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Original Article
2 (
1
); 1-9
doi:
10.25259/IJPGD_65_2023

Prevalence of Dermatoses and Associated Factors Among School Children in Vijayapura, Karnataka

Department of Dermatology, Venereology and Leprosy, Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India.

*Corresponding author: Arun C. Inamadar, Department of Dermatology, Venereology and Leprosy, Shri B. M. Patil Medical College, Hospital and Research Centre, BLDE (Deemed to be University), Vijayapura, Karnataka, India. aruninamadar@gmail.com

Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Albadri W, Inamadar AC, Marri S, Kotian P. Prevalence of Dermatoses and Associated Factors Among School Children in Vijayapura, Karnataka. Indian J Postgrad Dermatol. 2024;2:1-9. doi: 10.25259/IJPGD_65_2023

Abstract

Objectives:

The objectives of the study were to determine the prevalence of dermatoses among school children in Vijayapura, Karnataka and to assess the influence of factors on them.

Materials and Methods:

This prospective cross-sectional study was conducted in private, government, and residential schools in Vijayapura, Karnataka. A questionnaire regarding demographic factors was given to the students, which was to be answered by their parents. All students aged 5–14 years with completed responses to the questionnaire were included. During school visits, height and weight were recorded and the skin, hair, and nails of children were examined. Any dermatoses, if found, were noted. The prevalence of dermatoses in school children was determined and the frequency of various factors was assessed.

Results:

Among 2272 children, the prevalence of dermatoses was 89.4%. Non-infectious and infectious dermatoses accounted for 97.9% and 9.3%, respectively. Dermatoses were more prevalent in residential schools (92.4%). Non-infectious dermatoses were more prevalent in private schools (98.2%) and infectious dermatoses in government schools (13.5%). Non-infectious dermatoses were associated with good hygiene, no contact with pets, higher socioeconomic status, and overweight students; and infectious dermatoses with poor diet and hygiene, home overcrowding, lower socioeconomic status, and underweight students (P < 0.05).

Conclusion:

The prevalence of non-infectious dermatoses was more than the infectious dermatoses among school children in Vijayapura, Karnataka, which attributes to better education and understanding. Awareness regarding non-infectious dermatoses is important as it can have a significant impact on children if ignored.

Keywords

Dermatoses
Prevalence
School children
School survey
Vijayapura

INTRODUCTION

The school lays down the pillars for the future generation, along with the initial training for the maintenance of a healthy lifestyle.[1,2] Proper hygiene practices, along with a nutritious diet; through proper education can go a long way in preventing various communicable and noncommunicable diseases. An individual failing to maintain this becomes susceptible to infections, particularly involving the skin.[1]

Skin diseases pose a major health problem among individuals of all ages with substantial morbidity.[3] Children are common victims of dermatoses as activities at school that involve personal contact help in the transmission of infectious diseases. Skin diseases significantly impact the child’s social, physical and emotional well-being, which can lead to skipping school, ultimately impact learning.[4]

Skin diseases refer to disorders of exclusively (or predominantly) the superficial layers of the skin. In developing countries, low hygienic conditions with difficulty in access to water, climatic conditions, and the presence of overcrowding contribute to the high prevalence and incidence of skin disorders.[5] This is usually true when it comes to infectious diseases, which are more prevalent in these countries, whereas non-infectious dermatoses are predominant in the more developed countries.

In most of the regions of India and through the majority of the year, the climate is hot and humid. In addition, the population is vast, many of whom reside in villages or slums, with widespread poverty and malnutrition, poor personal hygiene, low literacy and a lack of public understanding of cleanliness. As a result, skin problems are more common, particularly infections.

Due to better education, awareness, and changing lifestyles, developing countries are now experiencing a reduction in infectious diseases and a rise in non-infectious or noncommunicable diseases. School surveys are useful in determining the prevalence of diseases among a large number of children of a particular age group in a given community. The prevalence of skin diseases in children reflects the status of health awareness, availability of healthcare services, hygiene and personal cleanliness of that particular society.[3]

This study was conducted to determine the prevalence of skin diseases among primary and secondary school children in Vijayapura, Karnataka and to determine the influence of various factors on them.

MATERIALS AND METHODS

This prospective cross-sectional study was conducted in private, government, and residential schools in Vijayapura, Karnataka from August 2022 to January 2023. Approval of the Institutional Ethical Committee was taken (BLDE [DU]/ IEC/807-C/2022-23). We included students belonging to the age group of 5–14 years, those with completed responses to the questionnaire and those present on the day of the school visits. Students and parents not willing to take the examination were excluded.

Schools were selected at random. Approval was taken from the schools’ principal. Two days before the school visits, a semi-structured questionnaire was handed over to the students, which was to be answered by their parents, along with informed consent. It included questions such as address and contact details, monthly income, education, and occupation of the parents (for determining socioeconomic status by modified Kuppuswamy method[6]), number of family members living in the same home, and number of rooms (for determining overcrowding at home by Eurostat criteria[7]), presence of pets, dietary habits, hygiene practices followed and immunisation status. The questionnaire has been included, as shown in Supplementary File 1.

SUPPLEMENTARY FILES

On the day of the school visits, the height and weight of every child were measured to calculate basal metabolic index (BMI), weight-for-age, height-for-age, and weight-for-height (plotted on IAP graphs[8]) to determine nutritional status. The children were asked questions regarding their diet and hygiene practices and skin, hair, and nails, excluding genitalia, were examined in a private room with good illumination, with the part being examined well exposed. If a skin lesion was found, photographs were taken and findings were documented in a pro forma. Diagnosis of skin lesions was based on clinical features. Conditions whose diagnosis was doubtful and those requiring further investigations were not recorded. The prevalence of dermatoses in school children was determined and the frequency of various factors was assessed.

Statistical analysis

The data obtained were entered into a Microsoft excel sheet and statistical analysis was performed using JMP Pro 16 software version 16 (SAS Institute). Results are presented as frequency and percentages. The association between categorical variables was compared using the Chi-square test. Statistical significance was deemed when P < 0.05.

RESULTS

Three private, two government, and one residential school were included in this study with a total of 2272 students. One thousand two hundred and eleven (53.3%) students were included from private schools, 438 (19.3%) students from government schools and 623 (27.4%) from residential school. The ratio of students aged more than 10 years and those aged <10 years was 1.8 and male-to-female ratio was 2.1. The distribution of various variables among different schools is depicted in Table 1.

Table 1: Distribution of various variables among different schools (n: number of subjects).
Demographic variables Private school Government school Residential school All schools
n % n % n % n %
Age
  <10 630 52 181 41.3 0 0 811 35.7
  ≥10 581 48 257 58.7 623 100 1461 64.3
Gender
  Male 628 51.9 329 75.1 590 94.7 1547 68.1
  Female 583 48.1 109 24.9 33 5.3 725 31.9
Good diet 1044 86.2 319 72.8 600 96.3 1963 86.4
Good personal hygiene 1052 86.9 280 63.9 592 95.0 1924 84.7
Presence of household pets 204 16.8 118 26.9 0 0 322 14.2
Overcrowding at home 410 33.9 315 71.9 623 100 1348 59.3
Immunised 989 81.7 388 88.6 566 90.9 1943 85.5
Socioeconomic status
  Upper class 226 18.7 1 0.2 71 11.4 298 13.1
  Upper middle class 862 71.2 13 3.0 361 57.9 1236 54.4
  Upper lower class 9 0.7 238 54.3 3 0.5 250 11.0
  Lower middle class 114 9.4 186 42.5 188 30.2 488 21.5
BMI
  Normal 732 60.4 262 59.8 496 79.6 1490 65.6
  Overweight 117 9.7 11 2.5 22 3.5 150 6.6
  Underweight 362 29.9 165 37.7 105 16.9 632 27.8
Weight-for-age
  Normal 771 63.7 272 62.1 506 81.2 1549 68.2
  Increased 185 15.3 29 6.6 95 15.2 309 13.6
  Decreased 255 21.1 137 31.3 22 3.5 414 18.2
Weight-for-height
  Normal 641 52.9 242 55.3 471 75.6 1354 59.6
  Increased 223 18.4 31 7.1 50 8.0 304 13.4
  Decreased 347 28.7 165 37.7 102 16.4 614 27.0
Height-for-age
  Normal 880 72.7 331 75.6 481 77.2 1692 74.5
  Increased 104 8.6 33 7.5 137 22.0 274 12.1
  Stunted 227 18.7 74 16.9 5 0.8 306 13.5

BMI: Basal metabolic index

A total of 82 dermatoses were diagnosed and grouped as non-infectious and infectious dermatoses. Under non-infectious dermatoses, 70 conditions were grouped into 10 categories and 12 infectious dermatoses were grouped into four categories. Supplementary File 2 contains the list of various dermatoses in each category. Figures 1 and 2 shows images of some of the conditions in each category of non-infectious and infectious dermatoses.

Conditions in each category of non-infectious dermatoses (AMN: Acquired melanocytic nevus).
Figure 1:
Conditions in each category of non-infectious dermatoses (AMN: Acquired melanocytic nevus).
Conditions in each category of infectious dermatoses.
Figure 2:
Conditions in each category of infectious dermatoses.

The overall prevalence of dermatoses was 89.4%. Among these, the prevalence of non-infectious and infectious dermatoses was 97.9% and 9.3%, respectively. The residential school had the highest prevalence of dermatoses (92.4%) and non-infectious and infectious dermatoses were most prevalent in private (98.2%) and government (13.5%) schools, respectively. Under non-infectious dermatoses, the most common category of dermatoses was nevi and hamartomas (843; 42.4%), followed by disorders of keratinization (806; 40.5%) and inflammatory dermatoses (750; 37.7%). The three most common categories of infectious dermatoses were fungal infections (69; 36.7%), infestations (58; 30.9%) and viral infections (45; 23.9%). The prevalence of various dermatoses among different categories and schools is shown in Table 2.

Table 2: Prevalence of various categories of dermatoses among different schools (n: number of subjects).
Diseases Private school Government school Residential school All schools
n % n % n % n %
All dermatoses 1061 87.6 394 90 576 92.4 2031 89.4
Non-infectious dermatoses 1042 98.2 384 97.4 560 97.2 1988 97.9
Nevi and hamartomas 448 43 134 34.8 261 46.6 843 42.4
Disorders of keratinization 365 35 245 63.8 196 35 806 40.5
Inflammatory dermatoses 372 35.7 99 25.8 279 49.8 750 37.7
Pigmentary disorders 183 17.6 90 23.4 92 16.4 365 18.4
Scars 89 8.5 56 14.5 88 15.7 233 11.7
Other dermatoses 86 8.3 47 12.2 57 10.2 190 9.6
Papulosquamous disorders 95 9.1 22 5.7 49 8.8 166 8.6
Nail disorders 15 1.4 12 3.1 19 3.3 46 2.3
Hair disorders 17 1.6 0 0 11 2 28 1.4
Congenital anomalies 3 0.3 1 0.2 2 0.4 6 0.3
Infectious dermatoses 61 5.7 53 13.5 74 12.8 188 9.3
Fungal infections 14 22.9 8 15 47 63.5 69 36.7
Infestations 26 42.6 17 32.1 15 20.3 58 30.9
Viral infections 19 31.1 16 30.1 10 13.5 45 23.9
Bacterial infections 6 9.8 14 26.4 5 6.8 25 13.3

Associated factors

Dermatoses with associated factors that showed statistical significance (P < 0.05) among different schools are shown in Table 3.

Table 3: Distribution of dermatoses and associated factors with statistical significance (P<0.05) among different schools.
Factors All schools Private schools Government schools Residential school
Age
  <10 years • Pigmentary disorders
• Disorders of keratinization
• Pigmentary disorders • Non-infectious dermatoses
  ≥10 years • Non-infectious dermatoses
• Nevi and hamartomas
• Inflammatory dermatoses
• Papulosquamous disorders
• Hair disorders
• Other dermatoses
• Infectious dermatoses
• Fungal infections
• Non-infectious dermatoses
• Inflammatory dermatoses
• Papulosquamous disorders
• Hair disorders
• Other dermatoses
Gender
  Males • Non-infectious dermatoses
• Nevi and hamartomas
• Scars
• Pigmentary disorders
• Nail disorders
• Other dermatoses
• Fungal infections
• Bacterial infections
• Non-infectious dermatoses
• Nevi and hamartomas
• Scars
• Pigmentary disorders
• Other dermatoses
  Females • Papulosquamous disorders
• Infestations
• Papulosquamous disorders
• Hair disorders
• Infestations
• Papulosquamous disorders
• Infestations
• Inflammatory dermatoses
• Papulosquamous disorders
Diet
  Good • Nevi and hamartomas • Nevi and hamartomas
  Poor • Disorders of keratinization • Disorders of keratinization
• Infectious dermatoses
Personal hygiene
  Good • Inflammatory disorders
  Poor • Disorders of keratinization • Congenital anomalies • Hair disorders
• Infectious dermatoses
• Fungal infections
Pets
  Yes • Pigmentary disorders
• Disorders of keratinization
  No • Inflammatory disorders
• Nail disorders
• Fungal infections
• Inflammatory disorders • Other dermatoses
Overcrowding at home
  Yes • Scars
• Disorders of keratinization
• Infectious dermatoses
• Fungal infections
• Nevi and hamartomas
  No • Pigmentary disorders
Immunisation status
  Yes • Scars • Disorders of keratinization
  No • Congenital anomalies
• Viral infections
• Viral infections • Congenital anomalies • Congenital anomalies
Socioeconomic status
  Upper class • Inflammatory dermatoses
• Papulosquamous disorders
• Inflammatory dermatoses
  Upper
middle class
  Upper lower class • Pigmentary disorders
• Disorders of keratinization
• Infectious dermatoses
• Bacterial infections
• Viral infections
• Disorders of keratinization
• Bacterial infections
• Fungal infections
• Nevi and hamartomas
  Lower middle class • Scars
BMI
  Normal • Infectious dermatoses
• Fungal infections
  Overweight • Inflammatory dermatoses
• Papulosquamous disorders
• Disorders of keratinization
• Nail disorders
• Other dermatoses
• Papulosquamous disorders
• Disorders of keratinization
• Other dermatoses
• Non-infectious dermatoses
• Papulosquamous disorders
• Inflammatory dermatoses
• Papulosquamous disorders
• Nail disorders
• Other dermatoses
  Underweight • Pigmentary disorders
• Bacterial infections
• Pigmentary disorders • Pigmentary disorders
Weight-for-age
  Normal • Non-infectious dermatoses
  Increased • Non-infectious dermatoses
• Inflammatory dermatoses
• Papulosquamous disorders
• Disorders of keratinization
• Non-infectious dermatoses
• Disorders of keratinization
• Other dermatoses
• Non-infectious dermatoses
• Disorders of keratinization
• Inflammatory dermatoses
• Papulosquamous disorders
  Decreased • Pigmentary disorders
• Bacterial infections
• Pigmentary disorders • Pigmentary disorders • Bacterial infections
Weight-for-height
  Normal • Infectious dermatoses
• Fungal infections
• Infectious dermatoses • Non-infectious dermatoses
  Increased • Inflammatory dermatoses
• Papulosquamous disorders
• Disorders of keratinization
• Other dermatoses
• Disorders of keratinization
• Other dermatoses
• Non-infectious dermatoses
• Disorders of keratinization
• Papulosquamous disorders
• Other dermatoses
  Decreased • Pigmentary disorders
• Nail disorders
• Bacterial infections
• Pigmentary disorders • Nevi and hamartomas
• Nail disorders
Height-for-age
  Normal
  Increased • Scars
• Infestations
• Scars
• Disorders of keratinization
  Stunted • Inflammatory dermatoses
• Nail disorders

BMI: Basal metabolic index

DISCUSSION

In this study, we analysed the prevalence of dermatoses and associated factors among private, government, and residential school children in a semi-urban city in North Karnataka. The prevalence of dermatoses was found to be 89.4% and non-infectious dermatoses (97.9%) were more common than infectious dermatoses (9.3%). This could indicate a rising trend toward non-infectious dermatoses, probably due to increased awareness among the population as more emphasis is made on the prevention of communicable diseases.

Majority of the students belonging to all schools and private schools were aged more than 10 years and were males. Hence most of the dermatoses were found in these categories and showed a significant association. Infestations, in which pediculosis capitis was one of the conditions, show a significant association in females in all, private and government schools.

Children with poor dietary habits had a significant association with disorders of keratinization, which includes phrynoderma, acanthosis nigricans, and xerosis, which are seen in children with improper nutrition. Inflammatory dermatoses included atopic dermatitis and its various manifestations, which showed an association with children following good hygiene practices in all schools and also with those not having contact with pets in all schools and private schools. This corroborates with the hygiene hypothesis, which is one of the etiologies for atopic dermatitis. Poor hygiene practices were associated with infectious dermatoses and fungal infections in residential school children. Infectious dermatoses and fungal infections were significantly associated with overcrowding at home among all schools, which is known to be a factor in the spread of infections. Students belonging to upper-class socioeconomic status had a significant association with inflammatory dermatoses in all and private schools and papulosquamous disorders in all schools, whereas those belonging to upper lower class show an association with disorders of keratinization and infections, which could be attributed to increased education and awareness among parents and family members, better diet and hygiene practices followed by those of a higher class.

Students who were overweight (increased BMI, weight-for-age, and weight-for-height) were associated with non-infectious dermatoses, inflammatory dermatoses, papulosquamous disorders (association with metabolic syndrome), disorders of keratinization (includes acanthosis nigricans which is a cutaneous manifestation of obesity) and other dermatoses (includes acrochordons and striae which are cutaneous manifestations of obesity).

Similar studies have been conducted in various parts of India and the world among school children and their findings are mentioned in Table 4.[1,3,4,9-19] In the studies conducted in India, the prevalence of dermatoses ranged between 15.41% and 75.4%, which was lower than the prevalence in our study (89.4%) and the majority were infectious dermatoses. An exception to this are studies by Nijhawan et al.[9] and Vora et al.[14] conducted in Jaipur and Anand, Gujarat, respectively, where non-infectious dermatoses were more common (69.7% and 79.6%, respectively). Non-infectious dermatoses in our study had a prevalence of 97.9%. This higher prevalence in their studies was attributed to individuals being residents of semi-urban areas and belonging to a higher socioeconomic status. Vijayapura, the location of our study, is also a semi-urban area and the majority of the students belonged to families of the upper middle class. The prevalence of infectious dermatoses was higher in other parts of the world as well, but studies done by Sula et al.[18] in Diyarbakir, Turkey and Khalifa et al.[19] in Baghdad found non-infectious dermatoses to be more prevalent. The former study demonstrated an association with the female gender and showed a predominance of infectious dermatoses in boarding schools, whereas the latter study found an association with parents’ education. Our study found a predominance of infectious dermatoses in students of government schools.

Table 4: Prevalence of dermatoses in school children from studies conducted in different parts of India and the world.
Study Year Location Prevalence Most common disease Other comments
Indian studies
Nijhawan et al.[9] 2019 Jaipur 60.59% Non-infectious
dermatoses – 69.7%
Infectious dermatoses – 19.8%
Nutritional dermatoses – 10.5%
The study was conducted in a semi-urban area
Shreekrishna and Bhat[10] 2018 Mangalore, Dakshina Kannada 55.5% Fungal infection – 27.5% Included only infectious dermatoses
Shameena et al.[11] 2017 Mulky, Dakshina Kannada 63% Fungal infection – 26.1% Included only infectious dermatoses
Jose et al.[3] 2017 Salem, Tamil Nadu 68.2% Infectious dermatoses – 50.73%
Non-infectious dermatoses – 37.1%
Nutritional deficiency dermatoses – 12.17%
Kumar et al.[1] 2016 Hyderabad, Telangana 29.54% Scabies – 16.9% Significant association- Personal hygiene
Villa and Krishna[12] 2014–2015 Medak, Telangana 75.4% Parasitic infections – 35.15% Association of skin diseases with rural residence
Tulsyan et al.[13] 2011 Lucknow 42.3% Pityriasis alba – 14.3% Association between transmissible disease and socioeconomic status and education of parents
Vora et al.[14] 2006–2010 Anand, Gujarat 15.41% Non-infectious dermatoses – 79.6%
Infectious dermatoses – 18.14%
Nutritional deficiency dermatoses – 2.26%
Association of non-infectious dermatoses with semi-urban area and good socioeconomic status
Dogra and Kumar[15] 2001 Chandigarh 38.8% Infections – 11.4%
International studies
Mengist Dessie et al.[4] 2018 Debre Berhan town, Northern Ethiopia 61.2% Dandruff – 38.4%
Infectious diseases>Non-infectious diseases
Significant association of skin diseases with occupation of father, personal hygiene, previous history of skin diseases, exchange of clothes and towels among family members, not a member of health insurance
El-Khateeb et al.[16] 2011–2012 Damietta, Egypt 100% Benign neoplasms – 87%
El-Dawela et al.[17] 2009 Sohag Governorate, Egypt 41.5% Infectious diseases – 59.1%
Non-infectious diseases – 40.9%
Significant risk factors- Rural residency, older age, females, overcrowding, low socioeconomic status
Sula et al.[18] 2008 Diyarbakir, Turkey 59.1% Eczema – 32.8%
Non-infectious diseases>Infectious diseases
Significant association- Non-infectious diseases in females, Infectious diseases in boarding schools
Khalifa et al.[19] 2004 Baghdad 40.9% Non-transmissible diseases – 33.7%
Transmissible diseases – 8.8%
Significant association of diseases with parents’ education

The prevalence of skin diseases in children helps give a rough idea about the diseases prevalent in the population of that area. This will help bring about necessary changes in the habits and practices of society for preventing these diseases by establishing relevant educational programs and raising awareness.[3]

The population should be encouraged to take appropriate help and consultation when required as ignorance can increase morbidity, which has a higher impact on children as this is the prime age for mental and physical growth and development. School check-ups are a medium whereby the students and their parents can be kept informed about the conditions affecting the children, whether benign or otherwise, and encourage them to take necessary help if required or to be given appropriate counsel.

Limitations of the study

Since this is a cross-sectional study that could not cover all the schools in the area, the prevalence of dermatoses may have been underestimated as diseases of short duration (e.g., varicella) could have been missed and the aftermath of those diseases was recorded under another category (e.g. post-varicella pigmentation mentioned under disorders of pigmentation). The questionnaire answered by the parents included parameters such as personal hygiene, which may have been fabricated to make it socially desirable due to fear of stigma against the child. Most of the students were examined in the winter months (December 2022 to January 2023), during which conditions such as xerosis and keratolysis exfoliativa were recorded the most, increasing the number of cases included under the category disorders of keratinization. The prevalence of dermatoses in school children calculated in this study is only a reflection of the overall prevalence and further studies involving a larger population should be conducted to determine the actual prevalence for a better understanding of what is needed to improve the health of society.

CONCLUSION

The prevalence of dermatoses in school children in a semi-urban city in North Karnataka, India, was found to be 89.4%, with a predominance of non-infectious dermatoses, which were significantly associated with better hygiene practices, no contact with household pets, higher socioeconomic status, and overweight students. Infectious dermatoses were less prevalent and associated with poor diet and hygiene practices, overcrowding at homes, lower socioeconomic status, and underweight children. Multiple health awareness and education programs are present for the prevention of infectious diseases, which have proven to be very effective. Similarly, awareness should be raised regarding non-infectious diseases and the population should be trained to detect such conditions and encouraged to take appropriate help when required.

Ethical approval

The author(s) declare that they have taken the ethical approval from IEC (BLDE [DU]/IEC/807-C/2022-23).

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Financial support and sponsorship

Nil.

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