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Prevalence of Skin Diseases Among Schoolchildren in Magong, Penghu, Taiwan

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Prevalence of Skin Diseases Among Schoolchildren in Magong, Penghu, Taiwan View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector ORIGINAL ARTICLE Prevalence of Skin Diseases Among Schoolchildren in Magong, Penghu, Taiwan: A Community-based Clinical Survey Guan-Yu Chen,1,2 Yu-Wen Cheng,3 Cheng-Yu Wang,3 Tsung-Jen Hsu,4 M. Ming-Long Hsu,5 Pei-Tun Yang,6 Wen-Chieh Chen3* Background/Purpose: Skin diseases are common in children. Epidemiologic studies of skin diseases in schoolchildren performed by direct inspection by dermatologists are limited in Taiwan. The current study surveyed the prevalence of selected childhood dermatoses in Magong City, Penghu, the largest offshore island of Taiwan. Methods: A cross-sectional study was carried out in June 2005, in which a total of 3273 children aged 6–11 years living in Magong were examined by at least two board-certified dermatologists, with regard to the point prevalence of acne, ephelides, atopic dermatitis, warts, keloids, vitiligo, fungal infections, alope- cia areata and psoriasis. The skin of the scalp, face, neck, trunk and extremities were inspected; that of the breast, genitalia and feet were skipped for privacy. Results: Acne vulgaris was found at the age of 7 in both genders, with comedones being the earliest man- ifestation. The overall prevalence of acne was 17.3% (95% CI, 16–18.6%). Ephelides were frequently ob- served in the children (prevalence rate, 15.24%; 95% CI, 14–16.47%). The prevalence of atopic dermatitis was 4.33% (95% CI, 3.63–5.03%), with more boys affected than girls (1.49:1) (p = 0.03). The prevalence of warts on the hands was 2.81% (95% CI, 2.24–3.38%). Keloids were identified in seven boys and four girls, accounting for 0.33% of the children (95% CI, 0.13–0.53%). Three children had vitiligo (prevalence rate, 0.09%; 95% CI, 0–0.19%). The prevalence of fungal infection including tinea nigra, tinea versicolor and tinea corporis was 0.24% (95% CI, 0.07–0.41%). Neither alopecia areata nor psoriasis was identified. Conclusion: Compared with our previous study in Kaohsiung County using similar methodology, the point prevalence of atopic dermatitis and ephelides was significantly higher whereas that of fungal infec- tion was lower in Penghu. Unexpectedly, tinea nigra was not rare in Penghu. [J Formos Med Assoc 2008;107(1):21–29] Key Words: child, Penghu, prevalence, skin diseases ©2008 Elsevier & Formosan Medical Association ....................................................... 1Department of Dermatology, Armed Forces Taichung General Hospital, 2Central Taiwan University of Science and Technology, Taichung, 3Department of Dermatology, Chang Gung Memorial Hospital–Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, 4Department of Dermatology, Penghu General Hospital, Department of Health, Penghu, 5Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, and 6Department of Information Management, Tri-Service General Hospital, Taipei, Taiwan. Received: April 2, 2007 *Correspondence to: Dr Wen-Chieh Chen, Department of Dermatology, Chang Gung Revised: May 8, 2007 Memorial Hospital–Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung, Kaohsiung Accepted: October 2, 2007 833, Taiwan. E-mail: [email protected] J Formos Med Assoc | 2008 • Vol 107 • No 1 21 G.Y. Chen, et al Skin diseases are common in schoolchildren.1 all the children in each class were individually Epidemiologic studies of the general population, examined in the nursing room. The sampled however, are still limited, especially in Taiwan. children were selected from a population of ap- Many previous studies have the following restric- proximately 53,000 people living in an area of tions: (1) survey of referred patients in hospital- 33.9918km2, accounting for 58.44% of the total based settings could not entirely reflect the real population of Penghu. A total of 3273 school- situation in the general population;2 (2) self- children (1659 boys, 1614 girls; age range, 6–11 administered questionnaire studies or survey con- years) from grades 1 to 6 were examined, which ducted by non-dermatologists make the validity is 71.87% of the total of 4554 schoolchildren in of the diagnosis problematic.3–5 Magong. Skin diseases such as acne and alopecia areata, although not life-threatening, may be particularly Assessment distressing for this age group. For some chronic The assessment was conducted and confirmed by refractory skin diseases such as atopic dermatitis, at least two board-certified dermatologists through- psoriasis and vitiligo, the psychologic impact, dis- out the body, including head, scalp, neck and ease course and complications as well as thera- extremities but excluding the feet, because it is peutic decisions concerning long-term safety may labor-intensive and time-consuming for an aver- seriously concern affected families. Treatment of age of 26 children per class to take off their shoes intractable warts and keloids in children may pose and socks for examination. The chest, groin and a challenge for dermatologists. genital areas were also skipped due to privacy Penghu is the largest offshore island of Taiwan, concerns. The presence of at least three to five with Magong City being its most populous district. comedones was required for the diagno-sis of acne. As a relatively isolated area with little people Ephelides were identified by their characteristic migration, especially of children and the elderly, appearance on sun-exposed areas as groups of Penghu may serve as an ideal place for an epi- discrete, brown to yellowish, round or speckled demiologic prevalence study. The aim of this study macules with diameters of 2–3 mm.6 For a diagno- was to investigate the disease prevalence in the sis of atopic dermatitis to be made, all three of the general child population of Penghu by dermatol- following criteria had to be met: (1) pruritus; (2) ogist’s direct inspection in order to understand chronic or relapsing history for at least 6 months; the effect and impact of skin diseases on school- (3) typical morphology and distribution includ- children. Excluded were commonly encountered ing acute eczematous change or chronic licheni- or easily manageable diseases such as impetigo fication, prurigo and hyperpigmentation.7 Keloid and folliculitis or relatively innocuous conditions was defined as an overgrowth of dense fibrous such as pityriasis alba. tissue extending beyond the borders of the injury lasting for over 6 months. The diagnosis of warts, tinea versicolor, tinea corporis and vitiligo was Methods made by clinical observation without laboratory examination. The diagnosis of tinea nigra was con- Patients firmed by fungal culture on Sabouraud’s glucose This was a cross-sectional point-prevalence study agar and microscopic examination of the fungal carried out in June 2005 using a purposive slide culture of the scales scrapped from the le- sampling method to survey schoolchildren from sion. The collected data were encoded, registered 4/14 primary schools in Magong City, Penghu. and verified in a relevant database. Children who On the day of visit, the classes available for phys- required further management were referred to ical checkup were enlisted by school officials and Armed Forces Penghu Hospital. 22 J Formos Med Assoc | 2008 • Vol 107 • No 1 Skin diseases among schoolchildren in Magong, Penghu, Taiwan Statistical analysis Statistical analyses were performed using SPSS version 11.5 (SPSS Inc., Chicago, IL, USA) for Windows. Associations between skin diseases and the height, body weight or body mass index (BMI) of the respective children were examined by t test, while ANOVA was used to compare skin diseases and height, body weight and BMI. The χ2 test was used to determine the association of skin diseases with age, gender, and also the dis- tribution among different schools. A p value of less than 0.05 was considered to be significant. Results fungal infection. = Acne was the most common dermatosis followed by ephelides. No cases of psoriasis or alopecia areata were detected in our series. The prevalence of individual skin disorders was not associated atopic dermatitis; FI = with gender (p = 0.674) or age (p = 0.352). No differences existed between individual skin dis- eases and height, body weight or BMI. An interest- ing observation was that the number of children acne vulgaris; AD with ephelides seemed to cluster in certain schools; = Zong-Zheng primary school with 999 school- children had the highest prevalence of ephelides at 19.91% as compared to the mean prevalence of 15.24% (p < 0.05). Table 1 summarizes the data of the examined schoolchildren and the estimated disease prevalence. Table 2 compares the results total subjects examined; AV total subjects examined; AV of the epidemiologic studies conducted in school- = children in Penghu, Kaohsiung and Taitung. The first two studies had applied the same methodo- female; T = logy with regard to sampling, disease definition 5 and examination. male; F = Acne The overall prevalence of acne was 17.3% (95% CI, 16–18.6%), increasing with age from 5.7% at 6–8 years to 28.8% at 9–11 years. The clinical manifestations included comedones and papu- and estimated disease prevalence* of the examined schoolchildren profile Background lopustules, with comedones being the earliest manifestation, noticed in children as young as 6789 255/221/476 284/282/566 285/263/548 4/6/10 (2.1) 256/283/539 13/11/24 (4.2) 22/19/41 (7.4) 14/50/64 (11.8) 22/22/44 (4.9) 37/33/70 (12.3) 40/42/82 (14.9) 36/40/76 (14.1) 11/11/22 (3.8) 5/6/11 (2.3) 4/9/13 (2.3) 21/11/32 (5.6) 5/5/10 (1.8) 21/10/31 (6.5) 1/1/2 (0.3) 15/6/21 (3.8) 10/19/29 (5.3) 0/0/0 0/2/2 (0.3) 0/0/0 0/0/0 1/1/2 (0.3) 1/1/2 (0.4) 0/1/1 (0.1) 2/0/2 (0.4) 0/0/0 1/0/1 (0.1) 0/1/1 (0.1) Age(yr) All children (M/F/T)1011 AVOverall (M/F/T) 278/288/566 1659/1614/3273 301/277/578 212/354/566 (17.3) 45/101/146 (25.7) 114/167/281 (48.6) 240/259/499 (15.2) Ephelides (M/F/T) 45/53/98 (17.3) 60/69/129 (22.3) 45/47/92 (2.8) 85/57/142 (4.3) 5/7/12 (2.1) 15/9/24 (4.1) 2/1/3 (0.09) Warts (M/F/T) 10/5/15 (2.6) 8/6/14 (2.4) 2/6/8 (0.2) 7/4/11 (0.3) 1/0/1 (0.1) 0/0/0 (M/F/T) 0/1/1 (0.1) AD 1/1/2 (0.3) 0/0/0 (M/F/T) 4/1/5 (0.8) Vitiligo (M/F/T)FI (M/F/T) Keloids Table 1.
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