Diagnosis & Management of Dermatologic Disorders (Including STDs, Leprosy, HIV and AIDS) SK Punshi
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Global Panorama of Dermatology including Scope of Skin Diseases in IndiaChapter 1

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Dermatology is an essential part of general medicine and with clientele of family physician. Since the skin is not, by any means, foreign to the body which it covers. Diseases of the skin are a common occurrence. There are not many statistics to prove the exact frequency of skin diseases in this country, but commonly 20% of the skin diseases, a family physician and treating dermatologist encounters them in their day to day practice. A survey among school children in London revealed that skin diseases were responsible for an absentee rate of 23 per 100 children. Amongst the industrial workers covered by the Employees' State Insurance Scheme, there is a high rate of absenteeism due to skin diseases. While infections are more common in the tropics, chemical and psychogenic dermatoses are common in western countries. There is no truth in the statement that skin diseases are to be found only in the tropics.
 
THE INDIAN SCENARIO
The skin disease is commonly found in tropical and developing countries like India, Pakistan, Bangladesh, Sri Lanka, Maldives are pyodermas, scabies, fungus infections, leprosy, STDs, HIV. The most commonly states in India affected by this diseases are Maharashtra, Tamil Nadu, Manipur, Central parts of Madhaya Pradesh and Chhatisgarh, Uttar Pradesh and Haryana.
 
THE WORLD STATISTICS
Most of the African countries still suffer from diseases occuring from malnutrition, a Vitaminosis, Hypoproteinemia, Leprosy, STDs, HIV, AIDS. The diseases in the developed and advanced countries are because of industrial pollution, chemical factories, rubber, nylon and synthetic dyes etc. are the common causes of skin diseases. The modern stress and 3strain of human life are also contributing diseases like Neuro-dermatitis, Eczemas, Vitiligo etc.
The epidemiology of skin diseases, the etiology, prevalence of the skin diseases, effects of skin diseases on the life of human beings depend on the geographical, ecological, environmental, Social factors above all the education, status and information of the masses.
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Fig. 1.1: Skin diseases in India
 
SCOPE OF DERMATOLOGY
Skin reflects the internal disease process. It is more or less a glass and mirror of the body. There are various causative factors like physical, emotional, stress and strain and other known and unknown influences including genetics, genetic codes, RNA and DNA markers.
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Fig. 1.2: Etiology of skin diseases in general
 
SKIN CONDITIONS CAUSED BY PARASITES
These infestations are caused by common insects. Mostly because of poverty, unhygienic conditions, crowded environments, poor nutrition and lack of education.
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Fig. 1.3: Skin parasitosis
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STRESS AND SKIN
Beauty is skin deep. It is a common saying. It is the largest organ of the body. It acts as a mantle or cover and protects from the external injuries. Its a important organ which creates unique shapes and hues in various individuals. If it is affected it will cause various reaction patterns.
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Fig. 1.4: Reaction patterns of skin
Skin disfigurement however may be a barrier to priviliges and opportunities because of the profound social significance of appearance and the attitudes and prejudices of the society towards one whose appearance is atypical. Because of certain skin diseases, physically attractive people are believed to have more socially desirable traits than others.
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Fig. 1.5: Social attitude towards skin appearance
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The outcome of the various response patterns may result in to itching, pain, crawling etc. and in the emotional responces may lead to disability and depression with negative thinking processes and causing into failures and disinterestedness in surroundings and in life.
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Fig. 1.6: Brain mind body axis
The skin is affected by mind so called psyche. Also the human body is affected by emotions, stress and strain of life due to various factors. For example, neurodermatitis, stress urticaria etc.
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Fig. 1.7: Psychosoma
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Fig. 1.8: Physiology of skin irritation
The skin is the boundary between ourselves and the world around us. It is important organ which acts as a mirror and window for the internal disease process which many times exhibits on the skin.
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Fig. 1.9: Impact, perspective, course and outcome of skin disease
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This may produce not only psychological but functional and sociological impact on the patient and in severe cases it may produce dejection and death.
The course of the skin diseases is described and depicted as (1) Acute (2) Sub acute (3) Chronic. And some of the disease are fatal e.g. (1) Penphigus and AIDS etc. The course and prognosis is depicted by the following diagram.
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Fig. 1.10: The skin diseases
Since time immemorial, over the course of evolution, nature prepared man to bear up to the various influences of his environment and to establish permanent contacts with changing environmental processes. During thousands of years, biological rhythms developed in accordance with the activities of different functional systems of the body. Moreover, these rhythms changed parallel to changes in nature or environment.
The skin is a mirror of the internal, systemic disease process. Because of the change of body immunity also changes in the local skin immunity will produce definite changes and disease process on the skin so called dermatological disease.