A cross-sectional study with prospective data collection was conducted from December 16 to 18, 2019, at the Ouahigouya Prison and Correctional Facility (MACO). Established in 1966, this penitentiary institution housed 168 prisoners at the time of the study, distributed across three separate units according to sex and age: an adult male unit (comprising five cells, numbered 1 to 5), an adult female unit (one cell, no. 6), and a juvenile unit (one cell, no. 7).

All prisoners present during the study period who provided informed consent were included. Prisoners who were absent (e.g., for court hearings) were excluded. Thus, an exhaustive sampling approach was adopted.

Each participant underwent a structured interview and a complete dermatological examination performed by an experienced dermatologist, assisted by five medical students and two nurses. Data collected included sociodemographic characteristics, detention conditions, hygiene practices (such as bathing frequency), and dermatological findings. Diagnoses were established based on clinical criteria. Appropriate management was offered according to the identified condition and its severity.

Data were entered and analyzed using Excel 2019 and R software (version 4.3.0). Qualitative variables were described as counts and percentages (%), while quantitative variables were expressed as means and standard deviations. Fisher’s exact test was used to assess associations between dermatoses and categorical variables, given the modest sample size and expected counts sometimes below 5. For inmates presenting with multiple dermatoses, each condition was analyzed independently. The significance threshold was set at p < 0.05.

The study was approved by the institutional medical board as well as by judicial and prison authorities (authorization no. 2019-426CAO/TGI-OHG/PF). Written informed consent was obtained from each participant after a detailed explanation of the study objectives and procedures. Anonymity and confidentiality of data were strictly maintained throughout the study.

Of the 168 prisoners present at MACO during the study period, 149 were included, yielding a participation rate of 88.7%. Among them, 79 presented with at least one dermatological condition, corresponding to an overall prevalence of 53.0%.

The study population was predominantly male (98.7%), with a mean age of 29.9 ± 8.4 years (range: 10 - 60 years). The 20 - 29-year age group was the most represented (53.2%). More than half of the inmates (53.2%) had no formal education, and 21.5% had only primary-level education. Regarding occupation, the vast majority were informal sector workers (91.1%), mainly farmers (24.1%), traders (19.0%), and artisanal gold miners (16.5%). None of the prisoners had ever received a dermatological consultation prior to incarceration, and 96.2% reported no history of skin disease. The sociodemographic characteristics of prisoners are presented in Table 1 .

The mean duration of incarceration was 17.1 months (range: 1 - 144 months), with 54.4% of prisoners incarcerated for less than one year. Most inmates (73.4%) were concentrated in cells 1 (41.8%) and 2 (31.6%). Regarding personal hygiene, 69.7% reported taking two showers per day.

The majority of prisoners (78.5%) presented with a single dermatological condition. Only 26.6% reported subjective symptoms, with pruritus being the most common (8.9%). The conditions of detention and functional symptoms are summarized in Table 2 .

In all, 26 distinct skin conditions were identified and grouped into five categories. Figure 1 shows a case of lip vitiligo. It is a well-defined, irregularly shaped depigmented patch located on the lower lip and adjacent skin area. Figure 2 shows genital fixed pigmented erythema. It is a single, well-defined patch of purple-brown coloration located in the inguinal-genital region, corresponding to the pigmented phase of a fixed pigmented erythema. Figure 3 shows a case of pityriasis versicolor. These are multiple macules and fine hypopigmented patches, finely scaly, oval in shape, converging in patches on the trunk. These three photos provide a representative overview of the skin conditions observed in prisoners.

Inflammatory dermatoses were the most common (36.7%), followed by infectious skin diseases (34.2%) and tumoral/genodermatoses (29.1%).

Acne was the most frequent condition (31.6% of prisoners), representing 86.2% of inflammatory dermatoses. Pityriasis versicolor (17.7%) and palmoplantar hyperhidrosis (11.4%) were the next most common. Among infectious dermatoses, fungal infections accounted for 74.1% of cases, with pityriasis versicolor predominating. Parasitic dermatoses, including scabies, were rare (2.5%). The diagnostic profile of the identified dermatoses is detailed in Table 3 .

A significant association was found between age and acne (p < 0.01), with a marked predominance in the 20 - 29-year age group (64.0% of cases). The factors associated with the 10 most common skin diseases according to age are presented in Table 4 .

No significant association was found with educational level, although a trend was observed toward higher prevalence among inmates with no schooling or only primary education. The factors associated with the 10 most common skin diseases according to level of education are presented in Table 5 .

A significant association was identified between bathing frequency and certain dermatoses: taking two showers per day was associated with acne (p = 0.04), while three or more daily showers were associated with lipomas (p = 0.01). No association was observed between bathing frequency and infectious dermatoses. The factors associated with the 10 most common skin diseases according to frequency of showering are presented in Table 6 .

The distribution of dermatoses varied significantly by cell. Cells 1 and 2 accounted for the majority of cases of acne (p < 0.01), pityriasis versicolor (p = 0.01), palmoplantar hyperhidrosis (p < 0.01), keloids (p < 0.01), and keratosis (p = 0.04). Onychomycosis was present in cells 1 and 2 but showed a significant association with cell 5 (p < 0.01). The factors associated with the 10 most common skin diseases according to cell number are presented in Table 7 .

Therapeutic abstention was the most frequent approach (59.1%), reflecting the often benign nature of the conditions. Topical treatments (antiseptics, antihistamines) were used in 35.1% of cases. Only 3.5% of prisoners were referred to the regional university hospital center for specialized care. The therapeutic management of dermatoses is described in Table 8 .

CHUR: Regional University Hospital Centre.

Of the 168 prisoners incarcerated during the study period, 149 were included, yielding a participation rate of 88.7%. This figure is comparable to that reported by Zida et al. in Burkina Faso (92.2%) [13] . In contrast, lower rates have been reported by Diendéré et al. in Burkina Faso (32.6%) [12] , Kouotou et al. in Cameroon (58.8%) [14] , and Kuruvila et al. in India (73%) [15] . The high participation rate observed here may be explained by the provision of free medical care during the survey.

The overall prevalence of dermatoses was 53%, similar to findings from the central prison in Ouagadougou (55.6%) [11] and in Cameroon (57.1%) [14] . Higher prevalence has been reported in Nigeria (72.5%) [6] , whereas lower rates have been noted in other Burkinabe prisons (17.6%) [12] , France (23%) [5] , and Guinea (27.3%) [7] . A recent Nigerian study even reported scabies prevalence as high as 71.8% [8] . Such variations may be explained by differences in hygiene conditions, health care systems, climate, overcrowding, and prison promiscuity, which facilitate the transmission of infectious skin diseases [8] [9] [12] . The timing of the present study (December), coinciding with the Harmattan season, may also have influenced the occurrence of certain skin conditions. The Harmattan period, characterized by cold, dry, and dusty weather, may have contributed to an increase in skin xerosis and exacerbation of irritative dermatoses, while reducing the prevalence of certain fungal or parasitic infections that thrive in humid environments.

The mean age of prisoners was 29.9 years, with 86.1% under 40. These findings align with previous studies in Burkina Faso [11] [12] , elsewhere in Africa [7] [16] , and globally [17] [18] , reflecting the predominance of youth in prison populations, itself mirroring national and global demographic structures [19] [20] . The overrepresentation of young adults may be linked to unemployment, a major factor of social and economic vulnerability [19] [20] .

The prison population was overwhelmingly male (98.7%), consistent with reports from Burkina Faso [11] - [13] , other African countries [6] [14] , and Europe [19] - [21] . This gender imbalance is attributable to higher-risk behaviors among men, such as alcohol and drug use, and greater involvement in criminal activities [20] [21] .

Low educational attainment was also notable, with 53.2% of inmates unschooled and only 21.5% having primary-level education. This profile reflects the disadvantaged socioeconomic background of African prison populations [8] [9] [14] [19] , and may contribute to limited knowledge of basic hygiene practices. Most prisoners (91.1%) were employed in the informal sector, further confirming the link between socioeconomic precarity and incarceration.

Overall, the profile of inmates at MACO-young (mean age 29.9 years), male (98.7%), poorly educated (53.2% unschooled), and predominantly from the informal economy (91.1%) is consistent with West African prison demographics [6] - [9] [11] - [14] [16] [19] and with Bénézech’s rule linking crime, male gender, and youth [22] . This underscores the role of social determinants of health, where illiteracy and economic precarity act as vulnerability factors for both incarceration and the development of skin diseases, as recently confirmed by a meta-analysis on scabies [9] .

The average incarceration duration was 17.2 months, with more than half of prisoners (54.4%) detained for less than one year. These figures are in line with the African Prison Association report, which ranks Burkina Faso among the countries with the shortest average detention periods [23] .

None of the inmates had received dermatological consultation prior to incarceration, in contrast with reports from Guinea [7] and Morocco [2] . This difference may reflect the limited availability of dermatologists in the region before 2015.

Most prisoners (69.7%) reported bathing twice daily, a hygiene level higher than that observed in other African prison settings [2] [7] . While 73.4% of prisoners reported no dermatological complaints, pruritus was the most common symptom among those affected, consistent with findings from Togo [13] and Europe [24] [25] .

Inflammatory dermatoses (36.7%) and infectious dermatoses (34.2%) were the most frequent. The predominance of inflammatory conditions, in contrast to studies where infectious skin diseases were more common [6] [11] [26] , may be explained by stress, poor hygiene, and overcrowding [8] [9] [12] . Acne accounted for 89.2% of inflammatory dermatoses, an expected finding given the youthful prison population [6] [24] [27] . However, beyond age-related prevalence, the prison environment may exacerbate acne through chronic psychological stress, anxiety, and disruption of personal care routines. Severe acne can further impair mental health, self-esteem, and social interactions, worsening the burden of incarceration [19] [26] .

Among infectious dermatoses, fungal infections predominated (74.1%), in agreement with studies from India [15] and Nigeria [6] . Pityriasis versicolor was the most common fungal infection (51.8%), favored by cell overcrowding, heat, and humidity, which create an ideal environment for yeast proliferation. Conversely, studies in Cameroon, Guinea, and India have reported a higher prevalence of parasitic dermatoses [7] [14] [15] , possibly reflecting different climatic and hygienic conditions. Viral and parasitic dermatoses were relatively rare in this study (7.4% each). The low prevalence of scabies (7.4%) contrasts with much higher rates reported elsewhere [15] [26] [28] and may be explained by relatively better hygiene practices at MACO.

Tumoral dermatoses and genodermatoses (23.2%), notably keloids (34.8%), may reflect poorly healed skin trauma predating incarceration.

Acne was significantly associated with the 20 - 30-year age group (p < 0.001), consistent with epidemiological data [27] . Although not statistically significant, a trend was observed between dermatoses and low educational attainment, highlighting the potential role of social determinants.

Bathing frequency was associated with certain conditions: two daily showers with acne (p = 0.04), likely reflecting oily skin rather than a causal link; and three daily showers with lipomas (p = 0.01), likely a statistical artifact. No significant associations were observed between bathing frequency and infectious dermatoses, suggesting that overcrowding and environmental contamination are stronger risk factors. The link between two showers a day and acne could reflect oily skin, as people with seborrheic skin wash more frequently without any direct causal link. The association between three showers and lipomas seems to be more of a statistical artifact. This link could reflect an interpretation bias, as people with oily skin tend to wash more often to reduce seborrhea, without any direct causal effect. The association between frequent showering and lipomas is probably coincidental, with no pathophysiological basis, suggesting a statistical artifact related to the small size of the subgroups.

Dermatoses were unevenly distributed across cells. Cells 1 and 2 concentrated most cases of acne (p < 0.01), pityriasis versicolor (p = 0.01), hyperhidrosis (p < 0.01), and keratosis (p = 0.04), suggesting environmental influences (humidity, overcrowding, stress). Onychomycosis was concentrated in cell 5 (p < 0.01), possibly indicating a localized infectious cluster. These findings highlight cell-specific disparities and call for targeted sanitary interventions.

Therapeutic abstention was the most common management strategy (59.1%), given the benign nature of most dermatoses. One inmate with scabies received ivermectin, and three were referred for specialist care.