Immigration is a dynamic and inevitable process. Since 1999, the foreign population has increased exponentially in size. Between 1998 and 2012, the number of foreigners registered as residents in Spain increased more than 6-fold from 637 058 to 5.7 million.1

Although the recent economic crisis has forced many foreigners to leave Spain, the foreign population still accounts for 12% of the census population (as of January 2012).1 Children account for 14.5% of registered foreigners, that is, a proportion similar to the population of Spanish origin (15%), although this figure does not include children of foreigners settled in Spain, for whom no census data are available.

The new sociodemographic realities in our country demand an analysis of the needs and priorities at all levels of care.2 The foreign pediatric population may have a different prevalence of certain diseases compared to the Spanish population,3,4 as demonstrated in Spanish5,6 and international studies.7,8 Likewise, several Spanish studies have investigated the demand generated in dermatology clinics by foreign patients.9–11 However, there are no studies on skin diseases in the foreign pediatric population in Spain. We therefore thought it of interest to assess the skin diseases present in the foreign pediatric population and compare them with the Spanish population.

The objective of the study was to analyze skin diseases in foreign children and compare them with those in Spanish children and to evaluate certain socioepidemiologic variables and the frequency of visits to the different care settings within the department.

In this prospective, descriptive, and analytical study, patients had to be under 15 years of age and attended by a dermatologist between January and December 2007.

The study covered the care activity in the dermatology department of the Nineteenth Health District of the Valencian Community and included all outpatient and hospital clinics, as well as surgery appointments and walk-in visits.

Patients were divided into 4 categories: 1) Spanish patients (born in Spain of Spanish parents); 2) children of foreigners (born in Spain of at least one parent born outside Spain); 3) foreign children (born outside Spain); and 4) adopted children. Patients in the latter 3 categories were considered foreign patients for the purposes of this study.

The present study recorded 3108 visits, of which 14.3% corresponded to foreign children. This proportion is higher than that found in other studies on health care usage for dermatology among adults (approximately 4%),9,11 but is similar to the 13.2% reported by Taberner et al.10

Particularly noteworthy is that the foreign children made more use of walk-in appointments than Spanish children, in agreement with other studies.13,14 A number of explanations are available for the greater reliance on walk-in appointments. For example, foreign parents may be less aware of the normal access pathways or find it harder to attend scheduled appointments due to work constraints. Alternatively, some patients might not have their papers in order. In addition, certain skin diseases in children are a cause of great concern for parents and so a quicker visit is preferred to assuage their anxiety.

An important consideration is where the parents are from. Foreign children in our region originate mainly from Latin America (53.8% of all foreign children), in line with studies performed in the Son Llàtzer hospital in Mallorca, Spain,10 and the Miguel Servet Hospital in Zaragoza,11 (51.7% and 47.1%, respectively). The second most common place of origin was North Africa and Middle East (19.2%), with Eastern Europe in third place (9%). This order is identical to a previous study in our region.15

With regards the frequency of skin diseases and diagnostic categories, in comparison with other pediatric studies that did not take into account origin, our data are similar to those obtained in a pediatric population in Madrid,16 although large differences are apparent compared to those published for the Hospital Universitari Arnau in Vilanova.17 In the latter of these studies, neoplastic disease was reported as frequently as infectious skin disease (mainly because of melanocytic nevus). These 2 types of condition were the most frequent presenting complaint. The authors explain this observation through the high number of referrals for congenital melanocytic nevi by pediatricians and through the possible increase in melanoma in a region where the rates of annual sun exposure are very high.

If we look at the comparison of skin diseases in Spanish and foreign children, we see that foreign children are at almost twice the risk of suffering atopic dermatitis. In studies performed in Europe and Australia, a higher prevalence of atopic eczema was reported in certain immigrant pediatric populations, such as for example in black children18 and Asian children.19

The only infection reported more frequently in foreign children was scabies, with a 10-fold higher risk. Previous studies had suggested that scabies was more frequent in foreign children,20 with greatest prevalence among Asian children in a study in Madrid.21 In a recent study in Greece, scabies was reported twice as often among foreign children, although bacterial infections were also twice as frequent in that study, unlike in our study.8 The fact that this disease and others such as bites are more frequent in foreign children could be related to their socioeconomic status as they probably live in homes with worse hygiene and less effective means for keeping out arthropods and flying insects.

With regards the diagnostic categories, erythematous-desquamative and infectious disease were significantly more frequent in foreign children compared to Spanish ones. These 2 categories, along with the third most frequent category, melanocytic lesions, accounted for 70.5% of all disease, although this latter category was significantly more frequent in Spanish children, as was also the case for neoplastic disease.

Among children whose presenting complaint was a melanocytic lesion, foreign children had a 50% lower risk of having melanocytic nevus. This trend was reversed in the case of congenital nevus, which was approximately twice as common in the foreign population with melanocytic lesions. These data are in agreement with those of Albares et al.15 and with those of Monteagudo et al.22 in a study that analyzed neonatal disease.

This study is subject to a series of limitations. First, as this was a cross-sectional, observational study, patients were not followed up over time and certain skin conditions might therefore not have been detected. In addition, the variables analyzed were collected by different dermatologists and so interobserver variations may be present.

We can conclude that there appear to be differences in the way of seeking medical care for foreign children and Spanish children for skin diseases. We believe that awareness of these differences will help us design more effective dermatologic health promotion programs for these children.

The authors declare that they have no conflicts of interest.