Skin disease in the Eastern Cape (SKINSCAPE): A Global Psoriasis Atlas point prevalence study in rural South Africa

Abstract

Background The Eastern Cape is an under-resourced province and the poorest in South Africa, where little is known about the epidemiology of skin diseases. Objectives To examine the nature and prevalence of skin diseases in two neighbouring rural villages in the Eastern Cape, South Africa. Methods We conducted a cross-sectional point prevalence study of skin diseases of residents (adults and children) in Mtyholo Dlova and Mdolomba villages in December 2023. Through house-to-house visits, we collected data on the households, participant demographics and skin diagnoses following clinical skin examination by dermatologists. Point prevalence rates and 95% confidence intervals (CIs) were calculated for each skin condition. Results A total of 309 households were visited with 698 participants included of whom 99% were Xhosa people, 56% were female [mean (SD) age 37.4 (24.2) years], 39% were unemployed, 18% were retired, 60% did not smoke and 69% did not drink alcohol. Seventy-five per cent of households had an average monthly income < ZAR3000 South African Rand (128 GBP). In total, 439 people had at least one skin disease with a point prevalence of any skin disease of 62.9% (95% CI 59.3-66.5). The most prevalent diseases in children (aged < 18 years) were tinea capitis (16.4%), acne vulgaris (13.0%), pityriasis alba (10.6%), prurigo (4.8%), postinflammatory hyperpigmentation (3.9%), xerosis (3.9%), atopic dermatitis (3.4%) and scabies (3.4%). In adults, the most prevalent diseases were xerosis (7.8%), acne vulgaris (7.4%), melasma (6.2%), dermatosis papulosa nigra (5.6%), scarring alopecia (3.5%), nonscarring alopecia (3.1%) and tinea pedis (3.1%). Psoriasis was rare, with a prevalence of 0.3% in the study population. Generally, skin disease was more common in female than male participants (65.8% vs. 59.2%) with sex-specific differences in the prevalence of certain dermatoses; melasma, alopecia (scarring and nonscarring), seborrhoeic dermatitis, dermatosis papulosa nigra and irritant contact dermatitis were more prevalent in female participants, whereas there was a predominance of pseudofolliculitis barbae, atopic dermatitis, postinflammatory hyperpigmentation, acne vulgaris, pityriasis versicolor, scabies, tinea pedis and tinea capitis in male participants. Conclusions Skin disease is common in the Eastern Cape, South Africa. These findings may help strengthen the provision of dermatology services and the distribution of resources in the region, and highlight training opportunities for healthcare workers.