Epidemiology of skin disorders in Ethiopian children and adolescents: an analysis of records from the Italian Dermatological Centre, Mekelle, Tigray, Ethiopia, 2005 to 2009

Dermatophytosis and the associated risk factors among primary school children in southern and central Côte d'Ivoire

BACKGROUND

Dermatophytosis, particularly the subtype tinea capitis, is common among African children; however, the risk factors associated with this condition are poorly understood.

OBJECTIVES

This study aimed to determine the factors associated with tinea capitis and the prevalence rate of other dermatophytoses among primary school students in the rural and urban areas of the southern and central Côte d'Ivoire.

PATIENTS AND METHODS

The study was carried out in seven towns of Côte d'Ivoire from October 2008 to July 2009, among 17,745 children aged 4-17 years and attending urban and rural primary schools; a complete physical examination of the skin and appendages, including nails and hair, was performed by the physicians. Direct microscopic examination using 30% potassium hydroxide solution and culture on Sabouraud's dextrose agar supplemented with 0.5 g/L chloramphenicol and 0.4 g/L actidione was performed during sampling.

RESULTS

For the 17,745 children clinically examined, 2645 exhibited symptoms suggestive of tinea capitis. Positive cultures for dermatophytes were found in 2635 patients, and the overall prevalence rate of tinea capitis was 14.8%. The following factors, age, sex, pets at home, number of bathing daily, sharing of sponges, combs and towels and hair length, were statistically associated with tinea capitis (p < .001). In addition to tinea capitis, other superficial fungal infections were identified among these children. These included tinea corporis (0.9%), tinea unguium (0.6%) and pityriasis versicolor (0.4%).

CONCLUSION

Tinea capitis is common among pupils in rural southern and central Côte d'Ivoire, especially in young boys.

Skin conditions among pediatric dermatology outpatients in Botswana

BACKGROUND

An understanding of the prevalence patterns of skin diseases in children in Botswana is needed to guide national dermatological policy development, training, and resource allocation to improve patient care.

OBJECTIVE

To describe local skin disease patterns in children aged 0-18 years presenting for dermatologic care in Botswana.

METHODS

A retrospective review of records from 1st January 2011 to 31st December 2016 was conducted at the outpatient dermatology clinic of Princess Marina Hospital (PMH) in Gaborone, Botswana and outreach clinic sites.

RESULTS

There were 4413 pediatric visits constituting 18.6% of all dermatology visits. There was a slight male predominance of 1.2:1. The majority of disorders were noninfectious 80.1% (3537/4413) versus infectious 14.6% (645/4413), with 5.2% (231/4413) unclassified. In the noninfectious category, two-thirds were inflammatory, followed by disorders of nails, skin appendages, and pigmentary disorders. Atopic dermatitis was the most common inflammatory disorder. Over half of infectious skin diseases were viral, followed by fungal and bacterial disorders. In the HIV-related disorders, the majority were verrucae 94% (108/115) followed by Kaposi sarcoma. The nine most common skin diagnoses accounted for close to 70% of all skin diseases seen at the clinic, and these included atopic dermatitis (almost half of all cases), followed by verruca, acne, and vitiligo.

CONCLUSION

There is a high burden of skin disorders in children in Botswana. In our cohort, a small number of skin conditions made up the vast majority of pediatric diagnoses. This information can be used to guide dermatology training and resource allocation to better manage these common diseases.

Prevalence of skin diseases in school-age children

BACKGROUND

The prevalence of community-based skin diseases, especially among school-age children, depends on topography, climate, and age of population.

OBJECTIVE

We determined the prevalence of skin diseases among community-based primary school-age children and identified demographic characteristics in relation to particular skin conditions.

METHODS

This was a cross-sectional descriptive survey study of a subproject school cohort in children aged 5-14 years of 2 community-based primary schools. Demographic data and whole-body skin examination were collected. The association of individual skin conditions was analysed by using bivariate and multivariable binary logistic regression.

RESULTS

A total of 556 children were enrolled in this study. Of these, 90.2% had at least 1 skin disease. The most common skin disease was postinflammatory hyperpigmentation (PIH) (58.3%), followed by nevus/mole (40.1%), insect bite reaction (28.0%), acanthosis nigricans (20.0%), acne (13.7%), and pityriasis alba (12.9%). There was an increase of body mass index (BMI) in PIH and acanthosis nigricans with the adjusted odds ratios of 2.01 (95% confidence interval [CI] 1.40-2.87, P < 0.001) and 1.93 (95% CI 1.49-2.49, P < 0.001), respectively. Insect bite reaction was related to PIH with the adjusted odds ratio of 5.66 (95% CI 3.15-10.17, P = 0.001).

CONCLUSIONS

The most common skin disease in community-based primary school-age children is PIH which related to acanthosis nigricans and insect bite reaction. A decrease of BMI may lower the risk for PIH and acanthosis nigricans. Education on common skin diseases is recommended for both community-based schools and school-age children.

Psoriasis in Tigray, Ethiopia: Focusing on available treatments

Psoriasis has been reported to be rare in people with skin of color. However, the actual prevalence is probably underestimated by the lack of wide epidemiological studies. The aim of the study is to present our experience in Tigray, Ethiopia, focusing on the issues related to diagnosis, clinical features and therapies. A total of 1288 people affected by psoriasis were visited and 954 were included in a retrospective analysis through the review of medical records of patients attending at three Dermatologic Centers in Ethiopia from 2005 to 2016. The most common clinical form is plaque psoriasis (62.9%), followed by guttate (13.9%), pustular (9.5%), inverse (7.5%), and erythrodermic (6.1%) ones. The prevalence of psoriatic arthritis is 17%. It is often diagnosed late resulting in particularly deforming and debilitating disease. Patients with severe psoriasis often require hospitalization due to the reduced availability of effective treatments and appropriate skin care, resulting in a prolonged recurrence rate or decreased disease-free interval. In poorer rural areas, patients use some traditional African plants such as Kigelia africana which have been shown to have partial benefits in the treatment of psoriasis. Unfortunately, the only available conventional therapies are topical steroids, salicylic acid, methotrexate, and the sun. More studies concerning the appropriate management of people with psoriasis in low income countries, including standardization of indigenous therapies and a reduction of costs of conventional drugs, could help the care of people with psoriasis.

Epidemiology of skin diseases in the Tigray region of Ethiopia

BACKGROUND

Skin diseases are very common among people living in poor countries. Although many of these pathologies might not be fatal, some can have a great impact on the patient, impairing their ability to work or worsening his/her relationship with the community. Understanding the epidemiology of skin diseases in these areas, determining the prevalence of different disorders, is fundamental to develop better educational and preventative programs.

METHODS

We collected data from 467 consecutive patients referring to the Dermatology Center of the Axum Referral Hospital (Tigray region, Ethiopia). We investigated health status and environmental data. Diagnoses were classified into 6 groups (i.e. infectious, inflammatory, etc.). A statistical analysis was performed using IBM SPSS™ software version 25.0.1 (IBM SPSS Inc. Chicago, Illinois) and Stata™ software release 14.2 (Stata Corporation, College Station, Texas). Normality of the distributions was assessed using the Kolmogorov-Smirnov test. Categorical variables are compared with the use of the Chi Square test or the Fisher's exact test, as appropriate.

RESULTS

Inflammatory and infectious diseases were the most frequently observed. No significant differences in inferential tests between access to water, housing, education level, and any diagnoses group were found. Curiously, a statistically significant difference between inflammatory diseases and unemployment was found.

CONCLUSIONS

Easier access to medical care, medications, and clean water, together with a cleaner work and home environment, are the first goals to be achieved in order to decrease morbidity in these areas.

Pattern of skin diseases in children attending a dermatology clinic in a referral hospital in Wolaita Sodo, southern Ethiopia

BACKGROUND

Epidemiological studies to determine the pattern of skin diseases among children are important for proper health care planning and management. The purpose of this study was to describe the pattern of skin diseases among pediatric patients seen at a dermatology outpatient clinic of Wolaita Sodo Teaching and Referral Hospital, southern Ethiopia.

METHOD

We conducted a retrospective hospital-based, cross-sectional study between January 2016 and December 2017 at a teaching and referral hospital dermatology outpatient department. All children younger than 15 years presenting with newly-diagnosed skin diseases were included. Diagnosis was mainly made clinically, with some laboratory support.

RESULTS

A total of 1704 children with 1869 new skin diagnoses were included, of whom 139 (8.2%) had more than one disease. Of the children, 52.4% were males and 44.9% within the age-group 5-10 years. Eczematous dermatitis accounted for the largest group (23.9%, n = 447) of skin conditions followed by bacterial infections (21.3%, n = 398), fungal infections (18.8%, n = 351) and infestations (9.9%, n = 185). Seasonal variation was demonstrated, with eczematous conditions and bacterial infections being higher during autumn and winter.

CONCLUSION

Overall, eczema, bacterial and fungal infections were the three major pediatric skin diseases occurring among children attending this hospital's outpatient department. There was seasonal variation in some of the skin diseases. This study gives a snapshot of skin disorders presenting to hospital in children in southern Ethiopia and may help to plan dermatology service expansion, educational programs and preventive measures.

Development, Characterization, and Evaluation of Novel Broad-Spectrum Antimicrobial Topical Formulations from Cymbopogon martini (Roxb.) W. Watson Essential Oil

Background

Skin infections were the most frequently encountered of all infections and the 4th leading cause of nonfatal disease burden. Topical drugs have been used for the management of skin infections. The growing concern of drug resistance to the topical agents has warned the need for continuous development of novel drug. Essential oils are the best candidate for new drug with different mode of action and target as they are rich in chemical constituents.

Objective

To evaluate and develop safe and effective topical antimicrobial formulations from essential oil of Cymbopogon martini. Method. Essential oil was extracted using hydrodistillation aerial part C. martini and topical formulations were prepared in five different semisolid bases. In vitro antimicrobial investigations were performed on essential oil and topical formulations. Skin sensitizations of the formulations were evaluated using guinea pig maximization.

Results

The essential oil of C. martini has shown broad-spectrum antimicrobial potency against all tested organisms with MIC value ranging from 0.65 to 10 μg/ml. Absolute inhibitions of growth of fungi were observed against Trichophyton mentagrophytes and Trichophyton rubrum at concentrations above 1% of oil and against Microsporum canis and Trichophyton verrucosum at a concentration of 4% oil. Among topical formulations, the highest antimicrobial activity was recorded in hydrophilic ointment followed by macrogol blend ointment. The antimicrobial activity of oil was higher in fungal pathogen compared to bacteria. Gram positive bacteria were more sensitive than gram negative bacteria. Hydrophilic and macrogol blend ointment containing 5% oil did not produce any skin sensitization on guinea pigs.

Conclusion

In conclusion, topical formulations of C. martini essential oil can be alternative topical agents with safe broad-spectrum activity for the treatment of skin disorder. Further studies should focus on shelf life study and clinical study of the product.

The spectrum of skin biopsies and excisions in a pediatric skin center

Little is known about the spectrum of pediatric skin disorders requiring biopsy/excision, their indication, impact on further management, and the accuracy of clinical diagnosis. We aimed to address these questions in the patient population seen at our Swiss University referral center for Pediatric Dermatology and Plastic Surgery. All skin biopsies/excisions performed in patients aged ≤ 16 years over a period of 2 years were retrospectively analyzed. A total of 506 samples were included. The majority of biopsies/excisions (n = 413, 82%) was performed for tumors, cysts, and hamartomas and 18% for other skin conditions. Malignant tumors were found in 12 samples (2%) from four patients. In 121 (24%) patients, the histopathology had an important impact on patient management. In 80 (16%) cases, the pathology did not match with the clinical diagnosis. In 382 (75%) cases, excision was the treatment of choice. Of these, the indication for surgery was based on patient's request in 181 (47%) cases.

CONCLUSION

Surgical interventions for pediatric skin disorders are performed for diagnostic and therapeutic reasons. In this cohort, histopathology was essential for treatment in one quarter of cases. Skin tumors, cysts, and hamartomas often require excision during childhood, with families' request and esthetic considerations playing an important role. What is Known: • The spectrum of pediatric skin conditions has been studied in outpatient, inpatient, and emergency settings. • In contrast, no data exist on the spectrum of pediatric skin disorders undergoing biopsy/excision specifically. What is New: • We analyze biopsies/excisions in children, focusing on diagnosis, indication, and impact on patient management. • Surgical interventions for skin disorders in children are often performed for tumors and hamartomas with esthetic considerations playing a relevant role. If used for diagnostic purposes, they are often performed to confirm or rule out severe skin disease.

Mycological profile of tinea capitis in schoolchildren in rural southern Ethiopia

Tinea capitis is a known common infection among schoolchildren in developing countries that is still underreported in Ethiopia. The aim of this study was to examine the epidemiologic and etiologic profile of tinea capitis among school-aged children in a rural area in southern Ethiopia. We collected demographic and clinicodermatological data from school children aged 3-12 years with tinea infections. Pathologic specimens were taken for potassium hydroxide (KOH) mount and mycological culture. Dermatophyte species were identified by macroscopic examination of the colony and microscopic examination of fungal cultures. A total of 634 schoolchildren were screened in the study; 128 cases were suspected for tinea capitis based on clinical examination of which 99 patients (mean age 6.7 years within a range of 4-12 years), who were subsequently positive, either based on KOH examination or showed growth of dermatophytes on culture, were included in our study. The ratio of males to females was 3:1. A total of 88 patients (89.9%) had a culture positive for dermatophytes. The zoophilic species Trichophyton verrucosum was the most prevalent isolate (n = 29 cases), followed by the anthropophilic species T. tonsurans (n = 27). The other Trichophyton species implicated were T. mentagrophytes (n = 14), as well as T. schoenleinii, T. soudanense, and T. violaceum. Only 11 of the isolates belonged to the genus Microsporum: M. audouinii (n = 8), M. ferrugineum (n = 2), and M. gallinae (n = 1). T. verrucosum, followed by T. tonsurans were the most frequent causative agents in this study.

The prevalence and association with health-related quality of life of tungiasis and scabies in schoolchildren in southern Ethiopia

Background

The prevalence of skin disease in low and middle income countries is high and communicable skin diseases are a significant public health problem. Tungiasis is an ectoparasite infestation caused by the flea Tunga penetrans, which has a widespread geographical distribution. Tungiasis causes painful skin lesions and may affect activities of daily living.

Objective

We wished to determine the prevalence and impact of tungiasis and scabies in schoolchildren in southern Ethiopia.

Methods

A cross-sectional study was performed in which students were examined by dermatologists and the skin disorders recorded. Individuals with pyogenic skin infections, scabies and tungiasis were also invited to complete the Children’s Dermatology Life Quality Index.

Results

There was a high burden of skin disease amongst this cohort with more than 40% having an ectodermal parasitic skin disease. The majority of these were due to tungiasis. Tungiasis was evident in more than a third of children and was associated with onychodystophy. There was a significant association between wearing “closed” footwear and a greater number of tungiasis lesions but not tungiasis per se. Dermatophyte infections, acne and plantar maceration secondary to occlusive footwear were also common.

Scabies and tungiasis appeared to have a significant negative effect on quality of life.

Conclusion

Tungiasis is highly prevalent in schoolchildren in the part of Ethiopia where the study was conducted and is associated with a deleterious effect on quality of life. The role of footwear in both preventing and possibly exacerbating cutaneous ailments in this setting requires further study.

Skin disorders are very common in all geographical locations and especially so in low and middle income countries. In these settings many of the commonest skin disorders are communicable.

Human ectoparasites such as lice and scabies mites live on the skin and Tunga penetrans fleas enter the skin to shed their eggs and complete their lifecycle. All of these ectoparasites cause significant morbidity particularly in poorer communities.

We have shown that the infestations of scabies and tungiasis were the commonest skin disorders in the Ethiopian schoolchildren examined in this study. These conditions are associated with a significant impact on the quality of life of these children as measured by the Children’s Dermatology Life Quality Index.

Footwear protects individuals from many conditions both infectious and non-infectious however in this cohort footwear was associated with maceration of the skin and this requires further investigation.

Focus on the Top Ten Diagnoses Could Reduce Pediatric Dermatology Referrals

There is a sense that many patients seen at referral centers could be managed at a primary health care level. The objective of the current study was to examine the range of diagnoses among consultations at the Red Cross Children's Hospital in Cape Town, South Africa, to help develop a strategy for targeted education of primary health care personnel. This was a retrospective review of data for children seen at a pediatric dermatology clinic from 2005 to 2010, recorded according to International Classification of Diseases coding and compared with published data from similar clinical settings. There were 13,253 clinic visits, with 4,789 patients seen (median age 4.8 yrs, range 2 days to 18.6 yrs). The top 10 diagnoses accounted for 88.5% of consultations (59.5% atopic eczema [AE], 7.1% seborrheic dermatitis [SD], 4.2% superficial mycoses, 3.1% molluscum contagiosum, 2.8% vitiligo, 2.7% viral warts, 2.4% prurigo or scabies, 2.3% psoriasis, 2.3% hemangioma, 2.1% impetigo). Disease prevalence was somewhat different during the first year of life (AE 43.7%, SD 18.6%, hemangiomas 13.4%). Inflammatory dermatoses (76.6%) were more prevalent than infections and infestations (14.5%). The disease spectrum was similar to that in developed countries, although AE prevalence was higher in this study (followed by London 36%, Greece 35%, and Hong Kong 33%) than in 19 published studies. The top 10 diagnoses accounted for more than 70% of diagnoses in 12 studies. The retrospective nature and setting at a specialist clinic increased bias and limited generalizability. Focused education on the optimal care of common diseases, especially AE, could reduce referrals, improve access, and allow specialists at tertiary centers more time to manage complex and uncommon dermatoses.

Skin diseases in pediatric patients attending a tertiary dermatology hospital in Northern Tanzania: a cross-sectional study

Background

Skin diseases affect 21–87 % of children in developing countries in Africa. However, the spectrum of the skin diseases varies from region to region due to several factors such as genetics, socioeconomic and environmental. The aim of this study was to determine the spectrum of childhood skin diseases in Tanzania.

Methods

We conducted a prospective hospital- based cross-sectional study between September 2012 and August 2013 at a tertiary referral dermatology clinic. Children younger than 14 years presenting with new skin conditions were recruited. Diagnosis was mainly done clinically, but if the diagnosis was not clinically clear, further investigations were undertaken accordingly.

Results

A total of 340 patients were recruited of which 56 (16.5 %) had more than one skin condition. Both genders were equally affected. Infections and infestations accounted for the majority (43.5 %, n = 177) of the skin conditions followed by eczematous dermatitis (28.5 %, n = 116) and pigmentary disorders (7.4 %, n = 30). Among the 152 infectious skin diseases, fungal infections predominated (50.7 %, n = 77) in the infectious group followed by bacterial (29.6 %, n = 45), and viral (19.7 %, n = 30).

Conclusions

Skin infections are still the main cause of dermatological consultations in children although with a reduced prevalence. Inflammatory skin conditions are increasing and can be attributed to improved socioeconomic status and HIV pandemic.

Tinea capitis in schoolchildren in a rural area in southern Ethiopia

OBJECTIVES

Skin diseases, especially tinea capitis, represent some of the most frequent causes of morbidity in developing countries. The aim of this study was to examine the prevalences of fungal infections in schoolchildren in a primary school located in a rural area in southern Ethiopia and to perform an analysis of the risk factors associated with tinea capitis.

METHODS

This school-based, prospective cross-sectional study was conducted in October 2012 in Gambo School, Kore, West Arsi, Oromya Region, Ethiopia. Detailed interviews and dermatological examinations were performed. No laboratory examinations were conducted.

RESULTS

A total of 647 students were interviewed and examined. The mean age of these children was 10 years (range: 4-14 years). Of the children examined, 236 had some type of dermatophytosis (prevalence: 36.5%, 95% confidence interval [CI] 32.8-40.3), which represented the most frequent type of skin problem. The prevalence of dermatophytoses was more common in males than in females (42.2% and 30.5%, respectively; P = 0.002), and among pupils aged 5-7 years (46.9%; P < 0.001). A total of 159 (prevalence: 24.6%, 95% CI 21.3-28.1) children had tinea capitis, 56 (8.7%) had tinea pedis, 50 (7.7%) had tinea corporis, and six (0.9%) had tinea unguium. In multivariate analysis, the risk factors for tinea capitis were: age (odds ratio [OR] 0.75, 95% CI 0.69-0.84; P < 0.001), and male gender (OR 2.56, 95% CI 1.69-13.39; P = 0.002).

CONCLUSIONS

Fungal dermatoses, especially tinea capitis, are common in primary schoolchildren in rural areas of southern Ethiopia, especially in young boys.