Clinicoepidemiology of Skin Diseases in Children Seen at the University Hospital Center Morafeno, Toamasina, Madagascar

Introduction The child's skin diseases are common and very diverse. Many studies concerning pediatric dermatoses have been carried out in Africa and the rest of the world. Few epidemioclinical data reflect these skin diseases in children, especially in the east coast of Madagascar. We aim to describe the pattern skin diseases among children seen at the University Hospital Center Morafeno, Toamasina, Madagascar. Patients and Methods. A retrospective study over a 3-year period from January 2017 to December 2019 was conducted in children seen in the Dermatology Department of University Hospital Center Morafeno, Toamasina, with skin diseases. Results During the study period, 347 children out of the 1584 new patients were retained with a sex ratio of 0.86. The mean age was 6.4 years old. The main diseases identified were skin infectious diseases (43, 23%), allergic dermatoses (24.21%), and autonomous dermatosis (15.56%). Conclusion Our study revealed the importance of infectious and allergic dermatoses in Toamasina. It is necessary to carry out simple preventive actions such as hygiene.


Introduction
e child's skin diseases are common and very diverse. ese skin disorders give uneasiness and anxiety of parents. Many studies concerning pediatric dermatoses have been carried out in Africa and the rest of the world [1][2][3][4]. Environmental factors play a significant role in skin disease. However, in Madagascar, particularly in Toamasina, this entity remains little studied. Toamasina is a city on the east coast of Madagascar with a hot and humid climate. We aim to describe the pattern skin diseases among children seen at the CHU Morafeno, Toamasina, Madagascar.

Patients and Methods
is is a retrospective study of all patients aged ≤15 years attending the outpatient dermatology who were examined at the Department of Dermatology at the University Hospital Center Morafeno in Toamasina, Madagascar, during 36 months (from January 2017 to December 2019). Epidemiologic data (age and gender) and diagnosis were collected from the patient's medical records. Patients with missing information were excluded from the study. e diagnoses reported on the medical records were based on clinical features and were confirmed by laboratory tests when indicated. e studied cases were further divided according to etiology, into the following groups: infectious skin diseases (bacterial skin infections, parasitic infestations, fungal infections, and viral infections), allergic dermatoses, autonomous dermatosis or inflammatory skin diseases, genodermatosis or congenital dermatosis, skin tumors, dysimmune diseases, and toxidermia (drug reaction). e data collections were carried out by the Excel 2010 software. e statistical analysis was processed on the EPI-INFO software version 7.2.2 16.

Results
During the study period, a total of 1584 new patients with skin diseases were seen, including 347 pediatric patients. Pediatric consultations represent 21.90% of all dermatology outpatient. Among the 347 pediatric patients, 159 (46.36%) were boys and 184 (53.64%) girls.
Among the skin infectious disease, fungal infections were noted in 58 cases (31.67%) which consisted of pityriasis versicolor in 12.66% and tinea corporis in 10%. Regarding bacterial skin diseases, they were noted in 22 cases (14.67%) including impetigo (8%) (Figure 1), and there were 2 cases of skin tuberculosis. Viral infections represented 16.67% of infectious diseases, including molluscum contagiosum (10.66%). As for parasitic infestations, 41 cases were scabies (27.33%). Table 2 provides the distribution of children according to infectious diseases.
ere were 5 cases of autoimmune diseases including 2 cases of autoimmune bullous dermatosis and 3 cases of scleroderma. Finally, 4 cases of drug eruption were fixed pigmented erythema.

Discussion
e aim of this study was to describe the pattern skin diseases among children ≤15 years seen in Dermatological Outpatient Department at the University Hospital Center Morafeno, Toamasina. is study provided an overview of children's skin diseases in Toamasina. e present study found that 21.90% of the patients seen in dermatology in Toamasina were children; this frequency is comparable to the results of the literature [1,2,5]. e demographic profile of these children was superimposed on that of the literature.
ere was a predominance of the female gender in our study with 53.64%. Similar results were found in Côte d'Ivoire with a female predominance at 54.06% [3] and in Greece at 52.8% [6]. In Mali and India, it found a male predominance with, respectively, 55.10% and 58% [1,4]. e average duration of disease progression before consultation is quite long, around 12.18 months. is could be explained by the recent opening of the Dermatology Department at the University Hospital Center Morafeno, Toamasina (2016). Poor economic and geographic accessibility to healthcare services by patients, recourse to traditional treatments, or self-medication delayed specialist consultations [7].
Infectious dermatoses was the largest group of skin disorders in childhood in our study constituting 43.23% of total 347 cases, followed by allergic dermatoses (24.21%) and autonomous dermatoses (15.56%). As in other African studies, infectious skin diseases were frequent and affected different age groups of children [1,8]. e infectious diseases observed were fungal, parasitic, viral, and bacterial dermatoses. But the most common were superficial skin fungal infections (tinea corporis and pityriasis versicolor) and parasitic dermatoses in particular scabies.
is frequency could be the consequence of poor hygiene and limited socioeconomic condition. e hot and humid climate also favours the appearance of infectious dermatoses [9].
After infectious dermatoses, there were allergic dermatoses, mainly atopic dermatitis as in most studies both in Africa and in Europe [1,2]. ese dermatoses affected all age groups. Lifestyle factors linked to urbanization were associated with an increased risk of allergic diseases in Africa [10,11].
Concerning autonomous dermatoses, the most common were vitiligo, acne, and psoriasis. ese dermatoses mainly affected the 11-15 age group. Although benign, they could have a negative impact on the quality of life of children, adolescents, and their families [12]. is high frequency for this age group is thought to be due to the aesthetic discomfort leading to a consultation. Vitiligo can appear soon after birth until late adulthood. But it appears before the age of 12 in 32-40% of cases [13]. And acne is often associated with adolescence but can appear at any age, especially in the prepubertal period [14].
Skin tumors were benign and appeared mostly in the 11-15-year age group. In fact, skin cancers are rare in children except in the case of preexisting dermatoses such as albino or xeroderma pigmentosum. ese skin tumors were essentially keloids. e absence of comorbidities promotes good wound healing in children compared to adults due to good vascularisation of the skin. But hypertrophic and keloid scars are frequent in the prepubertal 2 Dermatology Research and Practice      [15,16]. Table 4 provides some studies of skin diseases in children reported in the literature.

Conclusion
Childhood skin diseases are variable and frequent in dermatological outpatient. e epidemioclinical characteristics of dermatoses in children in Toamasina did not differ from skin disorders in children seen in Africa. Our study revealed the importance of dermatological conditions, in particular infectious and allergic, as well as autonomous dermatoses. It is necessary to carry out simple preventive actions such as hygiene to encourage and educate patients to come to the hospital in time for appropriate treatment.

Data Availability
e data used to support the findings of this study are included within the article.

Conflicts of Interest
e authors declare that they have no conflicts of interest.