Spectrum of Pediatric Dermatoses in The Pediatric Outpatient Clinic of a Rural Teaching Hospital

Introduction: Skin diseases in the pediatric population are common all over the world including rural and urban areas. There is variation in the pattern and presentation of Dermatoses, with eczemas being the most common skin disorder in developountries and infections and infestations in the developing countries. Aims and Objectives: i) To study the spectrum of various dermatoses in infants and children attending pediatric outpatient clinic. ii) To study the pattern of common Dermatological conditions affecting the pediatric population of different age groups. Material & Methods: It was an observational retrospective database study of the spectrum of various dermatoses in infants and children attending pediatric outpatient clinic over past 6 months from July 2016 to December 2016. We included all patients coming with skin disorders to the pediatrics outpatient department. Results: The entire data was entered and cleaned in MS Excel before its statistical analysis. Among 2078 pediatric skin patients attending the Dermatology OPD, 597 cases were Infectious and 1481 cases were Non infectious. Males outnumbered the females. The distribution of diagnosis of dermatoses differs significantly between male and female cases studied (P-value<0.001). Three most common spectrums of dermatoses were pityriasisinfections (17.5%), Atopic dermatitis (11.4%) and Tinea infections (10.5%). Tinea infections were found to be highest (36.7%) and next common was scabies (24.5%) in Infectious variety followed by Chicken–pox / Varicella (7.7%). Conclusion: Over all fungal infections, Atopic Dermatitis and Pytiriasis were commonest which commonly occurred in adolescents and teen age groups which could be attributed to hormonal changes, excessive sweating, and bad hygiene.


Introduction
Dermatological conditions constitute at least 30% of all outpatient visits to pediatrician and 30% of all visits to dermatologists involve children. The incidence of skin diseases among children in various part of India has ranged from 8.7% to 38.8% in different studies usually school based surveys Because of more delicate nature of the skin of infant and children as well as contact exposure to trauma, most skin diseases of childhood are attributable to physical cause, infection and allergy. Also the disease pattern differs in a given population by different ecological factor [1]. Skin diseases are a major health problem in pediatric age group and are associated with significant mortality. Skin diseases in the pediatric population are common all over the world including rural and urban areas [2]. Various epidemiological studies have been undertaken across the world including India to study the pattern of pediatric dermatomes.
The epidemiological data in Indian studies is based on pattern of pediatric dermatitis in school going children in both urban and rural area and in tertiary care hospitals [3]. Pediatric dermatomes require a separate view from adult dermatomes as there are important difference in clinical presentation, treatment and prognosis [4]. Studies of pediatric

Original Research Article
Pediatric Review: International Journal of Pediatric Research Aailable online at: www.pediatricreview.in 667|P a g e population suffering from skin diseases can play an important role in public health policy making. The aim of this study is to give an overview of the statistical study of different dermatologic diseases in infant and children in rural hospital in Mavalregion.
Cutaneous infection sare common in school going children and can spread due to intermingling with each other if not treated properly. Adele scent population inhale different spectrum of disease pattern altogether. We want to under take this project to study the spectrum man pattern of different Dermatoses in pediatric patients of different age groups.

Material & Methods
Type of Study:Observational retrospective database study of the spectrum of various dermatoses in infants and children.

Place of Study: Pediatric Dermatology outpatient clinic.
Duration of Study: Over past 6 months from July 2016 to December 2016.

Sample size: 2078 cases.
Sample Collection: This Data was collected from the pediatric out patient registers and of patients coming with skin disorders was studied and their diagnosis confirmed after they were referred to the skin out patient clinic.
Inclusion criteria: All Pediatric patients coming with skin disorders to the pediatrics outpatient department.

Statistical Methods:
The entire data was entered and cleaned in MS Excel before its statistical analysis. The entire data was statistically analyzed using Statistical Package for Social Sciences (SPSS ver 21.0, IBM Corporation, USA) for MS Window Table- Total 2078 100.0

Original Research Article
Pediatric Review: International Journal of Pediatric Research Aailable online at: www.pediatricreview.in 669|P a g e  Values are n (% of cases). P-value by Chi-Square test. P-value<0.05 is considered to be statistically significant. ***P-value<0.001 (Highly Significant).
The distribution of diagnosis of dermatoses differs significantly between male and female cases studied (P-value<0.001). Noninfectious skin disorders were more prevalent than Infectious in in both sexes. 67.6% noninfectious in males as to only 32.4% cases were Infectious. Similarly, 75.7% were noninfectious in females as compared to only 28.7% infectious.

Discussion
The present study brings into focus the spectrum of pediatric Dermatoses encountered in Maval area in Pune District as our Hospital being a referral Centre. There is paucity of epidemiological data on Pediatric Dermatoses, hence this study taken up.
Among 2078 pediatric skin patients attending the Pediatric Dermatology OPD, Males (54.4%) outnumbered the females in our study (45.6%) similar to study in Western Nepal [6]. The distribution of diagnosis of dermatoses differs significantly between male and female cases studied (P-value<0.001).
About 597(28.7%) cases were Infectious and 1481(71.2%) cases were Noninfectious. This shows that Noninfectious skin diseases outstripped in our study which was similar to studies conducted by Vishal et al [7] where it was 52.65% and in many other studies where it varied between 40.9% to 58.7% [8][9][10]. The reason behind this may be increased awareness for non-infectious or allergic diseases due to Patient education and counseling.
Our study revealed the incidence of Infectious skin diseases to be only 28.7% for which we need to study the reasons behind the non-referral which is in  [14]. Our hospital being a major referral center from the peripheral Maval area, the awareness on common Dermatological conditions like Atopy and Allergies (Non-Infectious) in children and Acne (Non-Infectious) in Teenagers may be more which could be the reason for same.
Among the Infectious skin diseases spectrum, Tinea infections were found to be highest (36.7%) in our study as in the Libya study [15] which was 20% incidence. Next common was scabies (24.5%) which was very similar to the Pondicherry study by Kumar et al and a Himachal study [16][17]. Reason is selfexplanatory as both are highly contagious. Chickenpox / Varicellawas observed in 7.7% in our study. However, Varicella infection was not reported in many studies. The reason behind both observations could be direct indoor admission for Varicella.
Among the Non-Infectious spectrum, Pityriasis was common (24.6%) and next in the order was Atopic Dermatitis (15.9%) followed by Acne (12.8%) in our study. Higher incidence of Pityriasis could be explained due to dietary factors deficiency like zinc and trace elements. This was similar to the Turkey study [18] where Pityriasis was 18.3%, and Acne was 9.6%. However, they [18] had lesser prevalence of Atopic Dermatitis (1.6%) as this study was conducted only in primary school children and we covered all age groups from infancy to Adolescents which explains the reason behind Atopy and Acne.

Conclusion
In conclusion, our study shows that the prevalence and diversity of skin disorders varies from one area / country from another. The most common skin disorders found in our study were simple and could be cured easily like Taenia, Pityriasis, Atopic Dermatitis and Acne. Awareness of parents should be raised in terms of early referral to experts for these commonly treatable diseases. This study will help in education of the rural population regarding prevention of skin disorders related to hygiene, sanitation and dietary factors.
Implications: This study will help in education of the rural population regarding prevention of common skin disorders related to hygiene, sanitation and dietary factors like Taenia, Pityriasis, Atopic Dermatitis and Acne. Preventive and curative health services should be provided especially for adolescent skin diseases which is more prevalent in our study.