Clinical spectrum of dermatological diseases at a regional hospital

Modi, Zateen
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Background: The frequency of skin disorders varies considerably worldwide and is based on age; ethnicity; gender and geographical region amongst other factors. Tertiary referral hospitals, as well as private practices, serve specific patient profiles and are not necessarily representative of the general population. There is therefore a need for regional hospital research to meet the dermatologic requirements of specific communities. Objectives: This study aims to document the demography and spectrum of dermatological diseases seen at a regional hospital. Methods: A retrospective cross-sectional chart review of all patients (in/out-patients and adults/ children) seen at the dermatology department at Tambo Memorial Hospital between 6 February 2014 and 31 August 2018. All patients were diagnosed by staff (registrars and consultants) of the Division of Dermatology at the University of the Witwatersrand, with the academic head consulted via tele-dermatology for difficult cases. The diagnoses were made clinically with histopathology and biochemical investigations being performed where necessary. The demography and diagnoses were recorded for each patient. The demography was summarized using descriptive statistics. The skin disorders were classified according to the International Classification of Diseases (ICD 10) codes. The patients were divided into 2 age groups: children (0-18 years) and adults (>18 years). Results: We recorded 3150 patients, with 2334 adults (75.7%) and 749 children (23.8%). Females predominated amongst both the adults (60.7%) and children (52.1%). Black Africans comprised the majority of patients across all age groups. The 5 most common diseases identified were eczemas (41.4%; CI 39.7-43.1); infectious diseases (13.3%; CI 12.1-14.5); acne (12.4%; CI 11.2-13.5); papulosquamous disorders (7.6%; CI 7.5-7.7) and pigmentary disorders (5.3%; CI 5.1-5.5). Conclusion: The results of this study are largely consistent with epidemiologic data on skin diseases in South Africa. Noteworthy findings are the dominance of eczema and acne in our study which consolidate the shifting trend in the prevalence of skin disorders. Infections which previously predominated have decreased possibly indicative of general improved living conditions and improved access to specialist healthcare clinics. We are hopeful that the data generated by this study will contribute to an essential drug list which prioritizes common conditions. We have compiled a provisional list, based on our findings and suggest that this could assist towards a national, standardized drug list
A research report submitted to the Faculty of Health Sciences, University of Witwatersrand Johannesburg, in partial fulfillment for the degree of Master of Medicine in the division of Dermatology, 2021