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Print version ISSN 0365-0596
On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.79 no.3 Rio de Janeiro May/June 2004
CLINICAL, LABORATORY AND THERAPEUTIC INVESTIGATION
Pediatric dermatoses at the Clinicas Hospital, Federal University of Pernambuco*
Josemir Belo dos SantosI; Leilane Oliveira CordeiroII; Lillian Oliveira CordeiroII; Patrícia de Barros GuimarãesIII; Paula Maria Rodrigues de B. CorrêaIII; Silvia da Costa CarvalhoIV
IProfessor, Dept. of Dermatology,
Hospital das Clínicas - UFPE
IISixth year medical student - UFPE
IIIDermatology Resident, Hospital das Clínicas, UFPE
IVDermatologist and Preceptor, Dermatology Center of Recife-CEDER
BACKGROUND: Numerous skin conditions can
affect the pediatric population. There are few studies on Pediatric Dermatology
OBJECTIVES: To study the pediatric skin diseases at the Hospital das Clínicas in Recife, Pernambuco State - Brazil.
MATERIAL E METHODS: From May 1999 to May 2000, 307 cases of children treated at the Dermatology Clinic of the Federal University of Pernambuco were studied. Details of the patients' features, origin, reason for consultation, clinical laboratory diagnosis and previous treatment were examined.
RESULTS: Allergic dermatosis was the most frequent disease (17.64%), followed by disorders of pigmentation (15.54%) and viral diseases (13.44%).
CONCLUSION: This agrees with the literature. Infections represent a large percentage of cases studied and are probably due to the low socioeconomic level of the patients examined. Characterization of the epidemiology of cutaneous problems in children should be a priority in future studies.
Key words: child; skin diseases; prevalence
Although it is believed that the prevalence of dermatoses among children of developing countries is very high, there have been few epidemic reports on this matter, which makes difficult the planning of health programs.
The objective of this work was to establish the most common dermatoses in childhood and their distribution in the various age groups, in order to contribute to pertinent epidemic studies.
MATERIAL E METHODS
This work was done at a specialized public reference service that attends patients with a low socioeconomic level.
From May 1999 to May 2000, 307 medical records were analyzed of children seen at the Dermatology Clinic, Federal University of Pernambuco. Data were collected regarding individual characteristics, origin, motive for the consultation, clinical and laboratorial diagnosis, and prior treatment.
The children were classified according to age group into: newly born, up to 28 days of life; infants, between 29 days and two incomplete years; preschool, between two complete years and five incomplete years; and school age, five years up to 12 years of age. Regarding skin color, they were classified as white, mixed or black.
The diseases found in the review of the medical records were classified as follows: Sexually transmissible diseases (condyloma acuminatum); folliculosis (acne); bacterial infections (folliculitis, scarlatina and impetigo); viral infections (molluscum contagiosum, common and filiform warts, herpes simplex and zoster); fungal infections (pityriasis versicolor, tinea capitis, tinea corporis, tinea cruris, white piedra and celsus kerion); dermatozoonosis (scabies and larva migrans); cysts and organoid nevus and benign melanocytes (mucous cyst, milia, cheloid, syringoma, juvenile xanthogranuloma, Nevil, melanocytic nevus, verrucous nevus and sebaceous nevus); mesenchymal tumors (hemangiomas and pyogenic granuloma); genodermatosis (ichthyosis, epidermolysis bullosa and Darier's disease); eczematous eruptions (contact dermatitis, atopic dermatitis and dyshidrosis); erythematous desquamative eruptions (psoriasis, seborrheic dermatitis and Gibert's pityriasis rosea); urticarial eruptions (urticaria); dyschromia (vitiligo, achromic nevus, residual hyper/hypochromia); trichosis (telogen effluvium and alopecia areata); and others (amiantaceous pseudotinea, xerosis, keratosis pilaris and strophulus).
Thus a retrospective study was performed. Statistical analysis of the diagnosis of the diseases with the previous time was done using Pearson's Chi-square Test, at the 5% level of significance. The SPSS (Statistical Package for Social Sciences) version 9 was used for data analysis and the graphs were elaborated with Excel version 2000.
Out of 307 records, it was observed that 62% of the children were female (n = 191) and 38% were male (n = 116) (Graph 1). Most of the patients were from the Metropolitan Area of Recife, and 50% of them were from the city of Recife itself (Graph 1). School age children accounted for 50.82% of the total, followed by preschoolers 37.3%, infants 11.8%, and newly born 0.3%, showing that the need for specialized medical attendance increased with age.
Of the patients that practiced self-medication, 7.7% used home-remedies, specially aroeira (Astronium lecointei) tea, ice and crude soap.
The patients were classified into three groups of skin color: white, mixed and black with frequencies of: [n = 15] 4.2%, [n = 328] 91.6% and [n = 5] 4.2%, respectively. (Graph 2)
Of the 307 studied children, 238 (77.53%) presented a single dermatosis, 65 (21.17%) presented two or three dermatoses, and only four (1.30%) presented a normal dermatological exam. Since the group in which there was one diagnosis had a similar distribution of dermatoses to the group with more than just one disease, the following analysis was performed considering the group with only one diagnosis.
Additionally, the group of allergic dermatoses includes eczematous and urticate eruptions.
As shown in graph 3, the allergic dermatoses were the most prevalent, accounting for 17.64% (n = 42) of the total, followed by: dyschromia, 15.54% (n = 37); viral infections, 13.44% (n = 32); cysts and organoid and melanocytic nevi, 8.82% (n = 21); fungal infections, 7.98% (n = 19); dermatozoonoses, 6.72% (n = 16); bacterial infections, 5.04% (n = 12), erythematous-desquamative eruptions and mesenchymal tumors, 3.78% (n = 9) each; genodermatoses, 3.36% (n = 8), folliculoses, 2.1% (n = 5); sexually transmissible diseases, 0.84% (n = 2); and other dermatoses 9.66% (n = 23).
Regarding gender, it was observed that allergic dermatoses were the most common in both sexes, with a prevalence of 17.24% (n = 25) in girls and 17.52% (n = 17) in boys. In females, the dyschromias presented the same frequency as the allergic dermatoses, followed by viral infections and cysts, and organoid and melanocytic nevi, that presented a frequency of 11.72% (n = 17). In males, the viral infections were followed in order of frequency by dyschromia with 15.46% (n = 15) and 12.37% (n = 12), respectively. If we consider the infections as a single group, they become the most numerous in both sexes, with 28.27% (n = 41) in females and 39.17% (n = 38) in males. As for STD (n = 2), all of the cases occurred in females.
In relation to age group, among the infants the allergic dermatoses, with 21.42% (n = 6), represented the most prevalent group, followed by bacterial infections and dermatozoonoses, with 14.28% (n = 4) each. Among the preschool infants, the allergic dermatoses were again the most common, with 24% (n = 20), followed by dyschromias and fungal infections, with 15.66% (n = 13) and 12% (n = 10), respectively. In the school age group a change occurred in the prevalence profile, with the dyschromias forming the most numerous group (28.11%) (n = 23), followed by viral infections and allergic dermatoses, with 17.32% (n = 22) and 11.81% (n = 14), respectively.
In studies with 110 hospitalized children, Hubert et al.3 concluded by affirming that it is very important to be familiar with the dermatological diseases, since the cutaneous findings, besides very common in that group, could alter the diagnosis and/or treatment in 8% of the cases. However, it is worth underscoring that the present research was performed with ambulatory and non hospitalized patients.
Regarding self-medication, this consisted especially of aroeira tea, a very common plant in this region; ice; and crude soap; these substances were very probably used due to their easy availability, low cost and because they are considered innocuous.
From the data gathered, it was observed that mixed race comprise the majority of this population and were also the most numerous among the children seen. Another finding was that females constituted the majority of those attended at the clinic, accounting for 61% of the total.
Regarding the diseases diagnosed, allergic dermatoses formed the majority with 17.64% of the total. However, if one considers infections as a single group, they would incorporate 33.19% of the patients and consequently become the most prevalent. Likewise, Wisuthsarewong & Viravan4 in their work on 2,361 Thai children found a greater prevalence of eczematous dermatoses (41.2%) followed by cutaneous infections (21.9%).
Iranir et al. 5 in work done in Turkey determined the prevalence of dermatological diseases and their association with socioeconomic factors in elementary schools, among a total of 785 children. The authors concluded that the infectious dermatoses, atopic dermatitis, eczema and xerosis have a high prevalence among the poorest population.
In terms of the allergic dermatoses, it was observed that the prevalence varied between 21.42%, 24% and 11.81% in the infant, preschool and school age groups, respectively. Although eczema and infections are the most common dermatoses in childhood, there was less atopic and seborrheic eczema as age increased.1,6
Fungal infections represented only 7.98% of the total dermatoses. Stratified according to age group, the preschool group had a greater prevalence of dermatophytoses (12%). The results are not in agreement with the world literature, in which most authors report that fungal infections are common in childhood. This could be due to the fact that pediatricians are able to treat the dermatophytoses in general, thereby decreasing the demand on specialized services. Onychomycoses were not registered, and these data are in agreement with the literature, since the prevalence of this disease in children is substantially lower than in adults.2
Tomljanovic et al.7 have reported that in their work on 308 children with dermatophytoses, 81.49% presented infection by Microsporum spp and 18.51% by Trichophyton spp. Likewise, Pfützner8 has reported that these are the two agents that most commonly infect children.
Fung e Lo9 have registered that the most frequent dermatoses are acne vulgaris, eczema, café au lait spots, melanocytic congenital nevus, keratosis pilaris and pityriasis alba. These results differ from the ones in our work probably due to the fact that these authors from Hong Kong considered a total of 1,006 children and adolescents, whereas the present study only included children.
In a seroepidemiological study by Semenovitch & Lupi,10, on 160 children from the State of Rio de Janeiro, the authors found a prevalence of 58.1% for the chickenpox-zoster virus. The results were statistically significant and were correlated with an increase in age (p <0.0001). In the present research, viral infections were the most prevalent in both sexes, with 13.44% of the overall total. However, serological studies were not realized.
Bacterial infections were less frequent, with 5.04%. This could be due to fewer referrals of these patients to dermatologists by pediatricians, perhaps since they have greater knowledge about the therapeutic management in relation to viral dermatoses. Pfützner8 affirms that among the bacterial infections, impetigo is one of the most frequent, which is in agreement with the findings described in the present article.
Of all of the diseases diagnosed, allergic dermatoses were the most frequent, and these data are in agreement with the literature. Regarding infections, they represent a large percentile of the analyzed cases, probably reflecting the low socioeconomic level of the patients in this study.
There is a great lack of epidemiological studies on pediatric dermatoses, which hinders a good performance of health programs. The characterization of the epidemiology of cutaneous conditions in children should be a priority for future studies. The dermatoses in infancy should be monitored so that educational programs for cutaneous health and preventive measures can be planned and implemented effectively.
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Patricia de Barros Guimarães
Rua da Harmonia, 430 / 804 - Casa Amarela
52051-390 Recife PE
Received in May, 13th of 2003.
Approved by the Consultive Council and accepted for publication in March, 12th of 2004.
* Work done at "Hospital das Clínicas da Universidade Federal de Pernambuco/UFPE"