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Prevalence of scalp disorders among outpatients attending dermatology department in a semi-urban setup: a cross sectional observational study.

INTRODUCTION: Scalp disorders are quite prevalent in general population. (1) Though some epidemiological literature exists on prevalence of specific disorders involving scalp, prevalence of scalp involvement in general or specific groups of population have not been largely studied. (2,3,4,5) Our department works in a medical college hospital setting with the college location providing equal access to both rural and urban population. This offers us an excellent chance to study an optimum mix of disorders. We studied patients attending our outpatients department to assess the prevalence of scalp conditions in these attendees.

MATERIAL AND METHODS: The study was conducted at Department of Dermatology, Mahatma Gandhi Hospital, Sitapura, Jaipur. Scalp of first all patients attending the department over a fortnight were examined for any disease, disorder or abnormality. Demographic details including age, sex, residential background (urban/rural) and occupation were noted. Details of scalp examination and the presenting diagnosis were noted and a note was made whether the scalp condition, if present, was related to the presenting diagnosis or was entirely incidental. The findings were then analysed.

RESULTS: 602 patients were examined comprising of 280 males (46.5%) and 322 females (53.5%). 382(63.5%) attendees were from the urban background while 220(36.5%) from rural. The patients' age ranged from 7 months to 76 years. (Table 1).

Most of the patients were students (233, 38.7%). Rest of the patients comprised of teachers, retired servicemen and servicewomen, housewives, farmers, shopkeepers, self-employed, labourers, army servicemen and young children. (Table 2).

The complaints for which patients attended the outpatient department were variable. The dermatological diagnoses made on the patients are shown in Table 3.

109 patients (18.1%) had scalp involvement which was related to the signs and symptoms the patients presented with, while 181 patients (30%) had scalp findings unrelated to the presenting features and diagnoses. The incidental findings in scalp in the latter group included dandruff, male pattern alopecia, premature greying, matting of hair, hemangioma, cradle cap, sparse hair and woolly hair. (Table 4).

DISCUSSION: Scalp disorders, diseases and abnormalities are quite prevalent in general population, though many of these are not a cause of concern for the patients or parents. However, these features may be very helpful in diagnosing the patient's disorder, and moreover may need treatment.

Our study had slightly more females (53.5%) than males, with most patients from urban background (63.5%). Most outpatient attendees belonged to the age range 16-29 years. The above findings are most likely due to the location of our hospital in an institutional area, with many educational institutions in the surrounding. The hospital has easy access not only from adjacent Jaipur town area, but regular transport is available from surrounding villages too. Majority of the patients were students studying in the surrounding institutions. Housewives were the second largest group followed by farmers and labourers. The most common presenting diagnosis was acne, which is quite evident considering that adolescents formed the major group attending our department. Eczematous diseases formed the second major group with airborne contact dermatitis and photodermatitis being the most common conditions.

Dermatological diagnoses which were directly related to scalp included male/female pattern alopecia, eczema, pediculosis, psoriasis, bacterial infections, seborrheic capitis and telogen effluvium. However, examining scalp of 602 outpatient attendees revealed presence of scalp findings in an additional 181 patients forming 30% of the group. These findings included dandruff, male pattern alopecia, premature greying, matting of hair, hemangioma, cradle cap, sparse hair and woolly hair. These findings can not only help in getting to the dermatological diagnosis, but may need treatment as well. It is therefore imperative that scalp examination should be included as part of complete skin examination in all patients attending dermatology outpatients.

DOI: 10.14260/Jemds/2015/958

REFERENCES:

(1.) Grimalt R. A practical guide to scalp disorders. J Invest Dermatol Symp Proc 2007; 12: 10-14.

(2.) Foley P, Zuo Y, Plunkett A, Merlin K, Marks R. The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap). Arch Dermatol 2003; 139: 318-322.

(3.) Williams JC, Eichenfield LF, Burkle BL, Barnes-Eley M, Friedlander SF. Prevalence of scalp scaling in prepubertal children. Pediatrics 2005; 115: 1-6.

(4.) Misery L, Sibaud V, Ambonati M, Macy G, Boussetta S, Taieb C. Sensitive scalp: does this condition exists? An epidemiological study. Contact Dermatitis 2008; 58: 234-238.

(5.) Laurent Misery, Nora Rahhali, Antoine Duhamel and Charles Taieb. Epidemiology of Dandruff Scalp Pruritus and Associated Symptoms. Acta Derm Venereol 2011; 93: 80-81.

Ram Gulati [1], Manisha Nijhawan [2], Savita Agarwal [3], Isha Gupta [4], Shilpa Soni [5], Vibhor Goyal [6], Pallavi Goyal [7], Dinesh Mathur [8]

AUTHORS:

[1.] Ram Gulati

[2.] Manisha Nijhawan

[3.] Savita Agarwal

[4.] Isha Gupta

[5.] Shilpa Soni

[6.] Vibhor Goyal

[7.] Pallavi Goyal

[8.] Dinesh Mathur

PARTICULARS OF CONTRIBUTORS:

[1.] Assistant Professor, Department of DVL, Mahatma Gandhi Hospital, RIICO Institutional Area, Jaipur.

[2.] Professor, Department of DVL, Mahatma Gandhi Hospital, RIICO Institutional Area, Jaipur.

[3.] Senior Resident, Department of DVL, Mahatma Gandhi Hospital, RIICO Institutional Area, Jaipur.

[4.] Senior Resident, Department of DVL, Mahatma Gandhi Hospital, RIICO Institutional Area, Jaipur.

FINANCIAL OR OTHER COMPETING INTERESTS: None

[5.] Resident Doctor, Department of DVL, Mahatma Gandhi Hospital, RIICO Institutional Area, Jaipur.

[6.] Resident Doctor, Department of DVL, Mahatma Gandhi Hospital, RIICO Institutional Area, Jaipur.

[7.] Resident Doctor, Department of DVL, Mahatma Gandhi Hospital, RIICO Institutional Area, Jaipur.

[8.] Professor & HOD, Department of DVL, Mahatma Gandhi Hospital, RIICO Institutional Area, Jaipur.

NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:

Dr. Ram Gulati, Flat B-1, 367, Adarsh Nagar, Jaipur-302004, Rajasthan.

E-mail: dr_ramgulati@yahoo.com

Date of Submission: 07/04/2015.

Date of Peer Review: 08/04/2015.

Date of Acceptance: 01/05/2015.

Date of Publishing: 08/05/2015.
Table 1: Age distribution of the patients

Age range (years)           Number (n = 602)    Percentage

Less than or equal to 15           71              11.8%
16-29                              280             46.5%
30-44                              113             18.8%
45-59                              77              12.8%
More than or equal to 60           61              10.1%

Table 2: Occupation of patients

Occupation                  Number (n = 602)    Percentage

Students                           233             38.7%
Housewives                         131             21.8%
Farmers                            88              14.6%
Labourers                          33              5.5%
Teachers                           25              4.1%
Self employed                      23              3.8%
Shopkeepers/assistants             22              3.7%
Young children (< 5 yrs)           22              3.7%
Retired servicemen/women           20              3.3%
Army servicemen                     5              0.8%

Table 3: Dermatological diagnoses of patients attending the OPD

Diagnosis                          Number (n = 602)    Percentage

Acne                                      128             21.3%
Eczematous disorders                      122             20.3%
Male/female pattern alopecia              54               9%
Scabies/pediculosis                       41              6.8%
Urticaria                                 39              6.5%
Papulosquamous disorders                  37              6.1%
Superficial fungal infections             28              4.6%
Viral infections                          23              3.8%
Disorders of hyperpigmentation            22              3.6%
Bacterial infections                      22              3.6%
Seborrheic capitis                        16              2.7%
Vitiligo                                  12               2%
Plantar keratoderma/callosity             11              1.8%
Steroid induced facial                    11              1.8%
  telangiectasiae
Immunobullous disorders                   10              1.6%
Telogen effluvium                          6               1%
Miscellaneous                             20              3.2%

Table 4: incidental scalp findings in patients
attending OPD for other reasons

Incidental Scalp findings     Number (n=181)

Dandruff                            96
Male pattern alopecia               33
Premature greying                   27
Sparse hair                         15
Cradle cap                           7
Matting of hair                      1
Hemangioma                           1
Woolly hair                          1
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Title Annotation:ORIGINAL ARTICLE
Author:Gulati, Ram; Nijhawan, Manisha; Agarwal, Savita; Gupta, Isha; Soni, Shilpa; Goyal, Vibhor; Goyal, Pa
Publication:Journal of Evolution of Medical and Dental Sciences
Date:May 11, 2015
Words:1204
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