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Skin diseases in paediatric patients

April 08 2016

Skin diseases are a common occurrence amongst children in Africa, with estimates ranging from 21-87% of children affected. However, little attention is given to them compared to diseases such as malaria, and HIV/AIDS. This is despite the fact that skin diseases are still a major cause of morbidity in sub-Sarahan Africa, and the fact that the majority of skin conditions in this area are preventable. The spectrum of skin diseases changes over time, and varies according to environmental and socioeconomic factors. In developed countries, for example, eczema is the most predominant skin disease, whereas infections and infestations are more common in developing countries. It is important therefore to discuss the spectrum of these diseases amongst African populations and the changes that are taking place over time.

In a recent study, Kiprono et al recruited 340 children under 14 years of age, presenting with new skin conditions from a hospital in Northern Tanzania. 44% of the children were diagnosed with a skin infection and for over half of those children, the source of the infection was fungal, with the majority being diagnosed with tinea capitis (n=65). 45 children were diagnosed with bacterial infections, including impetigo, furuncles, folliculitis and ecthyma. 25 patients were diagnosed with scabies, which was the only infestation seen. Over half of the children with non-infectious skin diseases had eczematous dermatitis (n=116), while the rest were diagnosed with a range of diseases including pigmentary disorders, urticaria and drug reactions.

An example of tinea capitis in a child, showing marked hair loss.

One of the changing trends in skin diseases in African populations is the rise in inflammatory conditions, such as eczematous dermatitis, though this is still lower than in developed countries. Other changes include an increase in the number of patients seen with pigmentary disorders. The authors suggest that these changes could be due to a greater number of girls being more cosmetically concerned with changes in their skin colour. HIV has also contributed to changing trends; children are living for longer with HIV, and developing inflammatory skin conditions similar to the adult population.  Notably, a high percentage of fungal infections were found in this population, particularly tinea capitis. The authors suggest that this could be due to sharing of shaving machines, which is a common practice in the community studied.

Though infection remains the leading cause of morbidity amongst skin diseases in Tanzania, the improving socioeconomic status of the country seems to be reducing this frequency, whilst the recent HIV pandemic may be increasing the prevalence of inflammatory diseases. Common community practices such as sharing shavers have contributed to the high levels of fungal skin infections in this population.

Source: Original article 

LIFE page on tinea capitis