The present study presents for the first time in Cameroon, to the best of our knowledge, the spectrum of skin diseases in a rural community. The point prevalence of any skin disease of 62% found in the Mbam area is alarming, and validates the hypothesis of a high prevalence of common skin disorders in the rural community of Cameroon. This prevalence lies in the upper half of the range of 21-87% described in SSA . The prevalence found in our study is comparable to the 64% reported in a community survey in Timor-Leste  and 53% reported among school children in Dar es Salaam . However, this prevalence is less than the finding in a similar population in Ethiopia (80.4%) . Nevertheless, it is within two-folds higher than the 26.9% reported by Gibbs in a community-based study of two villages in Tanzania  and 38.8% reported by Dogra and collaborators in an Indian community . These data suggest that although the prevalence of common skin diseases is generally high, it varies quite substantially from one geographical area to another and between different segments of the same population. Given that the Mbam area is situated in the equatorial dense forest region of Cameroon with a warm and humid climate, it may not be appropriate to generalize the findings of this study to the whole of Cameroon that has 4 distinct ecological zones. The replication of the study in the other ecological zones of the country is necessary in order to construct a better understanding of epidemiology of skin disorders that will lead to improved care for these conditions in our communities.
In the review by WHO children were found to have more skin diseases compared to adults , a finding that was confirmed by the high prevalence rates described among school children in Ethiopia , Tanzania , Iraq , and in the community in Timor-Leste where scabies and pyoderma were more prevalent in children under 10 years of age compared to adults . An analysis of the prevalence rates of common skin disease across different age groups in our sample (Table 2), showed that fungal skin infections were statistically more common in the 10–14 age group (p = 0.032), while disorders of skin appendages (acne) was significantly more prevalent in the 20–24 years age group (p = 0.005) while parasitic skin infestations were most common in the above-40-years age group (p = 0.009). Fungal infections are common in the young as described by Andrews . The prevalence of acne in the 20–24 age group corresponds to acne in adults resulting from bad cosmetologic habits as described by Bissek et al. . Finally, the predominance of parasitic skin diseases in the above-40-years age group is probably related to chronic forms of onchodermatitis in this area with a high endemicity for onchocerciasis . Future studies in a door-to-door strategy may highlight the high prevalence of common skin diseases in this group in Cameroon.
In our study, skin infections and infestations were the commonest skin disorders accounting for 52.82%, followed by scars (21.38%), acne (8.87%), other disorders of pigmentation (4.84%) and dermatitis/eczema (4.03%). Although with varying proportions, the spectrum of skin diseases in our study was similar to that described in other community studies in the rural milieu in which skin infections constituted the bulk [6, 7, 9].
Superficial fungal dermatitis (25.40%) was the most common skin infection. The predominance of fungal diseases in the category of infections/infestations as shown in Table 1 is not an isolated phenomenon given that many hospital and community-based studies have described it [3, 13, 16].
Onchocercal skin lesions (18.55%) came second among common skin infections/infestations in our sample. This is unusual as bacterial infections or scabies depending on the context are generally the second most common skin infection described in the literature [3, 4]. The Mbam area where our study was based is a well known endemic zone for onchocerciasis  and this probably explains this peculiar finding. Secondary bacterial infection was present in about 5.24% of subjects with another skin disease. The repeated scratching in pruritic dermatoses such as fungal and onchocercal skin lesions as well as scabies, usually leads to skin abrasion thus facilitating secondary bacterial infection .
Our study demonstrates that common skin diseases constitute a serious cause of morbidity in the Mbam area. This may suggest that the rest of rural Cameroon probably faces the same challenges. This high magnitude of skin disease is grossly under-estimated by the community as only 40.8% of our subjects declared having any common skin disorder compared to the actual finding of 62.8% (p < 0.0001). This situation may be the result of lack of information in the communities on symptoms and eventual complications of common skin diseases. The implication is that some effort still has to be made to improve the level of information in the communities, by organizing sessions of Communication for Behavior Change led by health personnel through the fixed or mobile strategies. These interventions are expected to be effective given that the spectrum of skin disorders found in our study constitutes easily treatable and preventable conditions for the most part.
The prevalence of allergic dermatoses which is far below that of infections/infestations in the Mbam area (4.03% versus 52.82%) as in Bamako, Mali (15.5% versus 58.6%) , is strikingly different from the spectrum reported in the Yaoundé hospital-based survey, where allergic skin reactions were the leading cause of skin disorders . Hospital-based surveys in the dermatology unit, suffer from selection bias which according to Mahe  and Imudi  may be due to the orientation of patients with undiagnosed or chronic dermatoses to specialised centres. Nevertheless, the findings in the Yaoundé reference hospital  suggest that the profile of skin disorders in the urban centres is different from that in the rural areas, with a predominance of infections as opposed to allergic skin reactions in the cities. Nnoruka  and Ogunbiyi  observed a marked change during a comparative study of the spectrum of dermatoses in the hospital-setting in Enugu and Ibadan respectively during a period of 10 years, with a clear predominance of dermatitis especially eczema. The hypothesis proposed for this change has been that of the industrialization of our cities and the constant exposure of the population to allergens [3, 19]. Longitudinal population studies will allow a better understanding of this observation.
Although we know that certain skin conditions are closely associated with HIV infection, this was not the focus of our community-based study. Mbuagbaw and collaborators in a descriptive study reported in an urban setting in Cameroon  that mucocutaneous infections were the most common problems in a hospital sample of 384 HIV infected subjects. However, the estimated prevalence of HIV infection in the general population  (15–49 years) in Cameroon is 5.1% and had been shown to be much lower in the rural areas (6.7% versus 4.0%) .