The prevalence of melasma and its association with quality of life in adult male Latino migrant workers

Background  Melasma is a common condition of Latino women that detracts from their quality of life (QOL). The prevalence and impact of melasma in Latino men is not well characterized.
Aim  To assess the prevalence of melasma and its association with QOL in Latino men from Mexico and Central America working in the USA.
Methods  The prevalence of melasma was assessed in three studies of Latino men: by direct examination in a study of 25 Latino poultry workers; by direct examination in a study of 54 Latino farm workers; and by examination of store-and-forward teledermatology images in a study of 300 Latino farm workers. QOL was assessed with a Spanish version of the Dermatology Life Quality Index (DLQI).
Results  The prevalence of melasma was 36.0%, 7.4%, and 14.0% in the three studies. The prevalence of melasma was greatest amongst those aged 31 years and older, who were from Guatemala, and who spoke an indigenous language. The presence of melasma was associated with higher DLQI scores, indicating a poorer QOL, in the poultry worker population.
Conclusions  Melasma is a common condition in Latino men and is associated with a poor QOL in some affected individuals. Clinicians should be aware that melasma may be a concern for their male Latino patients. Research on the association of skin conditions with QOL amongst minority men is needed.     

The association of dermatologist-diagnosed and self-reported skin diseases with skin-related quality of life in Latino migrant farmworkers

Background Skin diseases are known to affect the quality of life (QoL), but data to support this are based on clinical samples. Few data document the skin‐related QoL in the general population, and whether its association differs with self‐reported or dermatologist‐diagnosed skin ailments. Farmworkers are at high risk for skin diseases, and are an appropriate population in which to explore these associations. Objectives To compare the association between skin‐related QoL and workers’ self‐reports of skin conditions or dermatologist‐diagnosed skin diseases over the course of a work season. Methods Three hundred and four Latino farmworkers were recruited from 45 randomly selected residential sites in North Carolina, USA, for longitudinal surveillance. The participants were interviewed up to five times at 3‐week intervals and the reported skin problems and Dermatology Life Quality Index (DLQI) were recorded. Nine digital photographs were taken of each participant. A board‐certified dermatologist rated each for the presence of specific skin diseases. Results An impact of skin disease on QoL was reported in 16% of interviews. In multivariate analyses with self‐reported skin problems, feet or skin fungus, rash, itching, and poison ivy were predictors of QoL. Dermatologist‐diagnosed inflammatory diseases and pigmentary disorders were significant predictors of QoL. The association was stronger for self‐reported skin problems than for dermatologist‐diagnosed conditions. Conclusions In a population of farmworkers, skin problems had a clinically significant impact on QoL. Itch‐related conditions and cosmetic conditions, such as acne and melasma, were important determinants of QoL. Treatment for these conditions in this population may enhance QoL.     

SKIN DISEASES AMONG ADOLESCENT BOYS IN ABHA, SAUDI ARABIA

Background. Adolescence is characterized by a sensitivity to issues of attractiveness. With dermatologic conditions, this may adversely affect early detection and compliance. Methods. A cross-sectional study was carried out on a multistage stratified random sample of 647 adolescent schoolboys in Abha, Saudi Arabia, to determine the prevalence of skin diseases. The age of the boys ranged from 11 to 19 years with an average of 15.3 ± 1.9 years. Results. It was found that 19.8% of the children were affected by one form or another of transmissible skin diseases (TSD). The most common types were: pediculosis capitis (9.6%), verruca vulgaris (3.9%), and tinea pedis (1.9%). The prevalence of TSD increased significantly as the age decreased and as the crowding index increased. As for nontransmissible skin diseases, acne vulgaris was the most prevalent disease (56.3%). The prevalence and severity of acne increased significantly as the age increased. Conclusions. The findings indicate the need to develop regional intervention programs at the school level. Appropriate continuing medical education programs for school health workers in the region are mandatory to achieve this goal.     

Pattern of skin disease at the Ethio-Swedish pediatric hospital, Addis Ababa, Ethiopia

Although skin diseases are common in children, only a very few prospective studies are available, in the literature, mainly from developed countries. This work reports the pattern of skin diseases in a tertiary referral hospital in Addis Ababa, Ethiopia, from June 1995 to July 1997. A total of 1000 consecutive new pediatric patients, ages 0-12 years, were studied. The male:female ratio was 1:1. Allergic skin diseases were most frequently found (55%), followed by infections (33%) and photodermatosis (8%). Of the allergic skin diseases, atopic dermatitis was the most prevalent (47%), followed by seborrheic dermatitis (17.4%).     

Epidemiology of skin disorders in Ethiopian children and adolescents: an analysis of records from the Italian Dermatological Centre, Mekelle, Tigray, Ethiopia, 2005 to 2009

Skin disorders are an important problem in children living in developing countries, but only a few epidemiologic investigations on pediatric dermatoses are available in the literature. Our study is an analysis of the range and frequency of skin diseases presenting to the Italian Dermatological Center in a pediatric Ethiopian population. A retrospective analysis was performed on 17,967 medical records of children aged 0 to 18 years attending the Italian Dermatological Centre in Mekele (Ethiopia) from January 2005 to December 2009. Infections and infestations accounted for 47% of the disorders seen; fungal infections were the most common (44.1%), followed by bacterial and parasitic diseases. Dermatitis constituted the second most common diagnostic category (24.7%) of the disorders seen, and contact dermatitis was the most common diagnosis (48.8%). Pigmentary disorders and disorders of skin appendages were more common in girls, whereas fungal and parasitic infections were more common in boys. Bacterial and parasitic infections were more common in children younger than 1 year old, fungal infections in those aged 1 to 5.9, and disorders of skin appendages and pigmentary disorders in those aged 15 to 18. These findings demonstrate that most of the disorders seen could be easily managed in clinical practice with appropriate skill development. It is crucial to ensure that training of medical students and pediatricians focuses on accurate recognition, diagnosis, and management of these common skin diseases and that families, teachers, health workers, and nurses be educated about the most common signs of prevalent skin diseases to help facilitate appropriate care.     

Contralateral distribution of nonmelanoma skin cancer between older Hispanic/Latino and non‐Hispanic/non‐Latino individuals

Background A recent review of the SEER database revealed that melanoma and Merkel cell carcinoma occur more commonly on the left side of the body. Similarly, a trend was reported in which nonmelanoma skin cancers (NMSCs) were found to be distributed more frequently on the left side of the body. Objectives To compare the sidedness of NMSC in a large patient population. There were five primary objectives of the present study: (i) to confirm or refute the left‐sided trend of NMSC in the largest patient population studied for asymmetry to date; (ii) to determine whether the left‐sided trend existed in Hispanic/Latino individuals; (iii) to examine skin cancer in older individuals across ethnicities; (iv) to compare distribution across anatomical location and ethnicity; and (v) to measure gender differences in the distribution of NMSC. Methods The last 3026 cases referred to the Mohs surgical unit at the University of Miami Miller School of Medicine during 2008–2011 were reviewed. The patient’s age, gender, tumour side, tumour type, anatomical location and ethnicity were recorded. Results There were 1505 (50·2%) right‐sided tumours and 1495 (49·8%) left‐sided tumours (P = 0·52). The Hispanic/Latino group had a nonsignificant right‐sided trend with 607 (52·7%) right‐sided cases and 545 (47·3%) left‐sided cases (P = 0·06). The non‐Hispanic/non‐Latino group between the ages of 60 and 85 years had 605 (46·9%) right‐sided tumours and 686 (53·1%) left‐sided tumours (P = 0·024). The Hispanic/Latino group between the ages of 60 and 85 years demonstrated 404 (54·0%) right‐sided tumours and 344 (46·0%) left‐sided tumours (P = 0·028). One hundred and fifty‐four skin cancers were located on the upper extremities of non‐Hispanic/non‐Latino individuals with 64 (41·6%) being right sided and 90 (58·4%) left sided (P = 0·036). Seventy‐eight skin cancers were located on the upper extremities of Hispanic/Latino individuals with 49 (62·8%) being right sided and 29 (37·2%) left sided (P = 0·024). Males had most of the skin cancers at 2125 (70·8%) cases and females had 875 (29·2%) cases (P < 0·001). Conclusions NMSC appears to be more common on the left side of older non‐Hispanic/non‐Latino individuals, while it is more common on the right side of older Hispanic/Latino individuals. This is likely to be secondary to an environmental factor, such as ultraviolet radiation. NMSC is significantly more common in males relative to females, which may be attributed to differences in gender roles or referral practices.     

Dermatological diseases presented before COVID‐19: Are patients with psoriasis and superficial fungal infections more vulnerable to the COVID‐19?

Recent studies have focused on the comorbid conditions of the COVID‐19. According to the current studies, numerous diseases including lung disease, cardiovascular disease and immunosuppression appear to be at higher risk for severe forms of the COVID‐19. To date, there are no data in the literature on the comorbid dermatologic diseases and COVID‐19. We tried to analyze the previous dermatological comorbidity of 93 patients with COVID‐19 (51 males, 42 females) who presented to the dermatology outpatient clinics for the last 3 years. The most common dermatologic diseases in patients with COVID‐19 who have dermatologic diseases for the last 3 years were superficial fungal infections (24, 25.8%), seborrheic dermatitis (11, 11.8%), actinic keratosis (10, 10.8%), psoriasis (6, 6.5%), and eczema (6, 6.5%), respectively. In addition, the number of COVID‐19 patients who presented to dermatology in the last 3 months was 17 (11 men, 6 women). The median age of these patients was 58 (minimum 18, maximum 80) years, and the most common dermatologic diseases before diagnosed COVID‐19 were superficial fungal infections (5, 25%), psoriasis (4, 20%), and viral skin diseases (3, 15%). The possible similarity between cutaneous and mucosal immunity and immunosuppression suggests that patients with some dermatologic diseases especially superficial fungal infections and psoriasis may be more vulnerable to the COVID‐19.     

Occupational dermatoses in a plant producing binders for paints and glues

A survey of occupational dermatoses, based on a questionnaire, clinical examination and patch testing, was carried out among present and former employees in a plant producing binders for glues and paints. The binders are chemically based on vinyl acetate and/or acrylates. Preservatives are needed and those based on methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) are the most commonly used. The questionnaire was answered by 83 out of 85 present employees (97.6%) and 12 out of 15 former employees (80.0%). 76 of the present (89.4%) and 11 of the former employees (73.3%), respectively, participated in the clinical examination and patch testing, which was conducted with a standard test series and chemicals from the work environment. Occupational dermatosis was diagnosed in 22 present workers (28.9%). Irritant and allergic contact dermatitis was demonstrated in 9 (11.8%) and 13 (17.1%) employees, respectively. Occupational contact allergy to acrylates and formaldehyde was detected in 3 workers and 1 worker, respectively. 12 individuals (9 present and 3 former production workers) had an occupational contact allergy to MCI/MI. 4 of the present workers had spilled Kathon LX on their skin resulting in chemical burns and allergic contact dermatitis. In total, the figure for occupational skin diseases among all present production workers was 40.4%.     

Prevalence of skin diseases among male adolescent and post-adolescent boarding school students in Turkey

Skin disease is a common problem in boarding schools and may account for significant morbidity. To document the prevalence and patterns of skin diseases among male adolescent and post-adolescent boarding school residents, a cross-sectional epidemiologic survey was performed. A total of 682 students were examined for evidence of any skin disease, and subjects with skin disease(s) were also asked to fill in a questionnaire. Of the study population, 378 (55.42%) had at least one skin disease. The most prevalent diseases were tinea pedis (32.5%), acne vulgaris (28.6%), onychomycosis (8.06%), androgenetic alopecia (5.6%), common warts (5.3%), unguium incarnatus (4.1%), irritant hand dermatitis (3.6%), foot callosities (3.6%), and pitted keratolysis (2.6%). Of those with skin problem(s), 245 (65%) were not aware of their disease(s) and 45% of the remaining 133 subjects who were aware of their disease(s) had not sought medical help. We concluded that skin diseases, especially foot problems, are very common among male boarding school students. In additional to monitoring the epidemiology of skin diseases, intermittent medical education programs for both health-care workers and residents living in these communities would be useful for enhancing knowledge of available and effective treatments and implementing appropriate preventive measures.     

Skin diseases in rural Nyala,Sudan (in a rural hospital,in 12 orphanages,and in two refugee camps)

Skin diseases are considered to be common in Nyala, Sudan. This study was carried out to verify the prevalence of skin diseases in Nyala. This prospective observational study included skin examination of a total of 1802 people: 620 patients who were evaluated in the outpatient clinics (OC) and 1182 people from orphanages and refugee camps (ORC) in Nyala, Sudan. χ² test was used. The total prevalence of skin disorders in the sample was 92.6% (1670/1802). One thousand and fifty of 1182 (88.8%) people from ORC had a skin disorder. The most common skin diseases in this community were: fungal infections (32.6%), dermatitis/eczema (10.5%), bacterial skin infections (10.3%), disorders of skin appendages (8.7%), parasitic infestations (7.7%), atrophic skin disorders (7.4%), disorders of pigmentation (7.4%), hypertrophic skin disorders (6.4%), viral infections (5.8), benign neoplasm (1.9%), dermatoses due to animal injury (0.4%), bullous dermatoses (0.1%), and malignant neoplasm (0.1%). Hypertrophic and atrophic disorders of the skin were mainly lesions of scarification (mostly atrophic) (5.7%) and keloids (5.6%). Fungal infection, bacterial infection, and parasitic infestation were more common in the ORC group, while dermatitis and eczema, disorders of skin appendages, hypertrophic and atrophic disorders of the skin, disorders of pigmentation, and benign neoplasm were more common in the OC group. The prevalence of skin diseases in the rural Nyala was more than our expectation and was dominated by infectious skin diseases. In addition, infectious skin diseases were more common in ORC rather than OC.     

Contact dermatitis in tobacco farmworkers

Occupational skin disease is highly prevalent among agricultural workers. Tobacco cultivation and harvest are particularly hazardous for farmworkers. We report 5 migrant Latino farmworkers in North Carolina with contact dermatitis related to tobacco work. These cases show a characteristic distribution of contact dermatitis; the flexural and medial surfaces of the upper extremities were affected in each case, whereas most cases showed some involvement of the torso and axilla. This pattern most likely reflects a common occupational practice of holding the tobacco leaves under the arm and pressed against the body during harvesting.     

援鄂抗击新型冠状病毒肺炎医护人员的皮肤损伤和皮肤病调查

目的：对援鄂抗击新型冠状病毒肺炎医护人员的皮肤损伤和皮肤病发生情况进行调查分析。方法：利用问卷网制作调查问卷,通过微信群发放二维码在线填写。内容包括受访者的基本情况、皮肤症状和皮肤病发生情况。结果：共155名医护人员完成调查,其中医生52名（33.55%）,护士103名（66.45%）;男64名（41.29%）,女91名（58.71%）,平均年龄35.32岁。援鄂期间每天洗手大于10次的140名（90.32%）。最常见的皮肤症状为压痕（88.39%）、皮肤干燥（63.23%）、多汗（50.97%）。压痕和压疮最常见的部位是鼻梁（83.94%）。最常见的皮肤病为湿疹（24.52%）、痤疮（21.94%）和毛囊炎（21.29%）。结论：援鄂医护人员皮肤损伤和皮肤病发生率高,需要进行干预。     

Occupational allergic contact dermatitis and patch test results of leather workers at two Indonesian tanneries

Background. Tannery workers are at considerable risk of developing occupational contact dermatitis. Occupational skin diseases in tannery workers in newly industrialized countries have been reported, but neither the prevalence of occupational allergic contact dermatitis nor the skin‐sensitizing agents were specifically examined in those studies. Objectives. To assess the prevalence of occupational allergic contact dermatitis in Indonesian tanneries, identify the causative allergens, and propose a tannery work series of patch test allergens. Patients/methods A cross‐sectional study in all workers at two Indonesian tanneries was performed to assess the prevalence of occupational contact dermatitis via a questionnaire‐based interview and skin examination. Workers with occupational contact dermatitis were patch tested to identify the causative allergens. Results. Occupational contact dermatitis was suspected in 77 (16%) of the 472 workers. Thirteen (3%) of these 472 workers were confirmed to have occupational allergic contact dermatitis. Potassium dichromate (9.2%), N,N‐diphenylguanidine (5.3%), benzidine (3.9%) and sodium metabisulfite (2.6%) were found to be the occupationally relevant sensitizers. Conclusions. The sensitization pattern showed some differences from the data in studies reported from other newly industrial countries. We compiled a ‘tannery work series' of allergens for patch testing. A number of these allergens may also be considered for patch testing in patients with (leather) shoe dermatitis.     

Pattern of contact sensitivity in Indian patients with hand eczema

One hundred consecutive patients with hand eczema were patch tested with the Indian Standard Series and indigenous antigens after a detailed history and clinical examination. Both sexes were involved and the majority of them were in the age group between 20-39 years (56%). Their occupational profile varied in order of frequency from household work (37%), to masons (14%), students (11%), factory workers (7%), and others (31%). Itching was the most common presenting complaint (93%). A history of atopy was found in 36% of the patients. The predominant sites involved were the palms (43%), followed by fingers (32%), dorsum (17%), and the entire hand (8%). Dry, scaly skin was the most common morphological picture, followed by hyperpigmentation, fissuring, and lichenification. Based on history, clinical examination and patch test results, the diagnosis was made as allergic contact dermatitis in 67% of cases and irritant contact dermatitis in 15% of cases. Positive patch tests with one or more allergens were noted in 67% of the patients. Vegetables (21%) were found to be the most common sensitizers, followed by nickel sulphate (20%), potassium dichromate (18%), and others. Wet work, soaps, and detergents were found to be the most offending irritants. The present study confirmed the fact that hand eczema is a multifactorial disease caused by both irritants and allergens.     

Community health workers reduce skin diseases in East African children

Background Epidemiologic data concerning skin diseases in many rural areas in sub-Saharan Africa are not available. Little is known about the effect of regular treatment schedules by paramedical staff (especially community health workers) in the primary healthcare system on the severity and prevalence of dermatoses. Methods 5780 school and pre-school children from 13 primary schools in four sublocations in rural western Kenya (Kisumu District) were examined for dermatoses by the author, together with community health workers in 1993. On-the-spot training and weekend seminars about important and common dermatoses were also given. In 1994 a dermatology program was started within the primary healthcare system. Twelve trained community health workers carried out regular school visits once a week and diagnosed and treated pupils with dermatoses. Treatment was performed with gentian violet 1% solution for bacterial skin infections, Whitfield’s ointment for dermatophytoses, benzylbenzoate emulsion 25% for scabies, and hydrocortisone acetate 1% cream for eczemas. All schools were visited again in 1995 to evaluate the long-term effects of the program. Results In 1993, the prevalence rate for dermatoses was 32.4%. Most of the skin diseases found were of infective origin (27.1% were caused by bacteria, 21.6% by fungi, and 17.6% by arthropods, mainly scabies mites). Dermatitis accounted for 3.5%. In 1995, the prevalence of dermatoses declined to 29.6% (p<0.05), and this reduction was most strongly observed for tropical ulcers and tinea capitis. Additionally, there was an improvement in the extent and severity of skin diseases. Conclusions This study defines, for the first time, the number and extent of skin diseases in children in rural Kisumu District; most dermatoses were of infective origin. The study demonstrates that community health workers in the primary healthcare system are capable of dealing successfully with the most common dermatoses in children following a short training period.     

Analysis of the demand for dermatological care in the immigrant population served by hospital Miguel Servet in Saragossa, Spain

IntroductionIn recent years there has been an increase in the size of the immigrant population consulting dermatology services in Spain. The aim of this study was to describe the epidemiological characteristics of this sector of the population in the health care area served by Miguel Servet Hospital in Saragossa, Spain.Material and methodsData were collected on immigrant patients seen in the dermatology department of our hospital during 2004. Dermatological diagnoses were classified according to the International Classification of Diseases, Ninth Revision, Clinical Modification. Statistical analysis was undertaken using the SPSS statistical package, Access database management software, and Excel spreadsheets.ResultsA total of 706 patients were seen, corresponding to approximately 4% of all first appointments, and more women were seen than men, a difference that was statistically significant. The mean age of the patients was 31 years and there were no statistically significant differences in age between the sexes.In order of frequency, the most common countries of origin of the patients were Ecuador, Colombia, Romania, Morocco, Gambia, Guinea, and Senegal.The most common skin diseases in this population group were infectious diseases, in particular mycoses, followed by viral diseases and pyodermatitis, as well as sexually transmitted diseases. In all cases, the incidence of the disease was higher than in the Spanish population.ConclusionsAn appropriate knowledge of dermatological diseases in this population group is necessary both to obtain correct diagnosis and to develop preventative measures for imported diseases.     

Occupational skin diseases

Occupational skin diseases are the most commonly reported notifiable occupational diseases. In Germany, 23 596 out of a total of 71 263 reported occupational diseases in 2010 were classified as occupational skin diseases (BK No. 5101: “severe or recurrent skin diseases which have forced the person to discontinue all occupational activities that caused or could cause the development, worsening, or recurrence of the disease”). Contact dermatitis (allergic, irritant) of the hands is the most common skin disease and atopic skin diathesis is often an important co‐factor. The number of work‐related skin diseases is many times higher than the number of notified occupational dermatoses. This CME article explains the legal framework of occupational diseases, the tasks and obligations of the legal statutory work insurance. Typical allergens and irritants of high risk professions are also presented as are the important steps from diagnosis to compensation. Early prevention of occupational skin diseases is very important to avoid severe chronic hand eczema. Therefore the “dermatologist's report” is crucial. Other occupational dermatoses (outside of BK 5101) are briefly mentioned. In recent years the number of notifications of occupational skin cancer due to occupational UV‐irradiation has increased. According to recent epidemiological findings, there is a significant and consistent positive association between occupational UV‐irradiation and squamous cell carcinoma. Therefore, an important criterion for a new occupational disease is fulfilled.