A Dissertation on CLINICO EPIDEMIOLOGICAL STUDY OF FACIAL DERMATOSES AMONG ADULTS Dissertation submitted to THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI-600032 With partial fulfillment of the requirements for the award of M.D.DEGREE IN DERMATOLOGY, VENEREOLOGY AND LEPROLOGY (BRANCH - XX) REG. No. 201730201 COIMBATORE MEDICAL COLLEGE AND HOSPITAL COIMBATORE MAY 2020 DECLARATION I Dr . MANIVANNAN . M solemnly declare that the dissertation entitled “CLINICO EPIDEMIOLOGICAL STUDY OF FACIAL DERMATOSES AMONG ADULTS ” is a bonafide work done by me at Coimbatore Medical College Hospital during the year June 2018 to May 2019 under the guidance & supervision of Dr. M. KARUNAKARAN M.D., (DERM) Professor& Head of Department, Department of Dermatology, Coimbatore Medical College & Hospital. The dissertation is submitted to Dr. MGR Medical University towards partial fulfillment of requirement for the award of MD degree branch XX Dermatology, Venereology and Leprology. PLACE: Dr. MANIVANNAN .M DATE: CERTIFICATE This is to certify that the dissertation entitled “CLINICO EPIDEMIOLOGICAL STUDY OF FACIAL DERMATOSES AMONG ADULTS” is a bonafide original work done by Dr. MANIVANNAN.M. Post graduate student in the Department of Dermatology, Venereology and Leprology, Coimbatore Medical College Hospital, Coimbatore under the guidance of Dr. M. KARUNAKARAN M.D., (DERM), Professor and HOD of Department, Department of Dermatology, Coimbatore Medical College Hospital, Coimbatore in partial fulfillment of the regulations for the Tamilnadu DR.M.G.R Medical University, Chennai towards the award of MD., degree (Branch XX.) in Dermatology, Venereology and Leprology. Date : GUIDE Dr. M. KARUNAKARAN M.D., (DERM) Professor & HOD, Department of Dermatology, Coimbatore Medical College & Hospital. Date : Dr. M. KARUNAKARAN M.D., (DERM) Professor & HOD, Department of Dermatology, Coimbatore Medical College & Hospital. Date : Dr. B. ASOKAN, M.S., Mch., Dean, Coimbatore Medical College & Hospital, Coimbatore. COPYRIGHT DECLARATION BY THE CANDIDATE I hereby declare that The Tamilnadu DR.M.G.R Medical University, Chennai shall have the rights to preserve, use and disseminate this dissertation/thesis in print or electronic format for academic/research purpose. PLACE: COIMBATORE Dr. MANIVANNAN .M DATE: PLAGIARISM CERTIFICATE This is to certify that this dissertation work titled "CLINICO EPIDEMIOLOGICAL STUDY OF FACIAL DERMATOSES" of the candidate Dr. M. MANIVANNAN with Registration number for the award of M.D.DERMATOLOGY, VENEREOLOGY AND LEPROSY in the branch of XX. I personaly verfied the urkund.com website for the purpose of plagiarism check. I found that the uploaded thesis file contains from introduction to conclusion pages and results shows 1% of plagiarism in the dissertation. Signature of the Guide ACKNOWLEDGEMENT I solicit my humble thanks to the Dean Dr. B. Asokan, M.S., Mch., Coimbatore Medical College Hospital, for allowing me to conduct the study in this hospital. I am also immensely thankful to my guide Prof. Dr.M.Karunakaran M.D., (DERM) Professor Head of the Department, Dermatology and Leprology for his invaluable guidance, motivation and help throughout the study. I express my earnest gratitude to Dr. Muthukumaran M.D., Prof. and Head of the Department, Department of Venerealogy, all the Assistant Professors, Department of Dermatology Dr.B.Eswaramoorthy M.D., Dr.R.Madhavan M.D., Dr.S.Bharathi M.D., Dr.Swarnalakshmi M.D., Dr.pradeepa M.D , Dr. Ranjani M.D and Dr. Arul D.D.V.L without their help and guidance this work would not have been possible. I owe a lot to my parents and other family members who have always been my pillar of support in all stages of my life. My sincere thanks to my seniors Dr.A.Amutha, Dr.M.S.Krishnameera, Dr.Divya, Dr.Dhineshkumar and my fellow post graduate colleagues Dr.Vijayalakshmi, Dr.Neikhrielie Khro, Dr.Manipriya, Dr.Aravind and Dr.Kiruthika who have been of immense help throughout the study period. I am very grateful to all patients for their co-operation and participation in the study. TABLE OF CONTENTS S.NO CONTENTS PAGE NO. 1. INTODUCTION 1 2. REVIEW OF LITERATURE 2 3. AIM AND OBJECTIVES OF THE STUDY 51 4. MATERIALS AND METHODS 52 5. OBSERVATION AND RESULT 54 6. DISCUSSION 89 7. SUMMARY 95 8. CONCLUSION 97 9. BIBLIOGRAPHY 102 10. ANNEXURES PROFORMA CONSENT FORM KEY TO MASTER CHART MASTER CHART LIST OF TABLES S.No. TABLES PAGE NO. 1. CLASSIFICATION OF FACIAL DERMATOSES 3 2. CLINICAL GRADING SYSTEM OF ACNE 10 (PILLSBURRY’S CLASSIFICATION) 3. SUBTYPES OF ROSACEA AND THEIR CLINICAL 14 FEATURES 4. FITZPATRICK SKIN TYPES 15 5. TYPES OF MELASMA 17 6. BORDEAUX VITILIGO GLOBAL ISSUES 22 CONSENSUS CONFERENCE CLASSIFICATION 7. CLASSIFICATION OF SEGMENTAL VITILIGO OF 22 FACE 8. CLASSIFICATION OF PHOTODERMATOSES 27 9. AGE WISE DISTRIBUTION OF FACIAL 55 DERMATOSES 10. SITES OF DISTRIBUTION OF FACIAL DERMATOSES 58 11. AGE AND SEX WISE DISTRIBUTION OF ACNE 59 12. SITES OF DISTRIBUTION OF ACNE 61 13. GRADING OF ACNE 61 14. AGGREVATION FACTORS OF ACNE 62 15. AGE WISE DISTRIBUTION OF PIGMENTARY 63 DISORDERS 16. AGE WISE DISTRIBUTION OF INFECTIONS 70 17. AGE WISE DISTRIBUTION OF ECZEMATOUS 73 DISEASES 18. AGE GROUP WISE DISTRIBUTION OF SKIN 77 TUMOURS 19. INCIDENCE OF SKIN TUMOURS OF FACE 78 LIST OF CHARTS S.No. CHARTS PAGE NO. 1. SEX DISTRIBUTION IN FACIAL DERMATOSES 54 2. OCCUPATIONAL DISTRIBUTION OF FACIAL 55 DERMATOSES 3. SEASONAL VARIATIONS IN FACIAL 56 DERMATOSES 4. SYMPTOMS IN FACIAL DERMATOSES 57 5. INCIDENCE OF VARIOUS FACIAL DERMATOSES 57 6. GENDER DISTRIBUTION OF ACNE 59 7. OCCUPATIONAL DISTRIBUTION OF ACNE 60 8. OCCUPATIONAL DISTRIBUTION OF 64 PIGMENTARY DISORDERS 9. SEASONAL DISTRIBUTION OF PIGMENTARY 65 DISORDERS 10. SEX DISTRIBUTION OF MELASMA 66 11. OCCUPATIONAL DISTRIBUTION OF MELASMA 67 12. DISTRIBUTION PATTERN OF MELASMA 68 13. OCCUPATIONAL DISTRIBUTION OF INFECTIONS 70 14. INCIDENCE WISE DISTRIBUTION OF 71 INFECTIONS 15. OCCUPATIONAL DISTRIBUTION OF ECZEMAS 74 AFFECTING FACE 16. OCCUPATIONAL DISTRIBUTION OF SKIN 77 TUMOURS COLOUR PLATES S.No COLOUR PLATES PAGE NO. 1. ACNE VULGARIS 80 2. NODULO CYSTIC ACNE 80 3. MELASMA 81 4. HERPES LABIALIS 81 5. ACNE SCARS 82 6. PERIORAL DERMATITIS 82 7. TINEA FACIEI 83 8. VITILIGO 83 9. MOLLUSCUM CONTAGIOSUM 84 10. PHOTO SENSITIVE ECZEMA 84 11. DERMATOSIS PAPULOSA NIGRA 85 12. HERPES SIMPLEX 85 13. ROSACEA 86 14. HANSEN’S DISEASE 86 15. XANTHELASMA 87 16. SYRINGOMA 87 17. TRICHOEPITHELIOMA 88 18. TUBEROUS SCLEROSIS 88 LIST OF ABBREVIATIONS DPN : Dermatosis Papulosa Nigra SCC : Squamous Cell Carcinoma BCC : Basal Cell Carcinoma SLE : Systemic Lupus Erythematosus PMLE : Polymorphic Light Eruption. TLR : Toll Like Receptors PAMPs : Pathogen Associated Molecular Patterns. MITF : Melanocyte Inducing Transcription Factor. ABSTRACT TITLE : CLINICO EPIDEMIOLOGICAL STUDY OF FACIAL DERMATOSES AMONG ADULTS BACKGROUND AND PURPOSE OF STUDY : Face is cosmetically important area of the body. Any change in skin colour or appearance of rash over the face affects an individual both in psychological and social aspects. Each facial dermatoses have its own clinical presentations and also own demographic variations. Therefore detailed knowledge about the dermatoses affecting the face is important. AIM To study the clinical features and different pattern of involvement of various facial dermatoses and their epidemiological aspects like age , sex distribution and occupation. MATERIALS AND METHODS 200 patients with facial dermatoses were selected from OPD of dermatology, Coimbatore Medical College Hospital, for a period of 1 year. In each patient, the details of name, age , sex and occupation were noted. A detailed history of symptoms and their duration were recorded. Complete general and dermatological examination was carried out in all the patients. Investigations like KOH examination , woods lamp examination and skin biopsy was carried out in relevant patients. RESULTS Among the 200 patients enrolled in this study 63% were females and 37% were males. Most common age group affected was 26-32 years. Majority of them were housewives (27.5%.). Seasonal variation was reported in 60% of cases. Among the various facial dermatoses , most commonly reported in this study was pilosebaceous diseases , followed by pigmentary disorders and infections. CONCLUSION : Most of the studies in the facial dermatoses were focused on the specific diseases, this study highlights the need for comprehensive studies in facial dermatoses. KEYWORDS : ACNE, MELASMA, Skin Tumors INTRODUCTION Face is an important area of concern in aspects of health and disease. Facial appearance of an individual provides primary identity to a person. Facial skin is more prone to UV rays , allergens , infections and cosmetics usage than any other parts in our body. Any lesions on the face provoke more anxiety and seeks early medical need. The various dermatological conditions that affect the face are pilosebaceous diseases, pigmentary disorders , infections , eczema , connective tissue diseases and immune bullous disorders. Some of them pertaining to face only and some of them are early manifestation of systemic diseases as well. Hence early identification of these diseases are helps in proper management. 1 REVIEW OF LITERATURE CLINICO EPIDEMIOLOGICAL STUDY OF FACIAL DERMATOSES AMONG ADULTS Facial appearance is a primary identity for an individual. Facial skin is differ from other regions of the skin because of its rich vascular supply and abundant sebaceous glands. The dermo epidermal junction of facial skin have a flattened profile with consequent