range of factors such as climatic condition, geographical location, genetic makeover, hygienic standards, age,

Transcription

1 ISSN: X CODEN: IJPTFI Available Online through Research Article PATTERN OF SKIN DISEASES IN SOUTH INDIA AND THEIR EFFECT ON PATIENTS QUALITY OF LIFE C.Anirudh Jagannadh *, D.Rajeev Santosh Kumar, M.Mahima Swaroopa, J.John Kirubakaran Anirudh Jagannadh Chintalapati, Pharm-D, GIET School of Pharmacy, Rajahmundry, Andhra Pradesh, India. Received on Accepted on Abstract Background: There is never a specific pattern for occurrence of skin diseases and it varies due to a wide range of factors such as climatic condition, geographical location, genetic makeover, hygienic standards, age, gender, level of health care and many more. These diseases are also known to cause significant deprievement in patients' health related quality of life. The present study aims to investigate the pattern of occurrence of skin diseases and their effect on patients' quality of life. Materials and Methods: A prospective Cross-sectional study was carried in 186 adult patients presenting to Bhavya skin clinic, Rajahmundry, Andhra Pradesh, India for a period of 5 months. Patients were interviewed directly for collecting all the demographic details and in addition a validated questionnaire about Dermatology Quality Of Life Index was used in both English and Telugu language to measure the effect of skin disorder on quality of life since the past week. Results: In this study males constituted the majority of population accounting 59% and the predominant age group of the presenting population was years accounting 41%. Non-infective skin conditions were the most commonly occurring constituting 46% and among all the diseases fungal infections were most predominant and Acne vulgaris was the leading to all the other skin diseases. 47% of conditions had small effect on patients quality of life. Conclusion: The study infers that on contrary to many such studies performed males formed the majority of the study population. Fungal infections formed the majority of presenting disease conditions and the effect on patients Quality of life was small to moderate and large effect on patients quality of life was considerably negligible. Hence as a whole the present study necessitates the need for further such studies so as to IJPT July-2015 Vol. 7 Issue No Page 8155

2 provide further insight on the pattern of skin conditions and their extent of effect on patients quality of life. Keywords: Quality of life, Dermatology, Skin infections. Introduction: Skin diseases are considered to be one of the most commonly occurring condition s for attending primary health care amongst patient population. Apart from other diseases, skin diseases are known to cause a varied range of symptoms such as pain, itching and discomfort which exhibit profound impact both physically and psychologically ultimately leading to significant deprievment in patient s health related quality of life. Moreover, very scant Indian studies were carried on the pattern of skin diseases and the impact of these diseases on patients' quality of life. [1][5][6] Skin diseases have innumerable causes which might be either an infectious one (bacterial, fungal or viral) or non-infectious such as allergy, hypersensitivity, physical or chemical damage. Whatever may be the cause and origin of these disease s most of them end with a significant improvement in patients HRQoL. [1][4][5] Measuring patients' health related quality of life (HRQoL) is a complex paradigm which is usually affected by individual specific perception of his/her life considering several parameters such as physical and psychological well being, social and community relationships and various other factors. [2][3] Assessment of HRQoL allows the patient s to express their opinions about the level of health they are actually in and the way illness or treatment is affecting their quality of life. Although there are numerous validated instruments for assessment of dermatology conditions in general and also in a disease specific perspective, the selection of a suitable instrument depends on the type and method of assessment to be done. Hence, here comes the necessity for necessity of assessment of pattern of skin diseases and its effect on patient s HRQoL. [8][9][10] The Dermatology Life Quality Index (DLQI) is a validated questionnaire comprising 10 questions and is available in more than 40 languages (Finlay A.Y. & Khan G.K., 1994). DLQI use has been described in up to 1000 publications and many multinational studies. [7] Materials and methods: This prospective Cross-sectional study was carried in Bhavya skin clinic, Rajahmundry, Andhra Pradesh, India from April 2014 to August Bhavya skin clinic is an out-patient primary care center for skin and venereal diseases. IJPT July-2015 Vol. 7 Issue No Page 8156

3 Sample Population: A total of 186 random participants, both male and female were included in the study. The study subjects were adult patients of age 16 years and above. Patients suffering with HIV and patients in whom the diagnosis was not yet confirmed and required complex diagnostic techniques were taken to be exclusion criteria. Questionnaire Design A standard questionnaire for collecting patients demographic details was designed which included all the data of the patient (name, age, gender, educational and employment status etc.) and diagnosis of the presenting disease condition. A validated questionnaire (DLQI) was used so as to assess the impact of the disease and its treatment on the social and behavioral life of the patient. A prior permission was obtained from the authors of this questionnaire for its use in this project. Data Collection All the patients were directly interviewed by the researchers. Initially the patient was explained about the type and need of study and the details were collected as per the patients will. The demographic details were collected by asking open ended questions and the DLQI was given in English or Telugu (regional language) as preferred by the patients. Assistance was offered by the researcher in completing the questionnaire for those patients who could not read or have any kind of difficulty in answering it themselves. Data Analysis: The data obtained from the questionnaires Was processed in Excel (Microsoft corporation). Results and Discussion: Gender Analysis: A total of 186 patients attending primary dermatology care clinic were interviewed in the study among whom the majority were males who constituted a count of 59%(n=109) and females constituted 41%(n=77). The mean age of males was found to be 30 years and that of females was 29 years respectively. GENDER 41% 59% Male Fig no-1: Gender distribution in study population. IJPT July-2015 Vol. 7 Issue No Page 8157

4 Environment Analysis: C. Anirudh Jagannadh* et al. International Journal Of Pharmacy & Technology The environment analysis indicated that the presenting population were equal from both urban and rural settings constituting; urban 49%(n=91) and rural 51%(n=95). ENVIRONMENT 49% Rural 51% Urban Fig no-2: Environment of origin of study population. Age Group Analysis: The predominant age group presenting to the clinic was 21years 30years constituting 41%(n=76) followed by 16years-20years constituting 26%(n=49) followed by the rest of the age groups. Here, in the following table are cited the age group distribution relatively presenting to the dermatology clinic. Table no-1 AGE GROUP FREQUENCY(n) PERCENTAGE (%) 10 Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs Yrs. Above IJPT July-2015 Vol. 7 Issue No Page 8158

5 AGE GROUP DISTRIBUTION 10% 9% 26% 14% 10 Yrs Yrs. 21 Yrs Yrs. 31 Yrs Yrs. 41% 41 Yrs Yrs. 51 Yrs. Above Fig no-3: Age group distribution in study population. Professional Status: In a professional perspective the highest percentage of them attending the clinic were students constituting 39%(n=73) followed by job holders and housewives constituting 22% and 17% respectively followed by others such as daily wage, unemployed, homemaker and retired. Females who were unmarried and were care takers in home were considered as homemakers. Here in the following table are cited the distribution of study population as per patients professional data. Table no-2 Patient Profession Frequency Percentage(%) Daily Wage Homemaker 5 3 Housewife Job Retired 3 1 Student Unemployed 13 7 IJPT July-2015 Vol. 7 Issue No Page 8159

6 PATIENT PROFESSIONAL DATA UNEMPLOYED 13 7% DAILY WAGE 20 11% HOMEMAKER 5 3% HOUSEWIFE 31 17% STUDENT,73 39% RETIRED 3 1% JOB 41 22% Fig no-4: Analysis of professional status of study population. Classification of Skin Conditions: Around 31 different types of conditions were presented in the duecourse of study which were further classified into 14 subgroups and based on their origin all the conditions were classified into infective, noninfective and mixed(origin might be infective /non-infective/idiopathic). Following are the tables depicting the distribution of all the cases presented in the study. Based on origin of skin condition: Table no-3 ORIGIN FREQUENCY Infective 65 Non-infective 85 Mixed 36 IJPT July-2015 Vol. 7 Issue No Page 8160

7 ORIGIN 19% 46% 35% Infective Non-infective Mixed Table no-4 Fig no-5: Origin of skin condition. Type of skin disease Frequency Percentage(%) Adverse drug eruption Bacterial infection Benign skin tumor Eczematous dermatitis Endocrine disorder Fungal infection Hair disorder Inflammatory Parasitic infestation Photosensitivity Pigmentary disorder Pilosebaceous disorder Pruritic disorder Stretch marks IJPT July-2015 Vol. 7 Issue No Page 8161

8 Fig no-6: Classification of Skin conditions. Acne vulgaris was found to be the most commonly presenting condition in the course of study and of the total 27 patients, 19 were females (70.37%) and 8 were males (29.62%). This was followed by Tenia cruris a fungal infection accounting 24 of the presenting cases among which, among which there was only 1 female (4.16%) and the rest were males (95.83%). Scabies followed the above conditions constituting 18 of the presenting cases among which 5 were female patients (27.77%) and the rest were males (n=13;72.22%). This was followed by Eczema, photodermatosis, scalp psoriasis and the rest were less frequent complaints. Fungal infections were the most common presenting complaints which accounted 24.73% (n=46) of all the cases followed by pilosebaceous disorder (n=32;17.20%), photosensitivity (n=19;10.21%), parasitic infection, and eczematous dermatitis (n=18;9.67%) followed by inflammatory, pruritic and disorders. IJPT July-2015 Vol. 7 Issue No Page 8162

9 Assessment of Quality Of Life: C. Anirudh Jagannadh* et al. International Journal Of Pharmacy & Technology Dermatology life quality index (DLQI) analysis has shown that the majority of the population has shown a small effect on patients life constituting 47% (n=89) followed by no effect at all on a patient's life constituting 33% (n=62), 18% (n=33) moderate effect on patients life and only one case each have had very large and extremely large effect on a patient's life. Table no-5 CLASS FREQUENCY 0-1 (No effect at all on patient's life) (Small effect on patient's life) (Moderate effect on a patient's life) (Very large effect on a patient's life) (Extremely large effect on a patient's life) 1 1% 1% DLQI SCORE ANALYSIS 18% 33% 0-1(No effect at all on patient's life) 2-5(Small effect on patient's life) 6-10(Moderate effect on patient's life) 11-20(Very large effect on patient's life) 47% 21-30(Extremely large effcet on patient's life) Fig no-7: DLQI Score distribution. Conclusion The study accounts to the conclusion that in contrary to many other studies conducted on pattern of, skin conditions.the males formed the majority of population attending skin care clinic to that of females, though many previous studies postulated that it was females who were predominant. Both urban and rural IJPT July-2015 Vol. 7 Issue No Page 8163

10 populations presenting to the clinic were nearly equal. The major age group of presenting population was years. Among all the presenting conditions Acne Vulgaris was the most common one followed by TeniaCruris(fungal infection), scabies, eczema and photodermatosis. Fungal infections were the most commonly occurring, then other categories of skin conditions. The effect on patients' quality of life was not predominant and there was only a small effect on the patient's life for majority of presenting conditions and very rare (only 2 of 186) had very large and extremely large effect each on a patient's life. To conclude all together, though skin conditions have no profound impact on patients' quality of life they have small to moderate impact on the patient's life in various perspectives and hence skin care and hygiene are to be taken regularly by population of any age and region. It is also evident that the pattern of occurrence is not a uniform phenomenon and is a highly fluctuating aspect changing from place to place and hence a lot more study is to be conducted to understand the pattern of distribution of skin conditions and its variations in different population in different regions. However, in accordance with all the previously conducted studies, it is evident that any kind of skin condition has at least a minimum effect on patients' quality of life on the contrary high effect to patients' quality of life is confined only to a few skin conditions. Acknowledgement We are very thankful to Dr.P.V.S.Haranath M.D(DVL) for giving us an opportunity to carryon project work in his clinic and for encouraging and guiding us constantly from time to time in our entire project work. We would like to thank the Bhavya skin clinic authorities for their help and support in carrying on our project work. Finally, yet importantly, we thank all the patients who participated in the study without whom study would not have been possible. References: 1. Proksch, E; Brandner, JM; Jensen, JM (2008). "The skin: an indispensable barrier. Experimental Dermatology 17 (12): doi: /j PMID Madison, KC. (2003). "Barrier function of the skin: "la raison d'être" of the epidermis". J Invest Dermatol 121 (2): doi: /j PMID Kurd SK,Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: A population-based cohort study. Arch Dermatol 2010 Aug; 146:891. IJPT July-2015 Vol. 7 Issue No Page 8164

11 4. J N Rea, M L Newhouse, Halil T ; Skin disease in Lambeth. A community study of prevalence and use of medical care. Br J Prev Soc Med 1976;30: doi: /jech Andersen LK Global climate change and its dermatological diseases. J Dermatol May;50(5): doi: /j G O Horne FRCPE, Fobmerly. Climatic Environmental Factors in the Etiology of Skin Diseases. The Journal of Investigative Dermatology (1952) 18, ; doi: /jid Finlay AY. Quality of life indices. Indian J Dermatol Venerol Leprol.2004;70: Chwalow, A.J. (1995). Cross-cultural validation of existing quality of life scales. Patient Education and counselling,26, Dr. Joel Tsevat MD, MPH, Jane C. Weeks MD, MS. Using health-related quality-of-life information. October 1994, Volume 9, Issue 10, pp McCombs, K., & Chen, S. C. (2007). Patient preference quality of life measures in dermatology. Dermatologic Therapy, 20, Corresponding Author: C.Anirudh Jagannadh*, jagan.anirudh@gmail.com IJPT July-2015 Vol. 7 Issue No Page 8165