Patterns of Skin Disease among Prisoners in Central Prison in Nepal: A Descriptive Cross-sectional Study

Introduction: Skin diseases pose a significant health challenge globally, especially within prison settings where overcrowding and inadequate sanitation create a breeding ground for infections. Prisons, as part of society, exist in a dynamic equilibrium, serving as potential sources of infections that can spread beyond their confines. Despite facing similar challenges, there is a dearth of research focusing on skin diseases among inmates in Nepal. This study aims to assess patterns of skin diseases among prisoners. Methods: This was a descriptive cross-sectional study at the central prison, Kathmandu from December 2023 to March 2024. All patients with skin disease visiting the consultant Dermatologist and giving consent were included in this study. Ethical approval was obtained from the Nepal Health Research Council. Data were entered in Microsoft Excel 2010 and analysis was done by the Statistical Package for the Social Sciences software. Data were presented in the form of frequency and percentage. Results: A total of 253 patients visited the consultant Dermatologist for skin conditions. Out of which, eczema was 67 (26.50%), fungal infections 57 (22.50%), and bacterial infections 51 (20.10%). The mean age of the respondents was 34.21±12 years. Conclusions: The fungal and bacterial infections were common among the prisoners.


INTRODUCTION
Skin diseases are widespread in prisons due to overcrowding and poor sanitation.Prison inmates are among the vulnerable groups. 1,2In Nepal, like many other countries, prisons are often overcrowded and lack adequate healthcare facilities, making prisoners particularly vulnerable to various health conditions, including skin diseases. 3Despite the increasing vulnerability, the health issues of prisoners are understudied. 4Skin diseases can significantly affect a person's quality of life and more certainly overcrowding, hygiene limitations, and close contact in prisons elevate the risk of skin infections. 5Some of the common skin diseases that are prevalent among prison inmates are scabies, non-specific dermatitis, pediculosis, psoriasis, alopecia, acne, mycosis, eczema, skin infections, skin infestations, urticaria, hyperpigmentation, etc. 6,7 In Nepal, very little work has been done on the study area that describes patterns of skin diseases among prison inmates.Therefore, this study aims to determine the pattern of skin diseases among prison inmates.

METHODS
A descriptive cross-sectional study was conducted in a central jail, in Kathmandu, Nepal.All patients visiting consultant Dermatologist for skin conditions between December 2023 to March 2024 were included in the study.The patient over the age of 18 years were included in the study and those who had dermatological Free Full Text Articles are Available at www.jnma.com.npdiseases diagnosed before coming to jail were excluded from the study.The ethical approval was obtained from the Ethical Review Board of the Nepal Health Research Council (Ref no 803).Written consent was taken from those willing to participate.The study possesses minimal risks during data collection due to the use of routine history taking and laboratory examinations of the skin.Prisoners were informed about the study through an information sheet (Nepali language) explaining the procedures: cutaneous examination, medical history, and a potential second visit for treatment.
The consultant dermatologist then conducted medical history interviews and cutaneous examinations at the jail hospital.Examinations included clinical descriptions of lesions, palpation, dermatoscopy, and KOH tests as needed.Data was recorded in dedicated skin examination forms.Prisoners requiring further consultation or treatment were invited for a voluntary second visit, where appropriate interventions and medication prescriptions were provided free of charge within the Central Jail Hospital.Data were entered in Microsoft Excel 2010 and analysis was done by the Statistical Package for the Social Sciences software.Data were presented in the form of frequency and percentage.

RESULTS
Out of 253 participants, 127 (50.20)% of the population was under 30 years of age.The proportion of male respondents was 180 (71.10%) (Table 1).

DISCUSSION
Our study identified a higher proportion of fungal infections (41.10%) followed by eczematous diseases (26.48%).The pattern of skin diseases was similar when compared to studies conducted in Nepal, India, Pakistan, Taiwan, and Nigeria. 2,3,8,10,11Prison inmates may suffer from higher rates of eczema and fungal skin infections due to factors such as overcrowding, poor hygiene conditions, limited access to medical care, and increased stress levels. 3,4,8The sleeping area in the cells was far less than that of the dormitories, resulting in increased skin contact and more infections.According to data, the prison is more than twice as full as it can accommodate, meaning that 2750 inmates are housed in a space meant for 1250 inmates. 12The prevalence of infectious dermatoses is an index of socioeconomic development.Therefore, the highest burdens of transmissible dermatoses occur in resourcepoor settings in developing countries.Information on The predominant clinical manifestation was identified as eczema 67 (26.48%), tinea 47 (18.57%) followed by acne, dermatitis, scabies, pityriasis, etc.The health problems faced by prisoners aren't confined to prison alone; they also extend to society, as over 95% of inmates will reintegrate into the community eventually. 13Prisons and jails are constantly in flux with people entering and leaving, highlighting the importance of providing proper medical and social support for inmates. 14

CONCLUSIONS
The common skin conditions observed in prisoners were dermatitis, tinea, and acne.Most of the participants were male.

Acknowledgment: None
Conflict of Interest: The author declared no competing interests.
Author's Contribution: All authors contributed equally to the study.
Ethical Consideration: Ethical Issues (Including Plagiariasm, Data Fabrication, Double Publication) have been completely observed by authors.
Funding: None

Table 2 . Pattern of Skin Diseases (n=253).
Dhakal et al.Patterns of Skin Disease among Prisoners in Central Prison in Nepal: A Descriptive Cross-sectional Study Free Full Text Articles are Available at www.jnma.com.np the prevalence of skin infections among Nepali prison inmates was limited.
Taking care of inmates by ensuring access to medication, reducing overcrowding, and maintaining hygiene can lead to a decrease in skin disease rates inside prison.Improving personal hygiene and living conditions can reduce the prevalence of infections.Crowded environments and sharing personal items are key factors in spreading infections and infestations.Basic healthcare services in prison should match the standards available in the community, and prison health professionals should receive adequate training to address skin conditions effectively.This study was carried out for a short duration therefore this study does not cover the disease that varies with climate which is the limitation of this study.