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ORIGINAL ARTICLE
Year : 2012  |  Volume : 57  |  Issue : 1  |  Page : 35-37
A cross-sectional study of dermatological problems among differently-abled children


1 Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
2 Department of Dermatology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

Date of Web Publication10-Mar-2012

Correspondence Address:
Raghavendra Rao
Department of Dermatology, Kasturba Medical College, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.92674

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   Abstract 

Background: Differently-abled children may be particularly susceptible to skin disorders either as a direct consequence of their disability or due of lack awareness regarding personal and environmental hygiene. Aim: To study the prevalence of skin problems in differently-abled children. Materials and Methods: A total of 122 differently-abled children in two special schools were examined for this study. Details regarding the disabilities were obtained from the school records. Results: More than half (53.2%) of the children had skin problems. Infections and infestations, acne, and dermatitis were the common dermatoses encountered in the present study. Conclusion: Periodic skin examination is of vital importance for all people with disabilities to reach a proper diagnosis and to offer treatment. Health education for teachers and parents on maintenance of sound personal hygiene and a clean environment is also recommended.


Keywords: Differently-abled children, psychocutaneous diseases, skin diseases, school survey


How to cite this article:
Rao C, Rao R. A cross-sectional study of dermatological problems among differently-abled children. Indian J Dermatol 2012;57:35-7

How to cite this URL:
Rao C, Rao R. A cross-sectional study of dermatological problems among differently-abled children. Indian J Dermatol [serial online] 2012 [cited 2019 Dec 7];57:35-7. Available from: http://www.e-ijd.org/text.asp?2012/57/1/35/92674



   Introduction Top


Epidemiological studies can provide information about the prevalence, the age and sex predilections, and the regional distribution of skin diseases. [1] It also offers the most useful way of evaluating the causes of skin diseases in human populations. As Sir Richard Doll pointed out, 'epidemiology is the simplest and most direct method of studying the causes of diseases in humans and many contributions have been made by studies that have demanded nothing more than an ability to count, think logically, and have an imaginative idea.' [2]

Dermatologic conditions in children pose a special challenge to primary care physicians and pediatricians. It has been estimated that skin diseases account for about 30% of all pediatric consultations. [3] Identification of skin disease in this age-group by a trained dermatologist is very important. A hospital-based study revealed that examination by a dermatologist has altered the diagnosis and/or treatment in 8% of patients. [4]

Schools provide excellent arenas for public health research and interventions. [5] Previous studies from developing countries have reported high prevalence of skin disorders among schoolchildren, the spectrum of which has been highly variable. [6] A World Health Organization (WHO) review of prevalence studies done on skin diseases among children reported an overall prevalence ranging from 21% to 87%. [7]

The United Nations defines a differently-abled person as one who is 'unable to ensure by himself or herself, wholly or partly, the necessities of a normal individual and/or social life as a result of deficiency, either congenital or not, in his or her physical or mental capabilities.' [8] There is paucity of data regarding the dermatological problems encountered among physically and/or mentally challenged children. This study aimed to determine the magnitude and types of skin problems among differently-abled children.


   Materials and Methods Top


In this cross-sectional study, two schools for differently-abled children located in Southern India were identified and all the students were examined for the presence of skin lesions. Data regarding the disabilities among the children were obtained from the school records. The sample included 122 students of both sexes. We used descriptive statistics to determine the nature and magnitude of skin problems among these children.


   Results Top


Of the 122 children, 77 (63%) were males and 45 (37%) were females, giving a male/female ratio of 1.7:1. The mean age of the study population was 10.1±7.33 years (mean±SD). Sixty-two children (50.8%) had mild mental retardation, while 50 (40.9%) were suffering from moderate to severe mental retardation. Speech and hearing impairment and behavioral problems were present among 45 (36.8%) and 17 (13.9%) children, respectively.

A total of 65 (53.2%) children had skin problems [Table 1]. Seven children had more than one skin problem. There was no significant gender difference in the distribution of the diseases. Acne was the commonest condition encountered in these children, being seen in 15 (23.1%) patients. Infections and infestations were detected in 25 cases (38.5%); these included scabies (13 cases); fungal infections (3 cases of tinea versicolor and 2 of tinea cruris); viral warts (4 cases); and pyoderma (3 cases). Dermatitis was diagnosed in 8 children; this included 3 cases of lichen simplex chronicus, 2 cases each of nummular eczema and pityriasis alba, and 1 case of pompholyx. Genodermatoses was seen in three patients (one case each of tuberous sclerosis [Figure 1], progeria, and lamellar ichthyosis). Conditions such as psychocutaneous disorders (trichotillomania and dermatitis artefacta [Figure 2] in one each), alopecia (alopecia areata and traction alopecia in one patient each), acanthosis nigricans, xerosis, keloid, keratosis pilaris, and postinflammatory pigmentation were encountered in two patients each. There was also one case each of psoriasis, lichen striatus, nevus depigmentosus, angular cheleitis, callosity over the feet, fibrotic papules over the knuckles, and facial hemiatrophy.
Figure 1: Multiple adenoma sebaceum on the face

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Figure 2: Linear ulcer and scars on the forearms suggestive of dermatitis artefacta

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Table 1: Prevalence of skin diseases among 122 children

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   Discussion Top


Handicap due to the skin diseases may not be as explicit as that associated with, for example, a broken limb, but the psychological consequences may be enormous. [9] It has been shown that relatively minor skin complaints often cause more anguish than more serious medical problems. It is the combination of high prevalence and moderate morbidity that makes skin diseases very important from a public health point of view. [1] Differently-abled children may be particularly susceptible to skin disorders, sometimes as a direct consequence of their disability, which prevents them from undertaking normal care of their skin, or because they lack awareness regarding personal and environmental hygiene. All of these may result in skin problems, which add to the child's physical and emotional distress. [10]

The factors associated with an increased prevalence of skin diseases include low socioeconomic status, malnutrition, overcrowding, and poor standards of hygiene. Previous skin disease surveys conducted in developing countries have concluded that skin diseases are very common in children and adolescents, with infections and infestations being high on the list. In contrast, eczemas, including atopic dermatitis, are more common among children in developed countries; this is probably the influence of socioeconomic and environmental factors such as excessive hygiene and the use of carpets and central heating in dwellings. [2]

Even though dermatology is characterized by an enormous range of disease/reaction patterns, prevalence surveys suggest that the bulk of skin diseases belong to fewer than ten categories. [1] Such observations are useful in developing educational programs and primary health care policy.

Infective conditions (18.9%) were the most common dermatoses in the present study. Fathy et al. have made a similar observation in their study of students with disabilities. [10] Although infective dermatoses are commonly encountered even among normal children, [11] certain skin conditions are known to occur more commonly among children with disabilities than in normal children. In some instances patients appear to produce their skin lesions as an outlet for nervous tensions arising from interpersonal conflicts and/or unresolved emotional problems. [12] In the present study, we came across conditions such as dermatitis artefacta and trichotillomania, which have not been reported in previous school surveys involving normal children. It is also uncommon to detect genetic conditions such as tuberous sclerosis in regular schools. However, skin examination surveys at one point in time (point prevalence surveys) are likely to underestimate the true burden of skin disease among children, and there is a need to assess and address dermatological problems among differently-abled children by undertaking population-based studies. Such information and statistics can form an important basis for population-based health policies.

 
   References Top

1.Dogra S, Kumar B. Epidemiology of skin diseases in school children: A study from Northern India. Pediatr Dermatol 2003;20:470-3.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Williams HC. Epidemiology of skin disease. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook's Textbook of Dermatology. 8 th ed. Oxford: Wiley Blackwell; 2010. 6.1-6.19.  Back to cited text no. 2
    
3.Schachner L, Ling NS, Press S. A statistical analysis of a pediatric dermatology clinic. Pediatr Dermatol 1983;1:157-64.  Back to cited text no. 3
[PUBMED]    
4.Hubert JN, Callen JP, Kasteler JS. Prevalence of cutaneous findings in hospitalized pediatric patients. Pediatr Dermatol 1997;14:426-9.  Back to cited text no. 4
[PUBMED]    
5.Skin diseases among school children-can research lead to action and policy. Available from URL http://www.imakmj.com/articles/01-Editorial.pdf [Last accessed on 2011 July 22].  Back to cited text no. 5
    
6.Komba EV, Mgonda YN. The spectrum of dermatological disorders among primary school children in Dar es Salaam. BMC Public Health 2010;10:765-70.  Back to cited text no. 6
    
7.Epidemiology and management of common skin diseases in children in developing countries. Available from URL: http://whqlibdoc.who.int/hq/2005/WHO_FCH_CAH_05.12_eng.pdf. [Last accessed on 2011 July 23].   Back to cited text no. 7
    
8.Understanding differently abled children. Available from URL: http://www.bhojvirtualuniversity.com/ss/online_cou/b_ed/.../cp2b5u3.rtf [Last accessed on 2010 April 07].  Back to cited text no. 8
    
9.Savin J. The hidden face of dermatology. Clin Exp Dermatol 1993;18:393-5.  Back to cited text no. 9
    
10.Fathy H, El-Mongy S, Baker NI, Abdel-Azim Z, El-Gilany A. Prevalence of skin diseases among students with disabilities in Mansoura, Egypt. East Mediterr Health J 2004;10:416-24.   Back to cited text no. 10
[PUBMED]    
11.Ferie J, Dinkela A, Mbata M, Idindili B, Schmid-Grendelmeier P, Hatz C. Skin disorders among school children in rural Tanzania and an assessment of therapeutic needs. Trop Doct 2006;36:219-21.  Back to cited text no. 11
    
12.Obasi OE, Naguib M. Dermatitis artefacta: A review of 14 cases. Ann Saudi Med 1999;19:223-7.  Back to cited text no. 12
    


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