Comparative Analysis of Dermatological Conditions and Associated Systemic Comorbidities Among Paediatric and Adult Populations in Rural Eastern Cape, South Africa

Background: Skin diseases represent a formidable global public health challenge, contributing significantly to the global burden of non-fatal morbidity. In resource-limited rural settings, these conditions often remain underdocumented, despite their profound impact on quality of life and their role as sentinels of systemic health. Objective: This study aimed to describe and compare the spectrum, relative frequency, and associated systemic comorbidities of dermatological conditions among paediatric and adult populations in rural Eastern Cape, South Africa. Methods: A retrospective, cross-sectional analysis was conducted using 532 outpatient records from the Nelson Mandela Academic Hospital in the Eastern Cape, collected across a 12-month period between 1 August 2020 and 31 July 2021. Data regarding demographics, primary and secondary clinical diagnoses, and documented systemic comorbidities were extracted and analyzed using descriptive and inferential statistics. Results: The study population was predominantly female (61.5%) and adult (70.7%), with an overall median age of 31 years. Inflammatory dermatoses accounted for the primary burden in both paediatric (71.8%) and adult (71.3%) cohorts. Atopic dermatitis was the leading diagnosis overall (27.8%; n = 148/532), followed by acne vulgaris (10.2%; n = 54/532). Paediatric patients had a significantly higher prevalence of infectious dermatoses than adults (17.9% vs. 10.9%, p = 0.039). Systemic comorbidities were present in 28.4% of the cohort (n = 151/532), occurring almost exclusively in adults (38.0% vs. 5.1% in children, p < 0.001). Among adults with comorbidities (n = 143), HIV/AIDS (34.3%; n = 49), hypertension (28.0%; n = 40), diabetes mellitus (11.9%; n = 17), and tuberculosis (11.9%; n = 17) were the most frequent conditions. In multivariable logistic regression, only adult age group (adjusted odds ratio [aOR] 23.4, 95% CI 8.8–62.0, p < 0.001) and male sex (aOR 2.2, 95% CI 1.3–3.7, p = 0.005) were independently associated with comorbidity. Conclusions: In this tertiary hospital cohort, inflammatory dermatoses predominated, reflecting a complex interplay between dermatological presentations and the regional burden of HIV, tuberculosis, and non-communicable diseases among hospital attendees. Because findings are derived from a single tertiary referral facility, they reflect a selected patient population and cannot be generalized to the broader community or general population of the Eastern Cape. Nevertheless, these data highlight the need to strengthen primary healthcare diagnostic capacity and integrate dermatological screening into existing chronic disease programs.