The prevalence of skin and venereal diseases among the geriatric patients attending in a tertiary care Hospital in Dhaka , Bangladesh

Original article The prevalence of skin and venereal diseases among the geriatric patients attending in a tertiary care Hospital in Dhaka, Bangladesh Mohd. Nurul Alam 1, Md. Anwar Husain2, Ayesha Siddiqua3 Zahir Uddin Mohammad Babar 4, Md. Rashidul Hasan5 Abstract Background: The prevalence of skin and venereal diseases among geriatric populations generally differ in different countries and within various regions of a country depending upon social, economic, racial & environmental factor. The morbidity in elderly associated with skin and venereal diseases makes them an important public health problem. Very scanty literature was found on this geriatric problem in our country which is either disease based, community based or specified population group based. Objective: To assess the dermatological & venereal complaints of the elderly attending a dermatology outpatient department in a tertiary care hospital. Materials and Methods: We retrospectively analyzed a total of 1303 geriatric patients who were 60 years and above and came to the OPD of dermatology & venereology department of Ibn Sina Medical College Hospital, Dhaka, Bangladesh, over a period of 31⁄2 year from January, 2014 to June, 2017. Data were collected on special proforma and analyzed with appropriate method. Results: Among 1303 patients 676 (51.88%) were male and 627 (48.12%) were female and most of the patients belonged to the age group 60-69 year (73.6%), mean age being 66.8 ± 7.06 year. The most commonly presented skin complaints were eczematous dermatitis (42.6%), fungal infection (19.14%), generalized pruritus (5.06%), seborrheic dermatitis (5.06%), urticaria (4.75%) and viral infections (4.29%) respectively. Tinea corporis (29.3%) was the most common of fungal infections and herpes zoster (82.14%) was the most frequent of viral infections. Conclusion: Eczematous dermatitis was found to be the most common noninfectious disease and fungal infection was the most common infectious disease in all age groups and genders.


Introduction
With the advancement of medical science, the size and ratio of the elderly population has been increasing in both developed and developing countries.Aging is a progressive degeneration process that leads to a decrement in the function and the reserve capacity of the whole body system, including skin system. 1 The reasons for this are complex and not well understood. 2 Cell replacement capacity, barrier function, chemical clearance capacity, sensory perception, mechanical protection, wound healing, immune responsiveness, thermoregulation, sweat production, sebum production, vitamin D production and capacity to repair DNA results in some inevitable changes, such as roughness, wrinkling, laxity of the skin and atypical presentations of dermatological diseases. 12Due to these changes, their chances of developing skin disorders increases. 4Most of these dermatologic diseases are not life threatening, but affect the quality of life.In this study, we tried to evaluate the frequency as well as the age and gender distribution of the skin and venereal disorders in patients of 60 years and above of age.

Materials & Methods
This study was undertaken in the outpatient department of Dermatology & Venereology, Ibn Sina Medical College, Dhaka, Bangladesh.We retrospectively analyzed a total of 1303 geriatric patients who were 60 years and above and came to the OPD of dermatology & venereology department, from January, 2014 to June, 2017.The total study period was 3½ year.The frequently seen viral infections were herpes zoster (82.14%), wart (10.7%) and herpes simplex virus infection (7.14%).Of bacterial infections pyoderma ( furunculosis-91.67%,impetigo-8.3%) is the most common.Among the neoplastic diseases, benign neoplasia was 3.22% and malignant neoplasia was 0.46% of total dermatological presentations.Of malignant neoplasia, the frequency of basal cell carcinoma was 82.3%, squamous cell carcinoma was 12% and melanoma was 3.7%.Among papulosqumous disorders psoriasis (2.76%) and lichen planus (0.084%) were the main diseases found in 47 patients.Immunobullous disorders found in 6 (0.46%) patients.54 patients (4.14%), all males, came to our OPD with the complaints of erectile dysfunction & premature ejaculation.Among pigmentary disorders, vitiligo patients were slightly more (1.15%)than melasma patients (0.997%).Very few geriatric patients (0.38%) came to us for their alopecia problem (Table -2).In the age groups of 60-69 year and 70-79 year, the most frequent diseases are almost same.These are eczematous dermatitis, fungal infections, viral infections.In the age group of 80 year and above, eczematous dermatitis, viral infections( specially herpes zoster) and fungal infections were most frequently found (Table -3

Discussion:
All over the world as well as in Bangladesh, the elderly population has been increasing. 5The number of aged population has increased from 1.38 million to 7.59 million from the year of 1974-2001. 6angladeshis the seventh largest populated (152.51 million) and most densely (1015 person live per square kilometers) country. 7According to world population aging report 2013, worlds population 60+, 65+, and 80+ were 840628, 570459 and 120199 respectively.Moreover this number were 468549, 307699 and 57576 in Asia, 60033, 38513 and 5248 in Africa, 169874, 125152 and 33239 in Europe. 8n our study, the most frequent dermatological complaints of elderly people were eczematous dermatitis (42.6%).Most of these eczematous dermatitis in these cases were asteatotic dermatitis.The higher prevalence is due to excessive bathing with hot water and strong soap, increased sensitivity to the irritants and allergen due to epidermal barrier dysfunction. 9Besides, the eczematous lesions are medically resistant in such patients. 10Other studies [11][12][13][14] have shown frequency of dermatitis ranging from 16.3% to 58.7%, which is compatible with the findings of our study.Fungal infections were the most common infections in our study, similar to other studies. 11,15In our study frequency of fungal and viral infection is 19.06% and 4.29% respectively.The frequency of these infections were 38% and 12.3% respectively in one study, 11 but 3.4% and 4.0% respectively in another study. 14In our study the most frequent fungal infections were tinea corporis (29.3%), candidiasis (26.5%), tinea cruris (19.28%), onychomycosis (11.24%), tinea pedis (9.64%) respectively.But another study 17 shows, most commonly found fungal infections were tinea pedis (48.5%), tinea unguium (28.4%), tinea corporis (13.6%), pityriasis versicolor (5.7%) respectively.Among viral infections, herpes zoster (82.14%), and wart (10.7%), herpes simplex infection (7.14%) were most frequently seen.The frequency of herpes zoster, warts and herpes simplex infections were 78.4%, 16.4%, 4% respectively in one study, 12 and were 52.1%, 33.8%, 13.9% in another, 11 which are nearly similar to our study.but in another study 17 wart (44%) was found more than herpes zoster (35.5%).The reactivation of varicella zoster virus usually causes herpes zoster infection in elderly patients. 1,18ruritus was usually the most frequent complaint in dermatological survey in the elderly.In previous studies. 19,202][13][14] The frequency of generalized pruritus was 5.06% in our study.2][13][14] The frequency of malignant neoplasm in our study is somewhat lower than that of previous studies.The low prevalence may be due to the fact that, they present more commonly in surgery outdoor instead of dermatology outdoor.The incidence of bullous disease was 0.46% in our study, which was much lower than other studies. 21,22ay be most of the bullous disease patient went to medicine department through emergency, instesd of dermatology OPD.
The frequency of drug reaction is increased in the elderly population because of multiple drug use. 10esides, drug induced autoimmune skin diseases such as pemphigus, bullous pemphigoid and lupus erythematosus.The most common drug reactions in skin are itching, exanthema and urticaria in geriatric persons. 1 In our study the drug reaction frequency was 0.92%. in one study 11 the drug reaction frequency in elderly population was 0.5% and another 12 shows 1.4%.So our study result is compatible with the previous studies.Total 1303 patients of age 60 years and above were incuded in our study.Our study shows slight male predominance (male : female) = (1.08:1).This is similar with the findings of other studies 3,16,21 and contrary to a study. 20Most of the population belonged to the age group 60-69 year (73.6%), this was in accordance with other studies. 15,21

Conclusion :
The objective of this study was to find out the percentage of common dermatological problems of geriatric patients, so that we can prevent, diagnose and treat them.Most of the diseases found by the study could have been prevented by protective measures.Health education programme to be formulated about dermatological problems to include general and practical preventive information.These would improve the quality of life among the elderly population.
The inclusion criteria were age more or equals to 60 years, patients must have approached the dermatology OPD, the presence of accurate diagnosis in the medical records.Patients of less than 60 years of age, with inadequate data or without a definitive diagnosis were excluded.The patients were categorized according to their gender, age and dermatological & venereological diagnoses. ).

Table - 2
: Distribution of skin diseases according to gender

Table - 3
: Distribution of skin diseases according to age group Data gathering and idea owner of this study: Mohd.Nurul Alam , Md Anwar Husain Study design: Mohd.Nurul Alam, Ayesha Siddiqua Data gathering: Mohd.Nurul Alam, Md Anwar Husain, Zahir Uddin Mohammad Babar, Md.Rashidul Hasan Writing and submitting manuscript: Mohd.Nurul Alam , Ayesha Siddiqua, Md.Rashidul Hasan Editing and approval of final draft: Mohd.Nurul Alam , Md Anwar Husain Conflict of interest: Authors declared no conflict of interest Author's contributions: