Kiprono et al.

BMC Dermatology (2015) 15:16

DOI 10.1186/s12895-015-0035-9

RESEARCH ARTICLE Open Access

Skin diseases in pediatric patients

attending a tertiary dermatology hospital in
Northern Tanzania: a cross-sectional study
Samson K. Kiprono1,2*, Julia W. Muchunu1 and John E. Masenga1

Abstract
Background: Skin diseases affect 21–87 % of children in developing countries in Africa. However, the spectrum
of the skin diseases varies from region to region due to several factors such as genetics, socioeconomic and
environmental. The aim of this study was to determine the spectrum of childhood skin diseases in Tanzania.
Methods: We conducted a prospective hospital- based cross-sectional study between September 2012 and
August 2013 at a tertiary referral dermatology clinic. Children younger than 14 years presenting with new skin
conditions were recruited. Diagnosis was mainly done clinically, but if the diagnosis was not clinically clear,
further investigations were undertaken accordingly.
Results: A total of 340 patients were recruited of which 56 (16.5 %) had more than one skin condition. Both
genders were equally affected. Infections and infestations accounted for the majority (43.5 %, n = 177) of the skin
conditions followed by eczematous dermatitis (28.5 %, n = 116) and pigmentary disorders (7.4 %, n = 30). Among
the 152 infectious skin diseases, fungal infections predominated (50.7 %, n = 77) in the infectious group followed
by bacterial (29.6 %, n = 45), and viral (19.7 %, n = 30).
Conclusions: Skin infections are still the main cause of dermatological consultations in children although with a
reduced prevalence. Inflammatory skin conditions are increasing and can be attributed to improved
socioeconomic status and HIV pandemic.
Keywords: Pediatric, Skin diseases, Africa

Background infections and infestations are predominant in developing

Skin diseases affect 21–87 % of children in African de- countries [2, 4]. Infections account for 40–80 % of all skin
veloping countries and constitute up to a third of out- diseases in sub-Saharan Africa [5], and most of these
patient visits to Pediatricians and Dermatologists [1, 2]. diseases are preventable. However, Dlova et al. [5] re-
Despite their common occurrence, skin diseases receive ported changing trends in skin conditions among black
less attention as compared with diseases such as mal- South Africans with an increase in inflammatory condi-
aria, pneumonia and HIV/AIDS, which cause signifi- tions. In a community based study done in the 1990s in
cant mortality [3]. Tanzania, it was reported that one-half of the participants
The spectrum of skin diseases differs in different parts with skin diseases were children younger than 15 years
of the world. The patterns of skin diseases have been and the majority had infections [6]. Sub-Saharan Africa
shown to vary according to environmental and socioeco- has realized socioeconomic changes over the last 2
nomic factors [2]. Eczema has been reported to be the decades. Similarly during the same period there was an
predominant skin disease in developed countries, whereas increase in the number of people living with HIV due
to availability of anti-retroviral drugs. Therefore the aim of
* Correspondence: [email protected] this study was to determine the current spectrum of child-
1
Department of Dermatology, Regional Dermatology Training Center, P.O.
Box 8332, Moshi, Tanzania
hood skin diseases in northern Tanzania.
2
Department of Medicine, Moi University School of Medicine, P.O. Box 4606–
30100, Eldoret, Kenya

© 2015 Kiprono et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Kiprono et al. BMC Dermatology (2015) 15:16 Page 2 of 4

Methods infections consisting mainly of tinea capitis (84.4 %,

This was a cross-sectional study conducted at The Re- n = 65). Impetigo was the commonest (46.7 %, n = 21)
gional Dermatology Training Center (RDTC) skin clinic, diagnosis among the 45 children with bacterial infections.
which is a tertiary referral clinic in Northern Tanzania. All Other common bacterial infections were furuncles (24.4 %),
children younger than 14 years who came to the clinic with folliculitis (15.6 %) and ecthyma (13.3 %). Scabies was the
new skin disorders between September 2012 and August only infestation which was diagnosed in 25 patients.
2013 were randomly recruited by selecting every third Among 230 non-infectious skin diseases seen in this
patient that was registered in the clinic until the desired study, the majority (50.7 %, n = 116) was in the ec-
calculated sample size of 340 was obtained. The diagnosis zematous dermatitis group. Atopic dermatitis (92.2 %,
was mainly done clinically, but relevant laboratory investi- n = 107) was diagnosed in the majority of these patients
gations or histopathology was done in cases with unclear with eczema. Pigmentary disorders (13.1 %, n = 30), urti-
diagnosis. Outcomes were analyzed with SPSS version 16 caria and drug reaction (13.3 % n = 32) and genodermato-
and summary statistics obtained. Ethical approval for the sis (5.7 %, n = 13) were among the top five non-infectious
study was granted by The Kilimanjaro Christian Medical dermatoses.
University College ethics and research board. HIV test was done in 243 (71.5 %) children older than
18 months. The HIV prevalence rate in this group was
Results 5.8 % (n = 14). The median CD4 count was 636cells/
A Sample 340 children out of 1,339 children were sampled mm3 with an interquartile range of 279.25. The mean
with a male to female ratio of 1:1. The median age was age of the HIV positive children was 8.4 years. Six
4.2 years and ranged from 1 week to 13.9 years. The patients were currently on anti-retroviral treatment. Skin
majority (60 %) of the children resided in urban areas. A diseases seen in the 14 HIV positive children were flat
total of 407 skin diseases were diagnosed in 340 children warts (28.6 %, n = 4), papular pruritic eruption (28.6 %,
with 56 (16.5 %) children having more than one skin con- n = 4), tinea capitis (21.4 %, n = 3), Kaposi sarcoma
dition. Skin infections and infestation (43.5 %, n = 177) (14.3 %, n = 2) and seborrheic dermatitis (14.3 %, n = 2).
were the most common group of skin diseases. Other There was no association (p = 0.438) between HIV status
common groups shown in Fig. 1 are eczema (28.5 %, n = and cutaneous infections.
116) and Pigmentary disorders (7.4 %, n = 30). Six (1.5 %)
children were diagnosed with tumors. The skin diseases Discussion
were more common in children under the age of 5 years This study was conducted at a tertiary referral skin
(n = 179, 52.6 %) while (n = 87, 25.6 %) and (n = 74, clinic. The findings may not be generalized to other
21.8 %) was seen in age group of 5–10 years and above hospitals in the region or represent the true spectrum of
10 years respectively. the diseases in the community.
The distribution of the skin diseases among 340 chil- Skin diseases are still a major cause of morbidity in
dren are shown on Table 1. Among 152 children diag- children in sub-Saharan Africa [1, 2]. Majority of the
nosed with skin infections, 50.7 % (n = 77) had fungal skin diseases occur in children under the age of 5 years.

Fig. 1 The spectrum of skin diseases in 340 children treated at the Regional Dermatology Training Center
Kiprono et al. BMC Dermatology (2015) 15:16 Page 3 of 4

Table 1 Frequency of 407 cutaneous diseases seen in 340 Table 1 Frequency of 407 cutaneous diseases seen in 340
children attending tertiary dermatology clinic children attending tertiary dermatology clinic (Continued)
Diseases Frequency (%) Genodermatosis (n = 13, 3.8 %)
Bacterial infections (n = 45, 13.2 %) Albinism 7 (2.1)
Impetigo 21 (6.2) Xeroderma pigmentosa 3 (0.9)
Furuncles 11 (3.2) Itchyosis 2 (0.6)
Folliculitis 7 (2.1) Neurofibromatosis 1 (0.3)
Ecthyma 6 (1.8) Tumors (n = 6, 1.8 %)
Fungal infections (n = 77, 22.6 %) Kaposis sarcoma 2 (0.6)
Tinea capitis 65 (19.1) Basal cell carcinoma 1 (0.3)
Tinea facei 4 (1.2) Hemangiomas 3 (0.6)
Tinea corporis 7 (2.1) Others (n = 8, 2.4 %)
Tinea cruris 1 (0.3) Keloid 5 (1.5)
Viral infections (n = 30, 8.8 %) Xerosis 3 (0.9)
Warts 15 (4.4)
Molluscum contagiosum 5 (1.5)
Herpes simplex 4 (1.2) This high prevalence could be due to the lower immun-
ity or higher frequency of hospital visits by infants due
Varicella 4 (1.2)
to greater parental care. Skin infections are the most
Palmoplantar warts 1 (0.3)
predominant skin diseases in children in this study
Measles 1 (0.3) similar to others in developing countries [3, 4] but in
Infestations (n = 25, 7.4 %) contrast to those reported in developed countries [1, 7].
Scabies 25 (7.4) The high prevalence of infections and infestations in the
Eczematous dermatitis (n = 116, 34.1 %) African developing countries has been attributed to low
socioeconomic status, favorable tropical weather, neglect
Atopic dermatitis 107 (31.5)
and poor hygiene [6, 8]. Fungal infections and especially
Contact dermatitis 5 (1.5)
tinea capitis are the most prevalent infections in all ages.
Seborrheic dermatitis 3 (0.9) This could be due to sharing of shaving machines
Nummular eczema 1 (0.3) which a common practice in the community.
Papulosquamous disorders (n = 9, 2.6 %) The low prevalence of viral infections is in contrast to
Pityriasis rosea 7 (2.1) other studies which have shown cutaneous warts to be
the most common infective dermatosis [9]. This may be
Psoriasis 1 (0.3)
due to environmental factors, HIV co-infection or differ-
Lichen planus 1 (0.3)
ence in level of resistance to human papillomas virus
Urticaria and drug reaction (n = 32, 9.4 %) among ethnic communities. Few cases of infestations
Papular urticarial 19 (5.6) (all scabies) were diagnosed in this study in contrast to
Papular pruritic eruption 5 (1.5) what is expected to be in the community. Community
Urticaria and angioedema 4 (1.2) based studies done in Tanzania towards the end of last
century showed the prevalence of transmissible diseases
Fixed drug reaction 3 (0.9)
to be as high as 84 % [6, 10–12] while the current study
Drug exanthema 1 (0.3)
shows that infections and infestations are still the most
Pigmentary disorders (n = 30, 8.8 %) common group of skin diseases seen in a tertiary
Vitiligo 10 (2.9) hospital albeit with a lower prevalence.
Pityriasis alba 10 (2.9) According to Gibbs [6], poor socioeconomic status
Nevi 7 (2.1) was the only significant factor associated with transmis-
sible diseases. An improvement in social and economic
Postinflammatory hyperpigmentation 2 (0.6)
situation during the last 2 decades in Africa may have
Postinflammatory hypopigmentation 1 (0.3)
contributed to a lower prevalence of infectious diseases.
Disorders of skin adnexa (n = 16, 4.7 %) Henderson [12] reported the prevalence of Tungiasis
Acne 11 (3.2) and Pediculosis to be 1.5 and 5 % respectively in rural
Miliaria 5 (1.5) parts of Tanzania. However in this study scabies was the
only infestation diagnosed.
Kiprono et al. BMC Dermatology (2015) 15:16 Page 4 of 4

Pediculosis and tungiasis are still common diseases in participated in data interpretation and critical review of the manuscript.
Tanzania, but they are mostly considered to be clinically All authors read and approved the final draft of the manuscript.

insignificant [6]. No cases of Pediculosis was seen in this Acknowledgement

study. This could be attributed to patients not seeking We thank Prof. Ben Naafs for critically reviewing the manuscript and
medical help or being treated with local traditional Dr. B. Tank for correcting the English.

methods [10]. Likewise, these skin infestations are treated Received: 26 May 2015 Accepted: 6 September 2015
at primary health care facilities and rarely referred to
tertiary hospitals [8, 10].
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Conclusion
Skin infections still remain the leading cause of morbid-
ity among skin diseases despite the urbanization and
changing lifestyle in Tanzania although with a reduced Submit your next manuscript to BioMed Central
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Authors’ contribution
SKK and JWM conceived of the study and participated in data collection,
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