Prevalence of dermatological conditions in tribal place of Timbi, Bhavnagar (Saurashtra)

INTRODUCTION

Skin is one of the major organs of our body. With time people have started taking due care of their skin. Also with changing civilization, there are new problems up springing every now and then. Even prevalence of skin diseases is different from place to place.¹ What may be seen as a common disease, in one place may not be commonly seen at the other place. A search was made to know the burden of skin diseases prevalent in Timbi, but no precise data was available, which could throw sight onto the topic. Hence a study was undertaken to know the prevalence of various dermatological conditions prevalent in village of Timbi, Bhavnagar (Saurashtra).

Aim

The aim of the study was prevalence of dermatological conditions in tribal place of Timbi, Bhavnagar (Saurashtra).

METHODS

Patients attending the outpatient department of a Local hospital at Timbi were studied. Duration of study was from February 2017 to April 2017. The patients were explained in details, the need and importance of the study. Only then, cases that wished to enroll voluntarily were taken up for the study. Verbal consent was taken.

Males and females of all ages were undertaken. A total of 9500 cases were enrolled. Detailed history was taken. Needed investigations were performed.

RESULTS

Total cases- 9500; Males- 6500 (68.42%); Females- 3000 (31.57%).

Males outnumbered females in the study conducted (Table 1).

50% people were farmers by occupation while only 5% were unemployed (Table 2).

45% were highly educated, while 10% could not read or write (Table 3).

Diabetes and thyroid disorders were commonly seen co-exsisting with skin diseases (Table 4).

Fungal infection was the commonest skin problem seen in all ages and both sexes (Table 5).

DISCUSSION

A total of 9500 cases were studied. Both sexes were seen during the study. Males constituted major Population of the study. Even infants and females were seen in large number. People of all age groups were studied.

Skin and occupation

Occupation of person has a co-relationship with the skin disease he has. It was seen that most of polymorphous light eruptions and air borne contact dermatitis were commonly seen in farmers. Hand dermatitis and onychomycosis was commonly seen in females working constantly with water.

Scabies was commonly seen in unemployed and rag pickers. Irritant contact dermatitis was commonly seen in artisans and cement workers.

Fungal infection was commonly seen with population of all age groups. It could also be attributed to persistent hot environment, lack of aeration in houses.¹

Skin disease and literacy rate

It is now widely recognized that health outcomes are deeply influenced by a variety of social factors outside of health care system, this includes the education level and economy.²

Higher the literacy level, more is the understanding, about the disease. It was seen that the frequency of the follow up needed, for an educated person, were very less in comparison to an uneducated person.

The level of understanding about the nature and the cause of the disease, the care and precautions to be taken, were comparatively higher for an educated person.

Thus, Literacy has a role to play, directly or indirectly in occurrence and persistence of skin disease.

Skin diseases and systemic disorder

It is not uncommon to see the co-relationship of systemic disorder with skin diseases. The most common association is with endocrinopathy.

Out of every 10 cases of fungal infection, 4 had existing un-controllable diabetes. Out of every 20 cases of telogen effluvium, 5 had thyroid disorder and 2 had severe iron deficiency.

It was also observed that, once diabetes was controlled, the skin condition improved rapidly.³ Similarly when iron substitute was provided, the hairfall decreased drastically.

Multiple achrocordones were observed in patients with obesity and diabetes.

Skin diseases and alternate remedis

It was observed that many patients had taken up home remedy as means to treat their problem, few had taken ayurvedic and homeopathic medications before consulting us, and few directly opted to take allopathic medicines. Details as follow-

• A) Home remedy

It was observed that in 50% cases, home remedy was done for the prevailing skin condition. The most common home remedy used by patient were-

• 1. Lime for Milaria and acne,
• 2. Neem paste for Milaria and acne,
• 3. Turmeric for pyodermas,
• 4. Heena and curd for dandruff,
• 5. Bathing with neem water for pruritus.

B) Quacks

Around 12.8% cases referred to quacks. The reason for visiting quacks were-Cheap, easy accessible, time effective.

C) Ayurvedic therapy

Around 10.5% cases had undertaken ayurvedic medications. The most common reason for taking Ayurvedic medication was the mentality, of not wanting to take allopathic medicines.

D) Homeopathy therapy

Around 8.2% cases had taken homeopathy medicines.

E) Allopathy

Around 18.42% had directly opted to take allopathy medicines.

Skin and steroids

It was observed that, around 60% of cases were earlier treated with steroid.

The cases were either treated by quacks or patients purchased the steroid from over the counter pharmacy. Many claimed that they came to know about steroids from their neighbors /friends who had once used steroid for some other skin condition and it had improved.

The most common cases where irrational use of steroid was seen were-

• 1. Fungal Infection- especially Tineacorporis, cruris.
• 2. Teenagers who are obsessed with fairskin colour,use steroids to become fair.⁴
• 3. In acne cases, for quick improvement.

It was only after steroid lead to further complications like persistence or recurrence of condition like in tinea, or adverse effects like ochronosis- after using triple combination for melasma, or striae formation, that people referred to us.⁵

Pattern of skin diseases

Variety of skin manifestations were observed in case study of 9500 patients. Fungal infection especially Tineacorporis, cruris, faciei were abundantly seen in the population owing to the kind of climate, nature of occupation and lack of awareness.⁶

The dermatophytosis cases seen represented just the tip of the iceberg of the epidemic that is in the community.

Many cases of tinea incognito were observed due to irrational use of steroid. 3 cases of tinea with severe secondary infections were seen. Many cases were seen where entire families were affected with Tinea.

Eczema was also commonly seen. Mostly hand eczema was seen in females while both hand and foot eczema was seen commonly in males.

Psoriasis and urticaria were seen more commonly in males. Many cases of Atopic dermatitis were seen in young children. Around 10 cases had strong family history of atopy.

Even polymorphous light eruption was commonly seen in farmers. Acne was more common in teenagers.

CONCLUSION

Dermatological conditions are prevalent near and far. There is no end to the stigmatic condition of fungal disease. Improper understanding about the disease leads to further worsening of the situation. Misuse of topical corticosteroids appears to be a common problem in India, as seen in our study. Topical steroid abuse as a fairness cream is widely prevalent.

The long-term risk associated with its chronic use certainly outweighs the aesthetic benefit it may offer in some people. Easy availability of quick but temporary relief, from quacks, has been a major reason where the initial findings of skin conditions are tampered with, adding to further problems.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

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