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ORIGINAL ARTICLE
Abstract
Background: There is a trend of increase in number of contact dermatitis cases. Studies
on the prevalence and epidemiological pattern of allergic skin disorders in Indian scenario
are not much available. The present study was designed to assess the epidemiological
pattern of contact dermatitis in rural and urban areas in a peripheral district in eastern
India. Aims and Objectives: This study was undertaken to find the prevalence of contact
dermatitis and to assess the epidemiological pattern of contact dermatitis both in rural and
urban community. Materials and Methods: The study was conducted in a medical college
located at a semi‑urban area in eastern India with written informed consent obtained from
each participant. This hospital‑based cross‑sectional study was done from May 2017 to April
2018. Study population consisted of patients attending the dermatology OPD and having
lesions clinically suggestive of contact dermatitis and there were 268 such patients. Patients
attending the OPD were divided into urban and rural as per their address. Data analysis was
done using suitable, standard, and appropriate statistical methods. Results: The prevalence
of contact dermatitis was 4.38% among the dermatology OPD attendees. Urban prevalence
was statistically significantly (P < 0.05) higher than rural prevalence. Contact dermatitis
was common in the age group of 41–50 years. In urban areas, females were more affected
than those in rural areas. Occupationally, the difference between urban and rural patients of
contact dermatitis was statistically significant (P < 0.05). Cosmetic history in the urban group
was significantly more (P < 0.05). Conclusions: Contact dermatitis prevalence and patient
profile in certain factors showed a statistically significant difference between urban and rural
patients.
KEy Words: Allergic skin disorder, contact dermatitis, epidemiology, prevalence, urban and rural
Epidemiological Pattern of Contact Dermatitis among Urban and Rural
Patients Attending a Tertiary Care Center in a Semi-urban Area in Eastern
India
Shinjini Ghosh, Saurav Kundu1, Sanjay Ghosh2
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DOI: 10.4103/ijd.IJD_792_19
Introduction
Non‑communicable diseases have been highlighted in
recent reports describing the global burden in terms of
mortality and disability‑adjusted life years[1] and also
their economic impact.[2] Allergic diseases are manifested
as hyper‑responsiveness in the target organ, whether
skin, nose, lung, or gastrointestinal tract.[3] Allergic skin
disorders are defined as ailments present in the skin and
mucous membrane resulting from inflammatory disorders
based on abnormal humoral reactivity, T cell reactivity,
or other related pathology. There are various types of
allergic skin diseases like atopic dermatitis, contact
dermatitis, urticaria, polymorphic light eruption, drug
allergy, nummular dermatitis, seborrheic dermatitis,
autosensitization dermatitis, etc.[4] A steady increase in
the prevalence of allergic diseases globally has occurred
with about 30%–40% of the world population now being
affected by one or more allergic conditions.[5]
Dermatitis occupied the first most common subgroup
within the hypersensitivity diseases with a rate of
24.50% of the total. Among the dermatitis group,
contact dermatitis (17.54% of the total) is the most
commonly detected skin disease and may represent an
indicator of the relative development and urbanization
of the community.[6]
Contact dermatitis is defined as the superficial
inflammatory reaction of the skin induced by exogenous
From the Department of
Dermatology, MGM Medical
College, Kishanganj, Bihar,
1Department of Community
Medicine, Rampurhat Government
Medical College, Rampurhat,
West Bengal, 2Department
of Dermatology, Institute of
Allergy and Immunologic Skin
Disease(IAISD), Kolkata, West
Bengal, India
Address for correspondence:
Dr. Sourav Kundu,
Swabhumi Residency P-12,
Motijheel Avenue,
Kolkata - 700 074, West Bengal,
India.
E-mail: dr.skundu@yahoo.com
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How to cite this article: Ghosh S, Kundu S, Ghosh S. Epidemiological
pattern of contact dermatitis among urban and rural patients attending
a tertiary care center in a semi‑urban area in Eastern India. Indian J
Dermatol 2020;65:269‑73.
Received: December, 2019. Accepted: February, 2020.
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Ghosh, et al.: Epidemiological pattern of contact dermatitis
270 Indian Journal of Dermatology | Volume 65 | Issue 4 | July-August 2020
chemicals interacting on the skin. These reactions
can be allergic or irritant. The most common reaction
is an eczematous type but other types, such as
erythema multiforme like, exanthematous, lichenoid,
granulomatous, pigmented, and photosensitivity
reactions may also be encountered.[7]
In industrialized countries, contact dermatitis is one
of the common occupational diseases and has a great
socioeconomic impact. An estimated 15%–20% of the
general population suffers from contact allergy.[8] An
Indian study showed that the proportion of footwear
dermatitis was 24.22% among a total of 640 patients.[9]
We are unaware of the specific model of prevalence of
skin diseases and the association between the need,
supply, and demand for dermatological care. Moreover,
we are not aware of the extent of skin disease as a
public health problem. For this reason, performing
epidemiological studies is very crucial.[10] It is important
to determine the prevalence of skin disorders so that
necessary educational programs and preventive measures
may be formulated.[11]
However, there are very minimal data available on the
prevalence of skin diseases in the population in India,
especially in eastern India.
The present study was undertaken to find out the
prevalence of contact dermatitis and to assess the
epidemiological pattern of contact dermatitis both in
rural and urban communities.
Materials and Methods
After having ethical clearance from the Institutional
Ethics Committee, the study was undertaken in a
medical college located in a semi‑urban area in eastern
India. Written informed consent was obtained from each
patient.
This hospital‑based cross‑sectional study was done in
departments of dermatology and community medicine
from May 2017 to April 2018. All the patients coming to
dermatology outpatient department (OPD) having lesions
clinically suggestive of contact dermatitis were included
in the study.
The total number of patients having contact dermatitis
during the above‑mentioned period was 268 out of
6118 patient making the prevalence of 4.38 %. Patients
attending the OPD have been divided into urban and
rural depending on their address of residence.
Inclusion criteria were: i) Patients suffering from
contact dermatitis (allergic or irritant); ii) those who
were willing to participate. The exclusion criteria
included: i) Allergic skin diseases other than cases of
contact dermatitis; ii) non‑cooperative individuals; iii)
seriously ill persons; and iv) insane. Cases of contact
dermatitis were diagnosed by detailed history, relevant
clinical examination and through their correlation
as well as by excluding other forms of eczema by
the absence of their characteristic history and
clinical features. Clinical differentiation between the
irritant contact dermatitis (ICD) and allergic contact
dermatitis (ACD) was made on the following points:
i) Marked pruritus (usually) in ACD; ii) pronounced
pain and burning (usually) in ICD; iii) presence of
vesicles (commonly) in ACD; and iv) presence of
pustules (commonly) in ICD.[7]
Data of 268 respondents collected from the study were
processed, compiled, and analyzed. Analysis was done
using suitable, standard, and appropriate statistical
methods in the form of percentage and proportion.
Fisher’s exact test, Chi‑square test, t‑test were availed
for data analysis using Statistical Package for the Social
Sciences (SPSS) version 21. Two digits after the decimal
point were taken for analysis. P value of less than
0.05 was considered statistically significant.
Results
The total number of patients identified was 268 of which
156 (59%) were from urban and 111 (41%) were from
rural areas. Male comprised of 47% of total patients and
49% of urban and 51% of rural patients. Among females,
more patients were from the urban area than from the
rural area (67% vs. 33%) (P = 0.0042).
The age distribution of the patients is given in
Figure 1. Figure 1 shows that people in the age group
of 41‑50 years (19%) was maximum followed by the
patients in the age group of 21‑30 years (16%).
A similar prevalence (14%) was observed in the age
group of 11‑20 and 31‑40 years with a minimum (1%)
in the age group of 81–90 years. The mean age
of the total population was 37.26 ± 18.23 years
(range 3–81 years). Among the urban population,
0
5
10
15
20
25
30
35
40
45
50
0 - 10 11 to
20
21 to
30
31 to
40
41 to
50
51 to
60
61 to
70
71 to
80
81 to
90
Urban
Rural
Total
Figure 1: Distribution of Contact Dermatitis Patients according to age group (n = 268).
P value = 0.0006
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Ghosh, et al.: Epidemiological pattern of contact dermatitis
Indian Journal of Dermatology | Volume 65 | Issue 4 | July-August 2020 271
the mean age was 37.15 ± 19.07 years (range
3–81 years). In the rural population, the mean age was
37.42 ± 17.06 (range 5 to 70 years). The difference
in the age distribution between the two groups was
significant (P = 0.0006).
Occupation‑wise distribution of patients is depicted
in Table 1. Though the most common victim was
homemaker in both the groups, the difference between
urban and rural groups in the distribution of occupation
was statistically significant (P < 0.0001).
Regarding trigger by residential environmental disturbance,
Table 2 shows that 100 patients from the urban group
and 86 patients from the rural group were affected by
this factor. Dust, moisture, and construction materials in
a combined way were the main culprit. The difference
between urban and rural groups was also statistically
significant (P = 0.0007). As per allergic history [Table 3],
the maximum number of patients had no relevance; 53%
of urban and 74% of rural patients did not report any
history of allergy (P < 0.0001). Table 4 shows that the
history of cosmetic exposure had no significant impact on
39% of urban and 75% of rural patients (P < 0.0001).
Discussion
Prevalence of contact dermatitis was 4.38% in the
present study, which was much less than western
estimates of 15%–20%. Less industrialization and less
exposure to newer synthetic chemicals in our set up
may be the underlying reason for less prevalence of
contact dermatitis in our study. Urban prevalence was
higher than rural prevalence and the difference was
statistically significant. This information also further
confirms the common occurrence of contact dermatitis
in an economically advanced background.
The prevalence of allergic skin diseases was found
to be 45% in an Indian study,[12] which may be due
to overcrowding, poor hygiene, and easy exposure to
allergens. Rao et al.[13] concluded that environment,
overcrowding, poor living conditions, and poor hygiene
were found to be the major factors of skin diseases and
correction of these conditions shall significantly reduce
the occurrence of dermatoses.
In the study by Chowdhuri and Ghosh[9],
females [61.94% (n = 96)] were commonly affected than
males [38.06% (n = 59)], which is conforming largely
to our study (67% vs. 33%). One study on contact
dermatitis from Ludhiana, Punjab also showed female
preponderance.[14] Contact dermatitis in our study was
common in the age group of 41–50 years and least in
the age group of 81–90 yrs. This is also similar to the
above study[9] showing that predominantly involved age
group was the fifth decade. A previous study[14] from
Punjab also showed similar age group involvement.
The reason for which may be explained by the facts of
immunosenescence and less exposure to chemicals due
to less activity of life process in the latter age group.
In urban area, females are more affected than the rural
area, which may be related to increased occupational
and household exposure in the urban group than the
rural.
In the said study[9], occupation‑wise housewives were
most commonly involved, which is also supporting
our findings. However, their data showed much higher
involvement of 47.5%, which is comparatively low in
our study (26%). This difference may originate from
Table 1: Distribution of Contact Dermatitis Patients
(n=268) according to the Occupational Status
(Urban‑ Rural Comparison)
Occupation Urban Rural
No. Percentage No. Percentage
Professional 38 24% 14 12%
Pensioner/Retired 11 7% ‑ ‑
Homemaker 41 26% 29 26%
Student 38 24% 20 18%
Businessman 7 5% ‑ ‑
Skilled Laborer 6 4% 2 2%
Farmer 2 1% 5 5%
Paint shop 1 1% 19 17%
Unskilled Laborer 13 8% 20 18%
Vendor ‑ ‑ 2 2%
Total 157 100% 111 100%
P<0.0001
Table 2: Distribution of Contact Dermatitis Patients (n=268) according to the Residential Environmental pollution
Environmental Disturbances Urban nUrban Percentage Rural nRural Percentage
No history 100 62% 86 77%
Dust + Moisture + Contruction Material 26 17% 7 6%
Odor + Moisture 2 1% 6 5%
Dust + Construction Material 23 15% 10 9%
Toxic Fumes 1 1% 1 0.9%
Toxic Fumes + Dust + Construction Material 6 4% 2 2.1%
Total 157 100% 111 100%
P=0.0007
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Ghosh, et al.: Epidemiological pattern of contact dermatitis
272 Indian Journal of Dermatology | Volume 65 | Issue 4 | July-August 2020
the fact that the previous study was limited to only
footwear dermatitis. The study from Punjab[14] also
depicted the most common involvement of homemakers
with a higher number of female involvement (43.65%)
compared to ours as that was a focused study on metal
allergy.
Occupation‑wise homemakers were the commonest
sufferer for the obvious reasons of exposure to various
domestic materials. The use of soaps and cleansers and
wet work are the main reasons behind increased incidence
among homemakers. Vegetables (garlic and onion) were
the commonest suspected contactants (50%) followed
by soap and detergents (40%) and condiments (10%)
as shown in the study[15] of contact dermatitis on
housewives from northern India. Thus, the pattern of
work executed by the homemakers may differ from place
to place and this depends on the socioeconomic status
of the females. Occupationally, the difference between
urban and rural patients of contact dermatitis was
statistically significant, which may be explained by the
different occupational patterns in two setups.
A previous history of allergy in contact dermatitis
patients did not influence the course of the disease.
However, cosmetic history in the urban group was
significantly more than that in the rural group, which
may be due to easy accessibility of cosmetics in the
urban area and better economic background of these
groups of patients.
Conclusions
Regarding contact dermatitis, prevalence and patients’
profile in certain factors showed a statistically significant
difference between urban and rural patients.
The main limitation of the present study was that
the patients were selected from those attending the
hospital and not from the community. As such, there
was a chance of selection bias. In addition, the patients
were diagnosed with clinical presentation only and
no confirmatory methods, such as patch tests or
histopathology were used. However, patch test has no
role in diagnosing irritant contact dermatitis, which is
usually diagnosed clinically. In most cases, respondents
answered by recalling, so there was a possibility of recall
bias. Field study rather than the hospital‑based study
can only detect actual data on contact dermatitis in the
urban and rural set up, which may be attempted in the
future.
Declaration of patient consent
The authors certify that they have obtained all
appropriate patient consent forms. In the form the
patient(s) has/have given his/her/their consent for
his/her/their images and other clinical information
to be reported in the journal. The patients understand
that their names and initials will not be published and
due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conflicts of interest.
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Table 3: Distribution of Contact Dermatitis Patients (n=268) according to the Allergic History (Urban‑Rural
Comparison)
Allergic history Urban Urban percentage Rural Rural percentage
No Allergic History 83 53% 82 74%
Allergic Asthma + Allergic Conjunctivitis + Allergic Rhinitis 11 8% 3 3%
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Table 4: Distribution of Contact Dermatitis Patients
according to the Cosmetic History (Urban‑Rural
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Cosmetic History
Cosmetics Urban Urban
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Rural Rural
pecentage
No history of
cosmetic allergy
61 39% 83 75%
Perfume + BodySpray
+ makeup + Nail
Polish + Lip‑Stick
96 61% 28 25%
Total 157 100% 111 100%
P<0.0001
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Ghosh, et al.: Epidemiological pattern of contact dermatitis
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