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Indian Journal of Community Medicine

Study of Infective Dermatoses among Street Children and Adolescents in Mumbai

Author(s): K. Mukherjee, S.Z. Quazi, A. Gaidhane

Vol. 31, No. 2 (2006-04 - 2006-06)


Skin diseases are one of the leading causes of morbidity in children. It is believed that lack of personal hygiene and unhygienic conditions overcrowding, inadequate treatment hot and humid conditions, sharing of towels/combs result in a broad spectrum of infective dermatoses like scabies, pediculosis, pyoderma, fungal, viral infection and leprosy etc. All these may lead to secondary infection, which could be very severe resulting in cellulitis and septicemia. Studies have identified that children are susceptible to skin infections. It is suspected that this group is at a higher risk of developing severe sequlae of these infections later in life like glomerulonephritis, infective endocarditis etc. Various studies1,2 have been conducted in different parts of India to understand the skin problems in children, which have shown varying patterns. Complicating the health status of the street children is the lack of knowledge and awareness regarding good hygienic practices, like regular bathing with clean water, changing of clothes etc. Hence the present study was conducted to find out prevalence of infective dermatoses and correlate it with age of children, frequency of bathing, frequency of changing clothes, drug abuse and sexual exposure.

Material and Methods

This was a cross-sectional study in which male street children & adolescents age 8 to 20 years residing at a shelter in Mumbai were investigated. Total numbers of boys in shelter were 121 out of which 107 were available for study (acceptable error rate being 10% at 95% confidence level). All these children were interviewed by means of a pretested interview schedule regarding their demographic profile and personal hygiene practices in terms of bathing and changing of clothes.

Bathing was defined as washing of all body parts including genital area with clean water. Changing of clothes was defined as change of clothes with clean ones. Drug abuse was defined as self-administration of a drug for non-medical reasons in quantities and frequencies which may impair an individuals ability to function effectively and which may result in social, physical or emotional harm.

Clinical examination of the boys was conducted by doctors to diagnose infective dermatoses and wherever required results were verified by laboratory investigations. The data collected was compiled and analysed using SPSS version 10.

Results and Discussion

The prevalence of infective dermatoses in the age group 8- 14 years was 80% while in the 15-20 years age group it was found to be 35% only. This difference was found to be statistically significant (p<0.001). Younger the age, more the chances of infective dermatoses; odds ratio being 7.4 with 95% confidence interval (C.I) 2.8-19.9. Pyoderma (41.7%) followed by scabies (40%), dermatophytosis (20%), pediculosis capitis (20%) were the common skin infections seen. Some of them had multiple skin infections. A study found pediculosis capitis to be 22.6% and pyoderrna to be 15.6% in a hospital set up. Some of them had multiple skin infections. A study on skin diseases in Gharwal region found pediculosis capitis to be 22.6% and pyoderma to be 15.6% in a hospital set up3.

Table I: Frequency of bathing change of clohes, drug abuse and infective dermatoses

Infective Dermatoses
  Present Absent Total
Bathing* <3 times a week 52 (83.9) 10 (16.1) 62 (57.9)
>3 times a week 8 (17.8) 37 (82.2) 45 (42.3)
Changing clothes** <2 times a week 49 (86) 8 (14) 57 (53.3)
>2 times a week 11 (22) 39 (78) 50 (46.7)
Drug abuse** Present 20 (42.5) 27 (57.5) 47 (43.9)
Absent 40 (66.7) 20 (33.3) 60 (56.1)
* p<0.001, ** p<0.001, ***p<0.05

Bathing less than 3 times a week, change of clothes less than 2 times a week and drug abuse are significantly associated with infective dermatoses. Taking drugs is usually associated with staying in groups and shaking of needles. It is possible that such close associations in unhygienic conditions in the street predispose to infective dermatoses. In a study on runaway adolescents a large number reported substance abuse4. In a study on risk factors of substance use among street children from Delhi more than half of the subjects had indulged in substance of use before coming to the observation home. The agents consumed were nicotine, inhalants, alcohol and cannabis5.

Sexual abuse of street children make them vulnerable to genital skin infections. The overall prevalence of genital scabies is 9.34%. 76.7% had history of sexual exposure. However in this study the prevalence of genital scabies among those with history of sexual abuse was low (2.4%). As the condition under study was infective dermatoses the other STIs which do not farm part of infective dermatoses have not been studied.

Table II: Sexual Exposure and genital Scabies

Genital Scabies Total
History of Sexual
Present Absent
(%) No. (%) No.
Present 2 (2.4) 80 (97.6) 82
Absent 8 (32) 17 (68) 25

Preventive measures in terms of health education, counselling etc need to be urgently initiated to address the issues of drug abuse and sexual abuse. Linkages need to be developed for the affected children with the police and other support groups.


The prevalence of infective dermatoses was 56.1% among the street children of shelter. Among the infective dermatoses the commonest were scabies and pyoderma. Significant difference was found between frequency of bathing, frequency of change of clothes and drug abuse with infective dermatoses. Infective dermatosis is a predominant skin disorder among street children. Improvement in personal hygiene and community awareness regarding dermatoses along with a proper and regular health check up may reduce the prevalence of infective dermatoses.


  1. Vikas.B. Extent and pattern of infective dermatoses in rural areas of Central India. Indian J Dermatol Venerol Leprol 1997; 63: 22-25.
  2. Bhansali KM, Mathur GM, Sharma RA. study of morbidity pattern in children (Udaipur), Indian J Dermatol Venerol, Leprol 1979; 46: I3-l7.
  3. Negi KS, Kandpal SD, Prasad D. Pattern of skin diseases in children in Gharwal region of Uttar Pradesh. Indian Pediatrics 2001; 38: 77-80.
  4. Khurana S, Sharma N, Jena S, Saha R, Ingle GK. Mental health status of runaway adolescents. Indian J Pediatr 2004; 71: 405-9.
  5. Pagare D, Meena GS, Singh MM, Sahu R. Risk factors of substance use among a street children from Delhi. Indian Paediatr 2004 41: 221-5.

Lokmanya Tilak Municipal Medical College Sion, Mumbai.
Received: 22.10.2002

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