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Therdpong Tempark, Khwaunrat Whaidee, Chansuda Bongsebandhu-phubhakdi, Orapa Suteerojntrakool, Prevalence of skin diseases in school-age children, Family Practice, Volume 39, Issue 3, June 2022, Pages 340–345, https://doi.org/10.1093/fampra/cmab164
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Abstract
The prevalence of community-based skin diseases, especially among school-age children, depends on topography, climate, and age of population.
We determined the prevalence of skin diseases among community-based primary school-age children and identified demographic characteristics in relation to particular skin conditions.
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.
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).
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.
About 90.2% of the school-age children have at least 1 skin disease.
Postinflammatory hyperpigmentation (PIH) is the most common skin disease.
PIH can be associated with insect bite reactions and obesity.
The other common skin diseases include nevus/mole and insect bite reaction.
Body mass index is related to PIH and acanthosis nigricans.
Education on insect bite prevention, body weight control should be advocated.
Introduction
Skin diseases are one of the most important health issues with significant impacts on school-aged children and cause nonfatal disabilities worldwide, particularly in low-resource regions.1,2 These include congenital, acquired, and life-threatening or non-life-threatening types of skin conditions, developmental anomalies, birth marks, infection, inflammation, trauma, and tumour, etc.
Many hospital- and community-based studies have been conducted on the prevalence of skin diseases, with various types of conditions depending on topography, climate, and age of participants. However, there are limited and few numbers of population-based studies in tropical countries, especially Thailand.3 Whereas, hospital-based studies are limited to only data of patients who come to see doctors at the hospital when they have severe skin diseases. Meanwhile, community- and school-based studies are particularly different in terms of type and severity of skin diseases and conditions.
To date, there are few informative data from previous studies to potentially provide fundamental problems on the community-based skin conditions and diseases, unlike the hospital-based data, which would be beneficial for family and healthcare providers towards the future improvement of various skin diseases in Thailand.
Thus, we conducted our survey study to determine the prevalence of community-based skin diseases, especially among primary school-age children in Bangkok, Thailand. Whilst, demographic characteristics in association with those skin diseases were also identified.
Methods
Study design
A cross-sectional survey study was performed in 2 community-based primary schools in the centre of Bangkok during January–April 2018 by Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Participants
Students aged 5–14 years who studied in grade 1–6 were recruited from 2 middle-class primary schools which randomly selected according to the school health screening project in the city of Bangkok. No previous health screening and none of the prevalence was available in this community area. Thus, a total of 556 community-based primary school students were enrolled in this study.
Data collection
Demographic data of participants were collected in a case record form, including sex, age, personal information, family history, parental education, and family income. All survey questionnaires were completed in all participants. Physical examination, including weight, height, and body mass index (BMI), was performed by paediatricians. Clinical examination of the entire body for skin conditions was also carried out by a paediatric dermatologist.
The written informed consent was explained and signed by parents of the participants. This study was approved by the Office of Research Ethics Review Committee, Chulalongkorn University (IRB No. 512/59).
Statistic analysis
Data were analysed using the Rstudio Version 1.0.153 and double-checked by another researcher. Quantitative variables were calculated and presented as percentage, range, mean, and standard deviation.
We determined the association between demographic characteristics and skin diseases/conditions. Bivariate and multivariable binary logistic regression was used to estimate crude and adjusted odds ratios. All factors were analysed in crossed conditions which provided a crude odds ratio. We selected conditions with adjusted odds ratio of the associated findings in accordance with our hypothesis. The adjusted odd ratio at <0.05 was considered as statistical significance.
Results
Data of demographic characteristics of 556 primary school-age children, with age range from 5 to 14 years and mean age 9.3 years, are shown in Table 1. A majority of parents graduated with less than a bachelor’s degree (65%) and about one-third of the family (36.7%) were in the middle-class income range according to data from the surveillance of National Statistical Office Thailand.4
| Data . | Number = 556 . |
|---|---|
| Gender | |
| Male (n) (%) | 291 (52.3%) |
| Female (n) (%) | 265 (47.7%) |
| Age (year) (range) | 9.3 ± 1.8 (5–14) |
| Height (cm) (range) | 137.3 ± 12.9 (104.5–170) |
| Weight (kg) (range) | 35.3 ± 13.2 (15.2–89.9) |
| BMI | 18.2 ± 4.2 (12.2–35.9) |
| Parent education | |
| Less than Bachelor’s degree | 361 (65%) |
| Bachelor’s degree | 167 (30%) |
| Higher than Bachelor’s degree | 28 (5%) |
| Family income per month (baht) | |
| <15,000 | 145 (26%) |
| 15,001–30,000 | 204 (36.7%) |
| 30,001–50,000 | 130 (23.4%) |
| 50,001–100,000 | 77 (13.9%) |
| Data . | Number = 556 . |
|---|---|
| Gender | |
| Male (n) (%) | 291 (52.3%) |
| Female (n) (%) | 265 (47.7%) |
| Age (year) (range) | 9.3 ± 1.8 (5–14) |
| Height (cm) (range) | 137.3 ± 12.9 (104.5–170) |
| Weight (kg) (range) | 35.3 ± 13.2 (15.2–89.9) |
| BMI | 18.2 ± 4.2 (12.2–35.9) |
| Parent education | |
| Less than Bachelor’s degree | 361 (65%) |
| Bachelor’s degree | 167 (30%) |
| Higher than Bachelor’s degree | 28 (5%) |
| Family income per month (baht) | |
| <15,000 | 145 (26%) |
| 15,001–30,000 | 204 (36.7%) |
| 30,001–50,000 | 130 (23.4%) |
| 50,001–100,000 | 77 (13.9%) |
| Data . | Number = 556 . |
|---|---|
| Gender | |
| Male (n) (%) | 291 (52.3%) |
| Female (n) (%) | 265 (47.7%) |
| Age (year) (range) | 9.3 ± 1.8 (5–14) |
| Height (cm) (range) | 137.3 ± 12.9 (104.5–170) |
| Weight (kg) (range) | 35.3 ± 13.2 (15.2–89.9) |
| BMI | 18.2 ± 4.2 (12.2–35.9) |
| Parent education | |
| Less than Bachelor’s degree | 361 (65%) |
| Bachelor’s degree | 167 (30%) |
| Higher than Bachelor’s degree | 28 (5%) |
| Family income per month (baht) | |
| <15,000 | 145 (26%) |
| 15,001–30,000 | 204 (36.7%) |
| 30,001–50,000 | 130 (23.4%) |
| 50,001–100,000 | 77 (13.9%) |
| Data . | Number = 556 . |
|---|---|
| Gender | |
| Male (n) (%) | 291 (52.3%) |
| Female (n) (%) | 265 (47.7%) |
| Age (year) (range) | 9.3 ± 1.8 (5–14) |
| Height (cm) (range) | 137.3 ± 12.9 (104.5–170) |
| Weight (kg) (range) | 35.3 ± 13.2 (15.2–89.9) |
| BMI | 18.2 ± 4.2 (12.2–35.9) |
| Parent education | |
| Less than Bachelor’s degree | 361 (65%) |
| Bachelor’s degree | 167 (30%) |
| Higher than Bachelor’s degree | 28 (5%) |
| Family income per month (baht) | |
| <15,000 | 145 (26%) |
| 15,001–30,000 | 204 (36.7%) |
| 30,001–50,000 | 130 (23.4%) |
| 50,001–100,000 | 77 (13.9%) |
About 90.2% of the primary school-age children had at least 1 skin condition. The most common skin diseases were postinflammatory hyperpigmentation (PIH) (58.3%), followed by nevus/mole (40.1%), insect bite reaction (28.0%), acanthosis nigricans (20.0%), acne (13.7%), pityriasis alba (12.9%), xerosis (5.9%), and atopic dermatitis (5.5%), respectively.
There was no association of the PIH group regarding sex, age, height, parental education, and family income, as shown in Table 2. However, BMI and puberty increased a risk for PIH with adjusted odds ratio of 2.01 (95% confidence interval [CI] 1.40–2.87, P < 0.001) and 2.16 (95% CI 0.62–7.58, P = 0.02), respectively.
| Skin diseases . | Demographic data . | Crude OR (95% CI) . | P . | Adjusted OR (95% CI) . | P . |
|---|---|---|---|---|---|
| PIH | Gender (male) | 1.54 (1.08–2.21) | 0.02∗ | 0.37 (0.12–1.18) | 0.09 |
| BMI | 1.05 (1.01–1.09) | 0.02∗ | 2.01 (1.40–2.87) | <0.001∗ | |
| Age | 0.91 (0.83–1.00) | 0.07 | 0.77 (0.56–1.04) | 0.09 | |
| Puberty | 0.67 (0.46–0.97) | 0.03∗ | 2.16 (0.62–7.58) | 0.02∗ | |
| Nevus/mole | Gender (male) | 2.05 (1.42–2.96) | 0.001∗ | 2.29 (1.45–3.62) | <0.001∗ |
| Age | 1.12 (1.01–1.23) | 0.23 | 1.05 (0.92–1.19) | 0.48 | |
| Insect bite reaction | Gender (male) | 1.11 (0.75–1.64) | 0.59 | — | |
| Age | 1.01 (0.91–1.12) | 0.88 | — | ||
| PIH | 5.23 (3.22–8.50) | 0.001∗ | 5.66 (3.15–10.17) | 0.001∗ | |
| Acanthosis nigricans | BMI | 1.58 (1.45–1.72) | 0.001∗ | 1.93 (1.49–2.49) | <0.001∗ |
| Age | 1.16 (1.03–1.30) | 0.02∗ | 0.86 (0.50–1.48) | 0.57 | |
| Height | 1.06 (1.04–1.08) | 0.001∗ | 1.05 (0.94–1.16) | 0.39 | |
| Systolic blood pressure | 1.06 (1.04–1.09) | 0.001∗ | 0.95 (0.90–1.01) | 0.10 | |
| Puberty | 1.89 (1.20–2.97) | 0.01∗ | 2.30 (0.46–11.50) | 0.31 | |
| Acne | 2.06 (1.18–3.62) | 0.01∗ | 0.26 (0.03–1.66) | 0.15 |
| Skin diseases . | Demographic data . | Crude OR (95% CI) . | P . | Adjusted OR (95% CI) . | P . |
|---|---|---|---|---|---|
| PIH | Gender (male) | 1.54 (1.08–2.21) | 0.02∗ | 0.37 (0.12–1.18) | 0.09 |
| BMI | 1.05 (1.01–1.09) | 0.02∗ | 2.01 (1.40–2.87) | <0.001∗ | |
| Age | 0.91 (0.83–1.00) | 0.07 | 0.77 (0.56–1.04) | 0.09 | |
| Puberty | 0.67 (0.46–0.97) | 0.03∗ | 2.16 (0.62–7.58) | 0.02∗ | |
| Nevus/mole | Gender (male) | 2.05 (1.42–2.96) | 0.001∗ | 2.29 (1.45–3.62) | <0.001∗ |
| Age | 1.12 (1.01–1.23) | 0.23 | 1.05 (0.92–1.19) | 0.48 | |
| Insect bite reaction | Gender (male) | 1.11 (0.75–1.64) | 0.59 | — | |
| Age | 1.01 (0.91–1.12) | 0.88 | — | ||
| PIH | 5.23 (3.22–8.50) | 0.001∗ | 5.66 (3.15–10.17) | 0.001∗ | |
| Acanthosis nigricans | BMI | 1.58 (1.45–1.72) | 0.001∗ | 1.93 (1.49–2.49) | <0.001∗ |
| Age | 1.16 (1.03–1.30) | 0.02∗ | 0.86 (0.50–1.48) | 0.57 | |
| Height | 1.06 (1.04–1.08) | 0.001∗ | 1.05 (0.94–1.16) | 0.39 | |
| Systolic blood pressure | 1.06 (1.04–1.09) | 0.001∗ | 0.95 (0.90–1.01) | 0.10 | |
| Puberty | 1.89 (1.20–2.97) | 0.01∗ | 2.30 (0.46–11.50) | 0.31 | |
| Acne | 2.06 (1.18–3.62) | 0.01∗ | 0.26 (0.03–1.66) | 0.15 |
OR, odds ratio.
∗Statistical significance.
| Skin diseases . | Demographic data . | Crude OR (95% CI) . | P . | Adjusted OR (95% CI) . | P . |
|---|---|---|---|---|---|
| PIH | Gender (male) | 1.54 (1.08–2.21) | 0.02∗ | 0.37 (0.12–1.18) | 0.09 |
| BMI | 1.05 (1.01–1.09) | 0.02∗ | 2.01 (1.40–2.87) | <0.001∗ | |
| Age | 0.91 (0.83–1.00) | 0.07 | 0.77 (0.56–1.04) | 0.09 | |
| Puberty | 0.67 (0.46–0.97) | 0.03∗ | 2.16 (0.62–7.58) | 0.02∗ | |
| Nevus/mole | Gender (male) | 2.05 (1.42–2.96) | 0.001∗ | 2.29 (1.45–3.62) | <0.001∗ |
| Age | 1.12 (1.01–1.23) | 0.23 | 1.05 (0.92–1.19) | 0.48 | |
| Insect bite reaction | Gender (male) | 1.11 (0.75–1.64) | 0.59 | — | |
| Age | 1.01 (0.91–1.12) | 0.88 | — | ||
| PIH | 5.23 (3.22–8.50) | 0.001∗ | 5.66 (3.15–10.17) | 0.001∗ | |
| Acanthosis nigricans | BMI | 1.58 (1.45–1.72) | 0.001∗ | 1.93 (1.49–2.49) | <0.001∗ |
| Age | 1.16 (1.03–1.30) | 0.02∗ | 0.86 (0.50–1.48) | 0.57 | |
| Height | 1.06 (1.04–1.08) | 0.001∗ | 1.05 (0.94–1.16) | 0.39 | |
| Systolic blood pressure | 1.06 (1.04–1.09) | 0.001∗ | 0.95 (0.90–1.01) | 0.10 | |
| Puberty | 1.89 (1.20–2.97) | 0.01∗ | 2.30 (0.46–11.50) | 0.31 | |
| Acne | 2.06 (1.18–3.62) | 0.01∗ | 0.26 (0.03–1.66) | 0.15 |
| Skin diseases . | Demographic data . | Crude OR (95% CI) . | P . | Adjusted OR (95% CI) . | P . |
|---|---|---|---|---|---|
| PIH | Gender (male) | 1.54 (1.08–2.21) | 0.02∗ | 0.37 (0.12–1.18) | 0.09 |
| BMI | 1.05 (1.01–1.09) | 0.02∗ | 2.01 (1.40–2.87) | <0.001∗ | |
| Age | 0.91 (0.83–1.00) | 0.07 | 0.77 (0.56–1.04) | 0.09 | |
| Puberty | 0.67 (0.46–0.97) | 0.03∗ | 2.16 (0.62–7.58) | 0.02∗ | |
| Nevus/mole | Gender (male) | 2.05 (1.42–2.96) | 0.001∗ | 2.29 (1.45–3.62) | <0.001∗ |
| Age | 1.12 (1.01–1.23) | 0.23 | 1.05 (0.92–1.19) | 0.48 | |
| Insect bite reaction | Gender (male) | 1.11 (0.75–1.64) | 0.59 | — | |
| Age | 1.01 (0.91–1.12) | 0.88 | — | ||
| PIH | 5.23 (3.22–8.50) | 0.001∗ | 5.66 (3.15–10.17) | 0.001∗ | |
| Acanthosis nigricans | BMI | 1.58 (1.45–1.72) | 0.001∗ | 1.93 (1.49–2.49) | <0.001∗ |
| Age | 1.16 (1.03–1.30) | 0.02∗ | 0.86 (0.50–1.48) | 0.57 | |
| Height | 1.06 (1.04–1.08) | 0.001∗ | 1.05 (0.94–1.16) | 0.39 | |
| Systolic blood pressure | 1.06 (1.04–1.09) | 0.001∗ | 0.95 (0.90–1.01) | 0.10 | |
| Puberty | 1.89 (1.20–2.97) | 0.01∗ | 2.30 (0.46–11.50) | 0.31 | |
| Acne | 2.06 (1.18–3.62) | 0.01∗ | 0.26 (0.03–1.66) | 0.15 |
OR, odds ratio.
∗Statistical significance.
In the nevus and mole group, male gender was shown to increase the adjusted odd ratio of 2.29 (95% CI 1.45–3.62, P < 0.001). Whereas, age, height, BMI, parental education, and family income yielded no association.
The insect bite reaction group was observed with an increase in the adjusted odds ratio of PIH for 5.66 (95% CI 3.15–10.17, P < 0.001).
Moreover, acanthosis nigricans was absolutely associated with obesity. Thus, our results were compatible with other studies that BMI could increase the adjusted odds ratio of acanthosis nigricans for 1.93 (95% CI 1.49–2.49, P < 0.001). However, sex, age, height, blood pressure, and puberty demonstrated no correlation.
Discussion
In this study, the most common skin diseases in our community-based survey were PIH, followed by nevus/mole, insect bite reaction, acanthosis nigricans, acne, and pityriasis alba. Also, our study revealed no association of PIH regarding gender, parental education, and family income.
From subgroup analysis, the top 5 disease ranking in the prepubertal students (age <8 years) revealed PIH (62.4%), nevus/mole (30.1%), insect bite reaction (26.0%), acanthosis nigricans (14.5%), and pityriasis alba (12.7%). These data were compatible with the postpubertal students (age ≥8 years), which represented PIH (56.2%), nevus/mole (45.6%), insect bite reaction (29.6%), acanthosis nigricans (23.3%), and pityriasis alba (13.0%).
In addition, our results yielded noninfectious conditions with similarity to those from community-based surveys in other countries, such as Hong Kong,5 Taiwan,6 Turkey,7 and Egypt8 (Table 3). Even though data from Taiwan6 and Tanzania9 also reported noninfectious conditions, most of their age groups were different from our study with unsimilar outcomes. According to their reports, acne became the most common findings, followed by the infection group. Yamamah et al. showed different results from survey in community-based populations (campaign field visit) in South Sinai, Egypt in the peer-group.10 In contrast to the study in Ghana, Gabon, and Rwanda11 found that infection was the leading cause of skin disease. Hence, there were multiple factors that confounded different results of the studies, such as geographic location and latitude, seasonal change (winter, summer, and rainy), basis of study (hospital-based, school-based, community-based), population, Fitzpatrick’s skin type, resident (rural, urban), environment, and socioeconomics.
| References . | Our study . | Fung and Lo5 1996–1997 . | Hogewoning et al.11 2004–2007 . | Chen et al.6 2007 . | Yamamah et al.10 2008–2009 . | Komba and Mgonda9 2010 . | El-Khateeb et al.8 2011–2012 . | Uludağ et al.7 2016 . | ||
|---|---|---|---|---|---|---|---|---|---|---|
| 2007 . | 2005 . | 2007 . | ||||||||
| City/country | Thailand | Hong Kong | Ghana | Gabon | Rwanda | Magong, Penghu/Taiwan | South Sinai/Egypt | Dar es Salaam/Tanzania | Damietta/Egypt | Turkey |
| Number | n = 556 | n = 559 | n = 1,394 | n = 454 | n= 2,528 | n = 3,237 | n = 2,194 | n = 420 | n = 6,162 | n = 1,386 |
| Mean age (year) (range) | 9.3 (5–14) | — (6–12.5) | — (4–20) | — (4–20) | — (4–16) | — (6–11) | — (≤18) | 11.4 (6–19) | — (6–12) | 7.31 ± 1.24 (5–14) |
| Rank 1st | PIH 58.3% | Atopic eczema/eczema 7.6% | Tinea capitis 8.7% | Tinea capitis 23.1% | Tinea capitis 20.6% | Acne 17.3% | Pediculosis 37.6% | Acne 36.4% | Benign neoplasm 87% | Acquired melanocytic nevus 70.2% |
| 2nd | Nevus/mole 40.1% | Nevus 4.8% | Scar 7% | Papular urticaria 7.5% | Prurigo simplex 2.1% | Ephelides 15.24% | Pityriasis alba 18.3% | Dermatophytosis 11.4% | Pigmentary disorder 68.3% | Postinflammatory hypopigmentation 15.4% |
| 3rd | Insect bite reaction 28.0% | Cafe au lait 4.5% | Pyoderma 5.8% | Miliaria/heat rash 4.2% | Acne 1.3% | Atopic dermatitis 4.32% | Xerosis 11.8% | Non specific dermatoses 10.7% | Infection 5.6% | Xerosis 6.6% |
| 4th | Acanthosis nigricans 20.0% | Acne 1.6% | Miliaria/heat rash 5.2% | Eczema 4% | Pyoderma 1.3% | Verruca vulgaris 2.78% | Seborrhoeic dermatitis 6.7% | Pityriasis vesicolor 8.6% | Adnexal disorders 4.8% | Pityriasis alba 5.5% |
| 5th | Acne 13.7% | Mongolian spot 1.1% | Acne 4.7% | Prurigo simplex 3.7% | Eczema 0.8% | Keloid 0.33% | Wart 4.1% | Non specific ulcer 5% | Hypersensitivity diseases 14% | Livedo reticularis 5% |
| 6th | Pityriasis alba 12.9% | Fungal infection 0.9% | Nevus and Prurigo simplex 3.7% | Other tinea 2.6% | Verrucae 0.4% | Tinea nigra, tinea versicolor, vitiligo 0.09% | Photosensitivity 4% | Pyoderma 4% | Genodermatoses 0.3% | Keratosis pilaris 4.8% |
| Remarks | School and community based | School-based study | School-based study | School-based study | Community-based study (campaign field visit) | School-based study | School-based study | School-based study | ||
| References . | Our study . | Fung and Lo5 1996–1997 . | Hogewoning et al.11 2004–2007 . | Chen et al.6 2007 . | Yamamah et al.10 2008–2009 . | Komba and Mgonda9 2010 . | El-Khateeb et al.8 2011–2012 . | Uludağ et al.7 2016 . | ||
|---|---|---|---|---|---|---|---|---|---|---|
| 2007 . | 2005 . | 2007 . | ||||||||
| City/country | Thailand | Hong Kong | Ghana | Gabon | Rwanda | Magong, Penghu/Taiwan | South Sinai/Egypt | Dar es Salaam/Tanzania | Damietta/Egypt | Turkey |
| Number | n = 556 | n = 559 | n = 1,394 | n = 454 | n= 2,528 | n = 3,237 | n = 2,194 | n = 420 | n = 6,162 | n = 1,386 |
| Mean age (year) (range) | 9.3 (5–14) | — (6–12.5) | — (4–20) | — (4–20) | — (4–16) | — (6–11) | — (≤18) | 11.4 (6–19) | — (6–12) | 7.31 ± 1.24 (5–14) |
| Rank 1st | PIH 58.3% | Atopic eczema/eczema 7.6% | Tinea capitis 8.7% | Tinea capitis 23.1% | Tinea capitis 20.6% | Acne 17.3% | Pediculosis 37.6% | Acne 36.4% | Benign neoplasm 87% | Acquired melanocytic nevus 70.2% |
| 2nd | Nevus/mole 40.1% | Nevus 4.8% | Scar 7% | Papular urticaria 7.5% | Prurigo simplex 2.1% | Ephelides 15.24% | Pityriasis alba 18.3% | Dermatophytosis 11.4% | Pigmentary disorder 68.3% | Postinflammatory hypopigmentation 15.4% |
| 3rd | Insect bite reaction 28.0% | Cafe au lait 4.5% | Pyoderma 5.8% | Miliaria/heat rash 4.2% | Acne 1.3% | Atopic dermatitis 4.32% | Xerosis 11.8% | Non specific dermatoses 10.7% | Infection 5.6% | Xerosis 6.6% |
| 4th | Acanthosis nigricans 20.0% | Acne 1.6% | Miliaria/heat rash 5.2% | Eczema 4% | Pyoderma 1.3% | Verruca vulgaris 2.78% | Seborrhoeic dermatitis 6.7% | Pityriasis vesicolor 8.6% | Adnexal disorders 4.8% | Pityriasis alba 5.5% |
| 5th | Acne 13.7% | Mongolian spot 1.1% | Acne 4.7% | Prurigo simplex 3.7% | Eczema 0.8% | Keloid 0.33% | Wart 4.1% | Non specific ulcer 5% | Hypersensitivity diseases 14% | Livedo reticularis 5% |
| 6th | Pityriasis alba 12.9% | Fungal infection 0.9% | Nevus and Prurigo simplex 3.7% | Other tinea 2.6% | Verrucae 0.4% | Tinea nigra, tinea versicolor, vitiligo 0.09% | Photosensitivity 4% | Pyoderma 4% | Genodermatoses 0.3% | Keratosis pilaris 4.8% |
| Remarks | School and community based | School-based study | School-based study | School-based study | Community-based study (campaign field visit) | School-based study | School-based study | School-based study | ||
| References . | Our study . | Fung and Lo5 1996–1997 . | Hogewoning et al.11 2004–2007 . | Chen et al.6 2007 . | Yamamah et al.10 2008–2009 . | Komba and Mgonda9 2010 . | El-Khateeb et al.8 2011–2012 . | Uludağ et al.7 2016 . | ||
|---|---|---|---|---|---|---|---|---|---|---|
| 2007 . | 2005 . | 2007 . | ||||||||
| City/country | Thailand | Hong Kong | Ghana | Gabon | Rwanda | Magong, Penghu/Taiwan | South Sinai/Egypt | Dar es Salaam/Tanzania | Damietta/Egypt | Turkey |
| Number | n = 556 | n = 559 | n = 1,394 | n = 454 | n= 2,528 | n = 3,237 | n = 2,194 | n = 420 | n = 6,162 | n = 1,386 |
| Mean age (year) (range) | 9.3 (5–14) | — (6–12.5) | — (4–20) | — (4–20) | — (4–16) | — (6–11) | — (≤18) | 11.4 (6–19) | — (6–12) | 7.31 ± 1.24 (5–14) |
| Rank 1st | PIH 58.3% | Atopic eczema/eczema 7.6% | Tinea capitis 8.7% | Tinea capitis 23.1% | Tinea capitis 20.6% | Acne 17.3% | Pediculosis 37.6% | Acne 36.4% | Benign neoplasm 87% | Acquired melanocytic nevus 70.2% |
| 2nd | Nevus/mole 40.1% | Nevus 4.8% | Scar 7% | Papular urticaria 7.5% | Prurigo simplex 2.1% | Ephelides 15.24% | Pityriasis alba 18.3% | Dermatophytosis 11.4% | Pigmentary disorder 68.3% | Postinflammatory hypopigmentation 15.4% |
| 3rd | Insect bite reaction 28.0% | Cafe au lait 4.5% | Pyoderma 5.8% | Miliaria/heat rash 4.2% | Acne 1.3% | Atopic dermatitis 4.32% | Xerosis 11.8% | Non specific dermatoses 10.7% | Infection 5.6% | Xerosis 6.6% |
| 4th | Acanthosis nigricans 20.0% | Acne 1.6% | Miliaria/heat rash 5.2% | Eczema 4% | Pyoderma 1.3% | Verruca vulgaris 2.78% | Seborrhoeic dermatitis 6.7% | Pityriasis vesicolor 8.6% | Adnexal disorders 4.8% | Pityriasis alba 5.5% |
| 5th | Acne 13.7% | Mongolian spot 1.1% | Acne 4.7% | Prurigo simplex 3.7% | Eczema 0.8% | Keloid 0.33% | Wart 4.1% | Non specific ulcer 5% | Hypersensitivity diseases 14% | Livedo reticularis 5% |
| 6th | Pityriasis alba 12.9% | Fungal infection 0.9% | Nevus and Prurigo simplex 3.7% | Other tinea 2.6% | Verrucae 0.4% | Tinea nigra, tinea versicolor, vitiligo 0.09% | Photosensitivity 4% | Pyoderma 4% | Genodermatoses 0.3% | Keratosis pilaris 4.8% |
| Remarks | School and community based | School-based study | School-based study | School-based study | Community-based study (campaign field visit) | School-based study | School-based study | School-based study | ||
| References . | Our study . | Fung and Lo5 1996–1997 . | Hogewoning et al.11 2004–2007 . | Chen et al.6 2007 . | Yamamah et al.10 2008–2009 . | Komba and Mgonda9 2010 . | El-Khateeb et al.8 2011–2012 . | Uludağ et al.7 2016 . | ||
|---|---|---|---|---|---|---|---|---|---|---|
| 2007 . | 2005 . | 2007 . | ||||||||
| City/country | Thailand | Hong Kong | Ghana | Gabon | Rwanda | Magong, Penghu/Taiwan | South Sinai/Egypt | Dar es Salaam/Tanzania | Damietta/Egypt | Turkey |
| Number | n = 556 | n = 559 | n = 1,394 | n = 454 | n= 2,528 | n = 3,237 | n = 2,194 | n = 420 | n = 6,162 | n = 1,386 |
| Mean age (year) (range) | 9.3 (5–14) | — (6–12.5) | — (4–20) | — (4–20) | — (4–16) | — (6–11) | — (≤18) | 11.4 (6–19) | — (6–12) | 7.31 ± 1.24 (5–14) |
| Rank 1st | PIH 58.3% | Atopic eczema/eczema 7.6% | Tinea capitis 8.7% | Tinea capitis 23.1% | Tinea capitis 20.6% | Acne 17.3% | Pediculosis 37.6% | Acne 36.4% | Benign neoplasm 87% | Acquired melanocytic nevus 70.2% |
| 2nd | Nevus/mole 40.1% | Nevus 4.8% | Scar 7% | Papular urticaria 7.5% | Prurigo simplex 2.1% | Ephelides 15.24% | Pityriasis alba 18.3% | Dermatophytosis 11.4% | Pigmentary disorder 68.3% | Postinflammatory hypopigmentation 15.4% |
| 3rd | Insect bite reaction 28.0% | Cafe au lait 4.5% | Pyoderma 5.8% | Miliaria/heat rash 4.2% | Acne 1.3% | Atopic dermatitis 4.32% | Xerosis 11.8% | Non specific dermatoses 10.7% | Infection 5.6% | Xerosis 6.6% |
| 4th | Acanthosis nigricans 20.0% | Acne 1.6% | Miliaria/heat rash 5.2% | Eczema 4% | Pyoderma 1.3% | Verruca vulgaris 2.78% | Seborrhoeic dermatitis 6.7% | Pityriasis vesicolor 8.6% | Adnexal disorders 4.8% | Pityriasis alba 5.5% |
| 5th | Acne 13.7% | Mongolian spot 1.1% | Acne 4.7% | Prurigo simplex 3.7% | Eczema 0.8% | Keloid 0.33% | Wart 4.1% | Non specific ulcer 5% | Hypersensitivity diseases 14% | Livedo reticularis 5% |
| 6th | Pityriasis alba 12.9% | Fungal infection 0.9% | Nevus and Prurigo simplex 3.7% | Other tinea 2.6% | Verrucae 0.4% | Tinea nigra, tinea versicolor, vitiligo 0.09% | Photosensitivity 4% | Pyoderma 4% | Genodermatoses 0.3% | Keratosis pilaris 4.8% |
| Remarks | School and community based | School-based study | School-based study | School-based study | Community-based study (campaign field visit) | School-based study | School-based study | School-based study | ||
To compare with other hospital-based studies in Thailand3,12 and other countries13–15 where most of them collected data from medical record reviews and diagnosis was done following the International Classification of Diseases 10th (ICD-10) system, we found different nonrealistic results from our hypothesis due to the selective bias of patients who visited their physicians at the hospital, as shown in Table 4.
| References . | Jongyorklang3 1994–2003 . | Wisuthsarewong and Viravan12 2000 . | Marrone et al.13 2005–2009 . | Furue et al.14 2007–2008 . | Katsarou et al.15 2005–2007 . |
|---|---|---|---|---|---|
| City/country | Thailand | Thailand | Ethiopia | Japan | Greek |
| Number | n = 55,587 | n = 2,361 | n = 17,967 | n = 2,099 | n = 4,071 |
| Mean age (year) (range) | — (<15) | 4 years ± 11 months (<13) | — (0–18) | — (6–10) | — (0–12) |
| Rank 1st | Eczematous dermatitis 38.8% | Eczematous dermatitis 41.2% | Dermatitis 24.7% | Atopic dermatitis 24.06% | Dermatitis/eczema 34.7% |
| 2nd | Skin infection 18.1% | Skin infection 21.9% | Fungal infection 20.7% | Viral wart 23.01% | Viral infections 19.3% |
| 3rd | Arthropod bites 10.1% | Pigmentary disorder 7.0% | Bacterial infection 12.1% | Miscellaneous eczema 16.9% | Nevus 5.6% |
| 4th | Hypersensitivity skin disease 8.4% | Hypersensitivity skin diseasesa 4.1% | Parasitic infestation 10.7% | Molluscum contagiosum 6.86% | Scabies 4.8% |
| 5th | Disorder of sweat gland 3.5% | Hair disorders 3.97% | Disorder skin colour 5.8% | Impetigo 5.24% | Insect bite 4.3% |
| 6th | — | Papulosquamous and exfoliative dermatitis 3.68% | Disorder of appendage 5.7% | — | Bacterial infections 3.7% |
| Remarks | Paediatric dermatology clinic, tertiary care hospital | Paediatric dermatology clinic, tertiary care hospital | Outpatient clinic and immigrant children |
| References . | Jongyorklang3 1994–2003 . | Wisuthsarewong and Viravan12 2000 . | Marrone et al.13 2005–2009 . | Furue et al.14 2007–2008 . | Katsarou et al.15 2005–2007 . |
|---|---|---|---|---|---|
| City/country | Thailand | Thailand | Ethiopia | Japan | Greek |
| Number | n = 55,587 | n = 2,361 | n = 17,967 | n = 2,099 | n = 4,071 |
| Mean age (year) (range) | — (<15) | 4 years ± 11 months (<13) | — (0–18) | — (6–10) | — (0–12) |
| Rank 1st | Eczematous dermatitis 38.8% | Eczematous dermatitis 41.2% | Dermatitis 24.7% | Atopic dermatitis 24.06% | Dermatitis/eczema 34.7% |
| 2nd | Skin infection 18.1% | Skin infection 21.9% | Fungal infection 20.7% | Viral wart 23.01% | Viral infections 19.3% |
| 3rd | Arthropod bites 10.1% | Pigmentary disorder 7.0% | Bacterial infection 12.1% | Miscellaneous eczema 16.9% | Nevus 5.6% |
| 4th | Hypersensitivity skin disease 8.4% | Hypersensitivity skin diseasesa 4.1% | Parasitic infestation 10.7% | Molluscum contagiosum 6.86% | Scabies 4.8% |
| 5th | Disorder of sweat gland 3.5% | Hair disorders 3.97% | Disorder skin colour 5.8% | Impetigo 5.24% | Insect bite 4.3% |
| 6th | — | Papulosquamous and exfoliative dermatitis 3.68% | Disorder of appendage 5.7% | — | Bacterial infections 3.7% |
| Remarks | Paediatric dermatology clinic, tertiary care hospital | Paediatric dermatology clinic, tertiary care hospital | Outpatient clinic and immigrant children |
Hypersensitivity skin diseases = urticaria, angioedema, drug and food eruption, erythema nodosum, and erythema multiforme.
| References . | Jongyorklang3 1994–2003 . | Wisuthsarewong and Viravan12 2000 . | Marrone et al.13 2005–2009 . | Furue et al.14 2007–2008 . | Katsarou et al.15 2005–2007 . |
|---|---|---|---|---|---|
| City/country | Thailand | Thailand | Ethiopia | Japan | Greek |
| Number | n = 55,587 | n = 2,361 | n = 17,967 | n = 2,099 | n = 4,071 |
| Mean age (year) (range) | — (<15) | 4 years ± 11 months (<13) | — (0–18) | — (6–10) | — (0–12) |
| Rank 1st | Eczematous dermatitis 38.8% | Eczematous dermatitis 41.2% | Dermatitis 24.7% | Atopic dermatitis 24.06% | Dermatitis/eczema 34.7% |
| 2nd | Skin infection 18.1% | Skin infection 21.9% | Fungal infection 20.7% | Viral wart 23.01% | Viral infections 19.3% |
| 3rd | Arthropod bites 10.1% | Pigmentary disorder 7.0% | Bacterial infection 12.1% | Miscellaneous eczema 16.9% | Nevus 5.6% |
| 4th | Hypersensitivity skin disease 8.4% | Hypersensitivity skin diseasesa 4.1% | Parasitic infestation 10.7% | Molluscum contagiosum 6.86% | Scabies 4.8% |
| 5th | Disorder of sweat gland 3.5% | Hair disorders 3.97% | Disorder skin colour 5.8% | Impetigo 5.24% | Insect bite 4.3% |
| 6th | — | Papulosquamous and exfoliative dermatitis 3.68% | Disorder of appendage 5.7% | — | Bacterial infections 3.7% |
| Remarks | Paediatric dermatology clinic, tertiary care hospital | Paediatric dermatology clinic, tertiary care hospital | Outpatient clinic and immigrant children |
| References . | Jongyorklang3 1994–2003 . | Wisuthsarewong and Viravan12 2000 . | Marrone et al.13 2005–2009 . | Furue et al.14 2007–2008 . | Katsarou et al.15 2005–2007 . |
|---|---|---|---|---|---|
| City/country | Thailand | Thailand | Ethiopia | Japan | Greek |
| Number | n = 55,587 | n = 2,361 | n = 17,967 | n = 2,099 | n = 4,071 |
| Mean age (year) (range) | — (<15) | 4 years ± 11 months (<13) | — (0–18) | — (6–10) | — (0–12) |
| Rank 1st | Eczematous dermatitis 38.8% | Eczematous dermatitis 41.2% | Dermatitis 24.7% | Atopic dermatitis 24.06% | Dermatitis/eczema 34.7% |
| 2nd | Skin infection 18.1% | Skin infection 21.9% | Fungal infection 20.7% | Viral wart 23.01% | Viral infections 19.3% |
| 3rd | Arthropod bites 10.1% | Pigmentary disorder 7.0% | Bacterial infection 12.1% | Miscellaneous eczema 16.9% | Nevus 5.6% |
| 4th | Hypersensitivity skin disease 8.4% | Hypersensitivity skin diseasesa 4.1% | Parasitic infestation 10.7% | Molluscum contagiosum 6.86% | Scabies 4.8% |
| 5th | Disorder of sweat gland 3.5% | Hair disorders 3.97% | Disorder skin colour 5.8% | Impetigo 5.24% | Insect bite 4.3% |
| 6th | — | Papulosquamous and exfoliative dermatitis 3.68% | Disorder of appendage 5.7% | — | Bacterial infections 3.7% |
| Remarks | Paediatric dermatology clinic, tertiary care hospital | Paediatric dermatology clinic, tertiary care hospital | Outpatient clinic and immigrant children |
Hypersensitivity skin diseases = urticaria, angioedema, drug and food eruption, erythema nodosum, and erythema multiforme.
Interestingly, there was an increased BMI in relation to PIH. Pathogenesis of PIH was hypothesized to cause increments of melanocytic activity responding to the inflammatory process16,17 and proinflammatory cytokine (such as prostaglandin and leukotrienes).18 Despite no exact evidence to explain why BMI could increase the odds ratio for PIH, there were many studies about adipokine and inflammation, such as psoriasis and obesity.19 Psoriasis is chronic inflammatory skin disease related to an increase of adipose tissue, adipokine, and proinflammatory cytokine, potentially aggravating skin inflammation in obesity.20
Our study showed that insect bite reaction was truly associated with postinflammation hyperpigmentation (PIH). Mosquito bite reaction is one of the common diseases in tropical countries and Southeast Asia region. It always causes itchy and scratching leads to an opened wound and PIH, respectively. Our study identified the students who had both insect bite reaction and PIH (23.3%). This pathogenesis supported the association of insect bite reaction and PIH which increased the adjusted odds ratio up to 5.6 times. Insect bite reaction, particularly mosquito bite, is extremely a common problem in tropical countries of Southeast Asia region. Nevertheless, protection from mosquito bite is extremely important to prevent a healthcare problem.
In this study, an increased BMI was also related to acanthosis nigricans, with similarity to previous studies21,22 despite the nonfully elucidated pathogenesis of this condition and obesity. Zhu et al. confirmed the change of inflammatory markers in obese men with acanthosis nigricans. BMI, fasting insulin, homeostatic model assessment of insulin resistance, tumour necrosis factor-α, and total testosterone, particularly interleukin-6, interleukin-8, and C-reactive protein, were significantly changed in obesity men with acanthosis nigricans.23
To provide an anticipatory guidance, clinicians should focus on the prevention of PIH i.e. physical protection (net, long sleeves), insect or mosquito repellents application, and advice for weight reduction towards a good child health.
There were several limitations in this study. First, the measurement in this cross-sectional study was performed only 1 time period. Thus, we could not determine the causes and effects properly. Second, our study was conducted in 2 community-based primary schools of the middle-income family. The population may have some bias with less generalizable. Socioeconomic status of the families in our study also affected survey outcomes. Nevertheless, this study was the first and only 1 pilot study in Bangkok, Thailand, or a tropical country. Lastly, the recruitment of a larger number of schools and samples should be recommended for future study.
Conclusion
The prevalence of skin diseases and conditions in our community-based survey is different from hospital-based studies. The most common skin disease in primary school-age children is PIH that related to insect bite reaction and acanthosis nigricans. There is a correlation of BMI with PIH and acanthosis nigricans. Effective intervention and education about insect bite prevention and body weight control with balance BMI among community-based school-age children should be recommended for potential benefits to both children and their parents.
Funding
This work was supported by a grant from the Thailand Research Fund (IRG 5780015).
Acknowledgements
The authors would like to extend thanks to Ms. Sranya Phaisawang and Ms. Sunattee Kessung for their assistance in editing and revising this manuscript.
Ethical approval
This research protocol (IRB No. 512/59) was approved by the Institutional Review Board, Research Ethics Committee of Faculty of Medicine, Chulalongkorn University.
Conflict of interest
None declared.
Data availability
The analysed datasets in this current study are available from the corresponding author on reasonable request.
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