Online ISSN:1234-5678
Document Type : Original Article
Authors
1 College of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region, 46012 Iraq
2 Department of Adult Nursing, College of Nursing, University of Raparin, Rania, Sulaymaniyah, Iraq
Keywords
Skin diseases are among the most common health conditions worldwide and constitute a substantial public health burden because of their high prevalence, chronic nature, and impact on quality of life. Although most dermatological disorders are not life-threatening, they contribute considerably to disability, psychosocial distress, healthcare utilization, and reduced work productivity. The Global Burden of Disease studies consistently rank skin disorders among the leading causes of years lived with disability, emphasizing their importance as a major healthcare concern [1,2].
The occurrence of dermatological diseases is influenced by a complex interaction of genetic, environmental, occupational, and socioeconomic factors. Age, sex, educational attainment, occupation, residence, and lifestyle behaviors have all been recognized as important determinants of skin health. Individuals employed in occupations involving frequent exposure to chemicals, moisture, ultraviolet (UV) radiation, or physical irritants are at increased risk of developing occupational skin diseases, including contact dermatitis and eczema [3,4]. Similarly, inadequate personal hygiene, overcrowding, and poor living conditions contribute to the transmission of infectious skin diseases such as fungal infections and scabies, particularly in resource-limited settings [5].
Different dermatological disorders exhibit distinct epidemiological patterns across age groups. Acne vulgaris predominantly affects adolescents and young adults because of hormonal changes, increased sebaceous gland activity, and genetic susceptibility [6]. In contrast, eczema and contact dermatitis are more frequently observed among adults and older individuals as a consequence of prolonged environmental and occupational exposures, impairment of the skin barrier, and cumulative contact with allergens or irritants [7]. Psoriasis, another chronic inflammatory skin disease, has a multifactorial etiology involving genetic predisposition, immune dysregulation, environmental triggers, and psychosocial stress [8].
Occupational and environmental exposures remain major contributors to skin disease worldwide. Agricultural workers, construction workers, healthcare personnel, and industrial employees are frequently exposed to sunlight, chemicals, detergents, dust, and biological agents that increase the risk of dermatological disorders [3,9]. Regular use of personal protective measures, including sunscreen, gloves, protective clothing, and sunglasses, has been shown to reduce the incidence of occupational and environmentally induced skin diseases. Nevertheless, compliance with these preventive measures remains low in many communities because of limited awareness, inadequate workplace policies, and socioeconomic constraints [10,11].
Sociodemographic disparities also influence access to dermatological care and preventive services. Individuals living in rural or underserved areas often experience delayed diagnosis, limited access to specialized healthcare, and increased exposure to environmental risk factors, resulting in a higher prevalence of infectious and occupational skin diseases [5,12]. Furthermore, educational level influences health literacy and health-seeking behavior, affecting individuals' ability to adopt preventive practices and recognize early manifestations of skin disorders [13].
Despite the growing burden of dermatological diseases, epidemiological evidence from Iraq, particularly the Kurdistan Region, remains limited. Most available studies have focused on specific skin conditions or hospital-based clinical outcomes rather than examining the broader relationship between sociodemographic characteristics and the spectrum of dermatological disorders. Understanding these relationships is essential for identifying vulnerable populations and developing evidence-based preventive strategies tailored to local healthcare needs.
Therefore, the present study aimed to determine the incidence of common skin disorders and investigate their association with sociodemographic characteristics among adult patients attending healthcare facilities in Ranya City, Kurdistan Region, Iraq. The findings are expected to provide valuable evidence for healthcare providers and policymakers in planning targeted health education programs, strengthening occupational health interventions, and improving dermatological services.
A descriptive cross-sectional study was conducted to determine the incidence of common skin disorders and examine their relationship with selected sociodemographic characteristics among adult patients attending dermatology clinics in Ranya City, Kurdistan Region, Iraq.
The study was carried out in Ranya City, Sulaymaniyah Governorate, Kurdistan Region of Iraq. Data were collected from outpatient dermatology clinics between 15 November 2024 and 1 March 2025.
The study population consisted of adult patients attending outpatient dermatology clinics during the data collection period. A total of 311 patients with physician-confirmed dermatological disorders were recruited using a convenience sampling technique.
Participants were eligible if they:
Patients were excluded if they:
Data were collected using a structured interviewer-administered questionnaire developed following an extensive review of the literature and previously validated instruments. The questionnaire consisted of four sections:
The questionnaire was administered through face-to-face interviews by the researcher to ensure completeness and accuracy of responses.
The questionnaire was adapted from previously published and validated instruments assessing dermatological conditions, occupational exposure, and preventive practices. Prior to data collection, the instrument underwent content validation by a panel of experts in dermatology, community health, and nursing to ensure clarity, relevance, and cultural appropriateness. A pilot study was conducted to evaluate feasibility and improve the wording of questionnaire items. The pilot participants were excluded from the final analysis.
Eligible patients attending the participating outpatient clinics were approached consecutively during the study period. After explaining the study objectives, written informed consent was obtained from each participant before enrollment. Face-to-face interviews were then conducted using the structured questionnaire. Each interview required approximately 15–20 minutes, and all questionnaires were checked immediately after completion to minimize missing data.
Ethical approval for the study was obtained from the Scientific Committee of the College of Nursing, University of Raparin. Official permission was also obtained from the participating healthcare facilities before commencing data collection. Participation was entirely voluntary, and informed consent was obtained from all participants. Confidentiality and anonymity were maintained by assigning identification numbers instead of participants' names, and participants were informed of their right to withdraw from the study at any time without consequences.
Data were entered, coded, cleaned, and analyzed using the Statistical Package for the Social Sciences (SPSS), version 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participants' characteristics and the distribution of skin disorders. Associations between sociodemographic variables and dermatological conditions were examined using the Chi-square test or Fisher's exact test, where appropriate. A p-value < 0.05 was considered statistically significant throughout the analysis.
A total of 311 adult patients with physician-confirmed dermatological disorders participated in the study. The sociodemographic characteristics of the participants are presented in Table 1. Females constituted slightly more than half of the study population (55.3%), while males accounted for 44.7%. The largest proportion of participants belonged to the 18–29-year age group (43.4%), followed by those aged 30–39 years (20.6%). More than half of the participants were married (54.3%), whereas 39.9% were single. Regarding educational attainment, 30.2% had completed institute or college education, while 27.0% were illiterate or had no formal education. Housewives represented the largest occupational group (35.4%), followed by unemployed individuals (22.5%) and students (20.6%). Most participants performed moderate-intensity work (50.2%), whereas only 11.9% reported heavy work (Table 1).
Table 2 summarizes participants' environmental exposure and protective behaviors. Approximately 40.2% reported rare exposure to sunlight or ultraviolet radiation, whereas 18.6% experienced frequent exposure and 3.5% reported daily exposure. Preventive practices against environmental hazards were generally poor. Nearly half of the participants (46.3%) reported never using sunscreen, and only 5.8% used sunscreen regularly. Similarly, 69.5% never wore sunglasses, and 37.6% reported never using protective clothing or gloves during environmental or occupational exposure (Table 2).
The distribution of dermatological disorders is illustrated in Figure 1. Eczema was the most frequently diagnosed skin disorder, accounting for 24.1% of all cases, followed by fungal infections (22.2%) and acne (16.4%). Less common conditions included contact dermatitis (8.0%), scabies (7.4%), and psoriasis (5.1%), indicating that inflammatory and infectious skin diseases represented the majority of dermatological presentations among the study participants.
The associations between sociodemographic characteristics and dermatological disorders are presented in Table 3. Acne demonstrated significant associations with marital status (p < 0.001), educational level (p < 0.001), occupation (p < 0.001), nature of work (p < 0.001), and age group (p < 0.001). Eczema was significantly associated with marital status (p < 0.001), occupation (p = 0.019), and age group (p < 0.001). Scabies showed a significant association with educational level (p = 0.043) and nature of work (p = 0.017), while fungal infections were significantly associated with place of residence (p = 0.028) and nature of work (p = 0.033). Contact dermatitis demonstrated no statistically significant associations with most sociodemographic variables. Furthermore, no significant relationships were identified between allergy history and any of the investigated skin disorders (all p > 0.05) (Table 3).
Overall, the findings indicate that dermatological disorders among adults in Ranya City are influenced by several sociodemographic characteristics, particularly age, marital status, educational level, occupation, type of work, and place of residence. Additionally, the widespread lack of protective behaviors against environmental hazards observed among participants may contribute to the occurrence and persistence of common skin diseases.
| Variable | Category | n | % |
|---|---|---|---|
| Gender | Male | 139 | 44.7 |
| Female | 172 | 55.3 | |
| Age group (years) | 18–29 | 135 | 43.4 |
| 30–39 | 64 | 20.6 | |
| 40–49 | 55 | 17.7 | |
| 50–59 | 33 | 10.6 | |
| ≥60 | 24 | 7.7 | |
| Marital status | Single | 124 | 39.9 |
| Married | 169 | 54.3 | |
| Divorced/Separated/Widowed | 18 | 5.8 | |
| Educational level | Illiterate/No formal education | 84 | 27.0 |
| Primary school | 48 | 15.4 | |
| Secondary/Preparatory | 68 | 21.9 | |
| Institute/College | 94 | 30.2 | |
| Postgraduate | 17 | 5.5 | |
| Occupation | Retired | 11 | 3.5 |
| Unemployed | 70 | 22.5 | |
| Student | 64 | 20.6 | |
| Housewife/Housemaid | 110 | 35.4 | |
| Full-time employed | 56 | 18.0 | |
| Nature of work | Light | 118 | 37.9 |
| Moderate | 156 | 50.2 | |
| Heavy | 37 | 11.9 |
| Variable | Category | n | % |
|---|---|---|---|
| Exposure to sunlight/UV radiation | Never | 33 | 10.6 |
| Rarely | 125 | 40.2 | |
| Occasionally (1–2 times/week) | 84 | 27.0 | |
| Frequently (3–5 times/week) | 58 | 18.6 | |
| Daily | 11 | 3.5 | |
| Use of sunscreen | Never | 144 | 46.3 |
| Rarely | 48 | 15.4 | |
| Sometimes | 101 | 32.5 | |
| Always | 18 | 5.8 | |
| Use of sunglasses | Never | 216 | 69.5 |
| Rarely | 72 | 23.2 | |
| Sometimes | 17 | 5.5 | |
| Always | 6 | 1.9 | |
| Use of protective clothing/gloves | Never | 117 | 37.6 |
| Rarely | 95 | 30.5 | |
| Sometimes | 83 | 26.7 | |
| Always | 16 | 5.1 |
| Skin disorder | n | % |
|---|---|---|
| Eczema | 75 | 24.1 |
| Fungal infection | 69 | 22.2 |
| Acne | 51 | 16.4 |
| Contact dermatitis | 25 | 8.0 |
| Scabies | 23 | 7.4 |
| Psoriasis | 16 | 5.1 |
| Other skin disorders | 52 | 16.7 |
| Total | 311 | 100.0 |
| Variable | Acne | Eczema | Psoriasis | Fungal infection | Scabies | Contact dermatitis |
|---|---|---|---|---|---|---|
| Gender | 0.389 | 0.141 | 0.340 | 0.091 | 0.453 | 0.622 |
| Marital status | <0.001 | <0.001 | 0.547 | 0.322 | 0.176 | 0.180 |
| Educational level | <0.001 | 0.134 | 0.987 | 0.468 | 0.043 | 0.496 |
| Occupation | <0.001 | 0.019 | 0.607 | 0.725 | 0.424 | 0.096 |
| Nature of work | <0.001 | 0.883 | 0.186 | 0.033 | 0.017 | 0.215 |
| Allergy history | 0.499 | 0.201 | 0.956 | 0.431 | 0.504 | 0.415 |
| Place of residence | 0.084 | 0.110 | 0.059 | 0.028 | 0.075 | 0.827 |
| Age group | <0.001 | <0.001 | 0.749 | 0.498 | 0.153 | 0.201 |
Chi-square test or Fisher's exact test was used where appropriate. Values shown are p-values. Statistically significant associations are indicated in bold (p < 0.05).
The present study investigated the distribution of common skin disorders and their association with sociodemographic characteristics among adult patients attending dermatology clinics in Ranya City, Kurdistan Region, Iraq. The findings demonstrated that eczema, fungal infections, and acne were the most frequently diagnosed dermatological conditions. In addition, several sociodemographic factors, including age, marital status, educational level, occupation, nature of work, and place of residence, were significantly associated with specific skin disorders. The study also revealed poor adherence to preventive skin protection practices, highlighting important opportunities for public health interventions.
Eczema was the most common dermatological disorder identified in this study, accounting for nearly one-quarter of all cases. This finding is consistent with previous epidemiological studies reporting eczema as one of the leading chronic inflammatory skin diseases worldwide because of increasing environmental exposures, occupational irritants, and impaired skin barrier function [1,2]. The relatively high prevalence observed in the present study may also reflect prolonged exposure to household detergents, chemicals, and occupational allergens, particularly among housewives and manual workers. Similar observations have been reported by Hamnerius et al., who found that frequent wet work and repeated exposure to cleaning agents substantially increase the risk of hand eczema among workers [3].
Fungal infections represented the second most common skin disorder among participants. This finding agrees with previous studies conducted in developing countries, where warm climates, excessive humidity, crowded living conditions, and inadequate personal hygiene contribute to increased fungal skin infections [4,5]. The significant association between fungal infections and rural residence observed in the present study further supports previous evidence indicating that agricultural activities, occupational exposure, and limited access to healthcare increase susceptibility to superficial fungal diseases [5]. Improving hygiene education and expanding access to dermatological services in rural communities may therefore contribute to reducing the burden of fungal infections.
Acne vulgaris accounted for approximately one-sixth of dermatological diagnoses and was significantly associated with younger age, marital status, educational level, occupation, and nature of work. These findings are consistent with previous literature demonstrating that acne predominantly affects adolescents and young adults because of hormonal changes, increased sebaceous gland activity, and psychosocial stress [6,7]. The higher prevalence among students and individuals with higher educational attainment may reflect increased psychological stress, cosmetic concerns, and greater healthcare-seeking behavior compared with older adults [8]. Similar findings have been reported by Aziz and Khan, who identified academic stress as an important contributor to acne severity among university students [9].
The present study demonstrated that age significantly influenced the occurrence of acne and eczema. Acne was predominantly observed among younger adults, whereas eczema was more common among older age groups. These findings are biologically plausible because acne is largely hormone-dependent, while eczema develops through cumulative environmental exposure, occupational irritants, and age-related impairment of the skin barrier [2,6]. Comparable age-related trends have been reported in large international epidemiological studies of dermatological diseases [10].
Marital status was another significant determinant of both acne and eczema. Acne was more frequently observed among unmarried participants, whereas eczema predominated among married individuals. Although marital status itself is unlikely to be a direct causal factor, it may reflect differences in age distribution, occupational responsibilities, stress, and environmental exposures. Previous studies have similarly reported variations in dermatological disease patterns according to social and demographic characteristics rather than marital status alone [11].
Educational level was significantly associated with acne and scabies in the current study. Individuals with higher educational attainment demonstrated greater frequencies of acne diagnosis, whereas scabies occurred more frequently among participants with lower educational levels. This finding may reflect differences in health literacy, hygiene practices, socioeconomic status, and healthcare utilization. Previous research has shown that education influences health awareness, personal hygiene, preventive behaviors, and timely access to medical care, thereby affecting the occurrence and management of dermatological diseases [12].
Occupation and nature of work also demonstrated significant relationships with several skin disorders. Acne and eczema were significantly associated with occupation, while fungal infections and scabies were significantly associated with physically demanding work. Manual workers frequently encounter prolonged exposure to dust, chemicals, moisture, friction, and inadequate sanitation, all of which increase susceptibility to infectious and inflammatory skin diseases [3,13]. Likewise, housewives may experience repeated exposure to detergents and household cleaning products, explaining the higher prevalence of eczema among this group. These findings emphasize the importance of occupational health measures and workplace protection to reduce dermatological morbidity.
An important finding of this study was the widespread lack of preventive skin protection behaviors. Nearly half of the participants never used sunscreen, approximately seventy percent never wore sunglasses, and more than one-third never used protective clothing during environmental or occupational exposure. These findings are comparable with previous studies reporting poor compliance with sun-protective behaviors among outdoor workers and the general population [14,15]. Inadequate awareness regarding ultraviolet radiation and occupational hazards may contribute to this low adherence. Health education campaigns promoting sunscreen use, protective clothing, and workplace safety practices are therefore warranted.
The study has several strengths. It included a relatively large sample of physician-confirmed dermatological cases and comprehensively evaluated multiple sociodemographic, occupational, and behavioral factors simultaneously. Furthermore, the use of standardized interviews improved the completeness and consistency of the collected data, providing valuable epidemiological information regarding common skin disorders in the Kurdistan Region of Iraq.
However, several limitations should be acknowledged. The cross-sectional design precludes establishing causal relationships between sociodemographic factors and dermatological diseases. The convenience sampling technique may limit the generalizability of the findings to other populations. Additionally, environmental exposures and protective behaviors were self-reported and may therefore be affected by recall bias or social desirability bias. Finally, clinical severity, laboratory confirmation of infectious skin diseases, and long-term follow-up were not included, limiting further interpretation of disease progression.
Overall, the present findings demonstrate that common dermatological disorders are strongly influenced by demographic, occupational, and environmental factors. Public health interventions focusing on occupational safety, improved personal protective practices, health education, and early dermatological screening may substantially reduce the burden of skin diseases, particularly among high-risk groups.
