Study of sex predominance in skin disorders in children aged 1 month to 5 years

Introduction: Skin diseases are common in children. Certain skin disorders show striking differences between sexes in incidence pattern. This study was undertaken to study the sex predominance of various skin disorders in children, aged 1 month to 5 years. Materials and Methods : 450 children aged between 1 month to 5 years attending Outpatient, Department of Pediatrics, D. Y. Patil Medical College and Hospital duringthe period of 1 st September 2017 to 31 St August 2018 included in this study. Age, sex and detailed history of all children were recorded. Skin examination was done under adequate illumination. Skin disorders were groupedunder 12 groups by clinical examination diagnosis. The data was analyzed statistically. Results: Maximum children of skin disorders belonged to age group 4-5 years and males 237 (52.66%) outnumbered females 213(47.34%).Highest incidence was infections 254(56.44%). Out of infections, 95 with bacterial, 72 viral, 47 fungaland 40 parasitic infestations, males were 60(63.16%), 50(69.45%),12(25.54%), 25(62.5%) and females were 35 (36.84%), 22(30.55%), 35(74.46%),15(37.5%) respectively. Forallergic disorders (38) and eczematouslesions (36) males were 28(73.68%), 20(55.55%) respectively while females were 10(26.32%), 16(44.45%) respectively. Congenital malformations (20) had 6(30%) males and 14(70%) females. Papulosquamous (26) and vesiculobullous (18) lesions had 8(30.77%) and 8(44.44%) males and 18(69.23%), 10(55.56%) females respectively. Nutritional deficiency (18) and pigmentary lesions (20) were common in females 12(66.67%) and16 (80%) respectively. Conclusion : Bacterial, viral infections, parasitic infestations and allergic disorders showed significant sex predominance in males whereas fungal infections, congenital malformations, papulosquamous disorders, nutritional deficiency and pigmentary lesions significantly in females.


Introduction
Skin diseases manifesting as primary and secondary cutaneous complaints account for a significant proportion (30%) of pediatric outpatient consultations [1,2]. The pattern of skin diseases is known to differ in different countries of the world and in different regions of the same country [3]. Most of the skin diseases were seen in the 1-5 years age (44.94%), followed by school children (29.6%) and infants (25.46%) [4]. Skin diseases in the pediatric age group can be transitory, chronic or recurrentand differ from those in adults in terms of diagnostic approach and management, while some of them manifest mainly or exclusively in children [5]. Socioeconomic status, external environment, climate exposure, dietary habits and different levels of functional development of skin are the more influential factors in skin disorders in children [6]. Along with these internal and external factorsan important factor amongst these is sex of the child which in fluence the prevalence of various skin disorders. Over the decades interest is growing regarding sex differences in disease with respect to epidemiology, pathogenesis, clinical presentation and response to treatment. Certain skin diseases show striking differences between sexes in incidence pattern [7]. Since there were very few studies, this study was undertaken to study the sex predominance of various skin disorders in children aged 1 month to 5 years. 450 children aged between 1month to 5 years of various skin disorders presented with chief complaint of skin diseases or having other minor complaints but having skin manifestations were included in this study. For every child, through history was taken with particular emphasis on age, sex, family history and previous history of similar skin condition.

Materials and Methods
The skin examination was performed under adequate illumination. The skin lesions were inspected, palpated, diagnosed and classified on the basis of morphology, size, color, texture, firmness, configuration, location and distribution into following twelve groups.

Results
In this study 450 children from the age group of 1 month to 5 years were studied. The children were placed into 5 subgroups of 1 year each as given in Table I. Maximum number of children belonged to age group 4-5 years (23.33%) and minimum number of children belonged to age group 1 month to 1 year (16.88%). Of them 237 (52.66%) were males and 213(47.34%) were females with male to female ratio being 1:0.9.

Discussion
Sex has a major impact on outcome from a range of infectious diseases to skin diseases, starting from the beginning of life. Overall morbidity and mortality rates are higher in males than in females throughout life [8]. about the pattern and sex in pediatric skin disorders in our area will help us in implementing essential changes in health education, disease control and prevention. In our study, total males outnumbered females but was not statistically significant. Bisht JS et al [10], Awal G etal [11] and Sardana k et al [12] observedmale predominance while few studies had female predominance [13,14,15].
Children between 4-5 years were more affected with skin disorders similar results found by Bisht [15] found significant sex predominance for females for infestations. In humans, females reportedly mount stronger humoral and cellular immune responses to infection or antigenic stimulation than do males [16]. Allergic disorders were also showed significant sex predominance in males, similar to Awal G et al [11].
Congenital malformations, papulosquamous disorders, nutritional deficiency disorders and pigmentary lesions showed significant female sex predominance in our study. The most common amongst congenital malformations were hemangiomas while for nutritional deficiency disorders it was phrynoderma.
Bisht JS et al [10] and Awal G et al [11] found pigmentary lesions significantly higher in females while Mostafa FF et al [15] found female predominance for papulosquamous disorders. Miscellaneous skin disorders constituted cases of tuberous sclerosis, milia, and erythema multiforme.
The reasons for underlying sex-based disparities in the incidence of skin and skin related disease remain largely unknown but are likely multifactorial.
The limitation of this study was, it was a single center study. A large prospective multicenter study needs to be conducted to know more sex predominance inpediatric skin disorders.

Conclusion
Bacterial, viral infections, parasitic infestations and allergic disorders showed significant sex predominance in males whereas fungal infections, congenital malformations, papulosquamous disorders, nutritional deficiency and pigmentary lesions showed significant sex predominance in females.
Contributors: SK, AC: designed the study, collected and analyzed the data and drafted the manuscript. AK: supervision of work and analyzed the data. SSK: literature search and drafted the manuscript. AK will act as the guarantor. All authors approved the final version of manuscript.