Profile of Inflammatory and Infective Skin Diseases

Profile of Inflammatory and Infective Skin Diseases Contributors with their highest academic degree: GIRI VISHAL P*. , MD (PHARMACOLOGY) GIRI OM P. , MD (MEDICINE), PhD (MEDICINE) GUPTA SUDHIR K. , MD ( SKIN VD) SHUBHRA KANODIA , MDS (Std), (ORAL MEDICINE AND RADIOLOGY) Department(s) and institution(s) : â€Å"Clinico-Epidemiological Profile of Inflammatory and Infective Skin  Diseases in a Tertiary Care Centre of South India† ABSTRACT The present medical audit-study was undertaken to analyze clinical and epidemiological profile of inflammatory and infective skin diseases and to arrive at important facts about these diseases.1134 patients who attended the Dermatology of a   Medical and College Hospital were the subjects of this study . The findings were recorded in a proforma for analysis and interpretation .Etiological analysis revealed that majority ( 599 ; 52.82 % ) of dermatoses belonged to inflammatory group followed by infective group ( 535 ; 47.18 % ). Of the inflammatory group, allergic contact dermatitis ( 209 ;18.43 % ) was the most common entity followed by irritant contact dermatitis (180; 15.87 %) , seborrhroeic dermatitis( 120 ; 10.58 % ), atopic dermatitis ( 50; 4.41 % ), psoriasis ( 20; 1.76 % ) and pompholyx ( 20 ; 1.76 % ).Of the infective group, bacterial infection was the most common disease ( 349 ; 30.78% ) followed by scabies (122 ; 10.76 %) , fungal (57 ; 5.02 %) and viral infection( 3 ; 0. 26 % ).This study provides a preliminary baseline data for future clinical research. It might also help to assess the changing trends of inflammatory and infective skin diseases . Key Words: inflammatory skin diseases, infective skin diseases, changing trends in skin diseases. INTRODUCTION The pattern of skin disease is a consequence of poverty , malnutrition , overcrowding , poor hygiene , illiteracy and social backwardness in many parts of India . The examination for skin diseases is an important component of health care practice for all. Status of health , hygiene and personal cleaniness of a society can be judged from the prevalence of certain skin diseases in the community . The pattern of skin diseases vary from one country to another and within the same country from one state to another due to various climatic , cultural and socio-economic factors.[1,2] MATERIAL AND METHODS The relevant data available from medical case records of the Dermatology outpatient department of a Medical College and Hospital was collected by the investigator in person during period January 2011 to June 2012 . Name ,age ,gender , type and duration of disease were recorded in a proforma for analysis and interpretation of data . Total 1134 ( one thousand one hundred thirty four ) medical case records of inflammatory and infective skin diseases were collected and scrutinized for this observational ,perspective and medical audit- study. RESULTS Out of 1134 patients scrutinized , 220 ( 19.40 % ) patients were children up to five years of age and 149 ( 13.14 % ) children were 6 to 10 years of age . Most of adults 358 ( 31.57 % ) were aged 21 to 40 years and 146 ( 12.87 % ) adults belonged to 41 to 60 years age group . Females ( 581 ; 51.23 % ) slightly outnumbered males ( 553 ; 48.77 % ). [ Table 1-6] The majority ( 599 ; 52.82 % ) of patients belonged to inflammatory group followed by infective group ( 535 ; 47.18 % ). [Table1,2] Pattern of inflammatory skin diseases revealed allergic contact dermatitis to be the commonest ( 209 ; 18.43 % ) followed by irritant contact dermatitis (180 ; 15.87 % ) , seborrhoeic dermatitis ( 120 ; 10. 58 % ) , atopic dermatitis ( 50 ; 4.41 % ) , psoriasis ( 20; 1.76 % ) and pompholyx ( 20; 1.76 % ). [ Table 1 ] Among infective skin diseases , bacterial infection ( 349 ; 30.78 % ) was most common entity . Scabies was recorded in 122 ( 10.76 % ) patients . Fungal infection was recorded in 57 ( 5.03 % ) and viral infection 3 ( 0.26 % ) patients .[ Table 2 ] Seasonal variation pattern was observed in some diseases . Impetigo and dermatophytosis were recorded mainly in rainy and summer seasons. Scabies was recorded mainly in winter and rainy seasons . Atopic dermatitis and seborrhoeic dermatitis were documented more in winter season . DISCUSSION Pattern of inflammatory and infective skin diseases has varied in different studies. In this study , majority ( 599; 52.82 % ) of skin diseases belonged to inflammatory group followed by infective group ( 535 ; 47.18 % ) . A similar pattern of dermatoses has also been reported in several other studies .[3-8] However, in other studies infective group has been the predominant dermatoses.[9-22] Of the inflammatory dermatoses , allergic contact dermatitis was the commonest ( 209; 18.43 % ) out of all 1134 patients followed by irritant contact dermatitis( 180; 15.87 % ), seborrhoeic dermatitis ( 120 ; 10.58 % ), atopic dermatitis ( 50; 4.41 % ), psoriasis ( 20 ; 1.76 % ) and pompholyx (20; 1.76 % ). In chidren aged up to five years atopic dermatitis was the commonest ( 8 ; 0.71 % ) followed by seborrhoeic dermatitis ( 7 ;0.62 % ) , irritant contact dermatitis ( 6;0.53 % ) and pompholyx ( 2 : 0.18 % ). Similar finding has been observed in other studies . [2,5,6] Of the infective dermatoses, bacterial infections (349; 30.78 %) were the most common followed by fungal ( 57; 5.03 % ) and viral infections ( 3; 0.26 % ). Similar pattern has been observed in some other studies as well .[2,5] Studies have reported fungal infection to be more common.[13,14,22] Viral infections out-numbered bacterial and fungal infections in few studies .[7,8] Impetigo was the commonest ( 158 ; 13.93 % ) bacterial infection followed by secondary pyoderma ( 133; 11.73 % ), folliculitis ( 25 ; 2.20 % ), furunculosis ( 20; 1.76 % ) and acute paronychia ( 13; 1.15 % ). Scabies was the most common infestation seen in 122 ( 10. 76 % ) patients in the present study . CONCLUSION Majority of dermatoses belonged to inflammatory group followed by infective group , though the difference is narrow (64 ; 5.64 % ).Of the infective group bacterial infection was the most common disease followed by scabies , fungal and viral infection. This study points towards changing trends in dermatoses . This study provides preliminary baseline data for the future epidemiological and clinical research . It might also help to assess the changing trends of dermatoses. REFERENCES 1. William H.C. â€Å"Epidemiology of skin diseases† in : Burns T, Breathnach.S COXN Griffiths editors, Rook’s Textbook of Dermatology, 7th ed. Oxford : Blackwell science ; 2004 ; 81 : 06-21. 2. Balal M , Khare AK , Gupta LK , Mittal A , Kuldeep CM. Pattern of paediatric dermatosis in a tertiary care centre of South West Rajasthan . Indian J Dermatol 2012 ; 57 : 275 -8 . 3. Das DA, Haldar HS, Das DJ, Mazumdar MG, Biswas BS, Sarkar SJ. Dermatological disease pattern in an urban institution in Kolkata. Ind J Dermatol 2005;50:22-3. 4. Symvoulakis EK, Krasagakis K, Komninos ID, Kastrinakis I, Lyronis I, Philalithis A, et al. Primary care and pattern of skin diseases in a Mediterranean island. BMC Fam Pract 2006;7:6. 5. Gul U ,Cakmak SK, Gonul M, Kilic A , Bilgili S . Pediatric skin disorders encountered in a dermatology outpatient clinic in Turkey .Pediatr Dermatol 2008 ; 25 :277-78 . 6. 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Table 1 : Pattern of skin inflammation in both sexes Diseases Male Female Total No. % No. % No. % Allergic contact dermatitis 105 9.26 104 9.17 209 18.43 Irritant contact dermatitis 81 7.14 99 8.73 180 15.87 Seborrhoeic dermatitis 71 6.26 49 4.32 120 10.58 Atopic dermatitis 19 1.68 31 2.73 50 4.41 Psoriasis 11 0.97 9 0.79 20 1.76 Pompholyx 8 0.70 12 1.06 20 1.76 Total 295 26.01 304 26.81 599 52.82 Table 2 : Pattern of skin infection in both sexes Diseases Male Female Total No. % No. % No. % Impetigo 72 6.35 86 7.58 158 13.93 Secondary pyoderma 72 6.35 61 5.38 133 11.73 Folliculitis 10 0.88 15 1.32 25 2.20 Furunculosis 8 0.70 12 1.06 20 1.76 Acute paronychia 5 0.44 8 0.70 13 1.15 Scabies 56 4.94 66 5.82 122 10.76 Pediculosis 2 0.18 2 0.18 4 0 .35 Dermatophytosis 22 1.94 15 1.32 37 3.26 Pitiriasis versicolor 11 0.97 9 0.79 20 1.76 Molluscum contagiosum 0 0 3 0.26 3 0.26 Total 258 22.75 277 24.43 535 47.18 Table 3 : Pattern of skin inflammation in different age groups (years) Diseases up to 5 6-10 11-20 No. % No. % No. % Allergic contact dermatitis 0 0 4 0.35 33 2.91 Irritant contact dermatitis 6 0.53 7 0.62 27 2.38 Seborrhoeic dermatitis 7 0.62 14 1.23 29 2.56 Atopic dermatitis 8 0.71 5 0.44 4 0.35 Psoriasis 0 0 0 0 0 0 Pompholyx 2 0.18 5 0.44 3 0.26 Total 23 2.03 35 3.09 96 8.47 Table 4 : Pattern of skin inflammation in different age groups ( years ) Diseases 21-40 41-60 61-100 No. % No. % No. % Allergic contact dermatitis 80 7.05 47 4.14 45 3.97 Irritant contact dermatitis 104 9.17 30 2.65 6 0.53 Seborrhoeic Dermatitis 40 3.53 20 1.76 10 0.88 Atopic dermatitis 20 1.76 3 0.26 10 0.09 Psoriasis 13 1.15 3 0.26 4 0.35 Pompholyx 10 0.88 0 0 0 0 Total 267 23.54 103 9.08 75 6.61 Table 5 : Pattern of skin infection in different age groups ( years ) Diseases up to 5 6-10 11-20 No. % No. % No. % Impetigo 96 8.47 37 3.26 15 1.32 Secondary pyoderma 59 5.20 35 3.09 23 2.02 Folliculitis 1 0.09 1 0.09 3 0.26 Furunculosis 1 0.09 1 0.09 4 0.35 Acute paronychia 0 0 1 0.09 1 0.09 Scabies 37 3.26 34 3.00 23 2.03 Pediculosis 0 0 0 0 3 0.26 Dermatophytosis 1 0.09 4 0.35 4 0.35 Pitiriasis versicolor 0 0 0 0 0 0 Molluscum contagiosum 2 0.18 1 0.09 0 0 Total 197 17.37 114 10.05 76 6.70 Table 6 : Pattern of skin infection in different age groups (years) Diseases 21- 40 41- 60 61- 100 No. % No. % No. % Impetigo 7 0.62 3 0.26 0 0 Secondary pyoderma 8 0.70 4 0.35 4 0.35 Folliculitis 15 1.32 4 0.35 1 0.09 Furunculosis 10 0.88 3 0.26 1 0.09 Acute paronychia 4 0.35 6 0.53 1 0.09 Scabies 20 1.76 4 0.35 4 0.35 Pediculosis 0 0 0 0 2 0.18 Dermatophytosis 17 1.50 10 0.88 2 0.18 Pitiriasis versicolor 10 0.88 9 0.79 1 0.09 Molluscum contagiosum 0 0 0 0 0 0 Total 91 8.02 43 3.80 16 1.41 1