|Year : 2021 | Volume
| Issue : 2 | Page : 149-152
Skin behind the bars!
Komal Ramteke, Sumit Kar, Safa Patrick, Ajinkya Sawant, Pooja Manwar, Pratiksha Sonkusale, Subhor Nandwani
Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India
|Date of Submission||20-Jul-2020|
|Date of Decision||06-Oct-2020|
|Date of Acceptance||23-Nov-2020|
|Date of Web Publication||26-Aug-2021|
Department of Dermatology, Venereology and Leprosy, Mahatma Gandhi Institute of Medical Sciences, Sewagram - 442 102, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Prisoners fall in the most vulnerable population group, but the health issue of this group is the most understudied. The various dermatological conditions that hamper their overall health and quality of life needs to be identified and serious measures should be undertaken for preventing them. Objectives: This study is one of the rare studies that aim to identify the dermatosis pattern and to relate with its etiological factors and suggest preventive methods to be undertaken for it. Materials and Methods: Total three visits were made to the district jail located in Central India over a period of 8 months, and the prison inmates were clinically examined. The data was recorded and results were drawn. Results: Scabies accounted for 31.51% while dermatophytes accounted for 30.83%. Other dermatoses seen were acne vulgaris (5.17%), allergic contact dermatitis (ACD) in 5.03%, pyoderma (2.71%), urticaria (2.86%), and tinea versicolor (2.62%). These were followed by the other dermatoses such as milia (1.81%), alopecia areata (0.5%), and irritant contact dermatitis (0.5%); viral infections such as herpes labialis (0.45%) and molluscum contagiosum (0.45%); and pigmentary disorders such as vitiligo (0.65%) and melasma (1.16%). Three new cases of Hansen's disease were diagnosed clinically (1.75%). Conclusion: We found that common dermatoses were scabies and fungal infections which are due to the overcrowding and poor hygiene facility in the prison premises. During the subsequent visits, the number of dermatophyte infections declined which may be attributed to patient counseling and awareness regarding hygiene and general cleanliness which was provided by us to the inmates in all previous visits. A detailed look into the matter may improve the overall dermatological health of the inmates.
Keywords: Central India, dermatoses, jail, prison inmates, skin
|How to cite this article:|
Ramteke K, Kar S, Patrick S, Sawant A, Manwar P, Sonkusale P, Nandwani S. Skin behind the bars!. Clin Dermatol Rev 2021;5:149-52
| Introduction|| |
Prison inmates are the most vulnerable population for various dermatological conditions. Various efforts can be made to improve their condition by conducting various studies to identify the dermatosis pattern and etiological factors for the same. Prison is a place where people are legally held as punishment for their crime. This study was conducted in the premises of a district jail located in Central India with a capacity of 252 inmates. At the time of study, a total number of inmates were 358 (351 males and 7 females). Area of the jail premises is 9720 m2. It has three big cells, each having an area of 200 m2 accommodating 70–80 inmates. It also has five small cells, each having an area of 125 m2 accommodating 20–30 inmates. There are three toilets in each big cell and one toilet for each small cell.
Some studies have postulated specific factors prevalent in the prison environment that may contribute to skin disease in this particular population, including stress, smoking, substance addiction, and personal hygiene and overcrowding. This study is the first of its kind to study the dermatoses prevalent in the prison inmates of one of the prisons in Central India where hot and humid climate is prevalent.
| Materials and Methods|| |
We conducted an observational study in the district jail premises, located in Maharashtra after obtaining institutional ethics committee approval. A total of three camp visits were done within the duration from October 2018 to June 2019, by the specialist doctors from the tertiary care institution. The inmates who symptomatically complained of any dermatological disease were included. No exclusion criteria were specified. Out of the total 358 inmates, we got 64 (18%), 74 (21%), and 51 (14%) inmates in the first, second, and third visits, respectively, who had one or the other dermatoses. A detailed history taking and prompt clinical examination was done to draw proper clinical diagnosis and appropriate counseling and treatment was given. Due to field limitation, no laboratory diagnostic tests were done. All the patients' epidemiologic profile and diagnosis was noted down and records were maintained. The data analysis was done by descriptive statistics and proper conclusions were drawn.
| Results|| |
During the first visit, 64 patients were examined [Figure 1]. Out of these, 25 (37.88%) showed dermatophyte infection. Among the dermatophyte infections, 17 (68%) had tinea cruris, 4 (16%) had tinea corporis, 2 (8%) had tinea faciei, and 2 (8%) had tinea corporis et cruris. Twenty-one (31.82%) had scabies. Urticaria, pityriasis versicolor, and allergic contact dermatitis (ACD) were seen in 3 inmates (4.5%) each. Due to certain limitations, patch testing was not done and the allergens responsible for causation of ACD could not be identified. Acne vulgaris was seen in 2 inmates (3.03%). Alopecia areata, irritant contact dermatitis (ICD), milia, pyoderma, and melasma were seen in only one patient (1.52%) each. Other skin disorders including keloid, postinflammatory hyperpigmentation, and miliaria were seen in 4 patients (6.06%).
During the second visit, 74 patients were seen [Figure 2]. Scabies was seen in maximum, i.e., in 29 (39.19%) inmates. It was followed by dermatophyte infection in 23 (31.08%). Among the dermatophyte infections, 13 (56.5%) had tinea cruris, 8 (34.78%) had tinea corporis, 2 (8%) had tinea faciei, and 2 (8%) had tinea corporis et cruris. Three inmates (4.05%) had urticaria. ACD, pyoderma, and acne vulgaris were seen in 2 inmates (2.70%) each. In this visit, 1 (1.53%) new case of lepromatous leprosy with type 2 reaction presented with ENLs, fever, and thickened nerves. He was diagnosed clinically and was referred to our tertiary care center for laboratory confirmation and further management. Pityriasis versicolor, herpes labialis, and molluscum contagiosum were seen in 1 patient (1.35%) each. Nine patients (12.16%) showed other skin disorders such as onychomycosis, xerosis, and miliaria.
During the third visit, 51 inmates had dermatoses [Figure 3]. The maximum number of inmates showed scabies and dermatophyte infections, i.e., 12 (23.53%) each. Among the dermatophyte infections, 9 (75%) had tinea cruris and 3 (25%) had tinea corporis. Acne vulgaris was seen in 5 inmates (9.80%), followed by ACD in 4 inmates (7.84%). Milia and pyoderma were seen in 2 patients (3.92%) each. Two (3.92%) new cases of lepromatous leprosy with type 2 reaction were diagnosed clinically during the third visit. Melasma, vitiligo, and pityriasis versicolor were seen in 1 (1.96%) inmate each and other skin disorders seen in 9 patients (17.65%).
Thus, on an average [Figure 4], 20.6 inmates per visit (31.51%) had scabies. Average of 20 patients per visit (30.83%) showed dermatophyte infection. Considering among the tinea patients, 13 (66.5%) had tinea cruris, 5 (25.26%) had tinea corporis, 1.33 (5.5%) had tinea faciei, and 0.66 (2.6%) had tinea corporis et cruris. ACD was seen in total 9 patients (5.03%). During all the three visits, 6 patients (2.86%) had urticaria and 4 patients (2.62%) had pityriasis versicolor. Three patients (1.81%) had milia. Alopecia areata and ICD were seen in 1 patient each during the first visit only (0.5%). Whereas, pyoderma was seen in total 5 patients (2.71%). We found a considerable number of patients of acne vulgaris on an average of 3 patients per visit (5.17%); 3 new cases of lepromatous leprosy with type 2 reaction (1.75) were diagnosed clinically. One patient during the second visit showed viral infections such as herpes labialis (0.45%) and one patient showed molluscum contagiosum (0.45%). Pigmentary disorder like vitiligo was seen in 1 patient (0.65%) during the third visit and melasma was seen in total of 2 patients (1.16%).
| Discussion|| |
In our study, the most common observed dermatosis was scabies, followed by fungal infections. Among all the tinea-infected patients, site-wise classification showed tinea cruris to be most common (66.5%), followed by tinea corporis (25.26%) and tinea faciei (5.5%). The main cause was overcrowding in the jail premises along with poor sanitation facility like sharing of towels and other linen. It becomes the most important factor for the rampant spread of dermatophyte infections and scabies in the inmates. The hot and humid climate prevalent in this geographic region further aids in high prevalence of these dermatoses among the prison inmates.
The study also found dermatoses such as contact dermatitis and urticaria. ACD was seen in 5.7% of the patients and ICD was seen in 0.5%. Urticaria was seen in 2.86% of the patients. This can be attributed to the outdoor activities which the prison inmates are instructed to do on a daily basis.
We were also able to find bacterial infections such as pyoderma and Hansen's disease. Pyoderma was seen in 2% of the patients. We detected three new patients of lepromatous leprosy with type 2 reaction in the span of just 1 year. This indicates that Hansen's disease is yet to be eliminated from this geographic region and new case detection is on rise even in recent time.
The least common dermatoses were pigmentary diseases such as melasma and vitiligo which accounted for 1.04% and 0.05%, respectively, and autoimmune diseases such as alopecia areata accounted for 0.05%.
The total number of patients with dermatoses declined during the subsequent visits. This can be accredited to the fact that appropriate counseling and prompt clinical treatment was given in previous visits. Furthermore, the provision of free medications during the camp visits further aided in the betterment of the providing dermatological care.
Kuruvila et al. studied dermatosis pattern among the inmates of Mangalore district prison, India, in the year 2002. They found that 63.6% of the inmates suffered from infectious and 36.4% suffered from noninfectious dermatoses. Among the infections, 51.3% were superficial dermatophyte infections, 16% were scabies, and 13.3% were pediculosis capitis. Among the noninfectious dermatoses, dandruff (21%) and pigmentary changes (21%) were the most common. One case was subsequently diagnosed as borderline tuberculoid leprosy similar to the findings of all study.
Roodsari et al. in 2007 suggested that the most common diseases were truncal acne in 185 cases (13.1%) and tinea versicolor in 158 (11.2%) cases and least common dermatoses were infection such as scabies in 31 (2.2%), 24% had pyoderma, folliculitis in 24 (1.7%), and pediculosis in 12 (0.9%) cases, contrary to the findings of all study.
Oninla and Onayemi studied the dermatosis pattern in the inmates at a Nigerian prison in Ilesha, Osun state, in 2012 and found infections such as dermatophytes, pityriasis versicolor, and bacterial infections to be most common as seen in our study.
Mannocci et al. studied dermatological diseases among male prisoners in Southern Lazio, Italy, in 2013 and found nnonspecific dermatitis as the most common dermatoses. Scabies was found to be least common, contrary to the findings of all studies.
Gavigan et al. studied the federal prison population in Ontario in 2016. In this study, acne, psoriasis, rosacea, and other superficial mycoses were found to be the most common, but scabies was seen only in one patient, contrary to the findings of our study.
| Conclusions|| |
Infectious diseases have been found to be more prevalent as compared to noninfectious autoimmune diseases in the prison inmates. Overcrowding, poor sanitation facilities, and hot humid environment coupled with relative ignorance of the inmates regarding hygiene pave the way to rampant spread of parasitic and fungal infections. Furthermore, during the subsequent visits, the number of dermatophyte infections declined that may be due to patient education regarding hygiene, general cleanliness, and provision for medicines provided for treatment during previous visits. These helped in providing better dermatological care; also, detection of new cases of Hansen's disease in jail prisoners is a matter of concern, and serious measures should be undertaken to provide medical care for such patients in the jail premises to prevent the progression of disease to severe form and also in preventing the spread of such chronic debilitating disease to other jail inmates. A detailed look into the matter may improve the overall dermatological health of the inmates.
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 initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]