Moisturizer therapy in prevention of atopic dermatitis and food allergy: To use or disuse?

OBJECTIVE: To critically appraise the evidence for the role of regular moisturizer application in early life to prevent atopic dermatitis (AD) and food allergy (FA). DATA SOURCES: Primary peer-reviewed literature. STUDY SELECTIONS: Original research articles based on systematic reviews, interventional studies, retrospective studies, case-control studies, and cohort studies related to the subject matter. RESULTS: There is good evidence to show that epicutaneous sensitization through a defective skin barrier is important in the development of AD and FA. This supports moisturizer use in prevention because some of them have been proven to restore skin barrier with clear benefits in AD, whereas there is some limited evidence that these products may reduce allergic sensitization. However, moisturizers have varied effects depending on ingredients and formulation, some of which are paradoxical, such as increasing transepidermal water loss and enhancing penetration of substances in the skin. These effects may be responsible for some of the conflicting outcomes of prevention studies, some of which suggest that moisturizers are not useful in prevention of AD and FA, whereas others show a positive trend. Interestingly, there is some suggestion that moisturizers may increase the risk for allergy development perhaps through these paradoxical effects. CONCLUSION: Although moisturizer use is beneficial in the management of AD, current evidence suggests that it may be ineffective in prevention of AD and FA. Further studies are needed to determine the effects of moisturization on allergic sensitization and inflammation and to investigate whether moisturizer type, frequency, duration, and age of application substantially affect the prevention and development of these allergies.

Chest imaging findings in COVID-19 patients: a case series from Nigeria.

COVID-19 is a global pandemic ravaging the whole world with large numbers of reported cases globally. It is a highly-contagious novel infectious disease that causes inflammation in the respiratory system. Chest imaging is a useful adjunct for diagnosis, documenting the extent of disease as well as observation of changes and is thus, strongly recommended in suspected COVID-19 cases, for initial evaluation, differential diagnoses and follow-up. Description of typical imaging findings abound worldwide with a dearth of similar publications in sub-Saharan Africa. This series documents the chest imaging findings from a single facility of four cases between the ages of 38 and 60 who all tested positive for COVID-19 with real-time, reverse transcriptase polymerase chain reaction of the nasopharyngeal swabs.

Cutaneous disorders of adolescence among Nigerian secondary school students.

INTRODUCTION: A community-based, age-specific survey of skin disorders is usually necessary to characterize the true burden of skin disease among a given population and help to tailor health care personnel training and delivery towards the prevalent disorders in resource poor settings. METHODS: This was a descriptive cross-sectional study among adolescents attending secondary schools in Ilorin, Kwara State, Nigeria. A thousand and three hundred students were recruited from public and private secondary schools through a multi-staged stratified random sampling method. Information was obtained via a semi-structured questionnaire and all students underwent a physical examination. Data was analysed using SPSS version 20. Information generated was presented with tables and figures. RESULTS: The prevalence of skin disease in the study was 66.5%. More females, mid-adolescents, students in senior class and those attending public schools had skin disorders. The most prevalent skin disease were: acne vulgaris, pityriasis versicolor, tinea capitis, pityriasis capitis and traction alopecia. CONCLUSION: Skin conditions are highly prevalent among the adolescent population. Infective and inflammatory skin conditions appear to be more prevalent than other classes. Most times, only a few skin disorders account for the bulk of dermatoses affecting this age group. Adolescent skin healthcare should be subsidized because of the high prevalence of skin disorders in this age group.

Mucocutaneous Disorders of Pediatric HIV in South West Nigeria: Surrogates for Immunologic and Virologic Indices.

OBJECTIVES: Nigeria has the world's highest burden of pediatric HIV. In the face of paucity of monitoring tests in Nigeria, we studied the spectrum of pediatric mucocutaneous manifestations and evaluated their clinical utility as surrogate markers for immunodeficiency and plasma viral load levels. METHODS: Cross-sectional study comparing mucocutaneous manifestations in 155 HIV-positive children aged 12 weeks to 14 years with 155 HIV-negative children. Relationships between mucocutaneous manifestations in HIV-infected patients and their immunologic and virologic indices were analyzed. RESULTS: Mucocutaneous lesions were seen in 53.5% of HIV-infected children compared with 18.1% of the controls. Prevalence of lesions increased with worsening levels of immunodeficiency and increasing viral loads (P < .01). Oral candidiasis, angular stomatitis, and fluffy hair were associated with more severe degrees of immunodeficiency. CONCLUSION: Mucocutaneous disorders are common in HIV-infected children. Oral candidiasis and nutritional dermatoses can be used as surrogates for advanced or severe immunodeficiency.

The Prevalence of Paediatric Skin Conditions at a Dermatology Clinic in KwaZulu-Natal Province over a 3-Month Period

Background. Skin conditions are common in children; and studying their spectrum in a tertiary dermatology clinic will assist in quantifying skin diseases associated with greatest burden. Objective. To investigate the spectrum and characteristics of paediatric skin disorders referred to a tertiary dermatology clinic in Durban; KwaZulu-Natal (KZN) Province; South Africa. Methods. A cross-sectional study of children attending the dermatology clinic at King Edward VIII Hospital; KZN; was carried out over 3 months. Relevant demographic information and clinical history pertaining to the skin conditions were recorded and diagnoses were made by specialist dermatologists. Data were analysed with EPI Info 2007 (USA).Results. There were 419 children included in the study; 222 (53%) were males and 197 (47%) were females. A total of 64 diagnosed skin conditions were classified into 16 categories. The most prevalent conditions by category were dermatitis (67.8%); infections (16.7%) and pigmentary disorders (5.5%). For the specific skin diseases; 60.1% were atopic dermatitis (AD); 7.2% were viral warts; 6% seborrhoeic dermatitis and 4.1% vitiligo. Dermatitis was significantly more common in males (p0.05). AD was the most common condition below 12 years of age; while the presence of viral warts was the most prevalent disorder among HIV-infected children. Approximately one-third (37.5%) of the disorders referred by other medical practitioners were misdiagnosed. Conclusions. AD constituted the highest burden both numerically and economically. Viral infections were a major contribution from HIV infection. The diverse spectrum and characteristics of skin diseases referred will assist in modifying the dermatology educational curriculum and bridge knowledge gaps among healthcare providers treating children

Ackee Fruit Poisoning in Eight Siblings: Implications for Public Health Awareness.

Ackee apple fruit is a native fruit to Jamaica and some parts of west Africa. Its toxicity known as "Jamaican vomiting sickness" dates back to the nineteenth century. However, there is a dearth of reported published data on toxicity from Nigeria where it is popularly known in the southwest as "ishin." We report a case series of eight previously well Nigerian siblings who presented at various intervals after ingestion of roasted seeds and aril of the ackee fruit.

Blindness and scalp haematoma in a child following a snakebite.

BACKGROUND: Snake envenomation is a major public health problem of the Savannah regions of West Africa. Ocular manifestations of snakebites are rare with few reports documenting blindness as a complication. OBJECTIVE: To highlight an unusual manifestation of snake bites and its attendant problems. METHODS: A report of scalp haematoma and blindness in a 10 year old child presenting 2 weeks after a snake bite (presumably carpet viper) is a rare manifestation. Local swelling, epistaxis, bilateral proptosis, exposure keratopathy and use of traditional eye medications were associated findings. Anti-venom though administered late saved the child's life but blindness could not be reversed. RESULTS: Ocular ultrasonography revealed layered retrobulbar collection in the left eye, presumably due to hemorrhage. The skull x-ray showed a soft tissue swelling and aspirate from scalp swelling was bloody. Cranial Computed Tomography (CT) scan done late detected no abnormalities. CONCLUSION: Snakebite is associated with lifelong morbidity. Ocular manifestations must be treated as emergency. This case highlights the effect of ignorance and poverty in a setting of a common medical emergency leading to blindness and reduced quality of life.

Giant melanocytic nevus with malignant melanoma: a rare disorder in a black African child.

INTRODUCTION: Giant congenital melanocytic nevus (GCMN) is rare in babies of African descent. Unfortunately, it has an increased potential for malignant transformation. REPORT: A 3-year-old female child presented with a 6-month history of multiple nodules on an existing giant congenital melanocytic nevus and swelling in the right axilla of four weeks duration. Skin biopsy of the nodular skin lesions was in keeping with a metastatic malignant melanoma (Clark stage 4). She completed a full course of chemotherapy but subsequently died four months after presentation. CONCLUSION: Patients with large GCMN should be counseled and followed up appropriately to improve and prolong life.