Skin conditions

What are skin conditions?

There are many different types of skin condition that can cause pain, itching or other types of discomfort. Skin conditions are common in the general population.

The most frequent conditions seen in general practice are skin infections (fungal infections/ dermatomycosis, erysipelas, impetigo), benign skin growths, birthmarks, various types of eczema (seborrhoeic eczema, constitutional eczema, contact eczema), atheroma (sebaceous cyst), acne and urticaria (hives).

  • Acne is a skin condition in which sebaceous glands get clogged or inflamed, and spots develop. Acne is particularly common in people aged between 15 and 25 years but it may also be seen in older age groups.
  • Constitutional eczema is an itchy skin rash in people who are susceptible to allergies.
  • Contact eczema is a skin irritation that occurs when the skin comes into contact with certain substances.
  • Seborrhoeic eczema is a harmless condition that causes flaking, particularly in the face, on parts of the head covered with hair and on the ears.
  • Psoriasis is a chronic skin condition associated with white/silver-grey skin flaking, redness and itching. The skin improves or worsens periodically. Psoriasis is not contagious.
  • Skin infections are caused by fungi, bacteria, viruses or mites.
    Hives (urticaria) is an itchy skin rash with pale to pink, slightly swollen spots. The rash develops suddenly and it usually disappears within a few hours or days.

 

What are the complaints associated with skin conditions?

  • Acne and spots. The blackheads (comedones) caused by the accumulation of oil (sebum) are characteristic of acne. When the sebaceous gland becomes inflamed, a red pimple develops, often with a yellow head containing pus. Acne can sometimes cause scars. Infected pimples may be sensitive or painful.
  • Constitutional eczema causes itching, redness, swelling, flakes, pimples, blisters, chapping or scabs. Skin affected by eczema can sometimes become infected and this may result in pustules, pus formation, yellow scabs and pain.
  • Contact eczema results in a number of complaints. In acute eczema, itchy blisters filled with fluid are often accompanied by a diffuse, fiery red swelling. The blisters eventually burst, resulting in moist spots on the skin that may become inflamed due to bacterial infection (secondary infection). In chronic eczema, the skin is actually extremely dry, red and flaky. In addition, the skin becomes thick and leathery (lichenification) and these symptoms may sometimes be accompanied by chapping and pain.
  • Chronic eczema is usually seen on the hands. A person with chronic eczema will often suffer more from chapping and pain than from itching.
  • Seborrhoeic eczema causes red skin and yellow, greasy flaking under the hair, on the hairline, in the eyebrows, and behind and in the ears. The eczema can also cause itching.
  • Psoriasis can present in several ways: isolated spots or extensive red areas with flaking and itching. The flakes are white or silver-grey and they detach easily. The main affected areas are the elbows and knees, the head and the lower back. The eczema may sometimes be located in folds of the skin, for example in the groin, the armpits, the cleft between the buttocks or below the breasts. It may persist for a few weeks or throughout life. Psoriasis can also result in nail deformities (small dents in the nails) and problems with the joints (particularly the fingers and toes).
  • Skin infections cause pain, itching, redness, flaking, blisters, chapping, white rashes, pustules and scabs. There is considerable variation between the different types of infection. Deeper infections such as erysipelas may also be accompanied by fever and general malaise.
  • Hives (urticaria) results in an itchy rash that develops suddenly and usually disappears within a few hours or days. It can also be present at particular times of the day (in the evenings, for example). It is usually caused by allergy/hypersensitivity but psychological factors (such as stress or tension) may also play a role.

    People with intellectual disabilities sometimes find it impossible to communicate these complaints. The people around them may then notice only a change in behaviour.

    How common are skin conditions in the general population?

    The one-year prevalence for all skin conditions (for which people see their GP) is 39.2%.  320
    This figure can be broken down for the individual skin conditions:

    • acne 0.8%  321
    • constitutional eczema more than 1%  571
    • contact eczema 4%  571
    • urticaria (hives) 0.73%  320
    • psoriasis 0.76%  572
    • bacterial skin infections 3.2% and specific impetigo in children up to the age of 9 years 3.0%  573
    • fungal skin infections 3.1% (of which almost half are foot infections)
    • scabies 0.04%
    • viral skin infections, including warts 2.5%
    • molluscum contagiosum 2.7%
    • herpes zoster (shingles) 0.38%
    • herpes simplex (cold sores and genital herpes) 0.25%.  320

How common are skin conditions in people with intellectual disabilities?

One-year prevalence is 43.8% to 48.3% in older people with intellectual disabilities 327 , 328  and 56% in adolescents and young adults with Down syndrome. 574
Broken down according to the different skin conditions:

 

  • Acne: A Dutch study compared the health problems of 318 people with intellectual disabilities with those of 48,443 people from the general population. The people with intellectual disabilities had acne almost twice as often (4.1%, as opposed to 2.3%). 329 . A study of 203 people with Down syndrome found that 5.9% had acne. 330  In young people with Down syndrome aged between 10 and 28 years, the prevalence rate is 71%, which is not higher than the prevalence rate at about this age in the general population. 575
  • Constitutional eczema: A Dutch questionnaire study answered by the parents of all 2271 adolescents with intellectual disabilities in the provinces of Groningen and Drenthe found that the one-year prevalence for chronic eczema was 4.3%. 331 . A number of skin orders, such as seborrhoeic eczema, are more common in people with Down syndrome but constitutional eczema does not seem to be significantly more prevalent than in the general population. 330 , 332
  • Contact eczema: It is not known how common contact eczema is in people with intellectual disabilities. Contact eczema with other types of eczema is found in 5.7% of people with intellectual disabilities. Dutch research looking at health problems found that eczema was 2.2 times more prevalent than in the general population 329 .
  • Psoriasis: A Dutch questionnaire study answered by the parents of all 2271 adolescents with intellectual disabilities in the provinces of Groningen and Drenthe found that the one-year prevalence for psoriasis was 1.3%. 333  . Psoriasis would not seem to be significantly more prevalent in people with Down syndrome than in the general population (0.5% to 8%). 330 , 332
  • Skin infections: Fungal infections of the feet in particular are more common in adults with intellectual disabilities than in the general population. A Dutch study found a prevalence rate of 19%, with compromised immunity and wearing orthopedic footwear as specific risk factors. 576  It is not known how prevalent the other skin infections are. More infections (such as scabies) have been seen in people with Down syndrome. 332
  • Hives: It is not known how common hives is in people with intellectual disabilities.
    39.20% General population
    43.8% to 48.3% People with intellectual disabilities
    56% People with Down syndrome
320

Linden van der MW, Wester GP, de Bakker DH, Schellevis FG. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk: klachten en aandoeningen in de bevolking en in de huisartspraktijk. Utrecht/Bilthoven: NIVEL/RIVM 2004.

321

Smeets JGE, Grooten SJJ, Bruinsma M, Jaspar AHJ, Kertzman MGM. NHG-Standaard Acne (Tweede herziening).Huisarts Wet 2007:50(6):259-68.

571

Dirven-Meijer PC, De Kock CA, Nonneman MMG, Van Sleeuwen D, De Witt-de Jong AWF, Burgers JS, Opstelten W, De Vries CJH. NHG-Standaard Eczeem. Huisarts Wet 2014;57(5):240-52

572

Van Peet PG, Spuls PhI, Ek JW, Lantinga H, Lecluse LLA, Oosting AJ, Visser HS, Burgers JS, Geijer RMM, Kolnaar BGM, Eizenga WH. NHG-Standaard Psoriasis(derde herziening). Huisarts Wet 2014;57(3):128-35

573

Wielink G, Koning S, Oosterhout RM, Wetzels R, Nijman FC, Draijer LW. NHG-Standaard Bacteriële huidinfecties. Eerste herziening Huisarts Wet 2007;50(9):426-44

327

Merrick J, Davidson PW, Morad M, Janicki MP, Wexler O, Henderson CM. Older adults with intellectual disability in residential care centers in Israel: health status and service utilization. Am J Ment Retard. 2004 Sep;109(5):413-20.

328

Janicki MP, Davidson PW, Henderson CM, McCallion P, Taets JD, Force LT, Sulkes SB, Frangenberg E, Ladrigan PM. Health characteristics and health services utilization in older adults with intellectual disability living in community residences. J Intellect Disabil Res. 2002 May;46(Pt 4):287-98.

574

Pikora TJ, Bourke J, Bathgate K, Foley KR, Lennox N, Leonard H. Health conditions and their impact among adolescents and young adults with Down syndrome. PLoS One. 2014 May 12;9(5):e96868

329

Schrojenstein Lantman-de Valk van HMJ, Metsemakers JFM, Haveman MJ, Crebolder HFJM. Health problems in peolple with intellectuel disability in general practice: a comperative study. Familiy Practice 2000. Vol17.No5 405-7

330

Schepis C, Barone C, Siragusa M, Pettinato R, Romano C. An updated survey on skin conditions in Down syndrome.Dermatology. 2002;205(3):234-8.

575

Bagatin E, Kamamoto CS, Guadanhim LR, Sanudo A, Dias MC, Barraviera IM, Colombo FC. Prevalence of acne vulgaris in patients with Down syndrome. Dermatology. 2010;220(4):333-9

331

Oeseburg B, Jansen DE, Dijkstra GJ, Groothoff JW, Reijneveld SA. Prevalence of chronic diseases in adolescents with intellectual disability. Res Dev Disabil. 2010 May- Jun;31(3):698-704.

332

Barankin B, Guenther L. Dermatological manifestations of Down’s syndrome. J Cutan Med Surg. 2001 Jul-Aug;5(4):289-93.

333

Oeseburg B, Jansen DE, Dijkstra GJ, Groothoff JW, Reijneveld SA. Prevalence of chronic diseases in adolescents with intellectual disability. Res Dev Disabil. 2010 May- Jun;31(3):698-704.

576

G. Asma, P. van Erp, E. van Hagen, P. van Vlokhoven. Prevalentie van Tina Pedis (voetschimmel) bij mensen met een verstandelijke beperking. Leeronderzoek AVG-opleiding ErasmusMC 2011. www.erasmusmc.nl/avgopleiding

Linden van der MW, Wester GP, de Bakker DH, Schellevis FG. Tweede Nationale Studie naar ziekten en verrichtingen in de huisartspraktijk: klachten en aandoeningen in de bevolking en in de huisartspraktijk. Utrecht/Bilthoven: NIVEL/RIVM 2004.

Smeets JGE, Grooten SJJ, Bruinsma M, Jaspar AHJ, Kertzman MGM. NHG-Standaard Acne (Tweede herziening).Huisarts Wet 2007:50(6):259-68.

Dirven-Meijer PC, De Kock CA, Nonneman MMG, Van Sleeuwen D, De Witt-de Jong AWF, Burgers JS, Opstelten W, De Vries CJH. NHG-Standaard Eczeem. Huisarts Wet 2014;57(5):240-52

Van Peet PG, Spuls PhI, Ek JW, Lantinga H, Lecluse LLA, Oosting AJ, Visser HS, Burgers JS, Geijer RMM, Kolnaar BGM, Eizenga WH. NHG-Standaard Psoriasis(derde herziening). Huisarts Wet 2014;57(3):128-35

Wielink G, Koning S, Oosterhout RM, Wetzels R, Nijman FC, Draijer LW. NHG-Standaard Bacteriële huidinfecties. Eerste herziening Huisarts Wet 2007;50(9):426-44

Merrick J, Davidson PW, Morad M, Janicki MP, Wexler O, Henderson CM. Older adults with intellectual disability in residential care centers in Israel: health status and service utilization. Am J Ment Retard. 2004 Sep;109(5):413-20.

Janicki MP, Davidson PW, Henderson CM, McCallion P, Taets JD, Force LT, Sulkes SB, Frangenberg E, Ladrigan PM. Health characteristics and health services utilization in older adults with intellectual disability living in community residences. J Intellect Disabil Res. 2002 May;46(Pt 4):287-98.

Pikora TJ, Bourke J, Bathgate K, Foley KR, Lennox N, Leonard H. Health conditions and their impact among adolescents and young adults with Down syndrome. PLoS One. 2014 May 12;9(5):e96868

Schrojenstein Lantman-de Valk van HMJ, Metsemakers JFM, Haveman MJ, Crebolder HFJM. Health problems in peolple with intellectuel disability in general practice: a comperative study. Familiy Practice 2000. Vol17.No5 405-7

Schepis C, Barone C, Siragusa M, Pettinato R, Romano C. An updated survey on skin conditions in Down syndrome.Dermatology. 2002;205(3):234-8.

Bagatin E, Kamamoto CS, Guadanhim LR, Sanudo A, Dias MC, Barraviera IM, Colombo FC. Prevalence of acne vulgaris in patients with Down syndrome. Dermatology. 2010;220(4):333-9

Oeseburg B, Jansen DE, Dijkstra GJ, Groothoff JW, Reijneveld SA. Prevalence of chronic diseases in adolescents with intellectual disability. Res Dev Disabil. 2010 May- Jun;31(3):698-704.

Barankin B, Guenther L. Dermatological manifestations of Down’s syndrome. J Cutan Med Surg. 2001 Jul-Aug;5(4):289-93.

Oeseburg B, Jansen DE, Dijkstra GJ, Groothoff JW, Reijneveld SA. Prevalence of chronic diseases in adolescents with intellectual disability. Res Dev Disabil. 2010 May- Jun;31(3):698-704.

G. Asma, P. van Erp, E. van Hagen, P. van Vlokhoven. Prevalentie van Tina Pedis (voetschimmel) bij mensen met een verstandelijke beperking. Leeronderzoek AVG-opleiding ErasmusMC 2011. www.erasmusmc.nl/avgopleiding