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Indian J Community Med
Indian J Community Med
IJCM
Indian J Community Med
Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine
0970-0218
1998-3581
Wolters Kluwer - Medknow India

IJCM-49-649
10.4103/ijcm.ijcm_940_22
Short Communication
Clinical Spectrum of Dermatological Disorders at an Urban Health Center in East Delhi
Soni Sonika
Garg Taru
Acharya Anita 1
Sarkar Rashmi
Department of Dermatology, Lady Hardinge Medical College, New Delhi, India
1 Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
Address for correspondence: Dr. Sonika Soni, D-26, Swarnakar Colony, Nehru Nagar, Jaipur – 302 216, Rajasthan, India. E-mail: sonikasoni940628@gmail.com
Jul-Aug 2024
09 7 2024
49 4 649653
21 11 2022
02 1 2024
Copyright: © 2024 Indian Journal of Community Medicine
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Dermatological disorders constitute a significant proportion of primary health care (PHC) setups. The pattern of dermatological disorders varies among different countries and different parts of the same country owing to climatic and geographical variations, level of education, access to health care, etc. To study the clinical spectrum of patients presenting with dermatological disorders at an urban health center (UHC) in East Delhi. To identify the various risk factors associated with dermatological disorders in study subjects. A total of 1,148 patients who reported skin diseases for the first time at the Dermatology Outpatient Clinic at UHC in East Delhi were recruited. Detailed demographic data, history, and examination and potential risk factors of skin diseases (socioeconomic status, level of education, occupation, comorbidities, and addictions) were recorded on a predesigned proforma. A total of 616 (53.7%) patients had infectious dermatoses and 532 (46.3%) had non-infectious dermatoses. Among the infectious dermatoses, fungal diseases (44.8%) were the most common followed by parasitic infections (31.17%) and bacterial infections (9.74%). Among the non-infectious group, eczematous disorders (28.01%) were the most common, followed by pigmentary disorders (21.62%) and acne (19.55%). A significant association between level of education, occupation, and comorbidities with the distribution of infectious and non-infectious dermatoses was found. As a significant proportion of patients with a vivid spectrum of dermatological disorders present at the PHC setups, therefore dermatologists supervise that specialty clinics should be held regularly at these centers along with the availability of all the basic investigations to aid diagnosis and management.

Clinical spectrum
East Delhi
urban health center
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pmcINTRODUCTION

Skin is the largest organ of the body and acts as the first barrier to exogenous insults such as injury and microbes thereby reflecting the health status of an individual.[12] Diseases of the skin are becoming an important concern at all levels of society and affect all age groups: infants, teenagers, adults, and the elderly.[3] They show variable patterns in different countries as well as different parts of the country. These variations across the country are observed especially in developing countries such as India.[3] The pattern of skin diseases can be affected by certain factors, namely, level of education, social backwardness, climatic variation, industrialization, access to primary healthcare facilities, and cultural and religious factors.[4] They cause huge psychological and financial burdens to the patient and the family.[5]

Although the burden of skin diseases is significant, the majority of people affected with skin problems do not report to health centers and hospitals to seek medical advice. The prevalence of skin diseases in the general population has varied from 7.86% to 11.16% in India as reported in various studies.[356]

Though there are a significant number of studies at a global level to understand the dermatological pattern, there is a paucity of studies in developing countries in this regard.[78] In India, most studies conducted in the past were either tertiary health center-based studies, health camps, or survey-based studies; therefore, we studied the prevalent spectrum of dermatological disorders at the PHC level, that is, urban health center (UHC), Kalyanpuri Resettlement Colony, East Delhi, North India.

MATERIALS AND METHODS

It was a UHC-based descriptive observational cross-sectional study conducted from November 2019 to October 2021. Institutional Ethics Committee approval was taken and written and informed consent was taken from all participants.

Our study was conducted at UHC, Kalyanpuri Resettlement Colony, East Delhi. Kalyanpuri is a resettlement colony, which is located in East Delhi. UHC, Kalyanpuri is one of the field practice areas for the Department of Community Medicine, Lady Hardinge Medical College and associated hospitals. Dermatology Outpatient Clinic is held once a week at UHC, Kalyanpuri Resettlement Colony, East Delhi. All patients presenting for the first time to this clinic during the study period were included in the study.

Detailed demographic data, history, and examination were conducted and recorded as per the predesigned proforma. All participants of the study were questioned about the potential risk factors of skin diseases. Diagnosis of dermatological diseases was made based on clinical history and examination. Clinical images of representative dermatological lesions were taken. Treatment was individualized as per dermatological disorders.

RESULTS

The maximum number of patients (n = 306, 26.6%) belonged to the age group of 21–30 years, closely followed by the age group of 11–20 years (n = 270, 23.5%). Females (n = 647, 56.4%) outnumbered males (n = 491. 42.8%). Ten transgender patients (0.9%) were also included in the study. The maximum number of patients had received a primary level of education (up to class 5) with 30.4% cases, followed by the secondary level of education (18.0%), closely followed by graduates (17.9%). According to occupation, the maximum number of patients were housewives (n = 381, 33.2%), followed by students (n = 338. 29.4%). Lesser common occupations were government jobs (11.9%), laborers (3.6%), drivers (1.4%), housemaids (1.9%), farmers (1.3%), and preschool infants and children (2.3%). According to the socioeconomic status, most patients belonged to the lower middle class (n = 476, 41.5%). The lowest number of patients was in the upper class (0.7%).

Among the associated comorbidities, the most common was hypertension (n = 89, 7.75%), closely followed by diabetes mellitus (n = 80, 6.97%). Other less common comorbidities observed were thyroid disorders and tuberculosis, and a few patients had a combination of more than one. Various addictions were studied in study subjects. Active smoking constituted 90 patients (7.87%), followed by tobacco users (n = 80, 6.97%) and alcoholics (n = 67, 5.84%). All addictions were more common in males than females. Seven hundred forty-three patients (n = 743, 64.7%) resided in overcrowded households.

Overall, patients with infectious diseases (n = 616, 53.7%) were more than non-infectious diseases (n = 532, 46.3%). The proportion of females with infectious dermatoses (56.67%) was more than males (49.90%) [Tables 1 and 2, Figure 1].

Figure 1 Distribution of participants according to dermatological diseases

Table 1: Distribution of participants with infectious dermatological diseases and gender

Diseases	Males n (%)	Females n (%)	Others n (%)	Total n (%)	
Fungal	111 (45.31)	161 (43.99)	2 (40)	274 (44.48)	
Parasitic	73 (29.80)	118 (32.24)	1 (20)	192 (31.17)	
Bacterial	24 (9.79)	35 (9.56)	1 (20)	60 (9.74)	
Viral	20 (8.16)	28 (7.65)	1 (20)	49 (7.95)	
Cutaneous TB	7 (2.8)	6 (1.63)	0	13 (2.11)	
Leprosy	3 (1.22)	4 (1.09)	0	7 (1.14)	
Combination of two or more	7 (2.86)	14 (3.83)	0	21 (3.41)	
Total	245 (100)	366 (100)	5 (100)	616 (100)	
n=Number of patients, %=Percentage, TB=Tuberculosis

Table 2: Distribution of participants with non-infectious dermatological diseases and gender

Diseases	Males n (%)	Females n (%)	Others n (%)	Total n (%)	
Eczematous	70 (28.46)	78 (27.76)	1 (20)	149 (28.01)	
Pigmentary	49 (19.92)	64 (22.78)	2 (40)	115 (21.62)	
Acne	44 (17.89)	58 (20.64)	2 (40)	104 (19.55)	
Papulosquamous	29 (11.79)	30 (10.68)	0	59 (11.09)	
Hair disorders	17 (6.91)	16 (5.69)	0	33 (6.20)	
Connective tissue disorders	5 (2.03%)	3 (1.07)	0	8 (1.50)	
Urticaria	4 (1.63)	2 (0.71)	0	6 (1.13)	
Vascular	1 (0.41)	3 (1.07)	0	4 (0.75)	
Neurocutaneous	0	2 (0.71)	0	2 (0.38)	
Neoplastic	1 (0.41%)	0 (0.00)	0	1 (0.19)	
Others	7 (2.85%)	3 (1.07)	0	10 (1.88)	
Combination of two or more	19 (7.72)	22 (7.83)	0	41 (7.71)	
Total	246 (100)	281 (100)	5 (100)	532 (100)	
n=number of patients, %=Percentage

The association of age (P = 0.525) and gender (P = 0.080) with infectious and non-infectious skin diseases was studied. It was not found to be statistically significant (P > 0.05). However, it was noted that in females the proportion of patients with infectious diseases (59.4%) was higher than that of non-infectious diseases (52.8%) and in males, the proportion of patients with non-infectious diseases (46.2%) was higher than that of infectious diseases (39.8%). The association of various risk factors, such as level of education, occupation, comorbidities, socioeconomic status, addictions, and overcrowding with respect to infectious and non-infectious skin diseases was studied. It was found to be statistically significant with the level of education (P = 0.001), occupation (P = 0.0001), and comorbidities (P = 0.001). However, the association with overcrowding (P = 0.432), socioeconomic status (P = 0.271), and addictions (P > 0.05) failed to reach the level of significance.

The Proportion of patients with different infectious diseases and non- infectious diseases has also been subclassified and noted in the study [Tables 3 and 4].

Table 3: Proportion of different infectious disease categories

Infectious diseases	Number of patients	Percentage	
Fungal	
    Tinea cruris	99	16.07	
    T. corporis	65	10.55	
    T. capitis	25	4.06	
    T. unguium	5	0.81	
    T. mannum	3	0.49	
    T. pedis	14	2.27	
    T. faciei	21	3.41	
    Candidiasis	24	3.90	
    Pityriasis. versicolor	18	2.92	
Bacterial	
    Folliculitis	27	4.38	
    Furunculosis	23	3.73	
    Other pyoderma	10	1.62	
Viral		0.00	
    Warts	18	2.92	
    Herpes	15	2.44	
    Others	16	2.60	
Scabies	192	31.17	
Cutaneous TB	13	2.11	
Leprosy	7	1.14	
Combination of two or more	21	3.41	
Total	616	100	
TB=Tuberculosis

Table 4: Proportion of different non-infectious disease categories

Non-infectious diseases	Number of patients	Percentage	
Eczematous	
    Foot eczema	42	7.89	
    Hand eczema	35	6.58	
    Atopic dermatitis (AD)	8	1.50	
    Seborrheic dermatitis (SD)	9	1.69	
    Irritant contact dermatitis (ICD)	11	2.07	
    Allergic contact dermatitis (ACD)	4	0.75	
    Pityriasis. alba	35	6.58	
    Others	6	1.13	
Pigmentary		0.00	
    Vitiligo	32	6.02	
    Melasma	71	13.35	
    Post inflammatory hyper/hypopigmentation (PIH)	8	1.50	
    Others	4	0.75	
    Acne	104	19.55	
Papulosquamous	
    Psoriasis	23	4.32	
    Lichen planus (LP)	11	2.07	
    Pityriasis rosea	25	4.70	
Hair disorders	33	6.20	
Others	19	3.57	
Urticarial	6	1.13	
Vascular	4	0.75	
Malignancy	1	0.19	

DISCUSSION

A rising trend of skin-related problems is noted in developing countries, including India. This can be correlated to multiple factors such as lower socioeconomic strata, climatic conditions, lack of access to health care, lower educational levels, and so on.[8910] The impact of dermatological problems in resource-poor areas of the world is important in forming a concerted and sustainable global response toward bringing down the burden.[1112]

This study was conducted on 1,148 patients at a UHC of East Delhi to study the spectrum of dermatological disorders at a PHC setup. Also, we studied different age groups presenting with various dermatological disorders in our study population. Risk factors known to influence the occurrence and distribution of various dermatoses such as socioeconomic status, overcrowding, level of education, occupation, comorbidities, and addictions were studied.

In our study, the maximum number of patients were in the age group of 21–30 years of age group (26.6%), closely followed by the 11–20 years of age group (23.5%). The least number of patients were found in the elderly age group, that is, > 60 years age group (5.1%). In a study conducted by Jain et al.,[5] the most common age group was similar to our study, that is, 21–30 years (26.8%). However, the elderly age group (>60 years) formed a significant proportion of 20.4% of patients and the least number of patients were in the 11–20 years age group (3.7%). In our study, the highest number of patients were in the 21–30 years age group could be because they are the most mobile group of the population, and more than 60 years being the least prevalent group because of least mobility and ignorance toward these non-life threatening skin problems.

In our study population, it was noted that patients who received the primary level of education (up to class 5) contributed to a higher prevalence of 30.4%, followed by secondary level of education (6 to class 8) with 18% cases, closely followed by graduates (17.9%). A similar distribution of patients with primary (38.31%) and secondary (25.51%) levels of education was noted in another study by Bommakanti and Pendyala.[13] The level of education is an important contributor to the health-seeking behavior of patients and thus can impact the dermatological spectrum.

In our study, the maximum number of patients were housewives (33.2%), followed by students (29.4%). This was very similar to the study by Prasada et al.[1] with the maximum patients being housewives (25%) followed by students (22%). Kar et al.[14] also reported the top two occupations in their study group as housewives (25.05%) and students (23.21%). The type of occupation also influences the spectrum of dermatological disorders such as hand eczema is more common in housewives and workers in chemical factories and therefore studying this factor is important.

According to the Kuppuswamy scale of socioeconomic status, our study group consisted of the maximum patients in the lower middle class (41.5%), followed by upper middle class (21.3%) and upper lower class (18.6%), closely followed by lower class (17.9%). Although both studies used different scales for socioeconomic status assessment, the most common group in both studies was of the lower socioeconomic strata. The socioeconomic strata reflect the overall standard of living and therefore affect the occurrence and spectrum of skin disorders.

In our study, it was noted that overcrowding in households was present in 64.7% of cases. It is considered an important factor in spreading transmissible dermatological diseases. In a survey conducted by Gibbs[15] to study the socioeconomic status in rural Africa based on regular cash income, crowded households, and level of literacy, it was concluded that crowded household settings were significantly associated with contagious skin diseases.

In our study, one-fourth (25.44%) of patients had either a single or more than one of the comorbidities. The most common one was hypertension (7.75%), followed closely by diabetes mellitus (6.97%), tuberculosis, and thyroid disorders. Jain et al.[5] also recorded hypertension (10.0%) as the most common comorbidity. Associated comorbidities predispose to various dermatological diseases and thus impact the spectrum of skin diseases. Various addictions observed in our study population were smoking (7.87%), alcohol consumption (5.84%), and tobacco chewing (6.97%). The changing scenario with regard to gender distribution and addictions was reflected in our study with addictions observed not only in males but also in females with 4.1% of females being alcoholics and 4.9% of females being active smokers. These addictions were associated with dermatological problems owing to ignorance toward self-care and hygiene and altered immunity. Also, they act as a trigger for various dermatological diseases, such as smoking which causes premature aging of skin.[1617] Similarly, alcoholism leads to varied skin manifestations such as urticarial reactions, flushing, psoriasis, rosacea, seborrheic dermatitis, and so on.[18] Therefore, studying these factors in association with skin diseases is important.

The prevalence of infective skin disorders noted in a few studies varied from 42.68% to 63.65%.[71920] On detailed analysis, it was found that infective disorders (53.7%) outnumbered the non-infective disorders (46.3%) in our study. Grover et al.[3] recorded a similar pattern of diseases where infectious cases (59.1%) were more common than non-infectious cases (40.9%). In contrast to our study, many studies noted that non-infectious diseases were more common than infectious ones. Bommakanti and Pendyala[13] recorded 60.15% cases of non-infectious diseases. This spectrum of dermatoses with predominant infectious diseases can be attributed to the fact that the community setting had overcrowding, ignorance toward healthcare, and poor hygiene. The differences in the distribution of infectious and non-infectious dermatoses in various studies can be attributed to different climatic and geographical diversities as well as different susceptibilities of different population groups.

Among the infectious group of disorders, fungal diseases dominated the spectrum with 23.87% of all study subjects, followed by parasitic infections (16.72%), bacterial infections (5.2%), and viral infections (4.27%). A similar pattern was noted by Das and Chatterjee[20] with the most common infections being dermatophytic (12.23%), followed by scabies (6.82%), although their proportions were lower than in our study. The higher prevalence of infectious dermatoses in our study can be attributed to overcrowding, lower socioeconomic strata, ignorance toward health, poor hygiene, and delayed presentations after using multiple over-the-counter treatments.

In the non-infectious group of diseases, we noted that the most common group was eczema (12.98%), followed by pigmentary skin diseases (10.02%), closely followed by acne (9.06%). Such a high percentage of acne can be attributed to the fact that we had a significant number of study subjects in the adolescent age group and early adulthood. This was due to the fact that the majority of patients were in 31–40 years and 0–10 years of age groups and a relatively lesser number of adolescents compared to our study.

In our study group, we studied the association of infectious and non-infectious diseases with respect to various risk factors. It was found that the association was found to be statistically significant with the level of education (P = 0.001), occupation (P = 0.0001), and associated comorbidities (P = 0.001. Occupation of the patients may be an important risk factor for dermatologic diseases, as has been noted in various studies.[1314] This can very well be explained by housewives and housemaids who are prone to developing hand eczema and candidiasis. It was noted that in all patients with comorbidities (n = 63), the proportion of non-infectious dermatoses was more than infectious dermatoses except in diabetics who had a higher proportion of infectious (8.9%) than non-infectious dermatoses (4.7%). This can be attributed to the decreased immunity status of diabetic patients. The association with other risk factors such as socioeconomic status (P = 0.271), overcrowding (P = 0.432), and various addictions (P > 0.05) was not found to be statistically significant.

Kar et al.[14] discussed that apart from environmental factors, skin diseases depend on occupation, socioeconomic status, and age of patients.

Based on our study, we recommend that there should be regular dermatologist-supervised specialty clinics at the PHC setups as these cater to a significant proportion of patients with a vivid spectrum of dermatological disorders. Also, the provision of health education regarding various risk factors for skin disorders as well as various ways to prevent them should be made. Because these centers are more accessible to patients, more studies should be conducted at these setups to determine a more accurate spectrum of dermatological spectrum in the community.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.
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