Wastage of family income on skin disease in Mexico

BMJ 1994; 309 doi: (Published 01 October 1994) Cite this as: BMJ 1994;309:848
  1. R J Hay,
  2. R Estrada Castanon,
  3. H Alarcon Hernandez,
  4. G Chavez Lopez,
  5. L F Lopez Fuentes,
  6. S Paredes Solis,
  7. N Andersson
  1. St John's Institute of Dermatology, Guy's Hospital, London SE1 9RT Centro de Investigacion de Enfermedades Tropicales, Universidad Autonoma de Guerrero, Acapulco, Mexico
  1. Correspondence to: Professor Hay.
  • Accepted 11 April 1994

Skin disease accounts for a major part of the work load of primary health care workers in developing countries. Prevalences vary, but skin conditions may affect over 60% of the community1 and are often poorly managed due to lack of training. We investigated the impact of ineffective treatment of skin disease on family life in rural Mexico.

Subjects, methods, and results

Working in the community of Cayaco, 10 km from Acapulco, we conducted our initial survey using proved field methods.2 It included a house to house questionnaire survey designed by the group to study the distribution of skin disease and the use and cost of treatments, including travel expenses, medical bills, and drugs. These figures were based on patients' estimates but were cross checked with prices in retail pharmacies. We also estimated the loss of work or schooling resulting from skin disease. The diagnosis in patients describing skin lesions in the initial survey was validated by physical examination in an outpatient clinic and in a separate random survey in 120 primary school children. Treatment was judged to have been ineffective if patients had the same lesions and symptoms for which they had been treated during the previous six months. Regression analysis was carried out using the software package NANOSTAT.

We surveyed 380 households containing 1528 people (713 males, 815 women), of whom 207 reported skin disease. One hundred and thirty one attended the outpatient clinic (41 males, 90 females). The commonest skin disease among them was pyoderma (27 patients), followed by scabies (26), pityriasis alba (23), acne (eight), dermatophytosis (eight), viral warts (eight), and pediculosis capitis (eight). Sixty six had other skin conditions ranging from urticaria (two) to scrofuloderma (one). Fifty eight patients had more than one condition, making a total of 189 dermatoses. In all, six conditions accounted for 102 of the dermatoses. Fifteen patients with scabies and 21 with pyoderma had received ineffective treatment over the previous six months at a mean cost of 66 (SE 19) new pesos (pounds sterling 12.45 (pounds sterling 3.58)) and 136 (30) new pesos (pounds sterling 25.70 (pounds sterling 5.67)) respectively. Many of the affected children had taken time off school - eight days for scabies (12 patients) and 15 days for pyoderma (10 patients).

Sixty eight of the 120 primary school children in the random survey had at least one treatable skin condition.


One of the major challenges in health care is the process of matching supply with demand for treatment, while making appropriate allowance for the resources available. It might be thought that skin disease should take a low priority in this calculation, given its low morbidity and mortality. This, however, would be to ignore the impact of the disease on the community. In our study half the households contained people who reported symptoms and signs, and 57% of children screened randomly had at least one treatable skin disease, confirming previous observations that skin disease is common in this environment.2

In Mexico, as in many other developing countries, people will use a limited family income to buy health advice from pharmacies, private doctors, or traditional healers if they are not satisfied with the treatment given by their usual source of medical advice. The mean total cost of ineffective treatment for the two commonest conditions over six months was a major financial burden on families in a marginal economy where the mean daily wage is 15.2 new pesos (pounds sterling 2.87).3 Furthermore, some children lost considerable time from school because of skin infection. Both diseases are readily curable by eliminating scabies,4 provided that all contacts are also treated and there is adequate compliance.

These data argue for a more logical approach to the management of certain skin diseases in developing countries on a community rather than an individual basis.4 In the area we surveyed a new system of community dermatology is being implemented with close collaboration between specialists and primary health care workers.5

We thank the Leverhulme Trust in the United Kingdom for financial support.


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