European Journal of Cardiovascular Medicine

Skin disorders are extremely common among all the age groups of the population. Approximately 6% of visits to all physicians entail a problem of the skin, hair, or nails; however, only approximately 40% of these patients are seen by dermatologists.¹ It’s a fact that in developing countries 70% of people suffer from skin diseases in some part of their life.

Skin diseases in children have been reported from 9-37% in various studies.²

The distribution of skin diseases varies from one country to another and across different parts of the same country like India due to varied beliefs, customs, religions, languages, climatic and socio-economic conditions and due to lack of awareness, early reporting to health care facility is also very less observed. And also interestingly up to 80% of the population suffering from skin problems may not seek medical help.³ In India as majority of the children (38%) living in rural area the problem is also more located in rural area.⁴ The prevalenceof skin diseases amongst children in various parts of India has ranged from 8.7% to 35% as per school-based surveys. Schools from rural areas showed relatively higher prevalence of skin diseases.⁵ Though the many skin disorders may not lead to mortality they do cause significant morbidity. In India majority of the school children are at risk of developing skin diseases at a greater  incidence but still adequate attention is not being paid when compared to systemic disorders in children.⁶

The skin over the the external genitalia is  a common site for rashes, itching, and minor infections as the skin  of this area has homeostasis around the ano-genitalia⁷ and also this area is warm, moist, and occluded, and it is frequently exposed to irritating urine, feces, and vaginal secretions.⁸Genital dermatoses pose serious diagnostic and therapeutic challenges due to privacy, persistant checkups, embarrassment, and the inability of necessary investigations⁹ These dermatoses may also lead to mental distress with the feeling of guilt and, if not treated properly in time, may lead to complications as well.^10,11 Creating awareness by means of Health eduction and mere improve of personal hygiene will have a lot of impact on the over all welbeing of children ¹².

So this study was planed to know the distribution and  to determine associated epidemiological factors of the Nonvenereal Genital Dermatoses among the children and adolescents attending Government General Hospital, Ongole so as to enable us for better understanding and management of above health problem.

The setting of the study was at department of DVL, Government General Hospital, Government Medical College, Ongole, Andhra Pradesh. A one year observational study was conducted during the period from December 2022 to November 2023. According to the hospital censes the prevalence of Non venereal Genital Dermatoses cases in the  OPD of departments of DVL and Paediatrics combindly 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% with a precision level of 5 at 95% CL, Q=100-P that is 84.91% and d=20% allowable error in ‘P’ that is 3 therefore N=200. All the cases of clinically diagnosed and  as per the the standard case definitions attended the OPD of DVL and Paediatric departments 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.Children of either sex between 1 to 18 years of age attending DVL and Pediatric OPD with a clinical diagnosis of genital dermatoses. Exclusion criteria: 1. Patients not willing to participate and parent or guardian not willing to allow their children for the study.2.Those cases which are repeated are also excluded. Objectives: 1. To know the socio-demographic profiles of the study subjects 2. To study the distribution and associated factors of Nonvenereal Genital Dermatoses. After receiving the Ethical committee clearance from the institution the study was began with the written and informed consent obtained from the Parents/attendents of the patients and the required data was collected by using a pretested proforma pertaining to their socio-demographic profiles, Clinical pattern & Types of Genital Dermatoses and other associated epidemiological factors etc. and further all the cases (study subjects) of the study were managed and followed on OPD basis until they got relief.

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 belonged to different authors and there by conclusions and recommendations were framed.

• In the present study, the majority of the Non venereal genital dermatoses cases were found in adolescents 9-18 years(36%) followed by School children 6-9 years(29%), Preschool children 3-5years(20%) toddlers 1-2years(15%) with the mean age 7.4 years, Mean = 4, Mean + 2SD = 3.54 – 18.34, P < 0.01
• In the above study males were more in number (5%) significantly when compared to females (28.5%). And among all the groups also male predominence was observed
• Among the total study subjects Infective Genital Dermatoses accounted for 80% and Non-Infective Dermatoses accounted for 20%. And among all the Infective Dermatoses Scabes occupies the major position (50.2%) followed by Fungal infections (26.5), Bacterial infections (19%) and Viral infections (4) respectively
• Non Infective dermatoses were seen in 20% (40) of total cases. And among them Phrynoderma (40%) was the most common one followed by Vitiligo Vulgaris (5%), Eczema (10%),Drug eruptions (7.5%), P.alba (5%), Fordyce spots (2.5%) Lichen Planus (2.5%), Lichen Striatus (2.5%), Haemangioma (2.5%), Phimosis (2.5%) and Traumatic ulcer (2.5%) respectively.
• Related to distribution of sex males were more in number among both the Genital Dermatoses but highly significant in Infective Dermatoses and regarding socioeconomic status also the similar result was observed as the more number of study subjects were belongs to middle & lower class of SES.
• And furthur it was also observed that among both the Genital Dermatoses more number of study subjects were belongs to Rural area (60.5%) followed by Sub urban (26.5%) and Urban (13%) respectively which was also statistically significant.
• About 34.5% of study subjects were residents of Hostels among all the study subjects.
• In adition to the above findings it was observed significantly that Genital Dermatoses was more observed among the study subjects who wear under garments (90.5%).
•  

In the present study it was observed that out of 200 study subjects, males were more in number (71.5%) when compared to females (28.5%) which was correlated with the findings of the other studies like N Vinay et al¹³, Puri N et al¹⁴ , Paudel V et al¹⁵ (Nepal) , Sharanbasava V et al.¹⁶, Acharya et al¹⁷, Degboe et al.¹⁸,  and Lakjiri et al¹⁹ which inturn shows that male kids & adolescents are spending more time in out doors towadrs playing,  friendships , schooling and staying in hostel as groups etc. and also because of stigma associated to reporting of girl’s genital organs health issues to the hospital is in lower rate usually in our setup when compared to boys genital health issues.

The mean age of the study subjects in the present study was 7.4 years and the majority of patients in the present study were belonged to10-18 years (adolescents) (36%), followed by school going children of 6-9 years (29%), preschool children of 3-5years (20%) and todlers of 1-2 years (15%) which was also closely related to the reports of Degboe et al¹⁸ study , Acharya et al¹⁷ study and Devi et al study²⁰ . It was also observed that among the total study subjects Infective Nonvenereal Genital Dermatoses accounted for 80% and Non Infective Genital Dermatoses accounted for 20% and similar figures were noted in Karthikeyan et al²¹ , KS Negi et al²² , Achrya et al¹⁷ ,Degboe et al¹⁸ and Devi et al²⁰ studies etc. And among Infective nonvenereal dermatoses Scabes was the most common infection noticed in this study followed by Fungal infections (26.5), Bacterial infections (19%) and Viral infections (4) respectively. But Candidiasis was the commonest infection observed in Paudel V et al¹⁵ , Joshi et al ²³, Puri et al¹⁴ ,Gumayum et al²⁴ and Sardana et al²⁵ studies and Bacterial infection was commonest infection observed in Singh et al²⁶ and Pathak et al²⁷ studies and among the bacterial infections Bullous impetigo was the commonest one observed in our study where as Folliculitis was the commonest one reported by Gumayum et al.²⁴

Regarding Non infectious Genital dermatoses, Phrynoderma (40%) was the most common one followed by Vitiligo Vulgaris (22.5%), Eczema (10%), Drug eruptions (7.5%), P.alba (5%), Fordyce spots (2.5%) Lichen Planus (2.5%), Lichen Striatus (2.5%), Haemangioma (2.5%), Phimosis (2.5%) and Traumatic ulcer (2.5%) were observed respectively. KS Negi et al²² and Joshi et al²³ were also reported that Phrynoderma (Nutritional deficiency dermatoses) was the common one in their study. But Vitiligo was the common variety as reported by PK Sarswat et al²⁸ , Acharya KM et al¹⁷ and Karthikeyan et al²¹ and Drug eruptions was common one as reported by Paudel V et al¹⁵ and Sharanbasava et al respectively which shows that the pattern of skin diseases varies from region to region due to different climatic conditions , cultural practices & socioeconomic factors etc.²⁹

With reference to socioeconomic class it was observed that significant number of study subjects were belongs to middle & lower class and also more number of  study subjects were belonged to Rural area (60.5%) followed by Sub urban (26.5%) and Urban (13%) area respectively which was also statistically significant. And also about 34.5% of study subjects were residents of Hostels among the  total study group.  The above findings reflects the Poor standard of living, poor housing environment, lack of personal and family hygiene , overcrowding and low level of purchasing capacity of the study subjects etc. In adition to the above findings it was observed significantly that Genital Dermatoses was more observed  among the study subjects who wear under garments (90.5%). This is because the factors like wearing tight under garments, nylon made under garments and the use of the mixed or polyester type of undergarments causes sweat, moisture, and humidity retention by trapping moisture and air between the skin and the fabric which creates a favorable environment for organisms such as bacteria and fungi to thrive which may result in urinary tract infection, bacterial, and fungal skin infections. Furthermore, tight undergarments can potentially cause slow blood circulation which is also an agravating factor. However Pathak et al²⁷ have shown a significant association with the use of powder and hypoallergic soaps for washing undergarments and also personal usage of anything that is irritant can lead to itching soreness of the skin  and irritation over any part of the body including genital area.

The study was a hospital based and conducted in a small group of patients. So that we could not measure the Prevalence and incidence of the health problem.

As the  distribution of the disease was more among the male kids significantly when compared to female kids,  it is important to take necessary steps to overcome the stigma related to reporting of girl genital health issues to health care facility. And also majority about 80% of the Non venereal genita dermatoses among children& adolescents 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.

From this study we significantly observed that communicable diseases like scabies, bacterial infections, fungal & viral infections and the other factors like nutritional deficiencies, poor socioeconomic conditions & hostel dwellings (over crowding) etc. were strongly associated with rapid & wide spread of Nonvenereal genital dermatoses among school going children & adolescents  reflecting their state of health status, poverty, lack of personal hygiene, poor housing, non availability of soaps and antifungals and over all poor standard of living conditions needs a prompt action. Hence we recommend that certain steps to be taken like conducting more & frequent  number of community, school & hostel based health education camps mainly focusing on the above issues by targetting parents, teachers,care givers & children and adolescents to create awareness, to adapt better nutritioal practices and over all improvement in  living & purchasing capacity of weaker sections of the society etc.

In addition to this, it is better to get  enquiry or examination of  external genitalia in case of children even if the patient does not have any genital complaints when ever they visit health care facility

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