European Journal of Cardiovascular Medicine

Skin diseases, especially those on the face, are often immediately visible to others unlike most of the internal illnesses and may lead to significant psychological consequences and dermatological consultations, thus explaining the growing importance of these disorders¹. Face extends superiorly from hairline, inferiorly to chin and mandible base, and on each side to the auricle². The facial skin differs markedly from the skin of other regions of the body, which makes the significant reasons for facial dermatoses unique nature. Facial skin is characterized by the exaggeration of sebaceous glands at some sites and profusion of pilosebaceous units, along with terminal hairs, and many adnexal structures, each surrounded by plexus of ramifying vascular elements at other sites³.The face has smaller hair follicles, particularly in the central facial area and, the epidermis is very thin with numerous melanocytes. The poor pattern of rete ridges at the dermoepidermal junction often makes the distinction between papillary and reticular dermis difficult to access ³.

The richness of blood supply to the facial skin and nearness of the superficial vascular plexuses to the skin surface, and the ready dilatation of its blood vessels, ensure that all inflammatory dermatoses affecting the face rapidly cause a deep erythema². The close proximity of several different skin types with slightly differing characteristics (example: lips & perioral skin, nose & cheek) also explain why facial rashes look different³.The wellbeing of the patients is adversely affected by the body image and self esteem⁴.

The prevalence of facial dermatoses varies with the level of awareness, socio- economic status, geographic area, climatic condition, and various other factors². It is important to identify all facial dermatoses to elaborate on the treatment of these apparent pathologies⁵. All the previous studies have focused on the specific diseases of facial dermatoses; however, there is a lack of comprehensive research on facial skin disorders. Hence this study has been undertaken to determine various skin disorders, their epidemiological and clinical aspects predominantly affecting the face to do better services towards preventive and curative aspects of the cases as these are very much associated with psychosocial stigma and affecting the social & family life. 

The setting of the study was at department of Dermatology, Government General Hospital, Government Medical College, Ongole, Andhra Pradesh. A one year observational study was conducted during the period from December2022 to November 2023. According to the hospital censes the prevalence of Facial Dermatoses cases ateending DVL OPD in department of Dermatology was found to be 15.09% with a precision level of ‘5’ at 95% Confidence Interval and the sample size was calculated by using the formula N=(Z (1-α/2)) ² x p (100-p) /d² where P=15.09%, Q=100-P that is 84.91% and L=20% allowable error in ‘P’ that is 10 therefore N=200. All the cases of clinically diagnosed and  as per the the standard case definitions attended to DVL OPD during the above period up to reach the required sample size was included in the study after duly following the inclusion and exclusion criteria as indicated below. Inclusion criteria: 1.Patients attending DVL OPD with skin lesions predominantly affecting the face irrespective of age and sex 2.Inpatients referred from other Departments with facial skin disorders. Exclusion criteria: 1. Patients who have already been diagnosed and receiving treatment for the facial skin disorder. 2.Patients with sole involvement of oral mucosal cavity, conjunctiva, and lips. Objectives: 1. To know the socio-demographic profiles of the study subjects 2. To study the pattern and associated factors facial skin disorders. After receiving the Ethical committee clearance from the institution the study was began and the required data was collected by using a pretested proforma pertaining to their socio-demographic profiles, Categorization & Types of facial skin disorders and their common mode of presentation, Duration of complaint and associated risk factors and all the cases (study subjects) of the study were managed and followed until discharge.

 Finally the collected data was analyzed by using appropriate statistical tools like percentages, proportions, measures of central tendency, measures of dispersion, standard error of mean and tests of significance etc. with the help of computer software. The study results were compared and discussed in the light of published material of various similar studies belongsed to different authors and there by conclusions and recommendations was framed.

Table 1: Age and sex wise distribution of study subjects      

                                         Mean = 31.9 Mean + 2SD = 20.62 – 43.18,  P < 0.01

• The majority of patients in the present study were belonged to 20-29 years (23.5%), followed by 40-49 years (19.5%), 30-39 years (17%),10-19 years (17%), 50-59 years (9%), <10 years (8%), and > 60 years (6 %).
• In the above study females were more in number (56%) significantly when compared to males (44%). And the mean age of the study subjects was found to be 31.9 years.               

Table 2 :  Categorization & Type of Facial Dermatoses

It was observed that regarding categorization and types of facial dermatoses majority were Pigmentary disorders (29%) followed by Acne, Rosacea and perioral dermatitis (19.5%), Infections (19.7%), Eczemas (13%) and Miscellaneous (10.5%) and Tumors (9%) etc. And among all the Pigmentary disorders most common presentation was melasma

Table 3 :  Occupation wise distribution of study subjects

Chart 3: Occupation wise distribution

• In the present study, about 24% of patients were agriculture laborers, followed by housewives (21.5%), students (20%), daily-wage workers (19%), professionals like teachers and other employees (9%), and the least incidence was seen among children <5 years(6.5%).

Table 4:  TYPE OF LESIONS

Table 1: Age and sex wise distribution of study subjects      

                                         Mean = 31.9 Mean + 2SD = 20.62 – 43.18,  P < 0.01

• The majority of patients in the present study were belonged to 20-29 years (23.5%), followed by 40-49 years (19.5%), 30-39 years (17%),10-19 years (17%), 50-59 years (9%), <10 years (8%), and > 60 years (6 %).
• In the above study females were more in number (56%) significantly when compared to males (44%). And the mean age of the study subjects was found to be 31.9 years.               

Table 2 :  Categorization & Type of Facial Dermatoses

It was observed that regarding categorization and types of facial dermatoses majority were Pigmentary disorders (29%) followed by Acne, Rosacea and perioral dermatitis (19.5%), Infections (19.7%), Eczemas (13%) and Miscellaneous (10.5%) and Tumors (9%) etc. And among all the Pigmentary disorders most common presentation was melasma

Table 3 :  Occupation wise distribution of study subjects

Chart 3: Occupation wise distribution

• In the present study, about 24% of patients were agriculture laborers, followed by housewives (21.5%), students (20%), daily-wage workers (19%), professionals like teachers and other employees (9%), and the least incidence was seen among children <5 years(6.5%).

Table 4:  TYPE OF LESIONS

In the present study, the most common type of lesion was patches 67 (23.5%), followed by papules 56 (21.05%), and the least presentations were erosions

In the present study, the most common type of lesion was patches 67 (23.5%), followed by papules 56 (21.05%), and the least presentations were erosions

Facial skin disorders, due to their easy visibility, have a high degree of psycho- social impact (stigma). The incidence and importance multiply due to increased patient awareness, greater use of cosmetics, and over the counter drugs etc. In young women, these are the significant causes of dermatology consultations. Most of these disease entities have distinct clinical characteristics and can be diagnosed easily by a detailed clinical history and examination with other aids like Wood's lamp and dermoscopy. On the other hand, some of the facial skin disorders are challenging to diagnose clinically, requiring invasive procedures like a biopsy to confirm the diagnosis.

 In the present study out of 200 study subjects, females were more in number (56%) when compared to males (44%) which was correlated with the findings of the other studies like Jain M et al⁶, Sharada VG et al⁷ and Bhagavat PV et al⁸, Krupashankar et al.⁹, Achar et al.¹⁰, Kumar et al.¹¹, DA Satish et al¹² and Pawar et al.¹³

The mean age of the study subjects in the present study was 31.9 years. The majority of patients in the present study were belonged to 20-29 years (23.5%), followed by 40-49 years (19.5%), 30-39 years (17%),10-19 years (17%), 50-59 years (9%), <10 years (8%), and  > 60 years (6 %). And  the highest number of facial dermatoses cases were seen in the third decade of life, constituting 23.5%, and the lowest incidence was seen in patients above 60 years of age  (6%). The present study was in concordance with Jain M et al’s study ⁶, where peak incidence is seen in the 3rd decade with 30.67%. In another study conducted by Bhagwat PV et al⁸, the majority belonged to the age group of 13-22 years (32%), followed by

23-32 years (24%). The least incidence was in the age group of above 72 years (1%). In another study conducted by Sharada VG et al⁷, the majority of cases were in the age group of 20-29 years 24%) which was also in correlation with our study.

It was observed that out of 200 cases, the majority presented with pigmentary disorders (29%), followed by acne, rosacea, and perioral dermatitis (19.5%) which were in concordance with the study conducted by Jain M et al⁶ where they observed pigmentary disorders (26.67%) was the most common among facial dermatoses, followed by acne, rosacea, and perioral dermatitis (16.67%).  Also, in a study conducted by Sharada VG et al⁷, pigmentary disorders were the most common among facial dermatoses, followed by infections (22%) and also in a study by Isidore KY et al¹⁴ where the commonest was Pigmentary disorders comprising of 25% among all the facial disorders & Dilip Chandra Chintada et al¹⁵ also reported the same as Pigmentary disorders were common (71%).  Whereas in the study conducted by Bhagwat PV et al⁸, infections were the most common facial dermatoses comprising of 37%, followed by skin tumors and miscellaneous conditions of the face consisting of 15% each, pigmentary disorders being the least common facial dermatoses comprising of 4.5%.

In this present study, the minimum duration of complaints was about one day, and the maximum period was six years. And it was also noticed that the majority were agriculture labourers (24%) followed by housewives (21.5), students (20%), daily-wage workers (19%), professionals (9%), and children <5 years (6.5%) which was similar to the study finding of Dilip Chandra Chintada et all ¹⁵ where agriculture laborers were the majority cases. But in a study conducted by Sharada VG et al⁷, the maximum patients were students by occupation, with 38% followed by housewives (29%), businessmen (11%), and agriculture people (9%). But in a study by Bhagwat PV et al⁸, the majority of the patients were housewives by occupation, with 28% followed by students (21.5%), manual labourers (17.5%), field workers (14%), 13.5% were self-employed, and 2.5% being professionals as identified.

In our present study, pigmentary disorders were presented by 58 patients; among them, the majority were belong to the age group of 30-39 years (31.03%), followed by 40- 49 years (24.14%) and 20-29 years (15.52%). The least number of patients were seen in the age group of ≥ 60 years with 6%. In a study conducted by Gupta et al ¹⁶ 40.3% of patients were between the age group of 31-50 years. In another study conducted by Hassan et al¹, the majority of patients belonged to the age group of 21-40 years, with 56.73%. Where as in another study conducted by Thoyyib M et al.¹⁷, the maximum number of patients with facial melanosis belonged to 21-30 years, with 31.4% with the minimum number belonged to above 60 years, with 3.6%, and the mean age was found to be 35.64+_12 years.

Melasma constituted the most common facial melanosis in the present study accounting for 39.7% of all cases, similar to the study conducted by Hassan et al ¹, Gupta et al ¹⁶ and Dilip Chandra Chintada et al ¹⁵.Whereas in the study conducted by Thoyyib  M et al¹⁷, the most common pigmentary disorder among facial dermatosis is post inflammatory hyperpigmentation with 35.3%.

LIMITATIONS

The study was a hospital based and conducted in a small group of patients.

The distribution of the disease was more among the female  study subjects significantly when compared to males because of  thought of use of cosmetics may increase their  facial beautification was more among females and the problem was also more among the younger population (20 - 29 years) which also proved the above fact. And  it was understood that the occurence of the disease was indirectly proportional to their literacy status as the majority of study subjects were Agriculture labourers, Daily-wage workers, students and house wives etc. And also commomly about 19% of the facial lesions in our study were due to infections which reflects the poor living standards like poverty, overcrowding, poor personal hygiene and low level of awareness etc.

Basing on the above conclusions it was recommended that control over the beautification clinics & centres, usage & grey marketing of cosmetics, over the counter drugs and self medication etc. preventive strategies by the concerned government authorities must be implimented properly in order to decrease the incidence of facial dermatoses and it´s psycho-social impact on the family & social life of affected individuals. And also measures to be taken  to create increase of awareness levels among the general public by means of health education based awareness campaigns and by electronic & print media towards careful usage of cosmetics, avoiding of sun light exposure by those who have melasma etc. and early report of adverse events following a chemical or drug exposure and any sign of skin lesions over the face and body to the the qualified doctors or to the government health care facilities etc.

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