Year : 2007 | Volume
: 52 | Issue : 2 | Page : 93--95
Pattern of skin diseases in a peripheral hospital's skin OPD: A study of 2550 patients
Sudip Das, Tapash Chatterjee
Department of Dermatology & Venereology, NRS Medical College and formerly Bankura Medical College, India
P-103, Bosenagore, Madhyamgram, 24 Parganas (N), Kolkata
This study was done amongst 2550 consecutive skin patients in our male OPD. Infective dermatoses was seen in 36.41% and allergic diseases in 29.88% of our patients. New cases of leprosy accounted for 5.64% of our cases, which we consider is a disturbing trend. Occupational dermatoses was seen 15.24% of our cases. Farmers and agricultural labourers comprised the largest segment (37.72%) of our patients.
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Das S, Chatterjee T. Pattern of skin diseases in a peripheral hospital's skin OPD: A study of 2550 patients.Indian J Dermatol 2007;52:93-95
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Das S, Chatterjee T. Pattern of skin diseases in a peripheral hospital's skin OPD: A study of 2550 patients. Indian J Dermatol [serial online] 2007 [cited 2021 Jul 27 ];52:93-95
Available from: https://www.e-ijd.org/text.asp?2007/52/2/93/33286
Bankura Sammilani Medical College located in South Bengal experiences extremes of temperature, where temperature rises to 48° C in summer months and 5° C in winter months. This study was conducted in the months of February - March, so that effect of temperature on skin conditions can be negated, at least partially.
Very few Indian studies are available to find out what exactly is the pattern of skin diseases amongst patients reporting regularly to the skin OPD. We attempted to find out what exactly is the occupational status and whether occupation is the cause of the dermatological disease (Occupational dermatoses), and what age group of patients do commonly report in male skin OPD.
The predominant patients, who report to this college are of low socioeconomic status and are chiefly farmers or engaged in work related to agriculture. However there are a large number of engineering and other colleges where there are a good number of students who come to study in Bankura from other parts of Bengal and also other states.
Materials and Methods
Two thousand five hundred and fifty consecutive male patients reporting to Skin OPD of Bankura Medical College were enlisted in the study. Male patient OPD caters to male patient and children above 10 years. All male patients were seen clinically by qualified dermatologists with degree in dermatology and the clinical diagnosis was registered including the age and occupation. No attempt was made to enlist controversial cases or where diagnosis was not possible at first chance. The case was noted in a OPD register by the consultant in charge of Skin OPD (male side) and then occupation and age was noted and correlation to the occupation (if any) was noted.
We broadly divided the skin disease into thirteen broad groups. The study revealed amongst the patients of our OPD, infective dermatoses (Gr-I) was the commonest (36.41%). Allergic diseases of skin (Gr-II) was a close second with 29.88%. The other groups recorded in our study were respectively papulosquamous disorders (nonmalignant) (6.11%), pigmentation disorders (6.78%), hair disorders (3.72%). autoimmune disorders (0.78%), connective tissue disorder of skin (0.6%), malignant disorders of skin (0.94%), nevus and other related disorders (1.18%), Keratinisation disorders (2.58%), acne and disorders of sebaceous glands (2.82%). There were also 10 cases of Steven Johnson, Toxic epidermal necrolysis and erythema multiforme comprising of (0.39%) of cases.
A large number of patients (197 out of 2550) were clubbed into miscellaneous group. This miscellaneous group comprised patients of aphthous ulcer (0.54 %), Papular Urticaria (0.43%), Chr. pustular folliculitis (1.05%), hyperhydrosis of palms and sole (1.13%). Xeroderma pigmentosum (0.11%), Bloom syndrome (0.04%), Poikiloderma (0.15%), Canities (0.11%), geographical tongue (0.35%) tuberous sclerosis (0.11%), neurofibroma (0.27%), Marfan's syndrome (0.2%), Vasculitic disorder (0.47%), Pscyhocutaneous disorders (1.37%) acanthosis nigricans (0.55%) and few others.
Infective dermatoses was seen in 929 out of 2550 patients. Out of the patients of infective dermatoses, the following was noted as shown in [Table 1].
Allergic diseases of the skin was seen in 762 out of 2550 patients (29.88%). The patient profile of this group is shown in [Table 2].
Of the Papulo squamous disorders (nonmalignant only) the majority (6.11%) of the cases were psoriasis (102 of the total 156 cases) accounting for 4% of the patients reporting to our OPD. Lichen planus was found in 1.72% of total number of cases and pityriasis rosea in (0.4%) of cases.
Pigmentary disorders was seen in 173 cases out of total number of 2550 patients accounting for 6.78% of cases, Vitiligo was seen in 3.6% of our OPD patients. The other major types of pigmentary disorders were postinflammatory hyperpigmentaion (1.41%), postin-flammatory hypopigmentation in 0.9%, depigmentation in 0.5% of our cases. Melasma, a common problem in young and middle aged females, but also present in 1.70% (18 patients) of our patients who reported to our OPD.
Hair disorders comprising of alopecia areata androgenetic alopecia and telogen effluvium mainly was present in 96 patients (3.72%). We did not encounter a single case of hair shaft disorders. Alopecia areata was seen in 50 patients (1.96%) androgenetic alopecia in 28 patients (1.09%) and telogen effluvium in 18 cases (0.70%).
Autoimmune bullous disorders was present in 20 of our patients (0.78%). Among the 29 patients, nine were of pemphigus vulgaris (0.35%), six were of bullous pemphigoid (0.23%), two cases of pemphigus foliaceous and one of pemphigus vegetans. We also encountered two cases of chronic bullous of childhood.
Fifteen patients of connective tissue disorders also reported to our OPD as shown in [Table 3].
We also encountered 24 cases (0.94%) of malignant disorders of skin. Basal cell carcinoma was commonest and seen in 11 cases. Squamous cell carcinoma in 8 cases, two cases of melanoma and three cases of mycoses fungoides were reported. Thirty cases of various nevuses reported to us comprising of Beckers nevus (0.23 %), nevus comedonicus (0.1%), N. Spilus (0.1%) and melanocytic nevus (0.6%).
Acne was seen in 60 (2.35%) of our cases, the other disorders of sebaceous glands was seen in 0.47 % of cases. Keratinisation disorders were seen in 66 cases (2.58%). Palmoplantar keratoderma was most common amongst them (36 out of 66). Rest of this group included, acquired keratoderma (0.39%), Perforating disorders (0.23%), Porokeratoses (0.23%), Darriers disease (0.08%), seb. keratosis (0.23%) among the total number of cases. Besides, there were large number of patients in small numbers and we clubbed them as miscellaneous groups (197 out of 2250). These diseases account for only a miniscule of total patients e.g., aphthous ulcer (0.54%), papular urticaria (0.43%), chronic pustular. folliculitis (1.05%) hyperhydrosis of palms and soles (1.13%). Xeroroderma pigmentosum (0.11%), Poikloderma (0.15%), Canities (0.11%) geographic tongue (0.35%), Blooms syndrome (0.04%), Psychocutaneous disorders (1.35%), acanthosis nigricans (0.55%), tuberous screlosis (0.4%), neurofibroma (0.27%), Vasculitis (0.47%), and glossitis and angular chelitis (0.39%), and Marfan's disease (0.02%).
We also tried to find out what age groups report to us in OPD and we divided them into six groups.
Bankura is a district town with rural back ground, so we also tried to estimate what were the occupations of these patients and what was the percentage of occupational dermatoses (as evident from 1 st visit in OPD).
Our study is unique in a pattern that no indexed Journal has reported such a study in a predominant male patients particularly from an Indian subcontinent. In a recent study by Das et al.,  reported from an urban institute in Kolkata eczematous disease in (31.4%), pyodermas as 14.36%, fungal infections in 9.7%,of cases. Two other similar studies from Indian subcontinent were carried out. Anand et al. ,  in a study from Saurashtra showed skin infection comprised 83.25% of skin diseases, followed by allergic (8.55) and miscellaneous disorders (8.25%). Amongst skin infections in this study pyoderma was the commonest of infective diseases. Yasmeen et al.,  in a study from Pakistan reported 31% of all patients of paediatric age group had skin diseases and skin infections was commonest (60%). In their study fungal infections were the commonest skin infection and 21% of the children with skin diseases had allergic diseases in their study.
Our study therefore clearly emphasizes that the basic pattern of two most common skin diseases are infective and allergic dermatoses comprising 36.41% and 29.88% respectively. Although papulosquamous disease was seen in 6.1% of total cases, psoriasis was the commonest (4.0%) The percentage of psoriasis reported in majority of studies in general populations are around 1 to 2%. Pigmentation disorders (6.75%), hair disorders (3.72%), keratinisation disorders (2.58%) acne and related disorders are also important comprising significant percentage in our study.
This study also clearly stresses that in a rural set up like Bankura farmers and agricultural labourers comprise the bulk of patients (37.72%), followed by surprising high number of students reporting to us (22.03%). There are a large number of teaching institutions in and around Bankura and the students mostly stay in hostels and report to our OPD for skin problems thus explaining their large number in our study. Occupational dermatoses i.e. where some relation of skin diseases with occupation could be clearly established was seen in 15.84% of our patients, which clearly shows that since this occupational dermatoses is preventable and patients must be properly counseled and proper history taking at the time of establishing the diagnosis is important.
We did not find any special importance in age group as although (21-30) years comprised the largest segment and 61+ the smallest segment of the patients reporting to skin OPD, this is probably more so because 21-30 years age group comprise the most mobile and 61+ the least mobile age group.
This study also focuses that fungal disease is the commonest infecting dermatoses in this age group of patient. Pyoderma, which were common in the study of Anand et al.,  in paediatric population was much less common in relatively older age groups (5.11%). Scabies is also common in Bankura because of generalized poverty and tendency of too many people living together and thus accounted for 6.82% of our patients. The disturbing trend in our study was that even after twenty years of National Leprosy Eradication Programme, we got 174 new cases of leprosy accounting for 5.68% of the new cases reporting to us. This should alert everybody to rethink whether, we have achieved or have been able to manage the resources of NLEP successfully. Allergic diseases were predictably the secondth commonest group and since most of the people are related to out door work, exogenous dermatitis remained very common (12.31%). Photo dermatitis is more common in this part of Bengal because sun relentlessly scorches the district from March to July in daytime without any cloud cover and most people are farmers working in field under scorching sun.
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