THE PATTERN OF SKIN DISEASES IN A HOSPITAL IN QUNFUDAH REGION, SAUDI ARABIA

Received: 25 October 2016 Final Accepted: 23 November 2016 Published: December 2016 Background and objectives: No available previousstudy conducted to described the pattern of skin diseases in Qunfudah region. Thus, a study in this regard was needed. The aimwas to assess the pattern of skin diseases suffered by patients in this area. Methods: It was conducted in dermatology department at South Qunfudah General Hospital(SQGH), Qunfudah, Saudi Arabia.Data ofnew patients who seen in clinic between October 2015 and September 2016 were retrospectively review. Results:This study included 792 patients, all of them were referred from primary health care centers. Of whom 450 (56.8%) were females and 342 (43.2%) were males; the female-to-male ratio was [1.3:1] and the mean age was 30 years. Females were dominant in most of the age groups. The distribution of skin diseases was: eczema/dermatitis (48.2%), pilosebaceous disorders (14.9%), infections (11.2%), pigmentary disorders (7.7%), hair disorders (6.2%), papulosquamous disorders (4.2%), urticaria (3.0%), autoimmune diseases (1.3%), keratinization disorders (0.4%), and miscellaneous disorders (2.9%). Conclusion:Our study was carried out in just one hospital (SQGH), it only provides a rough estimation for the prevalence of skin diseases in this area.Three-quarters of the patients had eczema/dermatitis, pilosebaceous disorders, and infections. It is recommended that training courses be developed to instruct primary health physicians on how to deal with these three skin disorders; this could help reduce referrals to dermatology clinics, as well as allowing patients to be treated earlier.


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Dermatological diseases are unique among other diseases, as can be clearly seen and diagnosed by the doctors, unlike the other diseases which the defect occur in the internal organs of the body. Fortunately, skin diseases are usually not life-threatening; however, they can be socially embarrassing for the sufferer and can have a marked impact on their life. Such effects can be summarized by the five D's: Disfigurement, Discomfort, Disability, Depression, and Death, the last of which is thankfully rare. 3 30% of patients with skin diseases have depression and anxiety disorders, 7 while some studies have even found that the suicide risk is much higher in sufferers of skin conditions. 8 In recent years, development and urbanization have been accelerating among many populations; the very same situation can be seen in Saudi Arabia, leading to certain changes in the lifestyle and health of communities. While a few studies have been published on skin disease patterns in certain areas of Saudi Arabia, [9][10][11][12] there is no information available on other areas such as the Qunfudah region, leading to the necessity of conducting this study in said locality. In order to achieve better health services and enable planning for future treatment projects, it is helpful to know which types of skin disease most prevalently affect which subgroups of the population; epidemiological studies are highly useful in this regard. Qunfudah is located on the coast in the south-west of the country. The area has more than 210,000 inhabitants, a fairly high average annual temperature, and humid weather with occasional rainfall. 13 This study was critical, as the climate of this area makes the population more liable to developing certain skin diseases, particularly infections; the results will help in the tackling of these conditions. The aim was to determine the pattern of skin diseases for patients attending South Qunfudah General Hospital's (SQGH) dermatology clinic.

Methods:-
Ethical approval was obtained from the hospital administration of SQGH. This was a retrospective study, including all new patients seen in the dermatology clinic between 1 October 2015 and 2 September 2016. All patients were assessed by consultants and specialist dermatologists. Their medical records were collected and reviewed, and the following information taken for each patient: file number (to avoid repetitions), gender, age, and diagnosis based on patient's history, clinical examinations, and laboratory investigations. Data was entered into Microsoft Excel 2016 and analyzed using Statistical Package for Social Science (SPSS version 21) by frequencies and measures of central tendency; in addition, a t-test was performed, with the significance value set to (P = 0.05).

Results:-
After reviewing all files for the dermatology clinic patients seen within the selected period, the total number of new patients was 792. Of these, 450 (56.8%) were females and 342 (43.2%) were males, with a female-to-male ratio of 1.3:1; there was no statistical significance in disease incidence regarding both sexes (P = 0.22). As shown in Figure  1, female patients were prevalent in every age group, except for the 45 to 54 and over-65s, where males were dominant. Patients were aged between 1 and 96 years, with the most common age group being 15-24 (25.1%); the mean age was 29.2 in females and 31.1 in males. 1367 According to Figure 2, which shows the order of skin diseases based on the number of patients, the percentages of prevalence of different conditions were as follows: eczema/dermatitis (48.2%), pilosebaceous disorders (14.9%), infections (11.2%), pigmentary disorders (7.7%), hair disorders (6.2%), papulosquamous disorders (4.2%), urticaria (3.0%), miscellaneous disorders (2.9%), autoimmune diseases (1.3%), and keratinization disorders (0.4%).

Discussion:-
After we reviewed all patients' files from the dermatology clinic for the selected period, we found that all of them were referred from primary health care centers. Our results show that female patients attend dermatology clinics more than males; similar results have been found in Norway, Egypt, Ethiopia, and India. 5,14-16 As shown in Figure 1, female patients were more prevalent in each age group, except for the 45 to 54 and over-65s, we think that this is because females care about their appearance more than males, but lose this concern as they become older. The higher number of females can clearly be seen in the 15-24 group; this may be explained by the fact that during this period, acne has the highest incidence rate, causing unwanted cosmetics problems. However, some studies conducted here in Saudi Arabia have found the opposite, with males being significantly more prominent than females in other regions; this may be due to cultural factors that prevent females from seeing doctors, or male lifestyles in these areas that make them more prone to skin diseases. [9][10][11][12] In general, the pattern of skin diseases in the area studied, as shown in Figure 2, is identical to what has been found in previous studies all around Saudi Arabia. However, in contrast with these previous studies, atopic eczema was 1369 also the most frequent disease, but the percentage of eczema was much higher in our area, while viruses were the commonest cause of infections in other areas, but in our region fungal infection was more prevalent. This may be caused by the geographical location of Qunfudah city; being beside the sea, there is a high level of humidity, and the hot climate year-round creates a viable breeding ground for fungal infections. [9][10][11][12] Infections were more common in males; we believe this is because males' lifestyle cause them to have more exposure to heat and humidity, as well as contact with animals. However, females had more hair disorders, which we believe are induced by pregnancy and breastfeeding, or perhaps because they use hair dyes more often than males, that contain chemicals that could lead to hair damage; a recent study conducted in South India supports this hypothesis. 17 When we compare our results with other studies performed outside Saudi Arabia, eczema was much more prevalent in our area, representing about half of all cases, while in other countries such as India, Nigeria, and Egypt, infections were more prominent. This could be due to the superior quality of healthcare services in Saudi Arabia; according to some studies, eczema is more common in developed countries and infections are more prevalent in developing countries. [4][5][6] Acne here is low compared to other countries, accounting for 36.7% of total skin diseases amongst the young in our area; figures were almost the same for both genders. In other countries, such as India, this was much higher, representing 66.5% of all skin diseases among youth, as well as being more prominent in females, which may be due to genetic differences between populations. 17 Therefore, our results support the hypothesis that skin disease prevalence differs according to many factors, such as environmental, socioeconomic, and racial.
This was the first study conducted in Qunfudah city to describe the pattern of skin diseases; because it was carried out in only one hospital (SQGH), it only provides a rough estimation for the prevalence of skin diseases in this area. In addition, our study was done through reviewing the dermatology clinic patients' files, which lacked certain useful information, such as patient occupation, habitation, socioeconomic status, and family history of the same condition. Accordingly, a larger population-based epidemiological study is recommended in order to determine the wider pattern of skin diseases.
In conclusion, the top five dermatological conditions seen in (SQGH) were: eczema/dermatitis, pilosebaceous disorders, infections, and pigmentary and hair disorders. All patients seen in the dermatology clinic were referred from primary healthcare centers, and most of these conditions can be diagnosed and treated by primary healthcare physicians. We recommend the development of key awareness campaigns to increase the population's knowledge of these diseases, as well as better training programs for primary healthcare physicians regarding skin diseases, which will be beneficial in reducing the referrals to dermatology clinics as well as allowing these diseases to be diagnosed and treated as early as possible.