Prevalence Of Dermatological Manifestations Research Articles

Editor’s Pick: Correlation of Cutaneous Manifestations with the Severity of Disease in Patients with Chronic Kidney Disease and Effect of Hemodialysis: An Observational Study

Aim: Chronic kidney disease is a non-communicable disease, and is the sixth fastest growing contributor of morbidity and mortality. Hemodialysis is one of the important therapeutic modalities that can improve survival in these patients, and can increase their life expectancy, but the cutaneous disorder can precede or follow the initiation of hemodialysis. Methods: This is a retrospective, observational study with a sample size of 250 patients, with a glomerular filtration rate <60 mL/min/1.73 m2 for a minimum duration of 3 months or more, undergoing hemodialysis. Patients post-renal transplant, HIV-positive cases, and pregnant patients were excluded from the study. Studied cases were recruited equally into two groups: the dialytic group (Group A) and non-dialytic group (Group B). Results: In the authors’ study, the prevalence of dermatological manifestations was 79% in the dialytic group and 75% in the non-dialytic group. The most common finding overall was xerosis (58%), which was more common in the dialytic (66%) group, both in number of patients and severity. The second most common finding was pallor (55%), which was seen more in the dialytic group (60%). Other major findings were pruritus (49%) and hyperpigmentation (37%). The intensity of pruritus was higher in non-dialytic patients. Specific cutaneous manifestations, such as Kyrle’s disease, were seen only in eight patients. Skin infections were seen in 17% of patients overall, and there was no major difference seen in both groups. The prevalence of nail findings, mucosal changes, and hair changes was also high in the dialytic group. Other specific cutaneous manifestations, like calciphylaxis, uremic frost, and nephrogenic fibrosing dermopathy, were not seen in the authors’ study. Hemodialysis has increased the life expectancy of patients with end-stage renal disease and has also brought about a rise in the number of manifestations, by giving time for these changes to occur. The severity of symptoms was also higher in patients on dialysis. This could be because of the higher mean duration of disease in the dialytic group compared to the non-dialytic group. Conclusion: Dermatological manifestations of chronic kidney disease were significantly associated with the mean duration of disease, which was higher in patients on dialysis. There was a higher prevalence of non-specific dermatological findings, such as xerosis, hyperpigmentation, nail findings, hair, and mucosal changes in the dialytic group, except pruritus. Any such cutaneous marker in the absence of a primary dermatological problem warrants a thorough search, including blood, urine, and radiological investigations, to rule out kidney disease.

Dermatological manifestations of Coronavirus Disease 2019 (COVID-19)

The prevalence of dermatological manifestations among patients with COVID-19 has a wide variation from 0.2 - 20.4% in different countries. The commonly described manifestations are; maculopapular eruptions, urticarial lesions, pseudo-chilblains, vesicular eruptions and livedo or necrosis. There are several other manifestations described such as; enanthems, purpuric flexural lesions, Dengue-like rash, erythema multiforme-like lesions and vasculitis-like lesions. The study done in the National Hospital of Sri Lanka has revealed a prevalence of 1.7%. The survey among dermatologists island wide shows few cases with different cutaneous manifestations of COVID-19. It is important to be vigilant as the COVID-19 virus as well as the knowledge about it, is still evolving.

Dermatological manifestations in hemodialysis patients in Iran: A systematic review and meta-analysis.

Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity. This meta-analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran. Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran-Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random-effect meta-analysis model. We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random-effect meta-analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half-and-half nail in hemodialysis patients were 48.03% (95% CI: 45.09-51.01), 52.85% (95%CI: 49.23-56.47), 19.88 (95% CI: 17.57-22.19), 51.14% (95% CI: 48.25-54.02), and 18.50% (95% CI: 16.0-21.0), respectively. his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common.

Prevalence of dermatologic manifestations and metabolic biomarkers in women with polycystic ovary syndrome in north China.

Cutaneous features of hyperandrogenism in polycystic ovary syndrome (PCOS) include acne, hirsutism, seborrhea, androgenic alopecia (AGA), and acanthosis nigricans (AN). However, the relationships have not been well known broadly in terms of clinical hyperandrogenism and biochemical markers. The aim of this study was to investigate biochemical and metabolic parameters in relation to cutaneous characters women in with and without PCOS. This was a cross-sectional retrospective study including 186 women with PCOS and 113 age-matched without PCOS women. Acne grade, hirsutism, seborrhea, AGA, and AN were recorded. Hormonal and metabolic parameters were measured. The most common finding was acne, and AN was the least dermatological manifestations between PCOS and non-PCOS groups. The severity location and type of acne did not differ in PCOS women compared to non-PCOS women. Significant differences were found with respect to free androgen index (FAI) (P=.036), sex hormone-binding globulin (SHBG) (P=.023), and body mass index (BMI) (P=.001) between PCOS with acne and PCOS without acne groups. Overall, age (P=.005) was significantly decreased, while BMI (P=.004) was significantly higher in PCOS with hirsutism. The mean serum total testosterone (TT), dehydroepiandrosterone sulfate, and FAI were significantly elevated, but SHBG was decreased between PCOS with and without hirsutism groups. There were significantly different BMI (P=.018) and triglyceride (P=.024) except other hormonal parameter of without AGA group. This study indicated a strong correlation between hirsutism and metabolic abnormalities. Hirsutism is the most common cutaneous finding in PCOS women. Acne and AGA are associated with other manifestations of clinical hyperandrogenism, but not obvious markers of biochemical hyperandrogenemia and metabolic dysfunction.

A study on the dermatological manifestations in type 2 diabetes mellitus patients in a tertiary care hospital in a rural setting

<p class="abstract"><strong>Background:</strong> Diabetes mellitus is very common metabolic disorder seen in our developing world. Skin is affected by both acute metabolic derangements and the chronic degenerative complications of diabetes. It is suggested that these skin changes may eventually be used as a reflection of the patient’s current as well as the past metabolic status<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> 200 diabetic patients were examined and their various cutaneous manifestations were analysed with parameters like age, sex, type of infection, HbA1c etc.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 200 diabetic patients with cutaneous manifestations were enrolled in our study. Majority were in 6th decade (34.5%) and 7th decade (30%) respectively. Males constituted 66% of the cases with a male to female ratio was 1.89:1 Among the cutaneous infections, out of the 132 cases with cutaneous infections, fungal infections (46%) were most frequent, followed by bacterial infections (16.5%) and viral infections (3.5%)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> This study showed demographic, social factors & prevalence of dermatological manifestations in type 2 DM patients. It is suggested that the various skin changes may eventually be used as a reflection of the patient’s current as well as the past metabolic status<span lang="EN-IN">.</span></p>

Prevalence of dermatological manifestations among the tribal school children of South India

Background: Skin diseases are particularly significant in children as they have the capability of contributing risk in developing other life-threatening illnesses. The prevalence of skin diseases among children in India ranges from 8.7% to 35%. Factors like socioeconomic status, environmental conditions, dietary habits, climate, hygiene, cultural factors, genetic factors and education status of parents influence the presence of skin diseases in children. Aim of the study was to assess the prevalence of dermatological lesions and the associated factors among the school going children of tribal area in South India. Methods: A cross sectional study was conducted at a community school in the tribal area of Yercaud in TamilNadu. The total number of children included in the study was 923 of various age groups. This school gives the complete representation of tribal children as this being the only school for a population of 10,000. The diagnosis of the dermatological lesions were made mainly by history and clinical examination and wherever required skin biopsy and skin scraping was done to confirm the diagnosis. Results: 596 (64.6%) children had dermatologic manifestations.386 (41.8%) children had only one skin disease, 160 (17.3%) had two skin diseases and 50 (5.5%) children had 3 or more skin diseases. Skin diseases were more common among the 5-9 age group (66.8%) children and 10-14 age group (69.4%). Factors like infrequent bathing and wearing clothes without regular washing had influenced the dermatological lesions in the children. Conclusions: Health education, regular periodical examination of the children by the teachers is the need of the hour. Early diagnosis and treatment measures for the affected children need to be taken to prevent and control the outbreak of skin diseases.

Cutaneous manifestations among Egyptian children and adolescents with type 1 diabetes

Background: Although almost all patients with T1DM eventually develop one or more skin manifestations, data on cutaneous manifestations of type 1 diabetes mellitus (T1DM) are scarce. They can be the first presenting sign, or even precede the diagnosis or develop from the long-term effects of diabetes. Objective: To detect the prevalence and spectrum of skin manifestations in children and adolescents with T1DM attending the DEMPU clinic, Cairo University and to investigate the effect of the disease duration on these dermatoses. Subjects and methods:Two hundred twenty-five children and adolescents with T1DM were examined for dermatological problems. Of them, 152 patients who had cutaneous manifestations with T1DM were included in this case-control study, 152 age and sex matched non diabetic patients were included as control group. A detailed dermatological examination was carried out by the dermatology team. Results: The overall prevalence of dermatologic manifestations was 67.56% (152 T1DM patients; 74 males and 78 females). The mean age of the patients was 8.38±3.79years and the mean diabetes duration was 2.80±2.86years. Cutaneous adverse effects related to insulin injections were the most common manifestation representing 28.9%, followed by cutaneous infections (bacterial, fungal and viral infections) in 25%, allergic skin diseases in 19.1% and pruritus in 15.1% of patients with T1DM. Conclusion: Broad spectrums of dermatoses are common (67.56%) in Egyptian patients with T1DM. Early referral to the dermatologist helps to detect skin complications of diabetes in these children and is essential for both prevention and management of these conditions.

Prevalence of dermatologic manifestations among people living with HIV/AIDS in Imam Khomeini Hospital in Tehran, Iran

Dermatological conditions are observed in an estimated 90% or more of all HIV infected people worldwide. Microbial infections, inflammatory conditions and neoplasms are the three main causes for the development of dermatological findings in HIV patients. A total of 276 HIV patients were examined by a dermatologist to identify skin, hair and nail pathologies. CD4 count was measured; Liver function test (LFT) and complete blood count (CBC) were also done. Skin biopsies were obtained and sent for pathological study. Analysis showed 90 (32.6%) of patients had at least one identifiable dermatological ailment. The most common dermatologic manifestations were dermatitis (22.3%), seborrheic dermatitis (13.8%), folliculitis (6.7%), dermatophytosis (6.7%), oral candidiasis (6.7%), warts (6.7%) and Herpes Zoster (3.6%). CD4 count was positively and significantly associated with occurrence of a dermatologic manifestation. Moreover, the type of antiretroviral drug was correlated with these manifestations. Due to high prevalence of skin diseases, severity of complications and overall influence on the patient’s quality of life, considerations should be given to timely diagnosis and treatment of dermatologic complications among HIV/AIDS patients. Key words: Dermatologic, HIV/AIDS, prevalence.

HIV-infected patients and dermatological manifestations in a tertiary care hospital in the tribal (Bastar) region of Chhattisgarh, India between January 2006 and June 2008

Objective: The aim of this study is to estimate the status of cutaneous manifestations in HIV-infected patients and its co-relationship with the CD4 cell count at a tertiary care centre at Bastar, Jagdalpur. Material and Methods: In this study, 137 HIV-positive subjects were enrolled. Information on demographics i.e. weight, height, socioeconomic status, age, educational status, sex, laboratory parameters (CD4 counts) and treatment regimens were noted, and patients were examined for skin disorders by a dermatologist. Data were analyzed using Chi-square test for categorical variables. Results: Majority of the patients resided in a rural area (65.69%), and belonged to low socioeconomic and educational status; 30.65% were housewives, 23.35% drivers and 16.78% laborers respectively. The predominant mode of transmission was heterosexual contact (94.16%). The most common HIV-related dermatological manifestations were seborrheic dermatitis (74.16%), xerosis (52.5%), generalized skin hyperpigmentation 56 (46.67%), onychomycosis 53 (44.16%), pruritic papular eruption 27 (22.5%), oral candidiasis 21 (17.5%), photo dermatitis 21 (17.5%) and scabies 4 (3.33%). Significant correlation with low CD4+ cell counts was found for oral candidiasis ( P P 0.03), while other disorders like seborrheic dermatitis ( P 0.22), xerosis ( P 0.25) and onychomycosis ( P 0.08) were not statistically significant. Conclusion: This study showed a high prevalence of dermatological manifestations in HIV-infected subjects, and they occur more frequently with progression of HIV and decline in immune functions. So, early diagnosis and management of skin disorders can improve the quality of life of HIV-infected subjects.