Journal of Taibah University Medical Sciences (2013) 8(1), 31–37

Taibah University

Journal of Taibah University Medical Sciences

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Clinical Study

Epidemiological spectrum of common dermatological conditions of

Ibrahim A. Al-Hoqail, MD

Department of Dermatology, College of Medicine, King Saud University, Kingdom of Saudi Arabia
Al-Majmaah University, Majmaah, Riyadh, Kingdom of Saudi Arabia

Received 6 September 2012; revised 16 November 2012; accepted 11 December 2012

KEYWORDS Abstract Background: Skin diseases and their complications are a significant burden on the health
Dermatological conditions; system of many nations. Epidemiological studies to determine the burden of skin diseases are
Dermatitis; important for proper healthcare planning. A paucity of data exists concerning the epidemiological
Epidemiological spectrum status among patients attending dermatologic consultations in university-affiliated clinics in the
Al-Majmaah Region (Kingdom of Saudi Arabia), prompting a need for conducting this study in
this area.
Objective: To identify the patter/spectrum of dermatological disorders in the outpatient setting
by dermatologists in order to improve future patient care and cost reduction through physician edu-
cation.
Methods: In this retrospective follow up, a multistage sampling technique was employed and
1006 patients with skin disorders were randomly selected from dermatology clinics between Septem-
ber 2011 and March 2012.
Results: A total of 1006 collected patient’s data included males 47.2% (mean age 27.24 ± 15.2)
and females 52.8% (mean age 27.62 ± 14.2). The patients were divided into different age groups as
0–10 (n = 102), 11–20 (n = 273), 21–30 (n = 293), 31–40 (n = 178), 41–50 (n = 71), 51–60
(n = 56) and 61 ears and above (n = 33). The dermatological referrals randomly selected in the
present study showed that the maximum number of disorders were present in patients under the
age group 21–30 years (293/1006). Eczema was the most frequent diagnosis, comprising 15.81%
(159/1006) while acne 14.71% (148/1006) was the second most common diagnosis followed by der-
matitis 12.33% (124/1006) among noninfectious dermatological disorders. The infectious dermato-
logical conditions largely included viral infection 13.32% (134/1006), fungal infection 7.56% (76/
1006) and bacterial infection 6.96% (70/1006). Under noninfectious dermatological disorders, the

Corresponding author: Associate Professor of Dermatology, King Saud University, Vice Rector, Al-Majmaah University, P.O. Box 66,
Majmaah, Riyadh, Kingdom of Saudi Arabia. Tel.: +966 1 463 4551; fax: +966 1 463 4487.
E-mail: [email protected]
Peer review under responsibility of Taibah University.

Production and hosting by Elsevier

1658-3612 ª 2013 Taibah University. Production and hosting by Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jtumed.2013.01.011
32 I.A. Al-Hoqail

number of patients infected with eczema was significantly higher (p < 0.05) in females 18.6% (99/
531) as compared to males 12.6% (60/475). However the male exhibited significantly higher cases of
dermatitis than females [male: 69 (14.5%) vs. female: 55 (10.4%), p < 0.05]. Of all the infectious
disorders related to dermatological conditions, the viral infection was more prevalent in males
13.7% (65/4750) and in females 13% (60/531). In the age group 21–30 years (293), eczema
16.4% (48/293), dermatitis 11.3% (33/293) and psoriasis 5.1% (15/293) were prevalent among
the noninfectious dermatological disorders. The infectious dermatological disorders showed the
prevalence of viral infection 9.2% (32/293) significantly higher than bacterial infection 3.8% (11/
293) and fungal infection 3.4% (10/293).
Conclusions: The spectrum of different dermatological conditions in Al-Majmaah Region
(Kingdom of Saudi Arabia) is alarming and seems to be highly neglected by the community.
Eczema was the most frequent diagnosis among all skin diseases and parasitic infections were
the least frequent diseases in this study. Health education is therefore necessary to curb their spread,
reduce the associated morbidity, and improve the health status of the population. This will provide
a better understanding of the epidemiology of skin disorders.
ª 2013 Taibah University. Production and hosting by Elsevier Ltd. All rights reserved.

Introduction Aims of the present study

Dermatology is often considered as an outpatient service by To characterize the profile of patients and the scope & referral
many physicians with very little attention given to admit pattern of outpatient dermatology consultations in tertiary
patients.3,13 Cutaneous diseases are diverse in clinical hospital at Majmaah, a subject that has not been well studied
presentation, severity and epidemiology. Dermatological previously.
conditions can be sudden in their onset and distressing to
the patient. Material and Methods
The referral pattern of acute dermatologic conditions is not
well described in either outpatients or hospitalized patients. Study design and setting
Despite the fact that skin disease is often associated with less
expensive diagnostic and therapeutic procedures and limited The Dermatology Clinic at King Khaled Hospital at
mortality, skin disorders are a leading cause of disability in Al-Majmaah and Sudayr Hospital caters both outpatient and
the society.4 Data from several studies on the overall commu- inpatient to those living within, around its current geographical
nity-based prevalence of skin diseases in developing countries setting. Al-Majmaah Governorate borders the Eastern Prov-
indicate that they are quite common, ranging from 20% to ince and Al-Qasim to the north, Thadig and Shaqra to the
80% and most of them result from infections such as superfi- south, Rumah to the east, and Zulfi and al-Ghat to the west.
cial mycoses, pyodermas and scabies.1,6 The prevalence of der- It has hot and dry summers, cold winters and rainfall in April
matological disorders among admitted patients reported by and May.
some of these studies shows an almost similar spectrum, differ- This was a retrospective study reviewing all outpatient
ing only in magnitude between developing and developed referrals for dermatology consultations at King Khaled Hospi-
countries.9 tal, Al-Majmaah and Sudayr Hospital (Sudayr). All new and
Monitoring trends in the number and type of referrals to old patients attending a dermatology clinic for skin problems
dermatology out-patient clinics is important in predicting the during this period were included in this study.
future developments, although the incidence of skin disease
can only be determined accurately by large scale population Ethical issue
surveys such as that in Lambeth in 1976.7 The frequencies of
the main diagnoses were determined, categorized and tabu- Approval for conducting the present study was obtained from
lated and the diseases were classified into different groups the Institutional Research Committee of Al-Majmaah,
according to the frequency of their presentation using the Al-Majmaah University. Subjects’ privacy and data confiden-
International Classification of Diseases8 and the Rook Text- tiality were maintained throughout the study.
book of Dermatology.
The pattern of skin diseases is, among other parameters, an Data analysis
index of community development and of quality of the pro-
vided care. An effort to improve primary care and alleviate Data entry and data processing was carried out using Statisti-
the burden on hospital care should be the target of a health cal Package for Social Sciences (SPSS) V19.0 software (SPSS
policy. Finally, it is hoped that this update will help correct, Inc; Chicago IL, USA; www.spss.com). Statistical significance
if necessary, any long-established but inaccurate notions about was determined by the two tailed t-tests. A p-value of less than
skin disorders affecting the region’s populace. 0.05 (p < 0.05) is considered statistically significant.
Epidemiological spectrum of common dermatological conditions 33

age of patients with skin problems was 27.4 ± 14.7 years, and
Table 1: Spectrum of different dermatological disorders present
there were more women (52.8%) than men (47.2%) with a
among the dermatological consultation randomly selected.
male to female ratio of 1:1.2 (Table 1). The patients were di-
Dermatological disorders No. of cases (n) Percentage vided into different age groups; 0–10, 11–20, 21–30, 31–40,
Infectious disorders 41–50, 51–60 and 61 years and above. Age distribution of dif-
Viral Infection 134 13.32 ferent dermatological condition is shown in Figure 2. The der-
Fungal Infection 76 7.56 matological referrals randomly selected in the present study
Bacterial Infection 70 6.96 showed that the maximum number of disorders were present
Parasitic Infection 8 0.8 in patients in the age group between 21 and 30 (293/1006).
Total 288 28.64 The most common noninfectious and infectious dermato-
Noninfectious dermatological disorders logical conditions among the patients attending outpatient der-
Eczema 159 15.81 matological consultation as represented in Table 1. Acne
Acne 148 14.71 14.71% (148/1006) and allergic skin disorders such as derma-
Dermatitis 124 12.33 titis 12.33% (124/1006) and eczema 15.81% (159/1006) were
Alopecia 61 6.06 very common among all dermatological consultations included
Psoriasis 43 4.27
in this study. Alopecia 6.06% (61/1006), psoriasis 4.27% (43/
Keratosis 35 3.48
Vitiligo (pigmentation disorder) 30 2.98
1006), keratosis 3.48% (35/1006) and vitiligo 2.98% (30/
Urticaria 26 2.60 1006) were among the moderately prevalent dermatological
Rosacea 16 1.59 disorders and referrals included in this study. Viral infection
SLE 15 1.49 13.22% (134/1006) turned out to be the most dominating of
Drug eruption 13 1.29 all the infectious dermatological disorders followed by fungal
Erythema 6 0.60 infection 7.56% (76/1006), bacterial infection 6.96% (70/
Hirsutism 5 0.50 1006) and parasitic infection 0.8% (8/1006) (Table 1).
Skin tags 5 0.50 Under noninfectious dermatological disorders, the number
Papular granuloma 4 0.40 of patients infected with eczema was significantly higher
Scar (ethnic/burn) 4 0.40
(p < 0.05) in females 18.6% (99/531) as compared to males
Keloid scar 3 0.30
ILVEN 3 0.30
12.6% (60/475) Table 2. However, the incidence of dermatitis
Lichen simplex chronicus 2 0.20 was significantly higher in males as compared to females [male:
Others 16 1.55 69 (14.5%) vs female: 55 (10.4%), p < 0.05].
Total 702 69.81 Acne 14.7% (78/531), hairfall 6.6% (35/531) and psoriasis
3.2% (17/531) were the other skin conditions prevailing in
the female population (Table 2). On the other hand, males
showed dominance of other skin conditions like acne 14.7%
Results (70/475), hairfall 5.5% (26/475) and psoriasis 5.5% (26/475).
The pigmentation disorder, vitiligo was found to be 3.2%
Between September 2011 and March 2012, 1006 patient’s (15/475) in males and 2.8 (15/531) in females. There was no sig-
charts were reviewed to determine who were presented to pri- nificant difference between the males and females in compari-
mary care physician with at least one skin problem. The mean son of infectious diseases. Of all the infectious disorders related

Figure 1: Graphical representation of the most common dermatological conditions present among the dermatological referrals separated
as noninfectious and infectious dermatological disorder.
34 I.A. Al-Hoqail

Figure 2: Distribution of Dermatological referrals according to different age groups.

Discussion
Table 2: Prevalence of noninfectious and infectious dermatolog-
ical disorders between the male and female population. Skin disorders can no longer be regarded as trivial for the
majority of the populace within our country. Monitoring
Dermatological conditions prevalent in male and female
trends in the number and type of referrals to dermatology
Diseases Male (n = 475) Female (n = 531) out-patient clinics is important in predicting the future devel-
Noninfectious dermatological disorders opments of our service. In light of this the author evaluated
Acne 70 (14.7) 78 (14.7) p = ns skin disease for a defined period of time. It is only by securing
Dermatitis 69 (14.5) 55 (10.4) p < 0.05 knowledge of the incidence of diseases affecting a population
Eczema 60 (12.6) 99 (18.6) p < 0.01 that effective planning and recommendations can be made
Hairfall 26 (5.5) 35 (6.6) p < 0.05
and appropriate healthcare resources of the nation be directed
Psoriasis 26 (5.5) 17 (3.2) p < 0.05
to the needs of the people. Thereby giving due consideration
Vitiligo 15 (3.2) 15 (2.8) p = ns
Urticaria 14 (2.9) 11 (2.1) p = ns towards ameliorating the increasing morbidity of dermatology.
Rosacea 5 (1.1) 11 (2.1) p < 0.05 Lacunae in literature on the patterns and specific skin diseases
Pruritis 6 (1.3) 1 (0.11) p < 0.05 due to unavailability of sufficient data in Kingdom of Saudi
Keratosis 7 (2.3) 21 (4) p < 0.01 Arabia led to conduct the present study.
Systemic lupus erythematous 4 (0.77) 12 (2.3) p < 0.05 The prevalence of various skin diseases varies according to
Infectious dermatological disorders geographical area and is related to racial, environmental and
Viral infection 65 (13.7) 69 (13) p = ns socioeconomic factors of the population. The developed coun-
Bacterial infection 34 (7.2) 28 (5.3) p < 0.05 tries reported the prevalence of eczema and dermatitis among
Fungal infection 33 (6.9) 41 (7.7) p < 0.05 the various dermatological conditions while skin infections are
Parasitic infection 3 (0.6) 5 (0.94) p = ns predominant in developing African and Asian countries.10,11
Souissi et al.12 reported fungal infections as the most fre-
quently seen skin conditions (43.8%) in Tunis where the rate
to dermatological conditions, the viral infection was more pre- of skin infection was 38.6% (28224 patients). Another study
valent in males 13.7% (65/4750) and females 13% (60/531) from Iran2 presented the occurrence of infectious and parasitic
(Table 2). diseases, including infections of the skin and subcutaneous
The pattern and the relative frequency of skin diseases tissues.
among all patients based on age groups are shown in Table 3. Seasonal variations in certain skin disorders are a well-
The age group 0–10 (n = 102) presented dominance of derma- known phenomenon that has been observed for centuries. A
titis 16.7% (17/102) and eczema 10.8% (11/102). In the age change in temperature, humidity, ultraviolet rays, wind and
group 11–20 (n = 273), eczema was 18% (48/273) and derma- atmospheric pollen allergens occurs with changing seasons.
titis was 9.9% (27/273). In age group 21–30 (293), eczema Low temperature and humidity can have a detrimental effect
16.4% (48/293) and dermatitis 11.3% (33/293) were prevalent on the epidermal barrier. When comparing the climate in our
among the noninfectious dermatological disorders. The most study setting with the climate in the settings of the studies con-
frequently occurring noninfectious dermatological disorders ducted in Kingdom of Saudi Arabia, we observed that Riyadh,
in the age group 31–40 (n = 178) were dermatitis 15% (27/ Jouf, Hail were similar, while the Asir region had a moderate
178) and eczema 12% (22/178). In the age group 41–50 climate and was rainy at most times of the year and had higher
(n = 71), the dermatological conditions comprised largely of humidity levels than Qassim, whereas Jeddah and the eastern
dermatitis 18.3% (13/71), eczema 15.5% (11/71). Viral infec- region have hot humid summers and moderately cold
tion was significantly higher among the different infectious winters.21
dermatological disorders in the age groups: 0–10 34.3% (34/ In the present study, the incidence of viral, fungal, bacterial
102); 11–20 9.2% (25/273); 21–30 9.2% (32/293); 31–40 13% and parasitic infections was found to be 28.6%. Out of all
(23/178); and 41–50 (n = 71) 14.1% (10/71). Furthermore, these infectious disorders, viral infection was the most preva-
the distribution of dermatological disorders among males lent. The top 5 non-infections dermatological disorders were
and females based on their different age groups is represented eczema, acne, dermatitis, alopecia and psoriasis (Figure 1;
in Table 4. Table 2). The results of this study are comparable to those
Epidemiological spectrum of common dermatological conditions 35

Table 3: Frequency and percentage of dermatological conditions in different age groups defined in the study.
Dermatological 0–10 years 11–20 years 21–30 years 31–40 years 41–50 years 51–60 years 61 years and
Conditions (n = 102) (n = 273) (n = 293) (n = 178) (n = 71) (n = 56) above (n = 33)
Noninfectious dermatological disorders – frequency (%)
Acne 1 (1) 87 (31.9) 18 (6.1) 12 (6.7) 3 (4.2) – –
Dermatitis 17 (16.7) 27 (9.9) 33 (11.3) 27 (15) 13 (18.3) 6 (10.7) 1 (3)
Eczema 11 (10.8) 48 (18) 48 (16.4) 22 (12) 11 (15.5) 8 (14.3) 11 (33.3)
Vitiligo 4 (3.9) 8 (2.9) 4 (1.4) 6 (3.4) 4 (5.6) 4 (7.1) –
Drug eruptions 4 (3.9) – 2 (0.7) 5 (2.8) – 2 (3.6) –
Hairfall – 19 (7) 11 (3.8) 1 (0.6) 2 (2.8) 2 (3.6) –
Psoriasis 1 (1) 5 (1.8) 15 (5.1) 18 (10.4) 3 (4.2) 1 (1.8) 1 (3)
Rosacea – 4 (1.5) 12 (4.1) – – – –
Urticaria 2 (2) 1 (0.4) 10 (3.4) 4 (2.2) 2 (2.8) 3 (5.4) 3 (9.1)
Systemic lupus – – – 9 (5.1) – – –
erythematosus
(SLE)
Keratosis 1 (1) 5 (2) 1 (0.3) 6 (3.4) 6 (8.5) 11 (19.6) 1 (3)
Pruritis – – – – 2 (2.8) 3 (5.4) 3 (9.1)
Infectious dermatological disorders – frequency (%)
Viral Infection 34 (34.3) 25 (9.2) 32 (9.2) 23 (13) 10 (14.1) 7 (12.5) 2 (6.1)
Bacterial Infection 5 (4.9) 15 (5.5) 11 (3.8) 16 (9) 1 (1.4) 3 (5.4) 2 (6.1)
Fungal Infection 3 (2.9) 19 (7) 10 (3.4) 12 (6.7) 7 (9.9) 3 (5.4) 5 (15.2)
Parasitic Infection 4 (3.9) – – – – – –

Table 4: Spectrum of different dermatological disorders in males and females of different age groups.
Age groups Dermatological Conditions Frequency (%) Dermatological Conditions Frequency (%)
0–10 Years Male (n = 54) Female (n = 48)
Noninfectious dermatological disorders
Eczema 3 5.6 Eczema 8 16.7
Dermatitis 11 20.4 Dermatitis 6 12.5
Infectious dermatological disorders
Viral Infection 20 37 Viral Infection 15 31.3
Bacterial Infection 3 5.6 Bacterial Infection 2 4.2
Fungal Infection 3 5.6 Fungal Infection 2 4.2
Parasitic Infection 3 5.6 Parasitic Infection 2 4.2
11–20 Years Male (n = 129) Female (n = 144)
Noninfectious dermatological disorders
Acne 41 31.8 Acne 46 31.9
Eczema 22 17 Eczema 26 18.1
Dermatitis 10 7.8 Dermatitis 17 11.8
Vitiligo 7 5.4 Keratosis 3 2.1
Hairfall 6 4.7 Hairfall 12 8.3
Rosacea 3 2.1
Psoriasis 3 2.1
Infectious dermatological disorders
Viral Infection 11 8.5 Viral Infection 14 9.7
Bacterial Infection 12 9.3 Bacterial Infection 3 2.1
Fungal Infection 8 6.2 Fungal Infection 11 7.6
21–30 Years Male (n = 136) Female (n = 157)
Noninfectious dermatological disorders
Eczema 23 17 Eczema 25 15.9
Acne 17 13 Acne 27 17.2
Dermatitis 15 11 Dermatitis 18 11.5
Hairfall 14 10.3 Hairfall 16 10.2
Psoriasis 12 8.8 Vitiligo 2 1.3
Urticaria 9 6.6 ILVEN 2 1.3
Infectious dermatological disorders
Viral Infection 14 10.3 Viral Infection 20 37
Bacterial Infection 10 7.3 Bacterial Infection 3 5.6
Fungal Infection 10 7.3 Fungal Infection 3 5.6
36 I.A. Al-Hoqail

Table 4: (Continued).
Age groups Dermatological Conditions Frequency (%) Dermatological Conditions Frequency (%)
31–40 Years Male (n = 79) Female (n = 99)
Noninfectious dermatological disorders
Dermatitis 18 22.8 Dermatitis 9 9.1
Psoriasis 11 13.4 Psoriasis 7 7.1
Acne 8 10.1 Acne 4 4
Drug Eruption 5 6.3 SLE 8 8.1
Keratosis 3 3.8 Keratosis 3 3
Vitiligo 4 4
Infectious dermatological disorders
Bacterial Infection 7 8.9 Viral Infection 1 1
Fungal Infection 5 6.3 Bacterial Infection 7 7.1
Viral Infection 9 11.4 Fungal Infection 14 14.1
41–50 Years Male (n = 32) Female (n = 39)
Noninfectious dermatological disorders
Dermatitis 10 31.3 Dermatitis 3 7.7
Eczema 3 9.4 Eczema 8 20.5
Acne 2 6.3 Acne 1 2.6
Keratosis 1 3.1 Keratosis 5 12.8
Vitiligo 3 9.4
Hairfall 2 6.3
Infectious dermatological disorders
Viral Infection 3 9.4 Viral Infection 6 15.4
Fungal Infection 6 15.4
51–60 Years Male (n = 27) Female (n = 29)
Noninfectious dermatological disorders
Keratosis 6 22.2 Keratosis 5 17.2
Dermatitis 4 12.8 Dermatitis 2 6.9
Eczema 2 7.4 Eczema 5 17.2
Drug Eruption 2 7.4 Vitiligo 4 13.8
Urticaria 3 10.3
Infectious dermatological disorders
Viral Infection 6 22.2 Bacterial Infection 3 10.3
Fungal Infection 3 11.1
61 Years and above Male (n = 18) Female (n = 15)
Noninfectious dermatological disorders
Eczema 4 22.2 Eczema 7 46.7
Pruritis 2 11.1 Pruritis 1 6.7
Urticaria 2 13.3
Infectious dermatological disorders
Fungal Infection 3 16.7 Fungal Infection 2 13.3
Bacterial Infection 2 11.1 Viral Infection 1 6.7

of other studies from Riyadh, Abha, Jouf, Hail, Jeddah, Naj- fungal infection was significantly higher in females as com-
ran, the Eastern Province and the Asir region of Kingdom of pared to the males.
Saudi Arabia.14–20 Similar spectrum of dermatological disor- Due to the short period of the study, it is advisable that fur-
ders amongst Saudi Arabian population has been reported in ther analytical studies are to be carried out for longer periods
these studies. of time. The seasonal variation of skin diseases; where this
The first 3 commonest presentations according to age study was conducted may not reflect the pattern in different
groups was presented in Table 4 which revealed that Acne seasons throughout the whole year.
and eczema were the commonest diagnosis in the 11–20 age
group, while viral infections is the commonest among the 0– Conclusion
10 age group which may be due to poor hygiene and easiness
of exposure to contagions. The age group between 21 and 30 This is the first study in which patients were followed up (via
presented the most dermatological disorders among all the se- their records) from their presentation at a primary care clinic
lected subjects in the present study. Further it was noticed that through their referral to a dermatologist. However, the popu-
the female population (18.6%) showed higher incidence of ec- lation studied was a selected group who had been referred to a
zema as compared to males (12.6%). Viral infection was more dermatology clinic, and therefore may be biased. Studies
common among the females but the difference between males similar to ours in a community will help confirm the most com-
and females didn’t reach to a level of significance. However, mon conditions seen in dermatology and will provide the
Epidemiological spectrum of common dermatological conditions 37

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