Skin diseases are among the most frequent health problems in childhood and constitute a substantial proportion of visits to pediatric and dermatology clinics worldwide.¹ They range from transient, self limiting conditions to chronic, recurrent disorders that significantly affect physical comfort, sleep, school performance, psychosocial well-being, and family quality of life. Because the skin is visible, even relatively mild dermatoses can lead to embarrassment, teasing, and social withdrawal, particularly in school age children who are highly sensitive to appearance and peer perception. Epidemiological studies from diverse regions demonstrate that a large proportion of schoolchildren are affected by at least one skin disease at any given time, although the exact prevalence and pattern vary with geography, climate, ethnicity, and socioeconomic conditions. In classic community-based work from the Purus Valley in Brazil, dermatoses were found in 21–87% of examined schoolchildren aged 6–16 years, with communicable conditions such as pediculosis, pyoderma, pityriasis versicolor, dermatophytosis, scabies, and viral infections predominating.² Similar high burdens have been documented in many low- and middle-income settings, underscoring that childhood skin disease is a major but often under-recognized public health problem rather than a purely cosmetic concern. In the Indian context, school surveys have shown that a sizeable fraction of children are affected by one or more dermatoses, with communicable conditions and nutritional dermatoses forming a major subgroup. Rao et al reported that communicable dermatoses alone accounted for 19% of students in an Indian school population, with additional contributions from nutritional and miscellaneous disorders.³ These findings reflect the close link between pediatric skin disease and underlying determinants such as overcrowding, poor sanitation, limited access to clean water, inadequate health education, and constrained access to early medical care.The school environment itself plays a critical role in the transmission and expression of skin diseases. Classrooms and playgrounds bring children into close physical contact, facilitate sharing of personal items such as combs, towels, and clothing, and create conditions that promote the spread of infectious dermatoses such as tinea, impetigo, scabies, and pediculosis capitis.^²,⁴ At the same time, exposure to sunlight, dust, heat, and environmental allergens, together with friction from backpacks and uniforms, may precipitate or aggravate inflammatory disorders such as eczema and papular urticaria. For many children, school hours represent the largest proportion of their daily time outside the home, so patterns of dermatoses in school-age children are shaped by both household conditions and school-based exposures. The spectrum of pediatric dermatoses is heterogeneous and can be broadly divided into infectious and noninfectious categories. In many developing regions, infectious dermatoses—including bacterial, viral, fungal, and parasitic infestations—remain the dominant group and often coexist with nutritional deficiencies and poor hygiene.^¹,³ In contrast, in more affluent or temperate settings, non infectious conditions such as atopic dermatitis, acne, pigmentary disorders, and benign nevi often assume greater prominence. A review of common skin problems in children emphasized that infections and infestations contribute substantially to morbidity in primary care, but chronic inflammatory conditions account for a significant share of clinic visits and long-term treatment needs.¹ Understanding the relative contribution of these groups is essential for prioritizing preventive measures, drug procurement, and training of primary-care providers. Marked geographic variation has been documented in the pattern of skin diseases among school-age children. In Eastern Saudi Arabia, a large cross-sectional survey of 2,239 female schoolchildren reported an extraordinarily high overall prevalence of skin disorders (98.6%), with pigmentary abnormalities (especially melanocytic nevi and post-inflammatory pigmentation) and eczema-related conditions far outnumbering classical infections.⁴ By contrast, in Amman, Jordan, another school-based study among male pupils found higher proportions of infections and infestations alongside eczema and acneiform conditions, reflecting different environmental, cultural, and clothing practices.⁵ Such contrasts highlight that local climate, sun exposure, clothing customs, and skin phototype can substantially influence the disease profile. Urban–rural differences and socioeconomic gradients further modify the epidemiology of pediatric dermatoses. Reports from Hong Kong school health services showed that skin diseases in schoolchildren and adolescents presenting to a student health centercentered around conditions such as acne, viral warts, atopic dermatitis, and other relatively noncommunicable dermatoses, mirroring a comparatively higher standard of living and hygiene.⁶ In rural Upper Egypt, however, a community-based survey documented a high prevalence of a wide range of dermatoses, including infections and infestations, among children and adults, with strong associations to low socioeconomic status and poor living conditions.⁷

This study was designed as an observational, descriptive investigation conducted in the Dermatology Outpatient Department of a tertiary care hospital. The aim was to assess the clinical spectrum, distribution, and associated factors of common skin diseases among school-age children. All observations were recorded systematically without any intervention from the investigators.  The study population consisted of 94 children aged 5 to 14 years who presented with dermatological complaints. Patients were included irrespective of gender, socioeconomic status, or residence. Only children accompanied by a parent or legal guardian were considered eligible for enrollment. Children with known chronic systemic illnesses or who were already receiving long-term dermatological treatment were excluded to reduce confounders.  A consecutive sampling method was used, wherein every eligible child attending the Dermatology OPD during the study period and meeting the inclusion criteria was recruited until the sample size of 94 was achieved. This ensured minimization of selection bias and allowed for accurate representation of the outpatient pediatric population.

Methodology

Data collection was performed using a structured proforma that captured demographic details, presenting complaints, duration of symptoms, personal hygiene practices, family history of dermatological disorders, environmental exposure, and any associated systemic symptoms. A detailed general examination and dermatological assessment were performed by qualified dermatologists using clinical diagnostic criteria for each skin condition.  Each child underwent a thorough cutaneous examination under adequate lighting. Lesions were evaluated based on morphology, distribution, number, and pattern. Photographic documentation was performed when necessary for verification and comparative analysis. In cases where diagnosis could not be confirmed by clinical features alone, additional tests such as Wood’s lamp examination, skin scrapings for KOH microscopy, or bacterial swabs were performed as required.  The primary parameters assessed included prevalence of specific skin diseases, age-wise and gender-wise distribution, presenting symptoms, hygiene-related practices, seasonal variation, and lesion characteristics. Secondary parameters included association with comorbid conditions, recurrence patterns, family clustering, footwear and clothing habits, and potential triggering or aggravating factors identified during history-taking.

Statistical Analysis

All collected data were entered into electronic spreadsheets and cross-checked for accuracy. Descriptive statistical methods such as frequencies, percentages, means, and standard deviations were used to summarize the findings. Comparative analysis among subgroups was performed where relevant. Results were presented in the form of tables and charts for clarity, though interpretation remained qualitative owing to the observational design.

The study included a total of 94 school-age children, with the age and gender distribution summarized in Table 1. A slightly higher proportion of children belonged to the 5–9-year age group (55.32%) compared to the 10–14-year group (44.68%), although this difference was not statistically significant (p = 0.214). Males constituted 59.57% of the sample, while females accounted for 40.43%. The gender distribution showed a statistically significant difference (p = 0.031), indicating that more male children attended the dermatology outpatient department for skin-related problems during the study period.  Table 2 presents the prevalence of major skin diseases among the study participants. Fungal infections were the most common dermatological condition, affecting 29.79% of the children. Infestations such as scabies and pediculosis were the second most common, observed in 21.28% of cases. Bacterial infections accounted for 19.15% of the cases, followed by viral infections at 12.77%. Eczema and dermatitis were seen in 10.64% of children, while miscellaneous conditions—including pigmentary changes and acneiform eruptions—comprised 6.38%.  The age-wise distribution of skin diseases (Table 3) revealed important trends. Fungal infections were significantly more common among children aged 10–14 years (38.10%) compared to those aged 5–9 years (23.08%), with the association reaching statistical significance (p = 0.047). This suggests increased exposure, hormonal changes, or lifestyle habits in older children may predispose them to fungal infections. Infestations were more frequent in the younger age group (26.92%), although the difference did not achieve statistical significance (p = 0.092). Bacterial infections, viral infections, eczema, and miscellaneous dermatoses showed similar distribution across both age groups, with no significant differences observed (p > 0.05).  Gender-wise comparison of skin diseases (Table 4) demonstrated that both males and females experienced a similar pattern of dermatological conditions. Although fungal and bacterial infections were slightly more common in males, and infestations appeared somewhat higher in females, none of these differences were statistically significant (p > 0.05). Viral infections, eczema, and miscellaneous skin conditions also showed no meaningful gender-related variation. Table 5 illustrates the association between hygiene practices and the occurrence of skin diseases. A clear and statistically significant relationship emerged for fungal infections and infestations. Children with poor hygiene practices demonstrated a substantially higher prevalence of fungal infections (39.13%) compared to those with good hygiene (20.83%), with the difference being statistically significant (p = 0.031). Similarly, infestations such as scabies were markedly more common among children with poor hygiene (30.43%) than those maintaining good hygiene habits (12.50%), and this association was also significant (p = 0.019). On the other hand, bacterial infections, viral infections, and eczema were not significantly influenced by hygiene status (p > 0.05).

Table 1. Age and Gender Distribution of Study Participants (n = 94)

Table 2. Prevalence of Major Skin Diseases Among School-Age Children (n = 94)

Table 3. Age-wise Distribution of Common Skin Diseases (n = 94)

Table 4. Gender-wise Distribution of Skin Diseases (n = 94)

Table 5. Hygiene Practices and Their Association With Skin Diseases (n = 94)

In the present study, infectious dermatoses predominated, accounting collectively for 82.99% of all conditions (fungal 29.79%, infestations 21.28%, bacterial 19.15%, viral 12.77%), while non-infectious disorders such as eczema/dermatitis and miscellaneous dermatoses comprised 17.02% (10.64% and 6.38%, respectively). This pattern is consistent with the profile of pediatric skin disease described from India, where Jain et al (2010) reported that infections and infestations constitute the largest diagnostic group in most hospital- and community-based series, and highlighted a wide overall prevalence of pediatric dermatoses (approximately 8.7–35.0%) across school surveys.⁸ When our data are compared with community-based rural studies, the burden of infectious dermatoses in this OPD cohort appears even more pronounced. In the current series, infectious conditions contributed 82.99% of all diagnoses, whereas Bhatia et al (1997) found infective dermatoses in 63.50% of episodes among rural children in Wardha, with pediculosis capitis in 20.40%, pyoderma in 16.07% and dermatophytosis in 6.61%.⁹ The higher proportion of fungal infections (29.79%) and bacterial infections (19.15%) observed in the present hospital-based study likely reflects referral bias toward more symptomatic or persistent infections, in contrast to the broader community case mix captured by house-to-house surveys. The internal pattern of disease categories in our cohort is broadly comparable with other large Indian hospital-based series, although with notable differences in rank order. Karthikeyan et al (2004) from a South Indian referral center reported that infections and infestations together accounted for 54.50% of pediatric dermatoses, followed by dermatitis/eczema (8.60%), pigmentary disorders (5.70%), insect-bite reactions (5.27%), hair and nail disorders (5.20%), and miliaria (4.10%).¹⁰ In our clinic population, fungal infections (29.79%) and infestations (21.28%) together contributed 51.07%, with eczema/dermatitis at 10.64% and pigmentary/miscellaneous lesions at 6.38%, suggesting a similar hierarchy in which infections and infestations dominate, but with relatively greater fungal involvement and slightly higher eczema burden in the present series. Differences in the proportional contribution of eczema and infestations become more apparent when our data are contrasted with earlier North Indian clinic reports. Sayal et al (1998) observed that among children and adolescents, infections comprised 31.00% of dermatoses, eczemas 24.00%, infestations 8.60%, and urticaria 5.30%, indicating a much larger share of eczematous disorders and a smaller contribution of infestations compared with our findings.¹¹ In the current study, eczema/dermatitis accounted for only 10.64% of cases, while infestations contributed 21.28%, more than double that reported by Sayal et al (1998), suggesting greater ongoing transmission of parasitic conditions such as scabies and pediculosis in our catchment area, possibly related to crowding and household-level hygiene practices. Age-specific patterns in our series showed that fungal infections increased significantly with age, affecting 38.10% of children aged 10–14 years compared with 23.08% in the 5–9-year group (p = 0.047), whereas infestations were more frequent in younger children (26.92% vs 14.29%, p = 0.092). This trend is in keeping with the concept that certain dermatoses cluster in older school-age children, as Nanda et al (1999) demonstrated in Kuwait: atopic dermatitis constituted 31.30% of all pediatric dermatoses across age groups, but viral warts (13.10%) were particularly more prevalent among school-age children than in younger age bands.¹² In the present study, males represented 59.57% of all participants, compared with 40.43% females, yet there was no statistically significant gender-wise difference in the distribution of specific disease categories, indicating broadly similar susceptibility to individual dermatoses in both sexes. In contrast, Wenk et al (2003) from Switzerland reported a slight female preponderance (53.80% girls vs 46.20% boys) among 1105 children attending a pediatric dermatology service, with atopic dermatitis (25.90%) being the leading diagnosis, followed by pigmented nevi (9.10%) and warts (5.00%).¹³ The male predominance in our series, coupled with the absence of gender-linked disease differences, likely reflects sociocultural factors and health-seeking behavior rather than biological vulnerability, whereas in high-income settings with easier access to care, gender representation tends to be more balanced. The strong association between poor hygiene and specific infections in this study—where fungal infections were seen in 39.13% of children with poor hygiene versus 20.83% with good hygiene (p = 0.031), and infestations in 30.43% versus 12.50% (p = 0.019)—reinforces the role of modifiable environmental determinants. Dogra et al (2003), in a large school survey of 12,586 children from northern India, found that skin infections (11.40%), infestations (5.00%) and eczemas (5.20%) were among the most frequent conditions and explicitly attributed the distribution of pediatric skin diseases to low socioeconomic status, malnutrition, overcrowding and poor standards of hygiene.¹⁴ Our findings mirror these observations, but with substantially higher clinic-based proportions of fungal infections (29.79%) and infestations (21.28%), suggesting that children from more deprived backgrounds with inadequate hygiene are both more likely to develop such conditions and more likely to present to tertiary care due to symptom severity or chronicity. The relatively modest proportion of eczema/dermatitis in this series (10.64%) contrasts sharply with patterns seen in many hospital-based cohorts from high- and middle-income countries, yet remains within the spectrum reported regionally. Javed et al (2006) from a tertiary hospital in Karachi documented 830 pediatric dermatology cases, among whom scabies (21.70%) and atopic eczema (21.40%) were the most common diagnoses, followed by fungal infections (15.70%), urticaria (12.10%) and bacterial infections (8.20%), with males constituting 65.00% of cases.¹⁵ Compared with that series, our cohort shows a similar male predominance (59.57%) and comparable prevalence of infestations (21.28% vs 21.70%), but a lower prevalence of eczema (10.64% vs 21.40%) and a higher burden of fungal infections (29.79% vs 15.70%), suggesting that climatic factors, referral patterns and genetic predisposition may modulate the balance between inflammatory and infectious dermatoses across neighboring South Asian populations.

In this observational study of 94 school-age children, infectious dermatoses—particularly fungal infections and infestations—were found to constitute the major burden of skin disease. Fungal infections were significantly more common in older children, while poor hygiene was strongly associated with both fungal infections and infestations. Gender did not significantly influence the pattern of skin diseases, indicating similar susceptibility among boys and girls. These findings highlight the need for school- and community-based interventions focusing on hygiene promotion, early detection, and prompt treatment of common pediatric skin diseases.

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