.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Mohanti BK, Rizvi SNA, Kuba R. Clinical Geriatrics, Miscellaneous Disorders, MME-05, IGNOU School of Health Sciences, 8, Unit 4, 48-75.  Back to cited text no. 5
    
6.
Das S, Chatterjee T. Pattern of skin diseases in a peripheral hospital's skin OPD: A study of 2550 patients. Indian J Dermatol 2007;52:93-5.  Back to cited text no. 6
  Medknow Journal  
7.
Kar C, Das S, Roy AK. Pattern of skin diseases in a tertiary institution in Kolkata. Indian J Dermatol 2014;59:209.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Hay RJ, Johns NE, Williams HC, Bolliger IW, Dellavalle RP, Margolis DJ, et al. The global burden of skin disease in 2010: An analysis of the prevalence and impact of skin conditions. J Invest Dermatol 2014;134:1527-34.  Back to cited text no. 8
    


    Figures

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    Tables

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



 

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