# Clinicoepidemiology of Skin Diseases in Children Seen at the University Hospital Center Morafeno, Toamasina, Madagascar

Authors: Irina Mamisoa Ranaivo; Fandresena Arilala Sendrasoa; Malalaniaina Andrianarison; Moril Sata; Onivola Raharolahy; Dimby Stephane Ralandison; Lala Soavina Ramarozatovo; Fahafahantsoa Rapelanoro Rabenja
Journal: Dermatology Research and Practice
 (2021)

---

## Abstract

Introduction. The child’s skin diseases are common and very diverse. Many studies concerning pediatric dermatoses have been carried out in Africa and the rest of the world. Few epidemioclinical data reflect these skin diseases in children, especially in the east coast of Madagascar. We aim to describe the pattern skin diseases among children seen at the University Hospital Center Morafeno, Toamasina, Madagascar. Patients and Methods. A retrospective study over a 3-year period from January 2017 to December 2019 was conducted in children seen in the Dermatology Department of University Hospital Center Morafeno, Toamasina, with skin diseases. Results. During the study period, 347 children out of the 1584 new patients were retained with a sex ratio of 0.86. The mean age was 6.4 years old. The main diseases identified were skin infectious diseases (43, 23%), allergic dermatoses (24.21%), and autonomous dermatosis (15.56%). Conclusion. Our study revealed the importance of infectious and allergic dermatoses in Toamasina. It is necessary to carry out simple preventive actions such as hygiene.


---

## Body

## 1. Introduction

The child’s skin diseases are common and very diverse. These skin disorders give uneasiness and anxiety of parents. Many studies concerning pediatric dermatoses have been carried out in Africa and the rest of the world [1–4]. Environmental factors play a significant role in skin disease. However, in Madagascar, particularly in Toamasina, this entity remains little studied. Toamasina is a city on the east coast of Madagascar with a hot and humid climate. We aim to describe the pattern skin diseases among children seen at the CHU Morafeno, Toamasina, Madagascar.


## 2. Patients and Methods

This is a retrospective study of all patients aged ≤15 years attending the outpatient dermatology who were examined at the Department of Dermatology at the University Hospital Center Morafeno in Toamasina, Madagascar, during 36 months (from January 2017 to December 2019). Epidemiologic data (age and gender) and diagnosis were collected from the patient’s medical records. Patients with missing information were excluded from the study. The diagnoses reported on the medical records were based on clinical features and were confirmed by laboratory tests when indicated. The studied cases were further divided according to etiology, into the following groups: infectious skin diseases (bacterial skin infections, parasitic infestations, fungal infections, and viral infections), allergic dermatoses, autonomous dermatosis or inflammatory skin diseases, genodermatosis or congenital dermatosis, skin tumors, dysimmune diseases, and toxidermia (drug reaction). The data collections were carried out by the Excel 2010 software. The statistical analysis was processed on the EPI-INFO software version 7.2.2 16.


## 3. Results

During the study period, a total of 1584 new patients with skin diseases were seen, including 347 pediatric patients. Pediatric consultations represent 21.90% of all dermatology outpatient. Among the 347 pediatric patients, 159 (46.36%) were boys and 184 (53.64%) girls. There was a female preponderance (sex ratio: 0.86). Age ranges from newborn to 15 years (mean age 6.4years). The time between the onset of illness and the first consultation varied between one day to120 months with a mean delay of 12.18 months. The main diseases identified were skin infectious disease (43, 23%), allergic dermatoses (24, 21%), autonomous dermatosis (15, 56%), genodermatosis or congenital dermatosis (9, 51%), tumoral dermatosis (2.88%), dysimmune diseases (1.44%), and toxidermia (1.15%). Table1 shows the frequency and pattern of skin diseases groups according to the age ranges of the patients.Table 1
The frequency and pattern of skin diseases groups according to the age ranges of the patients
Skin diseasesAge ranges<1 year1–5 years6–10 years11–15 yearsTotalPercentage (%)Infectious dermatoses2262442215043.23Autonomous dermatoses011514245415.56Allergic dermatoses113025188424.21Congenital dermatoses15080604339.51Dysimmune dermatoses000203051.44Tumors skin0020107102.88Toxidermia003010041.15Others050200072.02Total541229378347100Among the skin infectious disease, fungal infections were noted in 58 cases (31.67%) which consisted of pityriasis versicolor in 12.66% and tinea corporis in 10%. Regarding bacterial skin diseases, they were noted in 22 cases (14.67%) including impetigo (8%) (Figure1), and there were 2 cases of skin tuberculosis. Viral infections represented 16.67% of infectious diseases, including molluscum contagiosum (10.66%). As for parasitic infestations, 41 cases were scabies (27.33%). Table 2 provides the distribution of children according to infectious diseases.Table 2
The distribution of children according to infectious diseases.
DermatosesDiagnosisNumber of patients (150)Percentage (%)Fungal infectiousPityriasis versicolor1912.66Tinea corporis1510.00Tinea capitis149.33Seborrheic dermatitis106.66Total5838.67Parasitic infestationScabies4127.33Cutaneous larva migrans0402.66Total4530Viral infectionsMolluscum contagiosum1610.66Gibert’s pityriasis rosea032.00Varicella010.66Zona021.33Herpes010.66Warts021.33Total2516.67Bacterial skin diseasesImpetigo1208.00Furunculosis070.46Abcess010.66Cutaneous tuberculosis021.33Total2214.67Figure 1
Impetigo.Allergic dermatoses were mainly represented by atopic dermatitis (72.62%). Most of the autonomous dermatoses were represented by vitiligo (48.15%) (Figure2), followed by acne and psoriasis, respectively, 20% and 16.67%. Congenital dermatoses and/or genodermatoses mainly consisted of tuberous hemangiomas (42.42%), nevi (18.18%), and congenital ichthyosis (12.12%). These 3 groups of noninfectious dermatoses are given in Table 3. Skin tumors were mainly benign tumors (10 cases), of which 5 cases were keloids. There were 5 cases of autoimmune diseases including 2 cases of autoimmune bullous dermatosis and 3 cases of scleroderma. Finally, 4 cases of drug eruption were fixed pigmented erythema.Figure 2
Vitiligo.Table 3
The distribution of children according to noninfectious skin diseases.
DermatosesDiagnosticsNumber of patientsPercentage (%)Allergic dermatosisAtopic dermatitis6172.62Contact eczema1011.90Prurigo1214.29Urticaria011.19Total84100Autonomous dermatosesVitiligo2648.14Acne1120.37Psoriasis0916.67Lichen striatus0611.11Alopecia areata023.07Total54100Congenital dermatosesHemangioma1442.42Nevi0618.18Congenital ichthyosis0412.12Pityriasis rubra pilaris0309.09Neurofibromatosis0206.06Klippel–Trenaunay0103.03Bourneville tuberous sclerosis0103.03Anhidrotic ectodermal dysplasia0103.03Aplasia cutis congenita0103.03Total33100


## 4. Discussion

The aim of this study was to describe the pattern skin diseases among children ≤15 years seen in Dermatological Outpatient Department at the University Hospital Center Morafeno, Toamasina. This study provided an overview of children’s skin diseases in Toamasina. The present study found that 21.90% of the patients seen in dermatology in Toamasina were children; this frequency is comparable to the results of the literature [1, 2, 5]. The demographic profile of these children was superimposed on that of the literature. There was a predominance of the female gender in our study with 53.64%. Similar results were found in Côte d’Ivoire with a female predominance at 54.06% [3] and in Greece at 52.8% [6]. In Mali and India, it found a male predominance with, respectively, 55.10% and 58% [1, 4].The average duration of disease progression before consultation is quite long, around 12.18 months. This could be explained by the recent opening of the Dermatology Department at the University Hospital Center Morafeno, Toamasina (2016). Poor economic and geographic accessibility to healthcare services by patients, recourse to traditional treatments, or self-medication delayed specialist consultations [7].Infectious dermatoses was the largest group of skin disorders in childhood in our study constituting 43.23% of total 347 cases, followed by allergic dermatoses (24.21%) and autonomous dermatoses (15.56%). As in other African studies, infectious skin diseases were frequent and affected different age groups of children [1, 8]. The infectious diseases observed were fungal, parasitic, viral, and bacterial dermatoses. But the most common were superficial skin fungal infections (tinea corporis and pityriasis versicolor) and parasitic dermatoses in particular scabies. This frequency could be the consequence of poor hygiene and limited socioeconomic condition. The hot and humid climate also favours the appearance of infectious dermatoses [9].After infectious dermatoses, there were allergic dermatoses, mainly atopic dermatitis as in most studies both in Africa and in Europe [1, 2]. These dermatoses affected all age groups. Lifestyle factors linked to urbanization were associated with an increased risk of allergic diseases in Africa [10, 11].Concerning autonomous dermatoses, the most common were vitiligo, acne, and psoriasis. These dermatoses mainly affected the 11–15 age group. Although benign, they could have a negative impact on the quality of life of children, adolescents, and their families [12]. This high frequency for this age group is thought to be due to the aesthetic discomfort leading to a consultation. Vitiligo can appear soon after birth until late adulthood. But it appears before the age of 12 in 32–40% of cases [13]. And acne is often associated with adolescence but can appear at any age, especially in the prepubertal period [14].Skin tumors were benign and appeared mostly in the 11–15-year age group. In fact, skin cancers are rare in children except in the case of preexisting dermatoses such as albino or xeroderma pigmentosum. These skin tumors were essentially keloids. The absence of comorbidities promotes good wound healing in children compared to adults due to good vascularisation of the skin. But hypertrophic and keloid scars are frequent in the prepubertal period as part of the hormonal peak [15, 16]. Table 4 provides some studies of skin diseases in children reported in the literature.Table 4
Comparative analysis of some studies of skin diseases in children reported in the literature.
StudyCountryPeriod studyNumber of patientsMost frequent skin diseasesBen Saif and Al Shehab [17]Al-KhabarJanuary 2004 to January 2006383Dermatitis and eczema 30.30%Saudi ArabiaInfectious diseases 12.5%Pigmentary disorders 8.9%Sacchidanand et al. [9]BangaloreJanuary 2011 to June 20111 090Infectious diseases 32.4%IndiaEczema 20.66%Pigmentary disorders 7.4%Vakirlis et al. [6]ThessalonikiJanuary 2013 to December 2015940Dermatitis/eczema 31.4%GreeceViral infection 12.5%Pigmentary disorders 7.3%Özçelik et al. [18]ErzincanJanuary 2014 to November 201610 115Infectious diseases 24.62%TurkeyEczema 21.95%Acne and follicular diseases 18.45%Kourouma et al. [3]TreichvilleJanuary 2010 to December 20143 587Infectious diseases 29.2%AbidjanImmunoallergic dermatitis 29.1%Inflammatory dermatoses 26.67%Kiprono et al. [19]TanzaniaSeptember 2012 to August 2013340Infectious diseases 43.5%Eczema dermatitis 28.5%Pigmentary disorders 7.4%Miotto et al. [20]Sao PaoloJanuary 2017 to December 20172 330Atopic dermatitis 18.3%BrazilGenodermatoses 14.2%Infectious diseases 12.6%Present surveyToamasinaJanuary 2017 to December 2019347Infectious diseases 43.23%MadagascarAllergic dermatoses 24.21%Autonomous or inflammatory dermatoses 15.56%


## 5. Conclusion

Childhood skin diseases are variable and frequent in dermatological outpatient. The epidemioclinical characteristics of dermatoses in children in Toamasina did not differ from skin disorders in children seen in Africa. Our study revealed the importance of dermatological conditions, in particular infectious and allergic, as well as autonomous dermatoses. It is necessary to carry out simple preventive actions such as hygiene to encourage and educate patients to come to the hospital in time for appropriate treatment.



---

*Source: 6456448-2021-09-09.xml*