Black Skin Disease in South East London

Skin disease in black patients can present a diagnostic challenge both because of variations in clinical appearance and because certain disorders appear unique to black skin. The majority of dermatology text books and atlases concentrate mainly on white skinned patients. Our hospital serves a cosmopolitan local community in whom 40 percent of the population is black. We recorded the diagnosis made in 461 consecutive black (African, Afro-Caribbean and mixed-race) patients who attended a general dermatology new patient clinic in South East London. The aim of the study was to document the spectrum of skin disease seen in black patients and to highlight these disorders. 187 children and 274 adults were studied. In the black children atopic eczema was diagnosed in 38 percent, tinea capitis 26.7 percent, pityriasis alba 3.7 percent, viral warts 3.2 percent, keloids 2.7 percent, others 25.7 percent. Diseases recorded which are not seen in the white children included Facial Afro-Caribbean Childhood Eruption (FACE) and infantile acropustulosis. Of the 274 adults assessed, acne was diagnosed in 14.6 percent, eczema 10.2 percent, psoriasis 5.1 percent, pityriasis versicolor 4.0 percent, alopecia areata 3.3 percent, dermatofibroma 2.9 percent, urticaria 1.8 percent, pityriasis rosea 1.8 percent, cutaneous sarcoid 1.5 percent, discoid lupus 1.1 percent. Diseases more commonly seen in black skin were acne nuchae keloidalis/scalp folliculitis 14.6 percent, keloids 4.4 percent, post inflammatory pigmentation 3.6 percent and traction alopecia 1.1 percent; other disorders were seen in 30 percent. Normal variants recorded were dermatosis papulosa nigra, linear nail pigmentation and palmar pits. As the UK population becomes increasingly cosmopolitan, familiarity with skin disorders in both black and white skin is increasingly relevant to our practice. (AU)

Human T cell lymphotropic virus (HTLV-1): cutaneous manifestations

Skin manifestations are a common feature of HTLV-1 associated disorders and of HTLV-1 infection itself. These include the lymphomatous skin infiltrates in adult T-cell lymphoma/leukaemia, most commonly manifesting as persistent, generalised papules, nodules and plaques with later ulceration, acquired ichthyosis and xeroderma in HAM/TSP, infective dermatitis of children, dermatomyositis, crusted (Norwegian) scabies, psoriasiform rashes which may precede one of the more serious disease associations, and possibly also seborrhoeic dermatitis. Disorders typically associated with immunosuppression such as disseminated herpes zoster, and ulcerative non-healing herpes simplex may also be seen occasionally both in ATK as well as in other wise asymptomatic HTLV-1 infection (AU)

London-born black Caribbean children are at increased risk of atopic dermatitis

BACKGROUND: Previous reports suggest that atopic dermatitis is more common in black Caribbean children born in the United Kingdom than in white children. It is unclear whether these differences are caused by selection bias or variations in the use of the word "eczema" in the groups studied. OBJECTIVE: Our objective was to explore ethnic group differences in the prevalence of atopic dermatitis in London schoolchildren. METHOD: A cross-sectional prevalence survey of 693 junior school children in three schools was performed. Atopic dermatitis was defined in three ways: (1) by a dermatologist, (2) by visible flexural dermatitis as recorded by an independent observer, and (3) by a history of flexural dermatitis according to the child's parents. RESULTS: The prevalence of atopic dermatitis according to examination by a dermatologist was 16.3 percent in black Caribbean children and 8.7 percent in white children. This increased risk was present for different methods of defining of atopic dermatitis and persisted after adjustment for potential confounders. CONCLUSION: London-born black Caribbean children appear to be at an increased risk of having atopic dermatitis. (AU)

Infective dermatitis of Jamaican children 1966-1991 - abstract

Infective dermatitis of Jamaican children, first described by Sweet in 1966, is a chronic eczema associated with persistent infection of the skin or anterior nares with either staphylococcus aureus or B haemolytic streptococcus, or both. In 1990, we reported a pilot study of 14 children with infective dermatitis (ID) and 11 with atopic eczema (AE) as controls, which showed that all the ID patients were positive for antibodies to the human T-lymhotrophic virus (HTLV-1). We postulated then that there was an association between HTLV-1 infection and infective dermatitis, and suggested that this organism might be causing ID through an immune mechanism. This paper reports on findings of a case control study of 50 ID patients and 36 AE patients undertaken between December, 1990 and August, 1991, which confirms the association between HTLV-I and infective dermatitis. All 50 patients with ID were positive for HTLV-I and antibodies, while the AC controls were all negative. In addition, when compared to the atopic controls, the ID patients had lower haemoglobins, higher white cell counts, and higher ESRs. They also had lower serum albumins and serum irons. Investigations of their immune systems showed that both groups had normal responses to delayed hypersensitivity skin tests, and normal complement levels. However, there was a marked increase in the activity of both T and B-lymphocyte systems, with all immunoglobulin levels being significantly increased in ID patients. The CD4: CD 8 ratio was increased, with an increase in the CD4 counts. Monoclonal antibody tests showed increased T-cell activation. The results confirm the association between HTLV-1 infection and infective dermatitis and confirm immune dysfunction. The precise mechanism of the immunodysregulation, however, remains to be determined (AU)

Cutaneous infections in Trinidad

Skin infection is common in patients with any skin diseases where pruritus is a prominent feature. A retrospective analysis was performed on the results of skin swab cultures from patients with eczema and a variety of other conditions. This paper presents the findings of bacteriologic culture and sensitivity testing of 131 swabs from 122 patients over a period of 22 months and examines the results in terms of the reported relationship between scabies and acute poststreptococcal glomerulonephritis. Staphylococcus aureus was most often isolated, and this appears to indicate that antistaphylococcal antibiotics should be the first line of treatment in the absence of the results of cultures. (AU)

Incidence of skin disease in rural Jamaica

The incidence of skin disease in people seeking health care in rural Jamaica during the period January to December 1985 has been studied. Results indicate that of 14,179 clinic visits reviewed, 6 percent involved a primary dermatological diagnosis. Infectious and parasitic diseases predominated, with scabies, impetigo, and tinea being the most common diagnoses. Of these, scabies accounted for nearly one third of all dermatologic visits. Noninfectious skin disease accounted for less than 10 percent of dermatologic diagnosis, with unclassified eczema making up the majority. Undiagnosed skin conditions contributed one third of dermatologic visits, with an incidence inversely related to the incidence of scabies visits. This relationship suggests that many evaluations of skin conditions were based on the exclusion of scabies with no alternative diagnosis. (AU)

The pattern of childhood skin diseases in Jamaica

A review has been made of the skin disorders seen in children under 11 years of age at the Skin Clinic of the University Hospital of the West Indies during the 5-year period 1971 - 1975. Eczema (all types) was found to be the commonest condition (46.7 percent) followed by infections and infestations (25 percent). The third commonest disorder was papular urticaria (11 percent). The age pattern of the various diseases shows that infants are at greatest risk of developing skin diseases since 40 percent of all the disorders were seen during this age period. The possible factors responsible for the commoner skin diseases are discussed and suggestions are made for possible ways of dealing with them (AU)