A Clinico-Etiological Study of Dermatoses in Pediatric Age Group in Tertiary Health Care Center in South Gujarat Region

Burden of Disease, Unmet Needs in the Diagnosis and Management of Atopic Dermatitis: An Indian Expert Consensus

Background

Atopic dermatitis (AD) is a chronic inflammatory, non-communicable, and relapsing skin disease that affects all age groups. There is a dearth of literature that reports the disease burden, and epidemiology and highlights unmet needs in the diagnosis and management of AD in India.

Methods

A total of ten specialists including dermatologists, pediatric dermatologists, and pediatricians with more than ten years of experience and practicing in different parts of India served as the expert panel during the virtual meet conducted on January 24, 2021. A questionnaire comprising 32 questions on different aspects of AD management was categorized among different sections: burden of disease (five questions), age of onset and prevalence (five questions), etiology and pathogenesis (six questions), diagnosis and severity of the disease (seven questions), and treatment (nine questions). Consensus was defined when agreement was provided by ≥90% of the experts.

Results

Considering the profound impact AD has on the quality of life (QoL) of patients, the expert panel recommended patient counseling while moderate to severe cases of AD need a prompt referral to a specialist. The panel did not recommend any specific diagnostic and severity criteria as a standard due to the inherent limitations associated with every criterion. The role of environment and changing lifestyle in addition to genetic and familial risk factors for AD was also considered. The panel unanimously recommended to conduct a countrywide, multicenter survey/study to estimate the true prevalence of AD in India. Further, the experts recommended to follow proper treatment protocols and to perform longitudinal monitoring for understanding corticosteroid treatment associated side effects.

Conclusion

This guidance focuses on identifying the unmet gaps and provides practical recommendations for improving QoL, diagnosis, prognosis, and overall management of patients with AD in India.

Prevalence and Pattern of Skin Diseases in Tribal Villages of Gujarat: A Teledermatology Approach

Background

The prevalence and pattern of skin diseases are influenced by the overall ecosystem of the region. There is a dearth of research about prevalence, health-care seeking, compliance, and treatment outcome in skin diseases among scheduled tribes.

Objectives

The aim of this study is to understand the magnitude of skin diseases in tribal area of Dahod, Gujarat using a simple "Store and Forward" technique of teledermatology.

Materials and Methods

A cross-sectional study was conducted in 10 randomly selected villages of Dahod and Jhalod blocks of Dahod district of Gujarat during June-August 2017. Trained surveyors visited households randomly in different localities (called Faliya) of each village ensuring representativeness. Survey responses were captured on mobile-based MAGPI portal, and images of skin conditions were capture on smart phones, and de-identified images were transferred over WhatsApp.

Results

A total of 781 households were approached in 10 villages and 2214 participants consented. Among them, 549 were identified with suspected skin diseases, but 520 consented for photograph. The skin diseases were more prevalent among males, children, and elderly. Of 520, 44 (8.5%) could not be assess due to poor quality photograph and 35 (6.7%) did not have any clinically significant condition. Thus, of 2214 participants, 441 (20%) had skin diseases, and infections and eczema were major conditions constituting two-third of the skin diseases in the study population. The treatment-seeking behavior and compliance to treatment was poor.

Conclusion

Considering the high prevalence of skin diseases in tribal villages of Dahod, Gujarat coupled with limited availability of trained dermatologist, new innovative avenues like teledermatology should be explored.

Common misdiagnoses and prevalence of dermatological disorders at a pediatric tertiary care center

OBJECTIVES

Dermatological disorders are common in general pediatric practice. This study aimed to examine common skin problems and the manner in which they tend to be misdiagnosed.

METHODS

A cross-sectional study was conducted from January 2015 to December 2016 using medical record data from the Pediatric Dermatological Outpatient Unit at Khon Kaen University, Faculty of Medicine.

RESULTS

A total of 1551 visits by 769 patients were documented during the study period. A total of 114 presenting diseases were recorded. The most common skin disease in the study population was dermatitis (unspecified) (88/769, 11.4%), followed by atopic dermatitis (76/769, 9.8%) and infantile hemangioma (72/769, 9.3%). There was a total of 55 (48.2%) misdiagnosed diseases. Some unique cutaneous diseases were undiagnosed because of their rarity. However, the percentages of common cutaneous diseases, such as tinea capitis and molluscum contagiosum, which had been misdiagnosed, were also high (62.50% [95% confidence interval = 24.49-91.48] and 71.43% [95% confidence interval = 29.04-96.33], respectively).

CONCLUSION

A large percentage of misdiagnoses of common cutaneous diseases may be due to general pediatricians being undereducated in the field of dermatology. Accurate recognition and appropriate management of these conditions should be emphasized for educating general pediatricians in the future.

DERMATOSES IN THE EARLY NEONATAL PERIOD: THEIR ASSOCIATION WITH NEONATAL, OBSTETRIC AND DEMOGRAPHIC VARIABLES

Objective:

To evaluate the prevalence of neonatal dermatoses in the early neonatal period and to associate them with neonatal, demographic and obstetric variables.

Methods:

A cross-sectional study with neonates and their respective mothers, who were hospitalized in a public maternity hospital in Curitiba, PR, Brazil. Data collection was performed using information present in the medical records and a physical examination of the newborn during the period between April 2015 and May 2016.

Results:

350 neonates were evaluated. 54.8% were male, and 94.8% (332/350) presented a dermatosis. Among them, 84.6% had, concomitantly, two or more dermatoses. A total of 23 types of dermatoses were diagnosed. The most prevalent were: sebaceous hyperplasia (66%); fluff (42.6%); and salmon patches (41.4%). The mean age of the mothers was 24.9±4.9 years old, and they were predominately white (57.7%). Vernix caseosa was associated with the female gender (p=0.034). Nonwhite mothers were associated with genital hyperpigmentation (p=0.03) and Mongolian spots (p=0.001). Physiological flaking was associated with cesarean deliveries (p=0.03) and a gestational age of over 40 weeks (p=0.054). Salmon patches was associated with primiparity (p=0.0001).

Conclusions:

There was a high prevalence of neonatal dermatosis in the studied population. Each newborn had, on average, three different dermatoses. Dermatosis in neonates was associated with primiparity, nonwhites, a gestational age of over 40 weeks, and the sex of the newborn.

Infectious skin disorders encountered in a pediatric emergency department of a tertiary care hospital in Argentina: a descriptive study

BACKGROUND

Infectious skin disorders (ISDs) are commonly seen in pediatric emergency departments (PED), however the exact frequency is unknown. We provide an accurate evaluation of the incidence and characteristics of ISDs diagnosed in a PED from Buenos Aires, Argentina, over a 1-year period.

METHODS

Prospectively, descriptive study of children evaluated in the PED with ISDs during 2016. ISDs were analyzed on the basis of their incidence, patient demographics, seasonal variations, and hospitalization rates.

RESULTS

ISDs were diagnosed in 1680 (67.9%) of the skin consultations (M/F: 1.1; mean age: 4.4 ± 3.7 years). Bacterial infections were observed in 932 (55.5%) cases. Viral infections were seen in 604 patients (35.9%). Fungal and parasite skin infections were diagnosed in 33 (2%) and 111 (6.6%) children, respectively. The most frequent ISDs according to the etiology group were impetigo 377 (22.4%), varicella 397 (23.6%), tinea capitis 10 (0.6%), and scabies 109 (6.5%). A higher frequency of ISDs were reported during the summer (38.4%) and spring (38.2%) months. Bacterial skin infections were more frequent during the summer months, while viral skin infections were more prevalent during spring. Parasitic skin infections were diagnosed more frequently during the winter months. No differences were seen for mycotic skin infections. Hospitalization rate was 1% (all for bacterial skin infections).

CONCLUSION

Our data reveal the extremely high frequency of ISDs seen at the PED, underlying the need for closer cooperation between dermatologists and pediatricians.

Atopic dermatitis in Indian children: The influence of lower socioeconomic status

Atopic dermatitis (AD) is a chronic inflammatory condition afflicting children and adults. In developing countries like India, the scenario is slightly different from its western counterparts, where the disease has been commonly described. Despite running a milder course, AD still has a significant negative impact on the quality of life. Environmental factors have a great influence on pathogenesis. While the diagnosis has remained clinical, variations in minor clinical features have been observed worldwide. Many indigenous and herbal agents are used for its treatment in India, in addition to conventional therapies. Treatment modalities in India emphasize less costly therapies and family education. This contribution reviews the epidemiologic issues and therapeutic differences in the Indian population with AD, highlighting important nuances in the care of the Indian patient.

Epidemiology and Predisposing Factors for Erythema Toxicum Neonatorum and Transient Neonatal Pustular: A Multicenter Study

BACKGROUND/OBJECTIVES

Erythema toxicum neonatorum (ETN) and transient neonatal pustular melanosis (TNPM) are benign pustular skin conditions that are relatively common in newborns, but the predisposing factors for these conditions are unknown. Our goal was to verify the prevalence of ETN and TNPM and their predisposing factors in a large sample of neonates.

METHODS

In this prospective 1-year multicenter study, 2,831 neonates (age ≤72 hours) born in southern Brazil were randomized to undergo skin examination by a dermatologist.

RESULTS

Most were Caucasian (of European descent). There were 602 cases of ETN (21.3% prevalence) and 97 cases of TNPM (3.4% prevalence). ETN was more prevalent in Caucasian neonates, male neonates, those with 1-minute Apgar scores from 8 to 10, those who had no gestational risk factors, and those not admitted to a neonatal intensive care unit (NICU). Positive correlations were observed between ETN and gestational age and birthweight. ETN was least frequent in the winter. No NICU admission or birth during the spring was associated with TNPM.

CONCLUSIONS

At least in the region where this study was conducted, seasonality affects these benign pustular skin conditions. The health of the child at birth, gestational age, and birthweight influenced the development of ETN. This finding may indicate a role of immune system maturity in ETN, but additional studies are needed to confirm this.