Skin diseases have historically been underestimated, both by the public and medical practitioners, often considered trivial or cosmetic. This misconception has led to limited allocation of resources. However, the World Health Organisation (WHO) now recognizes skin diseases as a public health priority [1].

Global and regional surveys have revealed diverse dermatological profiles across populations. Limited large-scale data exist, especially for North India, despite major socio-economic and lifestyle changes. This study aimed to assess evolving dermatological disease profile of over an eight-year period (2017–2024) in a tertiary referral centre in North India. There has been a steady decrease in infectious dermatoses and a corresponding increase in non-infectious dermatoses, which are secondary to lifestyle changes or increased life expectancy [2-4], as well as improved medical infrastructure and greater awareness through media.

Aims and Objectives

1. To study the distribution of skin diseases at a referral centre in North India.
2. To compare disease trends over eight years (2017–2024).

A retrospective cross-sectional observational study was conducted in a premier tertiary care teaching hospital, which is a referral center for the north and west of India. Data of both outpatients (OPD) and from 2017–2024 were retrieved from hospital records. The top ten diseases annually ranked by frequency and proportion in descending order, were compiled. Percentages and means were calculated, and temporal comparisons made.

Table 1: OPD 2017

Table 2: OPD 2018

Table 3: OPD 2019

Table 4: OPD 2020

Table 5: OPD 2021

Table 5: OPD 2022

Table 6: OPD 2023

Table 7: OPD 2024

The data for inpatients are presented in Tables and the data for OPD are shown in Tables. Histograms illustrating these changing trends are shown in the figures.

Inpatient Burden (3,524 patients)

• Varicella: Declined from 47% of admissions in 2017 to 10% in 2024.
• Hansen’s disease: Increased by 42% (86 to 148 cases), without a dip during COVID.
• STIs: Stable, with temporary pandemic decline.
• Herpes zoster: Declined from 7% (2017) to 4% (2024).
• Eczema: Increased from 5% to 9%.
• Psoriasis: Inpatient cases rose from 8% to 16%.
• Dermatophytosis/mycoses: Stable (6–7%).
• Chronic urticaria/angioedema: Admissions rose by 73%.
• Erythroderma: Nearly doubled (from 9 to 17).
• Autoimmune bullous disorders: Sharp rise (+386%), from 7 cases in 2017 to 34 in 2024, reflecting newer treatment guidelines (e.g., rituximab use).

Outpatient Burden (735,730 patients)

• Fungal infections: Declined from 30% (36,184 cases) in 2017 to 15% (13,342) in 2024.
• Bacterial infections: Constant at ~10% throughout.
• Verrucae: Reduced from 8% in 2017 to 6% in 2024.
• Herpes zoster: Last recorded within the top 10 in 2021 (2%)
• Acne/pilosebaceous disorders: Stable (14% in 2017 vs 12% in 2024).
• Vitiligo: Declined from 7% in 2017 to <4% in 2024.
• Melasma/facial melanosis: Risen from 7% in 2017 to 15% in 2024 (+63% increase).
• Psoriasis: Fluctuated—peaked in 2019 (8%), dropped during COVID (2%), then recovered to ~7–10%.
• Eczema: Variable, from 12% in 2017 to 24% in 2023, dropping to 9% in 2024.
• Hair disorders: Emerged in top 10 after 2022.
• Chronic urticaria/angioedema: Appeared for the first time 2024 (9%).
• STIs: Sharp increase in 2024 (7,447 cases, mostly herpes genitalis).

Skin diseases are frequently regarded as non-fatal and primarily cosmetic, which has historically led to under-prioritization in health systems[5]. However, evidence consistently shows their significant contribution to morbidity. They were ranked the fourth leading cause of non-fatal disease burden in 2010 and 2013 [6] and the eighth in 2021[7]. The Global Burden of Disease Study (2019) estimated that 4.86 billion people were affected worldwide. Among refugees and displaced populations, skin diseases are the most common cause of morbidity, Dayrit JF et al. [8]. In Europe, Trakatelli et al. reported that 43% of individuals had at least one skin disease in the preceding year, with a substantial proportion experiencing embarrassment and professional impairment [8], because of the same.

In India, the epidemiology of skin disease reflects geographical, climatic, and sociocultural diversity. While most conditions are non-fatal, they can significantly impact quality of life, appearance, and social functioning. Rising life expectancy, literacy,

awareness, and social media presence have altered both the prevalence and perception of skin diseases, though regional disparities remain[9]. For example, Bundelkhand in Eastern Uttar Pradesh continues to show predominance of infectious dermatoses, Manish Kumar et al., while coastal humid regions report high fungal (34%) and bacterial (23%) infectious burdens, Bhat Ramesha M et al, [10]. In contrast, the present study demonstrates a decline in fungal infections, with mycetoma and filariasis becoming negligible.

Leprosy shows a divergent trend. While Southern India reports low prevalence, the present study and research by Masatkar et al. [11], document increasing numbers, possibly due to enhanced diagnostic facilities and heightened clinical suspicion.

There is a gradual and steady increase in non-infectious dermatoses, along with a simultaneous reduction in infectious dermatoses in the present study with similar epidemiological transitions reported globally. In Central Uganda, Namutebi et al., over a period of 6 years (2016-2022), described a shift from infectious to eczematous disorders, paralleling North India’s movement towards non-infectious dermatoses. Conversely, Pakistan continues to report higher burdens of fungal infections and scabies, Pathak et al [12], while in Saudi Arabia [10], eczema and appendageal disorders predominate.

Analysis of 735,730 outpatients and 3,524 inpatients over a period of 8 years (2017–2024), and across two COVID-19 pandemic disruptions, highlights certain clear transitions. Infectious dermatoses, which earlier comprised 39% of cases Kar et al., are now replaced by non-infectious conditions, consistent with observations by Kavita et al. This trend parallels socioeconomic development, and adds to the rising non-communicable disease burden.

Among infectious dermatoses, varicella and herpes zoster declined, with a slight post-COVID increase in the latter. Superficial fungal infections, though still significant (15% of OPD load), have reduced from 30% in 2017 as compared with an earlier study reporting higher dermatophyte infections, Sonia Jain et al. [13]. Verrucae show modest decline. In contrast, leprosy has risen by 63% over eight years, consistent with Mastakar’s et al, findings of continued transmission, childhood disease, and multibacillary cases. Better availability and utilization of diagnostic facilities, such as qPCR techniques, and a high index of suspicion may be factors for increased detection of leprosy

Non-infectious dermatoses have increasingly gained prominence. Pigmentary disorders, especially melasma, rose from 7% in 2017 to 15% in 2024, comparable to global prevalence estimates of 1.5–33%, as evidenced in a study by Grimes et al. Factors include heightened cosmetic awareness, and social media. Acne remained stable at ~12%, consistent with a Brazilian study by Miot et al. Vitiligo declined from 7% to 4%,, in contrast to reports of rising prevalence elsewhere, as in a study by Ray et al, underscoring the need for multicentric validation.

Eczema/dermatitis displayed variability: 23% in 2017, falling to ~9% in 2024. Despite declining outpatient numbers, inpatient admissions increased, reflecting greater severity and allergen exposure. In the U.S., eczema remains the leading dermatology diagnosis, as reported by Grada et al., illustrating global variations.

Inpatient trends show striking increases in papulosquamous and immunobullous disorders. Admissions for immunobullous diseases rose dramatically by about 385%, likely due to newer guidelines [14], recommending biologics as first-line therapy. Erythroderma admissions nearly doubled, driven by newer psoriasis management guidelines with biologic use and secondary causes such as hematological malignancy. These observations parallel reports by Sun QW et al and Katrina et al.

Other important observations include a 9% rise in chronic urticaria, with increasing inpatient care due to use of injectable omalizumab and C1 esterase inhibitors [15]. Hair disorders, particularly telogen effluvium, patterned baldness, and alopecia areata, have gained prominence in the post-COVID era. STI’s, particularly viral STI’s, show resurgence, consistent with literature citing increased herpes virus incidence. These trends underline the need for renewed preventive strategies and patient education.

In summary, this eight-year dataset demonstrates a clear epidemiological transition in North India, with infectious dermatoses steadily replaced by chronic, non-infectious conditions. This pattern reflects socioeconomic progress, urbanization, and evolving health-seeking behavior, but also underscores the persistent challenge of leprosy and fungal infections. Simultaneously, the rising burden of autoimmune, inflammatory, and cosmetic dermatoses highlights the dual demands on dermatology services, requiring balanced resource allocation between communicable and non-communicable disorders.

Limitations

Single-centre data.

No stratification by gender or age.

Seasonal variation not accounted for.

COVID (2020–22) disrupted normal disease reporting and health-seeking.

Institutional admission policies may bias inpatient profiles.

This eight-year study highlights a clear epidemiological shift in dermatological disease patterns, with an increasing burden of chronic non-infectious conditions: Decline in infectious dermatoses (fungal infections, varicella, herpes zoster). Persistence/rise in Hansen’s disease and STIs. Increase in chronic non-infectious dermatoses (melasma, psoriasis, eczema, hair disorders, urticaria). Rising inpatient load from severe psoriasis, immunobullous disorders, and erythroderma.   These findings call for: Improved dermatology infrastructure. Increased resource allocation for provision of biologics to manage life-threatening illnesses such as erythroderma, immunobullous disorders, and angioedema. Enhanced STI and leprosy surveillance. Coordinated public outreach. Multi-centre databases to guide public health planning. Dermatology is no longer limited to minor infections or cosmetic concerns—it reflects broader health, lifestyle, and societal transitions.

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