Lichen planus in African children: a study of 13 patients.

Lichen planus is an uncommonly encountered dermatosis in children, reported worldwide, however in sub-Saharan Africa there is paucity of data on Lichen planus among children. The aim of this study was to document the clinical types of Lichen planus observed in children in South East Nigeria from 1998 to 2001; and to highlight any differences and similarities with adult disease. In all, 13 patients (eight boys and five girls) aged between 3 and 15 years were diagnosed with Lichen planus. The limbs were the most common sites of involvement for nine (69.2%) children. Classic Lichen planus was the commonest clinical variant in eight (61.5%), while extensive hypertrophic plaques were observed in three (23.1%), linear lesions in two (15.4%) and eruptive generalized Lichen planus in two (15.4%). Koebner phenomenon was documented in five (38.5%); mucosal involvement, which is very uncommon in children affected by this disease, occurred in three (23.1%). Only one child had pterygium formation in all 20 nails (total nail dystrophy). No child had scalp or palmoplantar involvement. Despite the endemicity of hepatitis B surface antigen in our environment, this study also revealed that liver function tests were not significantly different between children with Lichen planus and hepatitis B surface antigen and those who were negative for this antigen; while anti-hepatitis C virus seropositivity was not recorded in any of these children.

Topical steroid abuse: its use as a depigmenting agent.

This study was undertaken to document prevalence, motives and observed complications of steroid use as a depigmenting agent amongst African blacks in southeast Nigeria. This practice is very common in the African environment. Consecutive new patients attending the dermatology clinic of the University of Nigeria TeachingHospital, Enugu, from June to December 2004 were recruited. Active substances of products used were determined from packages, while unknown concoctions were analyzed. Chi-squared and Fischer tests were used for statistical analysis, with a significant threshold fixed at 5%. Females aged 18-69 years accounted for 75% (414) of patients. Main topical steroids used by both women and men were class-1 steroids, and these were often compounded with other bleaching products. Median duration of usage was 9 years +/- 1.3. Disorders observed included steroid-induced acne (45.3%), macular hyperpigmentation of face (37.2%), mycoses (40.4%), striae (28.3%), telangiectasis (21.3%), hypertrichosis (13.9%) and diabetes mellitus (2.1%). Duration of utilization of these topical steroids was significantly associated with severe local and systemic consequences, while withdrawal of the offending steroids usually resulted in severe withdrawal dermatitis that was unpleasant to patients. This may suggest that discontinuation is impossible.

Baseline Renal Function among Antiretroviral Therapy-Naive, HIV-Infected Patients in South East Nigeria.

Background:Renal insufficiency has been shown to be a significant, independent risk factor for mortality among HIV-infected patients. Unfortunately, little is known about the prevalence and nature of renal impairment in African populations initiating antiretroviral treatment. This study aims to find the prevalence of abnormal renal function among antiretroviral therapy (ART)-naive, HIV-infected patients in the South Eastern geopolitical zone of Nigeria.Method:This is a cross-sectional hospital-based study, involving 300 ART-naive HIV-positive patients, seen over a 1-year period, aged from 18 years and older, presenting to the clinic for the first time.Results:A total of 300 patients were included in the study, 104 (34.7%) males and 196 (65.3%) females. The prevalence of significant renal disease was 24.3% (73 of 300), while 38.3% (115 of 300) had mild renal impairment. Using logistic regression, age, CD4 count, urea, creatinine, and hemoglobin were significantly associated with renal impairment.Conclusion:The authors observed a high prevalence of significant renal impairment among HIV-infected patients at the time of ART initiation.

Hair loss in children in South-East Nigeria: common and uncommon cases.

BACKGROUND: The cosmetic importance of hair as a unique structure of the scalp is immense, such that once the loss of hair becomes an issue for a child, parents, in most cases, project their own concerns, often expressed as guilt. The clinical presentation of hair loss and scalp disorders in children varies widely, often ranging from subtle to disfiguring forms, and may be acquired or congenital. This variable pattern of hair loss is seen in all regions, possibly based on the ethnic origin of hair types. AIM: To determine the clinical aspects of hair loss based on clinical appearance, age of onset, duration of disease, and associated features, and to provide a guide for the evaluation of acquired hair loss and scalp disorders commonly occurring in childhood in south-east Nigeria. METHODS: One hundred and thirteen children with hair loss and scalp disorders consulted the University of Nigeria Teaching Hospital Skin Clinic between February 2002 and March 2003. The data collected included age, sex, clinical presentation, associated symptoms, and family history. Laboratory tests [full blood count (FBC), thyroid function test (TFT), antinuclear antibody (ANA), urinalysis], microscopic examination, Wood's light examination, and histology were conducted for further confirmation where necessary. RESULTS: There were 71 males (62.8%) and 42 females (37.2%), aged between 3 months and 13 years. The presenting symptoms included scaly scalp, itchiness, and anxiety; some patients were asymptomatic. Hair loss and fear were the chief concerns of 89.6% and 51.3% of parents, respectively, who presented with their children. Commonly occurring diagnoses were tinea capitis (62; 54.9%), alopecia areata (43; 38.1%), psoriasis (5; 4.4%), and telogen effluvium (3; 2.7%). Seventeen patients with alopecia areata had atopic dermatitis and three had vitiligo. CONCLUSION: Commonly occurring hair loss in children in our region is mainly acquired, and the clinical course is related to the parent's attitude to treatment, particularly for tinea capitis.

Correlation of mucocutaneous manifestations of HIV/AIDS infection with CD4 counts and disease progression.

BACKGROUND: As the search for reliable clinical indicators for management of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in resource-poor settings continues, mucocutaneous disorders of HIV should be considered among key clinical indicators for prediction of underlying immune status, disease progression, and possible complications of highly active antiretroviral therapy in Africa. OBJECTIVE: To identify and correlate mucocutaneous disorders to CD4-positive cell count and total lymphocyte count in HIV/AIDS patients of southeast Nigeria. METHODOLOGY: Data were collected through interview-administered survey followed by clinical and dermatological examination of recruited patients and controls. RESULT: Mean CD4 cell count of HIV/AIDS patients was 303.81 cells/mm(3) and was significantly lower to the control group - 807.3 cells/mm(3) (z = 10.089 and P < 0.005). In comparison with the CD4 cell count of asymptomatic HIV-positive patients (mean 433.6 cells/mm(3)), CD4 cell count of HIV-positive patients with various mucocutaneous manifestations (mean 293.63 cells/mm(3)) was statistically correlated with low counts (z = 4.0731 and P < 0.05). Papulopruritic itch accounted for 32.2% (73/227) among patients with CD4+ cell counts of 51-200 cells/mm(3), while seborrheic dermatitis occurred most significantly with CD4 cell counts of 201-500 cells/mm(3) (43.1% vs. 12%P < 0.01) relative to those with lower CD4+ counts (51-200 cells/mm(3)). Mucocutaneous lesion counts of >100 cells/mm(3) were readily observed in advanced stage. CONCLUSION: Cryptococcus skin lesions occurred at low CD4+ counts of 200 cells/mm(3 )and as an early skin manifestation within our environment. Campaign for the skin as an important clinical organ for assessment, prediction of immune status, and management of HIV/AIDS, particularly for hard-to-reach and resource-limited health facilities, has to be undertaken.

Fixed drug eruption in Nigeria.

Fixed drug eruption (FDE) causes cosmetic embarrassment in Nigerian patients, particularly when the characteristic hyperpigmented patches affect the face and lips. Drugs that have been implicated in the etiology of FDE, and the sites of lesions, may vary from country to country. Antimalarials, such as Fansidar, Fancimef, Maloxine, Amalar, and Metakelfin, were the most common offending agents, accounting for 38% of FDEs, followed by trimethoprim + sulfamethoxazole (co-trimoxazole) (28%), dipyrones (10%), Butazolidin (6%), thiacetazone (6%), metronidazole (4%), paracetamol (3%), and naproxen (3%). Lesions induced by the combination of sulfadoxine and pyrimethamine (in antimalarials) mainly involved the face and lips. In most cases, patients took these sulfa-containing antimalarials in combination with numerous other drugs, particularly analgesics. Unlike chloroquine-induced pruritus, which affects most Africans, the association between antimalarials and FDE has not been well documented in our region. Co-trimoxazole was associated more often than antimalarials with FDEs involving the mucocutaneous junctions of the genitalia and lips. Males with genital lesions on the glans penis represented 11 (48%) of those with co-trimoxazole hypersensitivity. The trunk and limbs were affected mainly by pyrazoles and Butazolidin, respectively; however, solitary lesions on the trunk were usually due to co-trimoxazole, whereas solitary lesions on the limbs were associated with Butazolidin.

Hair loss: is there a relationship with hair care practices in Nigeria?

BACKGROUND Hair loss occurs in all ethnic populations, but the etiology varies considerably from group to group. In black women, many forms of alopecia are associated with hair care practices. However, the causes of alopecias in African women have not been extensively investigated. OBJECTIVE This descriptive, cross-sectional, hospital-based study was undertaken to document common complaints on initial presentation for hair loss, hair care practices and patterns of hair loss, and to determine if there is a relationship between hair loss and hair care practices. METHODS A total of 39 female patients seen over a 12 month period were enrolled in the study. Demographic information recorded included age, sex, marital status and occupation. Information regarding medical history included initial presenting complaints, duration of hair loss, site of hair loss, whether there was skin or systemic involvement, hair care practices and the duration of these practices. Examination of the scalp, a hair-pull test, documentation of the pattern of hair loss, relevant laboratory tests and biopsies were carried out. RESULTS All 39 patients were adults. Major complaints at initial presentation, apart from hair loss, included itchy scalp in 17 patients (43.6%), painful scalp in 11 patients (28.2%), hair breakage in seven patients (17.9%) and flaking scalp in four patients (10.3%). All the women relaxed their hair at some point in time. Chemical relaxants were consistently used by 22 patients (53.7%), eight patients (20.5%) alternated these with plaits/braids, and nine patients (23.1%) wore extensions. The use of local concoctions in hair care management was reported by three patients (7.7%). Scarred alopecias were observed in 20 patients (51.3%), while 19 (48.7%) had non-scarred alopecias. Those who reported prolonged and frequent use of chemical relaxants [mean duration (+/- standard deviation) 23.2+/-9.3 years] exhibited scarred alopecia more commonly than those who did not often use chemical relaxants (P<0.001). The application of local concoctions or pomades was also a regular practice amongst females with scarred alopecias. CONCLUSIONS Itchiness, pain, ready hair breakage and flaking scalp were common complaints at initial presentation. A range of alopecias were documented, and it was also observed that duration of hair care practice and hair styling were relevant to hair loss, particularly for women with central centifugal cicatricial alopecias (CCCAs), which resulted in scarring.

Current epidemiology of atopic dermatitis in south-eastern Nigeria.

BACKGROUND: Atopic dermatitis (AD) is a common pruritic, eczematous skin disorder that runs a chronic and relapsing course. In Nigeria, it is currently on the increase, particularly amongst infants, and has created cost burdens for families. It occurs in association with a personal or family history of asthma, allergic rhinitis and conjunctivitis. Major and minor criteria exist as guidelines for arriving at a diagnosis of AD, and surveys from Western countries have shown that these features, in particular the minor features, vary with ethnicity and genetic background and can be used to aid diagnosis. African dermatologists have also voiced concern that the much used Hanifin criteria for diagnosis of AD may need some adaptation for use in Africa. OBJECTIVE: To document the features and disease outcomes of AD seen amongst dermatology hospital patients in Enugu, south-eastern Nigeria, with a view to reflecting current features amongst Nigerian Blacks. METHODS: A prospective study of AD patients seen over a 2-year period at a tertiary referral dermatology clinic (University of Nigeria Teaching Hospital, Enugu, Nigeria) was carried out. A total of 1019 patients aged between 4 weeks and 57 years were included in the study. RESULTS: The prevalence of AD was 8.5%, which is much higher than the prevalence of AD reported in various parts of Nigeria 15 years ago. AD occurred before the age of 10 years in 523 (51.3%) patients, whilst 250 (24.5%) had onset after 21 years. The earliest age of onset in infants was in the first 6 weeks of life, and this was found in 129 patients (12.7%). Education and occupation of household heads were the most significant (P < 0.001) factors associated with seeking proper health care for the child's AD. Four hundred and forty-one (43.3%) patients presented with subacute atopic eczema and 326 (32%) patients with severe impeteginized eczema. Four hundred and twenty-five patients (41.7%) had at least one first-degree family member with AD (16.7%), allergic rhinitis (10.3%), asthma (14.6%) and allergic conjunctivitis (2.1%), while 55 (13.3%) of controls had a positive family history (P < 0.01) of allergy. A personal history of AD only, without concomitant respiratory allergies, was seen in 486 (47.7%) patients. The face was affected in 431 (42.3%) patients. Inverse distribution of a flexural rash was observed over the extensor aspect of the joints: the elbow in 502 patients (49.3%), the wrist joint in 183 patients (17.9%) and the knee joints in 354 patients (34.7). The commonly observed minor features included xerosis in 719 patients (71%), papular lichenoid lesions in 547 patients (54.1%), infraorbital folds in 498 patients (49.2%), palmar hyper linearity in 524 patients (51.8%) and raised peripheral blood eosinophils in 519 patients (51%), particularly for those with severe AD. Fissured heels, forehead lichenification, orbital darkening, nail pitting, sand paper-like skin lesions on the elbows/knees/lateral malleolli, knuckle dermatitis of the hands, palmar erythema and pitted keratolysis occurred more uncommonly as minor features. Infective complications were very common and included bacterial infections (folliculitis, impetiginized dermatitis and pyodermas) in 425 (41.7%) patients, fungal infections in 377 (37%) patients, parasitic infections (scabies) in 90 (8.8%) patients and viral infection (herpes simplex and molluscum contagiosum) in 29 (2.9%) patients. Thirteen of these atopics were also HIV positive. Aggravating factors most commonly reported included heat intolerance, excessive sweating, humidity, grass intolerance, thick woollen clothing and drug reactions. Only three patients had food intolerance. Three hundred and ten patients (30.4%) recalled their AD being worse in the hot humid periods and 383 (37.6%) could not recall any periods of relief or remission. CONCLUSIONS: The prevalence of AD amongst south-eastern Nigerian Blacks is on the increase, as in other areas, although it is still lower here than in other parts of the world. Many conventional minor features were found, but some occurred less frequently than in other countries, which may be attributed to ethnicity. Further studies will be required to confirm the ethnic differences in these features of AD amongst Nigerians and other Africans, to clarify the features of AD that are peculiar to Africans.

Epidemic (human immunodeficiency virus-related) Kaposi's sarcoma in West African women.

BACKGROUND: Most patients infected with human immunodeficiency virus (HIV) experience skin disease at some stage of their illness, either as a presenting feature or as a later manifestation. Different dermatoses may coexist during the course of the infection, and the unusual nature of the skin lesions can make an accurate diagnosis difficult. Kaposi's sarcoma is one of the acquired immunodeficiency syndrome (AIDS)-defining skin diseases and may coexist with other lesions in AIDS patients. Kaposi's sarcoma is caused by human herpesvirus 8 (HHV8), which is mainly transmitted through male homosexual behavior, and is less common in women than in men. METHODS: The clinical, histopathologic, and therapeutic aspects of AIDS-related Kaposi's sarcoma in three women (age, 18-34 years) who presented to the dermatology clinic of the University of Nigeria Teaching Hospital, Enugu, Nigeria, were studied over 18 months, beginning in August and September 1998. RESULTS: At presentation, the condition of the three patients was generally poor, with severe anemia and extensive dark-brown papules, plaques, and nodules. Mucosal involvement was extensive. Generalized lymphadenopathy was found in two patients, one of whom had extensive coexisting dermatophytosis. All three women were in stage III/IV of the disease at the time of initial presentation. Death occurred within days in one and within 7-8 months in two. CONCLUSIONS: Because these female patients with epidemic Kaposi's sarcoma lived in an almost entirely heterosexual population, the mode of contamination with HHV8 was obscure. The course of the disease was pervasive, aggressive, and devastating.