ORIGINAL RESEARCH Skin disease in the first two years of life in Aboriginal children in East Arnhem Land Erin McMeniman, 1,2 Libby Holden, 2 Therese Kearns, 4 Danielle B Clucas, 3 Jonathan R Carapetis, 4,5 Bart J Currie, 4,5 Christine Connors 5 and Ross M Andrews 4 1 Department of Dermatology, Princess Alexandra Hospital, 2 School of Medicine, Griffith University, Brisbane, Queensland, 3 Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, 4 Menzies School of Health Research, Charles Darwin University, 5 NT Department of Health, Darwin, Northern Territory, Australia ABSTRACT Background: The most common skin infections affecting children in remote Aboriginal communities are scabies and impetigo. Group A streptococcal skin infections are linked to the high rates of heart and renal disease occurring in Aboriginal Australians. Methods: A retrospective review of medical records was conducted in a primary health care centre in the East Arnhem region of the Northern Territory. Data was collected from all presentations to the clinic in the first 2 years of life for 99 children born between 2001 and 2005 as a component of the East Arnhem Regional Healthy Skin Project. Results: The median number of presentations to the clinic in the first 2 years of life was 32. Skin disease was recorded in 22% of all presentations. By 1 year of age 82% of children had presented to the clinic with their first episode of impetigo and 68% with their first episode of scabies. Antibiotics were administered to 49% of children with impetigo. Conclusion: Skin infections are a major reason for presentation to primary health clinics and contribute to the high disease burden experienced by children in the first 2 years of life. This high frequency of presen- tation provides multiple opportunities for interven- tion and monitoring. Key words: aboriginal, children, impetigo, infants, scabies, skin disease. INTRODUCTION Skin infections such as scabies and impetigo cause signifi- cant short term morbidity and are associated with long-term heart and renal disease. 1,2 Scabies is endemic in some Aboriginal populations, with a prevalence reportedly as high as 50% in children, and 25% in adults. 1 Scabies under- lies up to 70% of streptococcal skin infections. 3 Impetigo/pyoderma (synonymous with skin sores in pub- lished literature) is seen in 10–70% of Aboriginal children in remote communities. 1,2 Several studies have found that the primary pathogen causing impetigo is group A strepto- coccus (GAS), with 80–93% of lesions swabbed being GAS-positive. 1,4,5 Streptococcal skin infection can lead to post-streptococcal glomerulonephritis (PSGN) and acute rheumatic fever (ARF). 4,5 Studies have shown throat carriage of GAS in Indigenous communities is low (<5%) leading to the suggestion that skin infections, as opposed to those of the throat, lead to PSGN and ARF in Aboriginal populations. 4,5 Aboriginal communities have rates of PSGN and ARF that are among the highest reported in the world. 1,6 Indigenous Australians have 10 times the risk of end-stage renal disease of non-Indigenous Australians. 7 The current prevalence of rheumatic heart disease (RHD) in the general Australian population is 0.014%, while the prevalence in remote Aboriginal communities is 3%. 6 Skin diseases in Aboriginal children are a significant public health issue, with poverty, overcrowding and poor hygiene all contributing factors. 1,4,8–10 This study aims to describe the frequencies of scabies and impetigo in the first 2 years of life for children in a remote Aboriginal community and report on patterns of treatment for impetigo. Correspondence: Dr Erin McMeniman, Department of Dermatol- ogy, Princess Alexandra Hospital, 199 Ipswich Road, Woolloon- gabba, QLD 4102, Australia. Email: erinkmcmeniman@gmail.com Erin McMeniman, MPH. Libby Holden, PhD. Therese Kearns, M App Epi. Danielle B Clucas, MBBS. Jonathan R Carapetis, PhD. Bart J Currie, FRACP. Christine Connors, FAFPHM. Ross M Andrews PhD. Submitted 29 March 2011; accepted 7 July 2011. Abbreviations: ARF Acute rheumatic Fever GAS Group A streptococci PSGN Post streptococcal glomerulonephritis RHD Rheumatic heart disease Australasian Journal of Dermatology (2011) 52, 270–273 doi: 10.1111/j.1440-0960.2011.00806.x © 2011 The Authors Australasian Journal of Dermatology © 2011 The Australasian College of Dermatologists