Clinico-epidemiological profile of dermatology patients: a one-year study at a newly established tertiary care centre in India

INTRODUCTION

To accurately assess disease prevalence within a population, it is essential to thoroughly understand the distribution and severity of skin conditions. Additionally, identifying the prevalence of skin disorders is crucial for delivering effective healthcare to the community.¹ Geographic location and climate significantly influence the pattern of skin morbidity in a given area.² Various skin conditions are also affected by factors such as community behavior, genetics, nutrition, and socioeconomic status. In the general population, the prevalence of skin diseases ranges from 6.3% to 11.2%.³ Although skin diseases are not typically fatal, they contribute to substantial disability. In India, the non-fatal burden of skin and subcutaneous diseases surpasses that of cardiovascular diseases.⁴ In 2017, the years lived with disability due to cardiovascular diseases in India was 332.96 per 100,000 people, compared to 455.06 per 100,000 for skin and subcutaneous disorders. According to the 2017 Global Burden of Disease Study, skin diseases ranked 10th in age-standardized years lived with disability, while cardiovascular diseases ranked 12th.⁵ Skin disorders affect all age groups and genders, representing a significant cause of morbidity within the population.

There is limited literature available on the frequency of skin diseases across Uttar Pradesh's 75 districts. This retrospective analysis was conducted to address this gap and examine the pattern of skin disorders among patients attending the dermatology OPD over the course of a year.

METHODS

A retrospective cross-sectional study was conducted utilizing outpatient records of dermatology OPD from November 2022 to October 2023 at AIIMS, Raebareli. Records of patients who attended the dermatology OPD regardless of age, gender and social class were included. Sexually transmitted infection and leprosy case records were excluded. Those patients who had incomplete records were not included. Since the study used completely anonymized and delinked data, ethical approval was not required.

Diagnoses were primarily based on clinical assessments, supported by relevant investigations, and documented in the OPD register. Data from the register were systematically recorded and analyzed. Skin conditions were classified into categories for detailed examination, including vitiligo, lichen planus, psoriasis, leprosy, sexually transmitted infections (STIs), drug reactions, cancers, connective tissue diseases, pityriasis rosea, and other papulosquamous disorders.

Diagnoses were primarily based on clinical assessments, supplemented by relevant investigations, and documented in the OPD register. Data from the register were systematically recorded on an excel sheet and analyzed. The study categorized dermatological conditions into eighteen distinct groups. These included hair disorders such as androgenetic alopecia and alopecia areata; various types of dermatitis including allergic, contact, acute, subacute, and chronic; and hypopigmentary disorders such as vitiligo, pityriasis versicolor, and pityriasis alba. Hyperpigmentary disorders covered melasma and acquired dyschromia. Other categories included urticaria, scars, keloids, and connective tissue disorders (e.g., systemic lupus erythematosus and dermatomyositis). Additionally, genital conditions (e.g., scrotal dermatitis and candidiasis), nail disorders (e.g., onychomycosis and nail dystrophy), nevi (including congenital and acquired nevi, melanocytic nevi, and Becker’s nevus), papulosquamous disorders (such as psoriasis, lichen planus, and pityriasis rosea), and vasculitis were included. A miscellaneous group was designated for conditions that did not fit into the other categories.

Data were categorized by age, gender, and skin disease patterns. Descriptive statistics were used to analyze the clinical and demographic data, with counts and percentages summarizing the findings.

RESULTS

Over the course of the year, a total of 4,188 patients visited the dermatology OPD. Of these, 2,681 were adults (64%), 978 were pediatric patients (23.2%), and 529 were elderly patients (12.6%) (Figure 1). Among the patients, 2,212 (52.8%) were female and 1,976 (47.2%) were male, indicating a higher prevalence of female patients. Infections were the most common dermatological complaints, affecting 1,311 patients (31.3%). These infections were observed in 767 males (18.3%) and 444 females (10.6%). Various dermatoses encountered in the study population have been summarised in Table 1.

Infections were categorized as follows: fungal infections accounted for 1,024 cases (78.1%), viral infections for 96 cases (7.32%), bacterial infections for 65 cases (4.96%), and parasitic infestations for 126 cases (9.61%), excluding leprosy and sexually transmitted infections. Infections were most common conditions across all age groups with slightly more prevalence among paediatric and geriatric population. Distribution of various infections noted during the study are given in Table 2.

Dermatitis was the second most common condition, comprising 17% of cases, followed by acne vulgaris at 10.3% and urticaria at 8.28%. Dermatoses according to age group have been depicted in Table 3 and Figure 2. Dermatitis was found to be a common condition affecting all age groups with maximum prevalence amongst the paediatric population. Hair disorders affected the paediatric population the most and the prevalence was significantly less in geriatric age group. Connective tissue disorders were rare in all age groups with a slight increase in the geriatric population. Urticaria was most prevalent in adult population and it decreased a little in geriatric population. Acne was predominantly a disease of adult population and was non-existent in geriatric age group as expected. Pigmentary disorders were common in paediatric population. Carcinomas were very rare and limited to only geriatric population. Immunobullous disorders were uncommon and adult population was mainly affected. Patients presenting with pruritis increased significantly with age and was common in older individuals. Nail disorders were relatively uncommon. Papulosquamous disorders were more common in adult population followed by geriatric population. Vasculitis was rare across all age groups.

DISCUSSION

A cross-sectional retrospective analysis was conducted over the course of one year, during which demographic and clinical data were analyzed. The study found that the majority of patients were adults (64%), followed by geriatrics (23.2%) and pediatrics (12.6%). The study also noted a higher prevalence of female patients, with females comprising 52.8% of the population compared to 47% males. These findings are consistent with those of a study by Sanker et al, which was conducted in a hospital in North Kerala.⁶

In our study, infections and eczemas were the most commonly diagnosed dermatological conditions. These results align with findings from studies by Asokan et al and Nair et al. A similar retrospective cross-sectional study by Sander et al reported infections in 42.7% of individuals, followed by eczemas in 27.7%.^6-8 Fungal infections were prevalent in 78.1% of individuals, with scabies affecting 9.61%. These high rates may be attributed to factors such as poor hygiene, humid conditions, lower socioeconomic status, and limited literacy. In studies by Sander et al, Asokan et al, and Nair et al, fungal infections were reported in 30.1%, 18.74%, and 14.18% of cases, respectively. There has been a noticeable increase in dermatophytic infections across the country.⁹

In our study, fungal infections were most commonly observed in the adult and geriatric populations, a finding consistent with recent studies.^10,11 Specifically, 28.19% of adults were diagnosed with infections. The increase in tinea infections among this population may be attributed to factors such as low literacy levels, overcrowding, and the use of over-the-counter topical steroidal drugs. In the pediatric population, infections and infestations were prevalent, with eczematous disorders being the next most common. A clinico-epidemiological study by Sharma et al found that 50.6% of pediatric patients had infections, followed by 25% with eczematous conditions.¹² These results align with our findings. Similar trends have been reported in studies from North India.¹³ In our study, the most common infections in the pediatric population were scabies, followed by bacterial infections like impetigo contagiosa and fungal infections such as tinea capitis.

In the current study, infections and dermatitis were more prevalent among male participants, accounting for 18.3% and 8.28% of cases, respectively, compared to females. Conversely, 10.6% of females and 6.08% of males had infections and eczemas, respectively. One possible interpretation is that men may seek healthcare services more frequently. Given that many individuals in rural Uttar Pradesh are farmers, it is plausible that phytodermatitis and allergic contact dermatitis are more common in this demographic. Additionally, melasma and related hyperpigmentary disorders were more prevalent among females (1.74%) than males (0.55%). This could be due to females being more concerned about their appearance compared to males. These findings are consistent with those reported by Sanker et al.⁶

The current study highlights the pattern of skin diseases in a typical rural population and helps us to analyse the demographical and skin ailments the population. Based on the findings of this study, it can be concluded that infections, particularly fungal infections, are the most prevalent dermatological conditions across all age groups in the population studied. Dermatitis also emerged as a significant concern, particularly among adult patients. The high prevalence of infectious dermatoses, especially in geriatric and pediatric patients, highlights the need for targeted public health interventions and preventive measures. These infections and infestations could be prevented by raising awareness for hygiene. These results underscore the importance of continued surveillance and tailored treatment strategies to manage and mitigate the burden of skin diseases in the region. Peripheral institutions must be strengthened with personnel and the necessary dermatological expertise in order to do this.

Limitations

There is a possibility of information bias as the information retrieved is based upon records. As this is a retrospective study, the selection of patients is dependent on the availability of records which may not represent the entire patient population. The one-year time frame may not be sufficient to observe certain rare conditions.

CONCLUSION

Infections, particularly fungal infections, are the most prevalent dermatological conditions across all age groups in the population studied. Eczemas or dermatitis were 2nd most prevalent dermatoses. The importance of prevalence data lies in its valuable utility in planning targeted services based upon the regional dermatoses profile.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. Rao GS, Kumar SS, Sandhya. Pattern of skin diseases in an Indian village. Indian J Med Sci. 2003;57(3):108-10.
2. 2. Kar C, Das S, Roy AK. Pattern of skin diseases in a tertiary institution in kolkata. Indian J Dermatol. 2014;59(2):209.
3. 3. Patro BK, Tripathy JP, De D, Sinha S, Singh A, Kanwar AJ. Diagnostic agreement between a primary care physician and a teledermatologist for common dermatological conditions in North India. Indian Dermatol Online J. 2015;6(1):21-6.
4. 4. Kavita A, Thakur JS, Narang T. The burden of skin diseases in India: Global Burden of Disease Study 2017. Indian J Dermatol Venereol Leprol. 2023;89(3):421-5.
5. 5. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-858.
6. 6. Sanker A, George S, Bhaskaramenon SC, Sivaprasad R. Profile of Skin Diseases among Patients Attending a Dermatology Outpatient Clinic: A Record-based Cross-sectional Study from a Tertiary Care Centre in Northern Kerala, India. J Clin Diagn Res. 2023;17(4):WC05-8.
7. 7. Asokan N, Prathap P, Ajithkumar K, Ambooken B, Binesh VG, George S. Pattern of skin diseases among patients attending a tertiary care teaching hospital in Kerala. Indian J Dermatol Venereol Leprol. 2009;75:517-18.
8. 8. Nair SP, Gopalakrishnan Nair TV. Pattern of dermatological diseases in Trivandrum. Indian J Dermatol Venereol Leprol. 1999;65:261-3.
9. 9. Verma S, Madhu R. The great Indian epidemic of superficial dermatophytosis: An appraisal. Indian J Dermatol. 2017;62(3):227-36.
10. 10. Rajagopalan M, Inamadar A, Mittal A, Miskeen AK, Srinivas CR, Sardana K, et al. Expert Consensus on The Management of Dermatophytosis in India (ECTODERM India). BMC Dermatol. 2018;18(1):6.
11. 11. Verma SB, Panda S, Nenoff P, Singal A, Rudramurthy SM, Uhrlass S, et al. The unprecedented epidemic-like scenario of dermatophytosis in India: I. Epidemiology, risk factors and clinical features. Indian J Dermatol Venereol Leprol. 2021;87:154-75.
12. 12. Sharma R, Abrol S. A clinicoepidemiological study of dermatoses among paediatric population. Int J Res Med Sci. 2018;6(6):2106-10.
13. 13. Sharma RC, Mendiratta RC. Clinical profile of cutaneous infections and infestations in pediatric age group. Indian J Dermatol. 1999;44:174-8.