Report
The Incidence of Skin Diseases in Abu Dhabi (United Arab Emirates) Ahmed M. Abu Share'ah, M.D., and Hussein Abdel Dayem, M.D.
Abstract: This Is the first report on the incidence of skin diseases in the United Arab Emirates. A diagnostic analysis of 26,670 patients seen over the last 2 years (danuary 1987 to December 1988) at the Dermatology Clinic in Mafraq Hospital, Abu Dhabi, UAE, is presented. The skin diseases have been listed in order of frequency and their percentages are compared with figures from other parts of the world. The common skin diseases as well as the pecuiiarities are discussed.
The wide geographic variation in the incidence of skin diseases presumably is influenced by racial, ethnologic, climatic, and environmental factors. The United Arab Emirates (UAE) was proclaimed in 1971. It is the result of the union among seven Emirates, namely Abu Dhabi, Dubai, Sharjah, Ajman, Umm Al Quwain, Ras Al Khaimah, and Fujeirah. Abu Dhabi Emirate constitutes 80% of the total surface area of the UAE; Abu Dhabi city is the capital of the UAE. The climate is characteristically almost always hot with a very high relative humidity, and only occasional rainfall. Mafraq Hospital, the biggest hospital in the country, is located 33 km from the capital city and caters to all ages of the population. As a general hospital, all departments are well organized and equipped with modern, sophisticated facilities, with special units not available in other hospitals in the country (ie. Open Heart Surgery Unit, Organ Transplant Unit, the Oncology and Radiotherapy Centre, and the Medical Research Centre, which is linked to Al-Ain University and others). The Dermatology and Venereology clinic at Mafraq Hospital deals with skin, STD, male infertility.
From the Department of Dermatology and Venereology, Mafraq Hospital, Abu Dhabi. United Arab Emirates. Address correspondenee to: Ahmed M. Abu Share'ah, M.D.,Mafraq Hospital, P.O. Box 46142, Abu Dhabi. United Arab Emirates.
February 1991, Vol. 30, No. 2
and sexology problems. Because Mafraq is a referral hospital, patients are referred to it from diiferent centers in the country. There is a conspicuous absence of any epidemiologic data on the pattern of skin diseases in this part of the world, and with this in mind we decided to analyze epidemiologically patients attending the Dermatology and Venereology clinic in Mafraq Hospital. Materials and Methods • All new cases, ie, cases seen for the first time in the DertTiatology and Venereology clinic over a 2-year period (January 1987 to December 1988) constituted the scope of the present study. Diagnoses were made by the consultant and the specialists based mainly on clinical findings, and histopathologic examinations of skin biopsies when necessary. To simplify the study, the diseases were classified into 12 major groups according to their frequency of presentation, and data were compared with data from other parts of the world.
Resu/ts During the period of the present study (January 1987 to December 1988), the total hospital outpatient attendance was 287,660, of which 26,670 were seen in the Dermatology and Venereology clinic, comprising 9.3% of the total. Of this total number of patients attending the Dermatology and Venereology clinic only 10,688 were new cases (40%), with ages ranging from the first month of life up to 90 years. Men were more commonly seen than women, with a ratio of 1.3:1 (6,000:4,688). The number of diagnoses (10,995) was more than the number of new cases (10,688), as some patients had tnore than one dermatologic and/or venereal problem at the time of examination. These diagnoses were classified into 12 major groups according to their frequency of presentation. The frequency distribution 121
Vol. 30
International Joumal of Dermatology • February 1991
122
Table 1. Various Dermatologic Diagnoses Recorded at Dermatology Clinic, Mafraq Hospital (January 1987-December 1988) Diseases Group 1, Eczemas 2, Acne vulgaris 3, Sup, fungus infection (incl, candidal & TV) 4, Viral infections 5, Pig, disorders 6, Psoriasis 7, STD 8, Pyoderma 9, Alopecia 10, Lichen planus 11, Pityriasis rosea 12, Others
Total No. of Cases
Percentage of Each Group
2,307
20,98 9,07
997 935 813 595 494 314 280 249 104 082
Total
3,825
8,50 7,39 5,41 4,49 2,86 2,55 2,26 0,95 0,75 34,79
10,995
100,00
TV: tinea versicolor; STD: sexually transmitted diseases.
of each group is given in absolute numbers and percentage. As shown in Table 1, the eczemas group was found to be the largest, comprising 20,98% (2,307 diagnoses), followed by acne vulgaris, 9,07% (997), superficial fungal infections (including pityriasis versicolor and candidal infections), 7,39% (813), pigmentary disorders, 5,41% (595), psoriasis, 4,49% (494), STDs, 2,86% (314), pyodermas, 2,55% (280), alopecias, 2,26% (249), lichen planus, 0,95% (104), and pityriasis rosea, 0,75% (82), Male infertility, STDs, and other dermatologic diagnoses constituted 34,79% (3,825) of the total diagnoses. Tinea versicolor was the most common among the group with superficial mycotic infections, as shown in Table 2,where it constituted 43,96% of that group (411 cases). Candidal infections came next, comprising Table 2. Frequency of the Different Superficial Fungus Infections Seen at Dermatoiogy Clinic, Mafraq Hospitai (January 1987-December 1988)
Diseases Group 1, 2, 3, 4, 5, 6, 7,
T, versicolor Candidal infection Toe web disease T, cruris T, corporis T, capitis Others
Total
Total No. of Cases
Percentage of Each Group
411 176 113 97 81 41 16
43,96 18,82 12,09 10,37 8,66 4,39 1,71
935
100,00
18,82% (176 cases), followed by Toe-web disease, 12,09% (97 cases), tinea corporis, 8,66% (81 cases), tinea capitis, 4,39% (41 cases), and others (tinea ungium and tinea incognito), 1,71% (16 cases). In the viral infections group. Table 3 shows that human papilloma virus (HPV) infections were the most frequent, forming 71,96% ofthe total number of viral skin infections (585 cases), followed by molluscum contagiosa, 14,14% (115), herpes zoster, 9,47% (77), herpes simplex type I infections, 2,34% (19), and other viral skin infections, namely chicken pox, hand/ foot-and-mouth disease, and orf constituted 2,09% (17), It was observed that cases with pigmentary disorders constituted 5,14% ofthe total diagnoses (595 cases), among which 350 patients were suffering from vitiligo (3,18%), and 245 patients were victims of melasma-type hypeipigmentation (2,2%), Table 3. Frequency of Viral Skin Infections Seen at Dermatology Clinic, Mafraq Hospitai (January 1987December 1988)
Diseases Group 1, HPV infections 2, Moll, contag. 3, H, zoster 4, H, S, type I infection 5, Others Total
Total No. of Cases
Percentage of Each Group
585 115 11 19 17
71,96 14,14 9,47 2,34 2,09 100,00
813
HPV: human papillomavirus; H, S,: herpes simplex.
No. 2
Skin Diseases in Abu Dhabi • Abu Share'ah and Abcjel Dayem
Discussion In the present study, it is shown that patients seen at the Dermatology and Vetiereology clinic constitute 9.3% of the total number of patients attending the outpatient departments at Mafraq Hospital during the period from January 1987 to December 1988. Comparing this incidence with that from other parts of the world, it is similar to that reported in Scotland' and Bristol,^ where it was 8.3% and 10.5%, respectively, while a much higher incidence was reported from Calcutta, India,^ where it reached 20%. This high incidence in Calcutta not only reflects the influence of climate, but also the effects of socioeconomic and environmental factors. It is known that in developing countries the majority of the population belongs to the low-income group with inadequate hygienic environment, poor nutritional standards, and insufficient facilities for healthy living. However, Abu Dhabi has one of the highest per capita incomes in the world, and this is reflected in the standard of living. In the present study, diagnoses are classified into 12 major groups according to their frequency of presentations (Table 1). Seven countries representing both developing and well-developed countries were chosen with which to compare the results of the present study (Table 4). These countries are India (Calcutta),-^ the UK (London)," Mexico,^ Zambia,*^ Ethiopia,^ Kenya," and Canada (Vancouver).'' It is evident that the eczemas group of patients represents the highest incidence atnong our patients, where it reaches 20.98% of the total diagnoses reported. This incidence is comparable with others reported from different locations,^'^** although the incidences reported from the well-developed countries, represented by London" and Vancouver,' were tnuch higher, reaching 35.6% and 39.2%, respectively. This
123
may reflect the advanced industrialization of such communities, resulting in a high prevalence of industrial dermatitis and allergic contact dertnatitis. Cases of acne vulgaris constitute 9.07% of the total patients seen; this apparently is higher than what has been reported from other countries. This can be explained either by the well-known effect of racial influence or by the easy availability of health services offered in the UAE, free of charge, which encourages people to seek medical advice even for minor problems. The incidence of superficial fungus infections in the present work is 8.5%, which is comparable with incidences reported from other locations,**'* although it is less than that of Calcutta^ (15-20%) and Mexico^ (13%). Although both Calcutta and Mexico have climatic characteristics like Abu Dhabi's (hot, humid weather) that facilitate survival and spread of fungi producing the superficial mycoses, the lower incidence in Abu Dhabi can be explained by the high standard of living playing a major role in limiting such spread. Among the features of this high standard of living are the availability of good hygienic measures, absence of overcrowdedness, and presence of good preventive and therapeutic standards. The frequency distribution of the different superficial fungus infections (Table 2) is similar to that reported from other places.''-^'' Viral skin infections constitute 7.39% of the total patients examined. Of these, viral warts comprises the greatest number (71.96% of patients with viral skin infections), as shown in Table 3. The present study shows that other viral skin infections are seen less frequently; the satne finding was reported by Warin- in 1965. As regards the pigmentary disorders, they are present in 5.41% of the cases included in this survey. These
Table 4. Comparative incidence in Percentage of Common Dermatoses among Different Countries
Skin Diseases
Ethiopia''
Zambia''
London"
Vancouver^
Mexico^
Kenya^
Calcutta^
Abu-Dhabi
Eczemas Acne vulgaris Superficial Mycosis Viral wart Vitiligo Psoriasis Pyoderma Lichen pianus
23.0
14.7
35.6
5.0 7.8
2.1
5.6 3.2
39.2 7.3 4.3
^-12
28.1
15-20
20.98 9.07 8.50
7.4 NR 5.6 4.6 1.3
6.8 NR 4.7 5.7 NR
5 4 NR
NR: not recorded.
NR NR NR 7.1 NR
10.8 1.6 1.4 1.0
20.3 1.4
3 13
6.5 NR
3.9 9.5
2 2.9 3.2 6.4 1.6
3.5
15-20 2 4
0.5-1.5 30-40 0.5-1.5
5.47 3.18 4.49 2.55 0.95
124
International Journal of Dermatology • February 1991
disorders include both hypo- and hypermelanotic types of pigmentary disorders. The incidence of vitiligo is 3.18%, which is nearly the same as that for Calcutta,^ Mexico,^ and Kenya.^ However, it is higher than that of Zambia* (1.4%), while it is less than that reported from Nigeria'° (7%). The strikingly high incidence of pyodermas among patients from Calcutta^ (30-40%) and Zambia* (20-30%), when compared to patients from Abu Dhabi (2.55%), reflects and emphasizes the important role played by a high standard of living in limiting chances for spread of infections.
References 1. RatzerMA. Incidence ofskin diseases in the west of Scotland. Br J Dermatol. 1969;81:456-461.
Vol. 30
2. Warin RP. The incidence of skin diseases in man. In: Rook AJ. Walton GS, eds. Comparative Physiotherapy and Pathology of the Skin. Oxford: Blackwell, 1965 (cited from ref. 1). 3. Banerjee BN, Datta AK. Prevalence and incidence pattern of skin diseases in Calcutta. Int J Dermatol. 1973;12:41-47. 4. Calnan CD, Meara RH. St. Johns Hospital diagnostic index. Trans St Johns Hosp Dermatol Soc London. 1957;39:56-68. 5. Canizares O. Geographic dermatology: Mexico and Central America. Arch Dermatol. 1960;82:870-891. 6. Ratnam AV, Jayaraju K. Skin diseases in Zambia. Br J Dermatol. 1979;101:449-455. 7. West LG. Problems of tropical dermatology in Ethiopia. Int J Dermatol. I977;I6:5O6-511. 8. Verghan AR. Koten JW, Chaddah VK, et al. Skin diseases in Kenya: a clinical and histopathologieal study of 3,168 patients. Arch Dermatol. 1968;89:577-586. 9. Mitchell JC. Proportionate distribution of skin diseases in a dermatological practice. Can Med Assoe J. 1967;97:1346-1350. 10. George AO. Skin diseases in tropical Africa: medical, social and economical implications. Int J Dermatol. 1988;27:187-189.
This glass case shows a group of anatomical preparations from the old Faculty of Medicine of Barcelona, made during fhe second half of the Nineteenth Century. We can also see two boxes for dissection by instruments (Mathieu) used between 1870 and 1890. From the Fundacio-Museu d'Historia de la Medicina (Barcelona). Submitted by Felipe Cid, Barcelona, Spain.
The Incidence of Skin Diseases in Abu Dhabi (United Arab Emirates) Ahmed M. Abu Share'ah, M.D., and Hussein Abdel Dayem, M.D.
Abstract: This Is the first report on the incidence of skin diseases in the United Arab Emirates. A diagnostic analysis of 26,670 patients seen over the last 2 years (danuary 1987 to December 1988) at the Dermatology Clinic in Mafraq Hospital, Abu Dhabi, UAE, is presented. The skin diseases have been listed in order of frequency and their percentages are compared with figures from other parts of the world. The common skin diseases as well as the pecuiiarities are discussed.
The wide geographic variation in the incidence of skin diseases presumably is influenced by racial, ethnologic, climatic, and environmental factors. The United Arab Emirates (UAE) was proclaimed in 1971. It is the result of the union among seven Emirates, namely Abu Dhabi, Dubai, Sharjah, Ajman, Umm Al Quwain, Ras Al Khaimah, and Fujeirah. Abu Dhabi Emirate constitutes 80% of the total surface area of the UAE; Abu Dhabi city is the capital of the UAE. The climate is characteristically almost always hot with a very high relative humidity, and only occasional rainfall. Mafraq Hospital, the biggest hospital in the country, is located 33 km from the capital city and caters to all ages of the population. As a general hospital, all departments are well organized and equipped with modern, sophisticated facilities, with special units not available in other hospitals in the country (ie. Open Heart Surgery Unit, Organ Transplant Unit, the Oncology and Radiotherapy Centre, and the Medical Research Centre, which is linked to Al-Ain University and others). The Dermatology and Venereology clinic at Mafraq Hospital deals with skin, STD, male infertility.
From the Department of Dermatology and Venereology, Mafraq Hospital, Abu Dhabi. United Arab Emirates. Address correspondenee to: Ahmed M. Abu Share'ah, M.D.,Mafraq Hospital, P.O. Box 46142, Abu Dhabi. United Arab Emirates.
February 1991, Vol. 30, No. 2
and sexology problems. Because Mafraq is a referral hospital, patients are referred to it from diiferent centers in the country. There is a conspicuous absence of any epidemiologic data on the pattern of skin diseases in this part of the world, and with this in mind we decided to analyze epidemiologically patients attending the Dermatology and Venereology clinic in Mafraq Hospital. Materials and Methods • All new cases, ie, cases seen for the first time in the DertTiatology and Venereology clinic over a 2-year period (January 1987 to December 1988) constituted the scope of the present study. Diagnoses were made by the consultant and the specialists based mainly on clinical findings, and histopathologic examinations of skin biopsies when necessary. To simplify the study, the diseases were classified into 12 major groups according to their frequency of presentation, and data were compared with data from other parts of the world.
Resu/ts During the period of the present study (January 1987 to December 1988), the total hospital outpatient attendance was 287,660, of which 26,670 were seen in the Dermatology and Venereology clinic, comprising 9.3% of the total. Of this total number of patients attending the Dermatology and Venereology clinic only 10,688 were new cases (40%), with ages ranging from the first month of life up to 90 years. Men were more commonly seen than women, with a ratio of 1.3:1 (6,000:4,688). The number of diagnoses (10,995) was more than the number of new cases (10,688), as some patients had tnore than one dermatologic and/or venereal problem at the time of examination. These diagnoses were classified into 12 major groups according to their frequency of presentation. The frequency distribution 121
Vol. 30
International Joumal of Dermatology • February 1991
122
Table 1. Various Dermatologic Diagnoses Recorded at Dermatology Clinic, Mafraq Hospital (January 1987-December 1988) Diseases Group 1, Eczemas 2, Acne vulgaris 3, Sup, fungus infection (incl, candidal & TV) 4, Viral infections 5, Pig, disorders 6, Psoriasis 7, STD 8, Pyoderma 9, Alopecia 10, Lichen planus 11, Pityriasis rosea 12, Others
Total No. of Cases
Percentage of Each Group
2,307
20,98 9,07
997 935 813 595 494 314 280 249 104 082
Total
3,825
8,50 7,39 5,41 4,49 2,86 2,55 2,26 0,95 0,75 34,79
10,995
100,00
TV: tinea versicolor; STD: sexually transmitted diseases.
of each group is given in absolute numbers and percentage. As shown in Table 1, the eczemas group was found to be the largest, comprising 20,98% (2,307 diagnoses), followed by acne vulgaris, 9,07% (997), superficial fungal infections (including pityriasis versicolor and candidal infections), 7,39% (813), pigmentary disorders, 5,41% (595), psoriasis, 4,49% (494), STDs, 2,86% (314), pyodermas, 2,55% (280), alopecias, 2,26% (249), lichen planus, 0,95% (104), and pityriasis rosea, 0,75% (82), Male infertility, STDs, and other dermatologic diagnoses constituted 34,79% (3,825) of the total diagnoses. Tinea versicolor was the most common among the group with superficial mycotic infections, as shown in Table 2,where it constituted 43,96% of that group (411 cases). Candidal infections came next, comprising Table 2. Frequency of the Different Superficial Fungus Infections Seen at Dermatoiogy Clinic, Mafraq Hospitai (January 1987-December 1988)
Diseases Group 1, 2, 3, 4, 5, 6, 7,
T, versicolor Candidal infection Toe web disease T, cruris T, corporis T, capitis Others
Total
Total No. of Cases
Percentage of Each Group
411 176 113 97 81 41 16
43,96 18,82 12,09 10,37 8,66 4,39 1,71
935
100,00
18,82% (176 cases), followed by Toe-web disease, 12,09% (97 cases), tinea corporis, 8,66% (81 cases), tinea capitis, 4,39% (41 cases), and others (tinea ungium and tinea incognito), 1,71% (16 cases). In the viral infections group. Table 3 shows that human papilloma virus (HPV) infections were the most frequent, forming 71,96% ofthe total number of viral skin infections (585 cases), followed by molluscum contagiosa, 14,14% (115), herpes zoster, 9,47% (77), herpes simplex type I infections, 2,34% (19), and other viral skin infections, namely chicken pox, hand/ foot-and-mouth disease, and orf constituted 2,09% (17), It was observed that cases with pigmentary disorders constituted 5,14% ofthe total diagnoses (595 cases), among which 350 patients were suffering from vitiligo (3,18%), and 245 patients were victims of melasma-type hypeipigmentation (2,2%), Table 3. Frequency of Viral Skin Infections Seen at Dermatology Clinic, Mafraq Hospitai (January 1987December 1988)
Diseases Group 1, HPV infections 2, Moll, contag. 3, H, zoster 4, H, S, type I infection 5, Others Total
Total No. of Cases
Percentage of Each Group
585 115 11 19 17
71,96 14,14 9,47 2,34 2,09 100,00
813
HPV: human papillomavirus; H, S,: herpes simplex.
No. 2
Skin Diseases in Abu Dhabi • Abu Share'ah and Abcjel Dayem
Discussion In the present study, it is shown that patients seen at the Dermatology and Vetiereology clinic constitute 9.3% of the total number of patients attending the outpatient departments at Mafraq Hospital during the period from January 1987 to December 1988. Comparing this incidence with that from other parts of the world, it is similar to that reported in Scotland' and Bristol,^ where it was 8.3% and 10.5%, respectively, while a much higher incidence was reported from Calcutta, India,^ where it reached 20%. This high incidence in Calcutta not only reflects the influence of climate, but also the effects of socioeconomic and environmental factors. It is known that in developing countries the majority of the population belongs to the low-income group with inadequate hygienic environment, poor nutritional standards, and insufficient facilities for healthy living. However, Abu Dhabi has one of the highest per capita incomes in the world, and this is reflected in the standard of living. In the present study, diagnoses are classified into 12 major groups according to their frequency of presentations (Table 1). Seven countries representing both developing and well-developed countries were chosen with which to compare the results of the present study (Table 4). These countries are India (Calcutta),-^ the UK (London)," Mexico,^ Zambia,*^ Ethiopia,^ Kenya," and Canada (Vancouver).'' It is evident that the eczemas group of patients represents the highest incidence atnong our patients, where it reaches 20.98% of the total diagnoses reported. This incidence is comparable with others reported from different locations,^'^** although the incidences reported from the well-developed countries, represented by London" and Vancouver,' were tnuch higher, reaching 35.6% and 39.2%, respectively. This
123
may reflect the advanced industrialization of such communities, resulting in a high prevalence of industrial dermatitis and allergic contact dertnatitis. Cases of acne vulgaris constitute 9.07% of the total patients seen; this apparently is higher than what has been reported from other countries. This can be explained either by the well-known effect of racial influence or by the easy availability of health services offered in the UAE, free of charge, which encourages people to seek medical advice even for minor problems. The incidence of superficial fungus infections in the present work is 8.5%, which is comparable with incidences reported from other locations,**'* although it is less than that of Calcutta^ (15-20%) and Mexico^ (13%). Although both Calcutta and Mexico have climatic characteristics like Abu Dhabi's (hot, humid weather) that facilitate survival and spread of fungi producing the superficial mycoses, the lower incidence in Abu Dhabi can be explained by the high standard of living playing a major role in limiting such spread. Among the features of this high standard of living are the availability of good hygienic measures, absence of overcrowdedness, and presence of good preventive and therapeutic standards. The frequency distribution of the different superficial fungus infections (Table 2) is similar to that reported from other places.''-^'' Viral skin infections constitute 7.39% of the total patients examined. Of these, viral warts comprises the greatest number (71.96% of patients with viral skin infections), as shown in Table 3. The present study shows that other viral skin infections are seen less frequently; the satne finding was reported by Warin- in 1965. As regards the pigmentary disorders, they are present in 5.41% of the cases included in this survey. These
Table 4. Comparative incidence in Percentage of Common Dermatoses among Different Countries
Skin Diseases
Ethiopia''
Zambia''
London"
Vancouver^
Mexico^
Kenya^
Calcutta^
Abu-Dhabi
Eczemas Acne vulgaris Superficial Mycosis Viral wart Vitiligo Psoriasis Pyoderma Lichen pianus
23.0
14.7
35.6
5.0 7.8
2.1
5.6 3.2
39.2 7.3 4.3
^-12
28.1
15-20
20.98 9.07 8.50
7.4 NR 5.6 4.6 1.3
6.8 NR 4.7 5.7 NR
5 4 NR
NR: not recorded.
NR NR NR 7.1 NR
10.8 1.6 1.4 1.0
20.3 1.4
3 13
6.5 NR
3.9 9.5
2 2.9 3.2 6.4 1.6
3.5
15-20 2 4
0.5-1.5 30-40 0.5-1.5
5.47 3.18 4.49 2.55 0.95
124
International Journal of Dermatology • February 1991
disorders include both hypo- and hypermelanotic types of pigmentary disorders. The incidence of vitiligo is 3.18%, which is nearly the same as that for Calcutta,^ Mexico,^ and Kenya.^ However, it is higher than that of Zambia* (1.4%), while it is less than that reported from Nigeria'° (7%). The strikingly high incidence of pyodermas among patients from Calcutta^ (30-40%) and Zambia* (20-30%), when compared to patients from Abu Dhabi (2.55%), reflects and emphasizes the important role played by a high standard of living in limiting chances for spread of infections.
References 1. RatzerMA. Incidence ofskin diseases in the west of Scotland. Br J Dermatol. 1969;81:456-461.
Vol. 30
2. Warin RP. The incidence of skin diseases in man. In: Rook AJ. Walton GS, eds. Comparative Physiotherapy and Pathology of the Skin. Oxford: Blackwell, 1965 (cited from ref. 1). 3. Banerjee BN, Datta AK. Prevalence and incidence pattern of skin diseases in Calcutta. Int J Dermatol. 1973;12:41-47. 4. Calnan CD, Meara RH. St. Johns Hospital diagnostic index. Trans St Johns Hosp Dermatol Soc London. 1957;39:56-68. 5. Canizares O. Geographic dermatology: Mexico and Central America. Arch Dermatol. 1960;82:870-891. 6. Ratnam AV, Jayaraju K. Skin diseases in Zambia. Br J Dermatol. 1979;101:449-455. 7. West LG. Problems of tropical dermatology in Ethiopia. Int J Dermatol. I977;I6:5O6-511. 8. Verghan AR. Koten JW, Chaddah VK, et al. Skin diseases in Kenya: a clinical and histopathologieal study of 3,168 patients. Arch Dermatol. 1968;89:577-586. 9. Mitchell JC. Proportionate distribution of skin diseases in a dermatological practice. Can Med Assoe J. 1967;97:1346-1350. 10. George AO. Skin diseases in tropical Africa: medical, social and economical implications. Int J Dermatol. 1988;27:187-189.
This glass case shows a group of anatomical preparations from the old Faculty of Medicine of Barcelona, made during fhe second half of the Nineteenth Century. We can also see two boxes for dissection by instruments (Mathieu) used between 1870 and 1890. From the Fundacio-Museu d'Historia de la Medicina (Barcelona). Submitted by Felipe Cid, Barcelona, Spain.
