Ecologic perspective of dermatologic problems in North Eastern India

Introduction

The incidence of skin diseases is difficult to determine as the availability of dermatology services, and social and environmental factors affect incidence studies. The pattern of skin diseases differs in different countries and from region to region in the same country.[1] Epidemiology studies of skin diseases are important in the study of disease pattern, changes in disease pattern and for planning dermatology services and research for a country. There are few regional studies available from India in which the pattern of skin diseases has varied widely.[2],[3],[4],[5],[6],[7],[8] This report unveils the first hand knowledge of the incidence and nature of dermatological disorders in North Eastern region of India.

Materials and Methods

The material of this study comprised of well-maintained records of 36090 new dermatological cases who reported at military hospital (MH) Guwahati, MH Tezpur and Air Force hospital Jorhat from Jan 1995-Dec 1999. Diagnosis was based on history, clinical examination and relevant laboratory investigations. The results were compiled and data analysed.

Results

[Table - 1] & [Table - 2]

Discussion

The incidence of non-infectious dermatoses (58.07%) was slightly higher than that of infectious dermatoses (41.9%) in North East region. The low incidence of infective dermatoses in our study is possibly due to better health care and hygiene among defence personnel who constituted the bulk of our study population. On comparing our data with other regional studies we found that the incidence of infective skin disorders in this region almost approximate that reported from Mumbai,[2] Lucknow,[3] Jhansi[4] and Pune[5] but slightly lower than that reported from Ladakh[6] and Kashmir.[7]

In contrast to earlier published reports from our country, the incidence of fungal diseases predominated in this area. It accounted for almost fifty percent of the total infectious skin diseases. This is probably due to hot humid climate of the region, prolonged wearing of occlusive foot wear and owing to nature of military training. Among the fungal infection tinea corporis/cruris was the commonest (46.8%) followed by pityriasis versicolor (27.3%), onychomycosis (13.9%) and deep fungal infections (0.73%).

Herpes zoster accounted for 363 cases. This apparent high prevalence might be due to the fact that the majority of our study subjects were defence personnel who are a high risk group in acquiring STD and HIV infection leading to immunosuppression and reactivation of varicella zoster virus.

Most suprising was the low incidence of allergic contact dermatitis to parthenium hysterophorus, a dermatosis which is almost epidemic in India.[8] This is because of sparse growth of Parthenium hysterophorus in this part of the country.

Psychological stress and strain of serving in area of militancy may be the precipitating factor for slightly higher incidence of neurodermatitis and psoriasis among defence personnel.

Greater awareness, regular medical check up and ready availability of dermatologic services are probably responsible for higher incidence of non infectious dermatoses among troops as compared to most of the published reports. However, in accordance with almost all reports the incidence of eczemas was highest amongst non-infectious dermatoses.

Finally, as evident from the [Table - 1] and [Table - 2] there has been no significant variation in the incidence of skin diseases over the years in North East region. This is probably due to slow progress in industrialization, and urbanization in this part of the country as a result the macro-climate of this area has almost remained unchanged.