Section Skin & VD Original Article

Spectrum and Pattern of Paediatric

Dermatoses in A Tertiary Care Hospital in

Faridabad

1 2 Assistant Professor; Senior Resident; 3Junior Resident, Department of 1 2* 3 , Venereology and Leprosy, Shanta Passi , Kumar Himanshu , Sneh Lata ESIC Medical College and Hospital, NIT, Faridabad 121001

ABSTRACT

DOI:10.21276/iabcr.2019.5.1.13 Background: The prevalence of paediatric skin diseases varies worldwide. Paediatric dermatoses require a separate view from adult dermatoses as there are important differences in clinical presentation, treatment and prognosis. Their characterisation is essential for the preparation of Received: 18.02.19 academic, research and health plans. Accepted: 26.02.19 Aim: The study was carried out to find the incidence of skin diseases in children under 15 years of age.

*Corresponding Author Methods: All children below 15 years of age attending dermatology outpatient department for first time were evaluated for various skin dermatoses. Skin diseases were classified into groups like infections and infestations, eczematous, non-infective dermatoses and hypersensitivity reactions. Dr. Kumar Himanshu Results: Male children predominated with male female ratio 1.3:1. Infections and infestations were ESICMCH, Faridabad, Haryana the most common (41.8%) cause of skin dermatoses followed by dermatitis (20.7%), non-infective &

autoimmune dermatoses (13.4%) and hypersensitivity reactions seen in 10.8% patients. and Copyright: © the author(s) and publisher. other physical dermatoses contributed to about 6% of the total cases. IABCR is an official publication of Ibn Sina Academy of Medieval Medicine & Sciences, Conclusion: Majority of paediatric dermatoses can be grouped into 8 categories. Significant registered in 2001 under Indian Trusts Act, 1882. proportion of dermatoses are infectious and eczematous types. Infections are more prevalent in low socio-economic strata and with proper education and creating awareness they can be minimised to This is an open access article distributed in accordance with the Creative

a significant extent. Commons Attribution Non Commercial (CC BY- NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original Keywords: Paediatric dermatoses, Infection, Infestations, Dermatitis work is properly cited and the use is non- commercial

INTRODUCTION______Skin diseases in children are encountered frequently and are rise to differential prevalence of dermatoses among infants, either transitory or chronic and recurrent. Monitoring the toddlers, children and adolescents. So measurement of epidemiology of skin diseases in children helps in effectively impact of paediatric dermatoses is an important component planning relevant educational programmes and preventive of primary health care practice and helps in planning future measures. healthcare, health education, clinical research and allocation The prevalence of paediatric skin diseases varies worldwide. of more resources for care of children. At least 30% of patients visiting paediatric OPD and 30% of dermatology OPD consults constitutes children. Paediatric METHODS______dermatoses vary from adult dermatoses in terms of clinical A prospective study was performed on all children below 15 presentation, treatment and prognosis, thereby generating years of age with complaints of skin diseases attending special interest in this sub-speciality. Socio-economic status, Dermatology OPD at ESIC Medical College & Hospital from external environment and dietary habits are few of the many January 2018 to December 2018. Children referred from factors that are more influential in dermatoses in children other outpatient departments having skin complaints were than adults. Different degree of exposure to external factors also included. All patients presenting for the first time in and different level of functional development of skin may give

Access this article online How to cite this article: Passi S, Himanshu K, Lata S. Spectrum and Pattern of Website: Quick Response code Paediatric Dermatoses in A Tertiary Care Hospital in Faridabad. Int Arch BioMed www.iabcr.org Clin Res. 2019;5(1):46-49.

Source of Support: Nil, Conflict of Interest: None DOI: 10.21276/iabcr.2019.5.1.13

International Archives of BioMedical And Clinical Research Vol 5 | Issue 1 | January – March 2019 46

www.iabcr.org Passi S, et al.: Paediatric dermatoses dermatology OPD were recorded and follow up visit for the Table 1: Frequency of Various Dermatoses Seen In Children TOTAL same complaint was not included in the data. To compare PERCENTAGE OF DISEASE NUMBER OF CASES the pattern of dermatoses in different age groups within the CASES 1. Infections and infestations paediatric population, the patients were grouped into four A. Bacterial Infections 233 10.1% categories based on their age Infants (less than 1 year age), B. Fungal infections 292 12.6% C. Viral infections 113 4.9% Pre-school children (1-5 years age), school children (6-10 D. Cutaneous Tuberculosis 7 0.3% years age) and adolescents (11-15 years age). The data was E. Leprosy 3 0.1% F. Scabies 301 13% analysed for frequency of cutaneous diseases in children and G. Pediculosis 12 0.5% TOTAL 961 41.8% pattern in different age groups. Diagnosis was made mainly 2. Dermatitis on the basis of clinical examination and relevant A. Seborrheic dermatitis 171 7.4% B. Pityriasis alba 138 6% investigations were done to confirm the diagnosis. The cases C. Atopic dermatitis 63 2.7% have been summarised according to the frequency in Table D. Contact dermatitis 19 0.82% E. Nappy dermatitis 11 0.48% 1. F. 3 0.12% G. Juv plantar dermatoses 26 1.2% H. Pompholyx 8 0.3% I. Discoid eczema 34 1.47% RESULTS______J. Lichen simplex chronicus 4 0.17% TOTAL 477 20.7% 2284 children up to the age of 15 years if both sexes 3. Non-Infectious Dermatoses & Autoimmune Dermatoses attending OPD of Dermatology in ESICMCH, Faridabad were A. Vitiligo 61 2.65% included in the study. There was predominance of males with B. 29 1.24% C. Psoriasis 20 0.87% 1297 males and 987 females with a male to female ratio of D. 15 0.65% 1.3:1. The youngest patient was 7 days old while the oldest E. Nutritional deficiency 18 0.78% F. 138 6% patient was 14 years and 10 months of age. The largest G. Lichen striatus et atrophic 9 0.39% group was that of adolescents (11-15 years age) with 858 H. Lichen nitidus 4 0.17% I. Pityriasis rosea 14 0.6% patients (37.9%), followed by children of age 1-5 years with TOTAL 308 13.4%

4. Birthmarks and other Genodermatoses 740 patients (32.2%), while there were 454 patients (20%) of A. Haemangiomas 5 0.22% age group (6-10 years) and infants comprised 232 patients B. Naevi 7 0.3% C. Icthyosis (10%). 11 0.48% D. Neurofibromatosis 2 0.12% E. Tuberous sclerosis 1 0.01% TOTAL 26 1.1% DISTRIBUTION OF DISEASE 5. Miscellaneous dermatoses 25 1.08% Infection and infestation were the most common category A. Postinflammatory pigmentary changes

B. Physiologic changes representing 41.8% of dermatoses. Among infections and 17 0.74% C. Vasculitis 6 0.24% D. Xerosis infestations, scabies was the commonest constituting 43 1.9% E. Keloids 15 0.65% 31.25% (301 patients) of this category. Second most F. 17 0.74% TOTAL common infection was fungal infections (30% - 292 patients). 123 5.34% Most common fungal infection encountered was Tinea Cruris 6. Hypersensitivity/Drug reaction A. Urticaria/Angioedema 122 5.3% followed by Tinea Capitis. Bacterial infections composed B. Papular urticaria 102 4.4% C. Pedrous dermatitis 17 0.74% 24% of infections (233 patients) periporitis and secondary D. Drug reactions 6 0.24% being the commonest. Viral infections constitute TOTAL 247 10.8% 7. Physical factor induced 11.7% of total infections with Molluscum Contagiosum being A. Miliaria 4.3%

B. Corns and calluses 0.22% the commonest viral infection (43 patients) followed by Warts 99 C. Cold injury 0.1% 5 (24 patients) and viral exanthema (23 patients) and Herpes D. Polymorphic light eruptions 5.22% 3 TOTAL 5 Simplex and herpes zoster comprised of 15 and 8 patients 4.9%

Other dermatoses included mucocele, pyogenic respectively. 7 patients of cutaneous tuberculosis of which 3 112 granuloma, Trichoepithelioma, pityriasis had lupus vulgaris, 2 had scrofuloderma and 2 had lichen lichenoides chronica and Canites scrofulosorum. The second most common category was of Dermatitis Dermatoses caused by physical factors constituted 4.9% of (26.7% of patients). Seborrheic dermatitis and seborrheic dermatoses, with miliaria rubra being the commonest seen in capitis constituted biggest group (171 patients – 35.8%). 99 (88%) patients. Nutritional deficiencies associated Pityriasis alba and atopic dermatitis were seen in 138 (29%) dermatoses were seen in 1% of the patients and included patients and 63 (13%) patients respectively. phrynoderma, acrodermatitis enteropathica and angular Hypersensitivity reactions and related disorders constituted cheilitis. 247 patients. 122 patients had Urticaria. 102 patients were Birthmarks and genodermatoses contributed to 1.1% of the diagnosed as having popular urticaria and 17 patients having total cases in which Icthyosis was the commonest seen in 11 pedrous dermatitis. Drug reactions were seen in only 6 patients followed by melanocytic naevi (7 patients) and patients. infantile hemangioma seen in 5 patients. In the category of non-infective and autoimmune dermatoses Miscellaneous dermatoses comprised of 43 cases of majority of patients had acne vulgaris (138 patients). 6 new- Xerosis, 25 cases of post inflammatory pigmentary born babies presented with infantile acne. Vitiligo was seen abnormalities, and 17 cases of physiologic changes in in 61 patients, psoriasis in 20 patients, alopecia areata in 29 newborn such as milia, erythema neonatorum toxicum and patients and pityriasis rosea was seen in 14 patients. Lichen cutis marmorata. planus was diagnosed in 15 patients while lichen striatus et Others included mucocele (2 patients), pyogenic granuloma atrophicus was seen in 9 patients and lichen nitidus in 4 (2 patients), pityriasis lichenoides chronica (3 patients), patients. canites (2 patients) and trichoepithlioma seen in 1 patient.

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Table 2: Frequency and pattern of common dermatoses in different in all age groups maximum in 5-15 years & least in infants. age groups Pediculosis was observed in 0.52% patients, though 0-1 5-10 10-15 DIESEASE 1-5 years TOTAL years years years incidence of pediculosis is quite high in school going children. It may be explained by the fact that it is considered mild Scabies 7 65 113 116 301 illness and most of children don’t report to hospital and use Fungal Infections 18 43 67 164 292 over the counter drugs.

Bacterial Infections 23 93 89 28 233 Among infective dermatoses, fungal infections (12.6%) were most common followed by bacterial infections (10.1%) and Viral Infections 5 39 36 33 113 viral infections (4.9%). Sayal et al also reported fungal [5] Seborrhoeic Dermatitis 81 23 15 52 171 infections as most common. Sardana et al, Karthikeyan et al, Sharma et al, Awal G et al have reported higher incidence Atopic Dermatitis 29 15 12 7 63 of bacterial infections.[1,11,12,13] Wenk and Itin and Nagarajan Pityriasis Alba 6 80 26 16 238 et al observed viral infections to be the commonest. (7,9,14) This variation among infective dermatoses depends upon the Urticaria 5 47 39 31 122 region of study, environmental factors, type of population Papular Urticaria 22 37 32 11 102 studied, hygiene and nutritional status.[1] Out of 2284 children fungal infection was observed in 12.6% Miliaria 4 27 26 42 99 while Awal G et al & Sardana et al have reported 8.1% and Vitiligo 0 9 22 30 61 4.65% respectively.[1,13] Variance in the study maybe due to

Acne 6 0 13 119 138 adolescents forming largest group (31.9%) and ongoing epidemic of dermatophyte infections. Tinea corporis was

most common and seen in (40%) of children followed by T.

Table 3: Distribution of fungal infections capitis (22.6%). 84.6% cases of T. cruris were from 0-1 10-15 adolescents (10-15 years) age group. 66.7% cases of Tinea Dermatophyte 1-5 years 5-10 years TOTAL years years capitis belonged to pre-school & school children. Study by T. capitis 9 21 23 13 66 Sharma and Mendiratta found candidal intertrigo the most T. cruris 0 5 13 99 117 common fungal infection followed by Tinea capitis and Tinea [8] T. corporis 0 8 7 40 55 corporis. T. Viral infections were found in 4.9% of children in our study. 0 1 7 8 15 mannum/pedis Similar trend has been observed in studies by Sardana et al, T. faceii 6 5 13 0 24 Hayden et al, Anand et al and Gupta et al. Molluscum

P. versicolor 3 3 4 4 14 contagiosum was the predominant type with 43 patients followed by warts 24 patients and viral exanthema in 23 patients. Similar pattern has been observed in other studies. DISCUSSION______In a study by Wenk et al equal patients of Verrucae and Molluscum were seen.[9] Skin diseases in children are encountered frequently and The second most common presentation was dermatitis. their study is essential for academic, research and health Seborrhoeic dermatitis/ cradle cap was the most common planning. (1) The pattern of skin diseases in children is a entity in this group comprising 7.4% of the cases followed by consequence of poverty, malnutrition, environmental factors, P. alba seen in 6% and atopic dermatitis seen in 2.7% of the overcrowding, poor hygiene and illiteracy.[2] cases. Urticaria was seen in 5.3% of the children and was In our study total 2284 children were evaluated in a period of mostly acute in nature being secondary to upper respiratory one year extending from January 2018 to December 2018. tract infections or worm infestation. Male children outnumbered female patients with male: The high frequency of papular urticaria (4.4%) is because of female ratio of 1.3:1. Male preponderance was observed in hot climate conditions combined with scant clothing which other studies also.[1,3,4,5,6] This may be due to gender bias in exposes children to insect bites. This is in accordance with our society whereby parents are more concerned about male similar population base like in India (11) and Africa (6). Another children and secondly due to lower female population in condition prevalent in hot and humid conditions is Miliaria Haryana. Maximum number of cases were in age group of seen in 4.3% of the children. This is in consonance with other 10-15 years 37.9% followed by 1-5 yrs age group (32.2%). studies from North India. Vitiligo was seen in 1-2% of the Infants comprised 10% of patients. Nagarajan Kartik et al population worldwide. In our study 2.65% patients of vitiligo also had repeated maximum incidence in 5-12 yrs age group presented similar to studies by Thakare S et al and Balai et (50.75%)[7] which can be explained by increased exposure to al and Karthikeyan et al.[11,15,16] environment whereas Sharma et al and Sardana et al 1.24% of the children presented with alopecia areata. reported higher prevalence in younger age group of 1-5 Sardana et al reported 1.09% of patients with alopecia areata years.[18] in children.[1] Acne was observed in 6% of the children. 6 Infections and infestations were the most common category neonates presented with infantile acne while rest were seen (41.8%) followed by eczematous dermatitis (20.7%) similar in adolescents. trend has been observed in studies from different parts of Birthmarks and other genodermatoses formed a minor group India (1,4,5,8) but studies by Nanda et al, Wenk C et al and (1.1%). Capillary hemangiomas was the most common Bechelli LM et al outside India have reported dermatitis being vascular malformation. Melanocytic nevus, nevus the commonest manifestation.[6,9,10] depigmentosus constituted 3% of children. Icthyosis was Scabies was most prevalent in the present study (13%) seen in 0.5% of the children with Icthyosis Vulgaris being the which can be attributed to patients belonging to low socio most common sub-type. economic status and overcrowding. Scabies was prevalent International Archives of BioMedical And Clinical Research Vol 5 | Issue 1 | January – March 2019 48

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Post inflammatory pigmentary changes were seen in 1.08% paediatric dermatoses. Indian journal of Dermatology 2010; 55:44-46 4. Ghosh SK, Saha DK, Ray AK. A chronic aetiological study of dermatoses children similar to study by Sardana et al. This condition is in Paediatric age group. Indian journal of Dermatology. 1995; 40: 29-31 5. Sayal SK, Bal AS, Gupta CM. Pattern of skin diseases in paediatric age mainly seen in pigmented races with increased melanin group and adolescents. Indian journal of dermatology venereology and activity or due to disruption of basement membrane. leprology. 1998; 64:117-119 6. Nanda A, Hasawi FA, Al Saleh QA. A prospective survey of paediatric Physiological changes were seen in 17 neonates Comprising dermatology clinic in Kuwait, an analysis of 10000 cases. Paediatric of Milia, Erythema Toxicum Neonatorum and breast Dermatology 1999; 16: 6-11 7. Karthick Nagarajan, Nandkishore Singh, Khaiden Ibochuba, Kapila engorgement, vaginal discharge, cutis marmorata. Verma. Pattern of Paediatric Dermatoses in Northeast India. Indian Journal of Paediatric Dermatology 2107; 18: 286-91 8. Sharma RC, Mendiratta V. Clinical profile of cutaneous infections and infestations in the paediatric age group. Indian journal of Dermatology CONCLUSION______1999; 44:174-8 To conclude, similarities and differences exist between our 9. Wenk C, Itin PH. Epidemiology of paediatric dermatology and allergology in the region of Aargan, Switzerland. Paediatric Dermatology 2003; observations and those in other studies done previously. Our 20:482-7 10. Bechelli LM, Haddad N, Pimenta WP et al. Epidemiological survey of skin study reveals a preponderance of Infectious Dermatoses. diseases in school children living in the Porus Valley, Amazonia, Brazil. The role of poverty, over-crowding, poor personal hygiene Dermatologica 1981; 163:78-93 11. Karthikeyan K, Thappa DM, Jeewankumar B. Pattern of paediatric and low level of health education should be emphasised to dermatoses in referral center in South India. Paediatric Dermatology. prevent infectious dermatoses. It is necessary to focus on 204; 41:373-7 12. Sharma NK, Garg BK, Goel M. Pattern of skin diseases in urban school dermatologic education of medical students, primary care children. Indian journal of Dermatology, venereology and leprology. 1986; 52:330-1 physicians and paediatricians. So that they can diagnose and 13. Awal Guneet, Singh Surinder Pal, Sharma Saurabh, Kaur Jasleen. refer patients timely if the condition falls outside one’s Spectrum and pattern of Paediatric dermatoses in under five population in a tertiary care center. International journal of Research in expertise. Dermatology. 2016 Dec; 2:69-76 14. Gul U, Cakmak SK, Gnul M, Kilic A, Bilgli S. Paediatric skin disorders encountered in a dermatology outpatient in Turkey. Paediatric Dermaotlogy 2008; 25(2): 277-8 REFERENCES______15. Balai M, Khare AK, Gupta LK, Mittal A, Kuldeep CM. Pattern of paediatric 1. Sardana K, Mahajan S, Sarkar R, Mendiratta V, Bhushan P The dermatoses in a tertiary care centre of South West Rajasthan. Indian spectrum of skin diseases among Indian children. Indian Dermatology journal of Dermatology 2012; 57:275-8 2009; 26:-13 16. Thakare S, Singh A, Madnani A, Lakhar B. Scenario of paediatric 2. Schachner L, Ling NS, Press S. A statistical analysis of a paediatric dermatoses in rural population of central India. Global J of Dermatol dermatology clinic. Paediatric Dermatology 1983; 1:157-164 Venereol 2013;1:7-10 3. Banerjee S, Gangopadhyay D, Jana S, Chanda M, Seasonal variation in

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