Distribution and Predictors of Skin Diseases in a Multicenter Clinic-Based Cohort Across Four Regions of India

Background: Comprehensive multicenter data on the distribution and determinants of skin diseases in India remain limited. We aimed to characterize the burden of dermatological conditions and identify demographic, behavioral, and clinical predictors across four geographic regions. Methods: A retrospective, observational, multicentric, clinic-based, non-interventional study. About 6169 (including 422 children aged 1– 16 years) Patients data were collected from 415 dermatologists databases attending dermatology clinics across the North, South, East, and West regions of India between June and September 2024. Data was collected using standardized case report forms. Skin diseases were classified into seven major categories: fungal, bacterial, viral, parasitic, autoimmune, inflammatory, and allergic; each defined using uniform diagnostic criteria. Logistic regression models identified independent predictors of each disease category. Results: Fungal infections were the most common diagnosis (26.1%), followed by autoimmune (19.4%), inflammatory skin disease (18.4%) and allergic conditions (10.2%). Male sex was associated with higher odds of parasitic (aOR 1.84, 95% CI 1.39– 2.45; p < 0.001), bacterial (aOR 1.43, 95% CI 1.15– 1.79; p < 0.01), viral (aOR 1.35, 95% CI 1.10– 1.67; p < 0.01), and fungal dermatoses (aOR 1.36, 95% CI 1.19– 1.55; p < 0.001), and lower odds of inflammatory disease (aOR 0.69, 95% CI 0.60– 0.80; p < 0.001). Low income was associated with increased odds of fungal (aOR 1.55, 95% CI 1.20– 2.03; p < 0.001), bacterial (aOR 1.74, 95% CI 1.15– 2.69; p < 0.05), and viral diseases (aOR 1.60, 95% CI 1.07– 2.44; p < 0.05), and lower odds of autoimmune disease (aOR 0.69, 95% CI 0.52– 0.92; p < 0.01). Regional differences were observed relative to the East region: inflammatory disease was less frequent in the North (aOR 0.56, 95% CI 0.42– 0.76; p < 0.001), while viral disease was more frequent in North, South, and West regions (aORs approximately 2.0– 2.7). Allergic disease was more common in the South (aOR 2.06, 95% CI 1.42– 3.10; p < 0.001). Older age was modestly associated with autoimmune, allergic, bacterial, and viral disease, while children had a higher burden of parasitic infections. Conclusion: In this large clinic-based study of dermatology patients across India, fungal infections were the most frequent diagnosis and disease patterns varied by sex, income, age, and region. These findings highlight substantial sociodemographic and geographic differences among patients seeking dermatologic care and support the need for region-specific prevention and management strategies in clinical practice. Keywords: dermatological diseases, India, clinic-based cohort, epidemiology, skin disease distribution, multicenter study