Management Outcomes of Hand Dermatitis in a Tertiary Hospital in Southwest Nigeria.

BACKGROUND: Hand dermatitis (HD) is inflammation of the skin of the hands. It ranges in severity and has a significant impact on quality of life (QoL). The physical and psychosocial burden of the disease is comparable with psoriasis in impairment of the QoL of the patient and depression. Quality of life correlates with disease severity. AIM: To evaluate the management outcome of HD with a disease severity tool by the physician and quality of life index. MATERIALS AND METHODS: This was a cross-sectional study of a cohort of patients with HD over 24 weeks in the dermatology clinic of a tertiary hospital in Nigeria. Disease severity and quality of life were measured using the physician global assessment (PGA) and dermatology life quality index (DLQI), respectively. These were re-administered 6 weeks after treatment. Results were collated and analyzed. RESULTS: One hundred and seventy-seven (13.3%) of 1,329 patients had HD with F/M ratio of 1.2: 1; a mean age of 34.6 ± 7.4 years. Comparing PGA scores at baseline and 6 weeks, a statistically significant improvement was noted P < 0.001. The mean DLQI score at baseline was 10.38 and reduced to 3.02 post-treatment. The difference between the two means of the DLQI was ≥5 from baseline signifying improved quality of life. The domain of symptoms and feelings was the most affected at baseline and most improved afterward. CONCLUSION: HD has a significant impact on its sufferers and this correlates with disease severity. Appropriate management improves disease outcome and patients' quality of life.

Fungal Nail Infections amongst Cassava Farmers and Processors in Southwest Nigeria.

INTRODUCTION: Onychomycosis has been documented as an occupational dermatosis and dermatophyte infection of the nail is the most common infection amongst farmers. This study aims to determine the prevalence of fungal nail infections amongst cassava farmers and processors and identify causative organisms. METHODS: Consenting individuals engaged in the processing of raw cassava into 'garri' meal in Odogbolu local government area of Ogun State were included. Questionnaires contained demographic details, clinical descriptions, classification, and the presence of fungal infections in other parts of the body. Nail clippings were collected for direct microscopy using 40% Potassium hydroxide solution to break down nail keratin. Specimens were inoculated onto Sabouraud's dextrose agar with chloramphenicol and gentamicin incorporated, and incubated at 26°C and 35°C. RESULTS: Clinical features of onychomycosis were found in 119 (68.4%) participants. Distal subungual onychomycosis (68-57.1%) was the most common clinical type, followed by total dystrophic onychomycosis (49-41.2%), candida onychomycosis (34-28.6%), proximal subungual onychomycosis (14-11.8%) and superficial white onychomycosis (9-7.6%). One hundred and one (84.9%) respondents with clinically described onychomycosis had positive results in mycology studies. The non-dermatophyte molds (Aspergillus and Penicillium spp.) were found in 130 samples (78.8%); dermatophytes in 31 (18.8%) and yeast in 7 (4.2%). CONCLUSION: Non-dermatophyte molds, traditionally thought to be contaminants of nail cultures, were the main causative agents of primary fungal nail infections. Garri processors will benefit from public health intervention geared towards automation of some of these processes to minimize contact with soil and water, and health education on the use of protective materials.

INTRODUCTION: L'onychomycose a été documentée comme une dermatose professionnelle, et l'infection dermatophyte de l'ongle était l'infection la plus courante chez les agriculteurs. Cette étude vise à déterminer la prévalence des infections fongiques des ongles chez les cultivateurs et les transformateurs de manioc et à identifier les organismes responsables. MÉTHODES: Des individus consentants engagés dans la transformation du manioc brut en farine de 'garri' dans la zone de gouvernement local d'Odogbolu de l'Etat d'Ogun ont été inclus. Les questionnaires contenaient des détails démographiques, des descriptions cliniques, une classification et la présence d'infections fongiques dans d'autres parties du corps. Des coupures d'ongles ont été prélevées pour une microscopie directe en utilisant une solution d'hydroxyde de potassium à 40% pour décomposer la kératine de l'ongle. Les spécimens ont été inoculés sur de la gélose dextrose de Sabouraud avec du chloramphénicol et de la gentamicine incorporés, et incubés à 26°C et 35°C. RÉSULTATS: Des caractéristiques cliniques d'onychomycose ont été trouvées chez 119 (68,4%) participants. L'onychomycose sousunguéale distale (68­57,1 %) était le type clinique le plus fréquent, suivie par l'onychomycose dystrophique totale (49 à 41,2 %), l'onychomycose à candida (34 à 28,6 %), l'onychomycose sousunguéale proximale (14 à 11,8 %) et l'onychomycose blanche superficielle (9 à 7,6 %). Cent un (84,9 %) répondants présentant une onychomycose décrite cliniquement ont eu des résultats positifs dans les études mycologiques. Les moisissures non dermatophytes (Aspergillus et Penicillium spp.) ont été trouvées dans 130 échantillons (78,8%) ; les dermatophytes dans 31 (18,8%) et les levures dans 7 (4,2%). CONCLUSION: Les moisissures non dermatophytes, traditionnellement considérées comme des contaminants des cultures d'ongles, étaient les principaux agents causaux des infections fongiques primaires des ongles. Les transformateurs de garri bénéficieront d'une intervention de santé publique axée sur l'automatisation de certains de ces processus afin de minimiser le contact avec le sol et l'eau, et d'une éducation sanitaire sur l'utilisation de matériaux de protection. Mots clés: Onychomycose, 'garri', transformateurs de manioc, moisissures non dermatophytes, dermatophytes, levures.

Cross-Sectional Study of Trichoscopy Features, Prevalence, Types of Hair Loss and Hair Care Practices at a Lagos Urban Market.

BACKGROUND: Hair loss studies have mostly been clinical with no trichoscopy features of the hair loss documented in Nigeria. OBJECTIVE: The objective of this study was to determine the community prevalence, types of hair loss, trichoschopy features and the risk factors for the observed hair loss types. METHODS: This was a cross-sectional descriptive study of traders (Fitz Patrick's skin types V-VI) at an urban market. The traders were clinically evaluated for hair loss. Sociodemographic, clinical and trichoscopy data were recorded using a study questionnaire. Data was analyzed using SPSS version 22.0. Statistics such as means, medians, frequencies, t-test and chi-square test were presented. Levels of significance of all tests was set at, P<0.05%. RESULTS: A total of 307 participants (32.6% male and 67.4% female) with a mean age of 42.7±12.8 years were studied. The prevalence of hair loss was 68.7% (51% in males and 77.3% in females) and the mean age of those with hair loss was 44.8±12.3 years. The pattern of hair loss was patterned, diffuse and localized in 94.3%, 3.8% and 1.9% respectively. The main types of hair loss were androgenetic alopecia (26.9%) and traction alopecia (71.7%). The prevalent hair practices were; braids and weave-on (extensions) in 78.2%, turban-like head gear in 76.9%, and chemical relaxers in 73.8%. Trichoscopy features characteristic of the observed hair loss types were documented. CONCLUSION: Hair loss is common in the community. The common hair care practices and increasing age could be contributors to hair loss.

CONTEXTE: Les études sur la perte de cheveux ont surtout été cliniques et aucune caractéristique trichoscopique de la perte de cheveux n'a été documentée au Nigeria. OBJECTIF: L'objectif de cette étude était de déterminer la prévalence communautaire, les types de perte de cheveux, les caractéristiques de la trichoscopie et les facteurs de risque pour les types de perte de cheveux observés. MÉTHODES: Il s'agissait d'une étude descriptive transversale de commerçants (types de peau V-VI de Fitz Patrick) sur un marché urbain. Les commerçants ont été évalués cliniquement pour la perte de cheveux. Les données sociodémographiques, cliniques et trichoscopiques ont été enregistrées à l'aide d'un questionnaire d'étude. Les données ont été analysées à l'aide de SPSS version 22.0. Des statistiques telles que les moyennes, les médianes, les fréquences, le test t et le test du chi-deux ont été présentées. Le niveau de signification de tous les tests a été fixé à P<0,05%. RÉSULTATS: Un total de 307 participants (32,6% d'hommes et 67,4% de femmes) avec un âge moyen de 42,7±12,8 ans ont été étudiés. La prévalence de la perte de cheveux était de 68,7 % (51 % chez les hommes et 77,3 % chez les femmes) et l'âge moyen des personnes présentant une perte de cheveux était de 44,8±12,3 ans. La perte de cheveux était structurée, diffuse et localisée dans 94,3 %, 3,8 % et 1,9 % des cas respectivement. Les principaux types de perte de cheveux étaient l'alopécie androgénétique (26,9 %) et l'alopécie de traction (71,7 %). Les pratiques capillaires prédominantes étaient les suivantes : tresses et tissage (extensions) dans 78,2 % des cas, coiffure en turban dans 76,9 % des cas et défrisage chimique dans 73,8 % des cas. Les traits trichoscopiques caractéristiques des types de perte de cheveux observés ont été documentés. CONCLUSION: La perte de cheveux est fréquente dans la communauté. Les pratiques courantes de soins capillaires et l'âge croissant pourraient contribuer à cette perte de cheveux. Mots clés: Trichoscopie, Perte de cheveux, Pratique des soins capillaires, Communauté, Africaine, Prévalence.

Occupational Hand Dermatitis amongst Cassava Processors in Rural Communities in Southwest Nigeria.

BACKGROUND: Hand dermatitis (HD) is an inflammatory disorder of the hand. Agricultural industries (farming) have been reported as one of the leading occupation predisposing workers to health risks. Practices such as dumping cassava peels in farm environment, removal of heaps of peels, soaking of cassava and clearing of ditches have been identified as potentially harmful. These processes, which are wet works, are often done with bare hands predisposing cassava processors to HD. AIMS: This study aimed to determine the prevalence, predisposing factors and characteristics of HD amongst cassava processors in some rural communities in Southwest Nigeria. METHODOLOGY: This was a cross-sectional prospective study involving females engaged in farming and processing of raw cassava into 'garri' meal using the traditional methods. Four hundred and twenty-six female cassava processors were included. The questionnaire used was an adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) which is used to document work related skin diseases of the hand and forehand, and exposures to environmental factor. RESULTS: The mean age was 38.7 years and age range 13 - 70 years. Fifty-seven (13.4%) participants presented with HD within 12 months. Itching was the most common symptoms reported by 44 (10.3%) participants followed by pain 26 (6.1%) and small bumps 23 (4.9%) . The palmar surface of the right hand was most affected. None of the participants who use gloves regularly reported any symptoms of HD. CONCLUSION: Cassava processors have been shown to be at potential risk of occupational HD; hence, health education and use of protective materials are important measures for prevention.

CONTEXTE: La dermatite des mains (DH) est un trouble inflammatoire de la main. Les industries agricoles (agriculture) ont été signalées comme l'une des principales professions prédisposant les travailleurs à des risques pour la santé. Des pratiques telles que le déversement des épluchures de manioc dans l'environnement agricole, l'enlèvement des tas d'épluchures, le trempage du manioc et le curage des fossés ont été identifiées comme potentiellement dangereuses. Ces processus, qui sont des travaux humides, sont souvent effectués à mains nues, ce qui prédispose les transformateurs de manioc aux HD. OBJECTIFS: Cette étude visait à déterminer la prévalence, les facteurs de prédisposition et les caractéristiques de la DH chez les transformateurs de manioc dans certaines communautés rurales du sud-ouest du Nigeria. MÉTHODOLOGIE: Il s'agissait d'une étude transversale prospective impliquant des femmes engagées dans l'agriculture et la transformation du manioc brut en farine 'garri' en utilisant les méthodes traditionnelles. Le questionnaire utilisé était une adaptation du Nordic Occupational Skin Questionnaire (NOSQ-2002). RÉSULTATS: Quatre cent vingt-six femmes transformatrices de manioc ont été incluses. L'âge moyen était de 38,7 ans et la fourchette d'âge de 13 à 70 ans. Cinquante-sept (13,4 %) participantes ont présenté une DH dans les 12 mois. Les démangeaisons étaient les symptômes les plus courants rapportés par 44 participants, suivis par la douleur (26) et les petites bosses (23). La surface palmaire de la main droite était la plus touchée. Aucun des participants qui utilisent régulièrement des gants n'a signalé de symptômes de MH. CONCLUSION: Il a été démontré que les transformateurs de manioc sont exposés à un risque potentiel de MH professionnelle ; par conséquent, l'éducation sanitaire et l'utilisation de matériaux de protection sont des mesures importantes pour la prévention. Mots clés: Dermatite des mains, Manioc (garri), Agriculture, Profession, Transformateurs de manioc, Épluchures de manioc, Mains nues, Nordic Occupational Skin Questionnaire (NOSQ­2002).

Marginal Traction Alopecia: Hair Care Practices, Severity Score and Trichoscopic Features in Lagos, Nigeria.

BACKGROUND: Marginal traction alopecia (MTA) is commonly observed in adult females. Studies of prevalence, severity, trichoscopy and severity scoring are few. OBJECTIVE: The aim of this study was to determine the community prevalence, pattern, severity score and trichoscopy features of MTA amongst adult Nigerian females. Patient and method: This was a cross-sectional descriptive study of a cohort of 207 adult females in a community in Lagos, Nigeria. The participants were clinically evaluated for MTA. Sociodemographic, clinical and trichoscopy data was documented. Severity score was documented using the MTA severity score. Data was analyzed using SPSS version 22. RESULTS: The mean age of participants was 43±12.8 years and the prevalence of MTA was 76.3%. Marginal traction alopecia was frontoccipital in 65.2%. The MTA score was 1-3 in 22.2%, 4-6 in 29.7% and ≥6 in 48.1%. Fringe sign was observed in 30.4%, folliculitis in 9.5% and 13.9% had tight weaves. Trichoscopic features included preserved honeycomb pigment, preserved white dot architecture, varying hair length and single hairs from hair follicles. CONCLUSION: Marginal traction alopecia is common in Nigerian women. It is mostly severe, severity is not significantly associated with haircare practices and it is represented by common trichoscopy features. Appropriate awareness and education of females on hair styles can mitigate this hair loss.

CONTEXTE: L'alopécie de traction marginale (ATM) est couramment observée chez les femmes adultes. Les études de la prévalence, de la gravité, de la trichoscopie et de la notation de la gravité sont peu nombreuses. OBJECTIF: L'objectif de cette étude était de déterminer la prévalence, le modèle, le score de gravité et le score de gravité de la communautaire, le modèle, le score de gravité et les caractéristiques trichoscopiques de l'ATM chez les femmes adultes nigérianes. PATIENTE ET MÉTHODE: Il s'agissait d'une étude descriptive transversale d'une cohorte de 207 femmes adultes dans une communauté de Lagos, au Nigeria. Les participantes ont été évaluées cliniquement pour l'HTA. Les données socio-démographiques, cliniques et trichoscopiques ont été documentées. Le score de sévérité a été documenté en utilisant le score de gravité de l'ATM. Les données ont été analysées en utilisant. RÉSULTATS: L'âge moyen des participants était de 43±12,8 ans et la prévalence de l'ATM était de 76,3 % prévalence de l'AEM était de 76,3%. L'alopécie marginale de traction était frontoccipital dans 65,2 % des cas. Le score de l'ATM était de 1-3 dans 22,2%, 4-6 dans 29,7%. et ≥6 dans 48,1 %. Le signe de la frange a été observé dans 30,4%, la folliculite dans 9,5 % et 13,9 % présentaient des tissages serrés. Les caractéristiques trichoscopiques comprenaient pigment en nid d'abeille préservé, architecture de points blancs préservée, une longueur de cheveux variable et des poils isolés des follicules pileux. CONCLUSION: L'alopécie marginale de traction est fréquente chez les femmes nigérianes. Elle est le plus souvent sévère, sa sévérité n'est pas significativement associée aux pratiques de soins capillaires et elle est représentée par des caractéristiques trichoscopiques communes.Une sensibilisation et une éducation appropriées des femmes en matière de coiffure peuvent atténuer cette perte de cheveux. MOTS CLÉS: Alopécie marginale de traction, Pratiques de soins capillaires, Caractéristiques trichoscopiques, Évaluation de la gravité de l'alopécie de traction marginale.

Covid 19: A Prospective Observational Study on the Cutaneous Manifestations of Patients in Lagos, Nigeria.

BACKGROUND: Cutaneous manifestations of COVID-19 have been documented from Europe, USA, and China but none from Africa to date. Skin findings among Africans differ from Caucasians and it is important to report these in Nigerians with COVID-19. METHODS: A prospective observational review involving patients seen at the Emergency triage, and Isolation wards of the Lagos University Teaching Hospital. Demographic and clinical data were captured; skin and appendages were examined by a dermatologist between 0800hrs and 1600hours to minimise visual errors of artificial light masking cutaneous lesions. RESULTS: Of 235 participants, 17 (7.23%) had recent onset skin rash, with 7 (41.2%) experienced itching and 11 confirmed with COVID-19. There was a male: female ratio of 97:43 (2.3:1) among COVID-19 patients. Cutaneous findings were seen in 12 (5.1%) participants, with the face and trunk mostly affected and acne plus papular eruptions predominating. There was no significant relationship between COVID-19 and recent onset skin rash (χ2, p = 0.87). Only 2 of the 17 participants had a previously existing dermatoses ((χ2, p = 0.84). There was no significant relation between use of medications and onset of rashes (χ2, p = 0.72) or between those with co-morbidities and onset of rashes (χ2, p = 0.51). CONCLUSION: Cutaneous manifestations were found among Nigerian patients with SARS-CoV-2 infection. Most presented with pruritus and papular eruptions and no morphologic pattern was demonstrated. Physicians and dermatologists need to be aware and look out for skin changes in SARS-CoV-2 infection as they may be early pointers to COVID-19. Keywords: Cutaneous findings, manifestations, Skin, COVID-19, Nigeria.

CONTEXTE: Des manifestations cutanées du COVID-19 ont été documentées en Europe, aux Etats-Unis et en Chine, mais aucune en Afrique à ce jour. Les manifestations cutanées chez les Africains diffèrent de celles des Caucasiens et il est important de les signaler chez les Nigérians atteints de COVID-19. MÉTHODES: Une étude observationnelle prospective impliquant des patients vus au triage des urgences et dans les services d'isolement de l'hôpital universitaire de Lagos. Les données démographiques et cliniques ont été saisies ; la peau et les appendices ont été examinés par un dermatologue entre 8h00 et 16h00 pour minimiser les erreurs visuelles de la lumière artificielle masquant les lésions cutanées. RÉSULTATS: Sur 235 participants, 17 (7,23 %) ont présenté une éruption cutanée d'apparition récente, dont 7 (41,2 %) ont eu des démangeaisons et 11 ont été confirmées par le COVID-19. Il y avait un rapport hommes/femmes de 97:43 (2,3:1) parmi les patients atteints de COVID-19. Des signes cutanés ont été observés chez 12 (5,1 %) participants, le visage et le tronc étant les plus touchés, avec une prédominance de l'acné et des éruptions papuleuses. Il n'y avait pas de relation significative entre le COVID-19 et les éruptions cutanées d'apparition récente (χ2, p = 0,87). Seulement 2 des 17 participants avaient une dermatose déjà existante ((χ2, p = 0,84). Il n'y avait pas de relation significative entre la prise de médicaments et l'apparition d'éruptions cutanées (χ2, p = 0,72) ou entre les personnes présentant des comorbidités et l'apparition d'éruptions cutanées (χ2, p = 0,51). CONCLUSION: Des manifestations cutanées ont été constatées chez les patients nigérians atteints d'une infection par le SRAS-CoV-2. La plupart d'entre eux présentaient un prurit et des éruptions papuleuses et aucun modèle morphologique n'a été mis en évidence. Les médecins et les dermatologues doivent être attentifs et rechercher les modifications cutanées dans l'infection par le SRAS-CoV-2, car elles peuvent être des signes précurseurs du COVID-19. MOTS CLÉS: Résultats cutanés, manifestations, Peau, COVID-19, Nigéria.

Female Androgenetic Alopecia amongst Market Women in Lagos, Nigeria.

Background: Studies on androgenetic alopecia in Nigerian females are few. The aim of this study was to determine the prevalence of female androgenetic alopecia, its severity and trichoscopic features. Methods: This was a cross-sectional descriptive study of androgenetic alopecia amongst 207 adult female traders at an urban market in Lagos, Nigeria. The study was conducted in February 2020. All recruited female traders were examined. Documentation of clinical findings, sociodemographic data and trichoscopy features was done using a predesigned questionnaire. Severity of female androgenetic alopecia was assessed using the Olsen's scale he IBM statistics software version 22. Results: The prevalence of female androgenetic alopecia (FAGA) was 4.8% (10/207) and median age of the participants was 59 (IQR 45,63) years. The severity of FAGA based on Olsen's scale was grade I, II and III in 30%, 20% and 50% respectively and severity increased with age. Trichoscopy features included prominent white dots (90%), reduced hair density (90%), vellus hairs (70%), preserved honeycomb pigment network (70%) and variable hair diameter (60%). Conclusion: Androgenetic alopecia is uncommon in females. When present, it is noted to be severe. Trichoscopy features among African females in Nigeria are comparable to trichoscopy features in studies from other parts of the world.

Contexte: Les études sur l'alopécie androgénétique chez les femmes nigérianes sont peu nombreuses. Le but de cette étude était de déterminer la prévalence de l'alopécie androgénétique féminine, sa gravité et ses caractéristiques trichoscopiques. Méthodes: Il s'agissait d'une étude descriptive transversale de l'alopécie androgénétique parmi 207 femmes adultes commerçantes sur un marché urbain de Lagos, au Nigeria. L'étude a été menée en février 2020. Toutes les commerçantes recrutées ont été examinées. Les résultats cliniques, les données sociodémographiques et les caractéristiques de la trichoscopie ont été documentés à l'aide d'un questionnaire préétabli. La sévérité de l'alopécie androgénétique féminine a été évaluée à l'aide de l'échelle d'Olsen. Les données ont été analysées à l'aide du logiciel de statistiques IBM version 22. Résultats: La prévalence de l'alopécie androgénétique féminine (AAF) était de 4,8 % (10/207) et l'âge médian des participants était de 59 ans (IQR 45,63). Selon l'échelle d'Olsen, la gravité de l'alopécie androgénique féminine était de grade I, II et III dans 30 %, 20 % et 50 % des cas respectivement, et la gravité augmentait avec l'âge. Les caractéristiques de la trichoscopie comprenaient des points blancs proéminents (90 %), une densité capillaire réduite (90 %), des poils vellus (70 %), un réseau pigmentaire en nid d'abeille préservé (70 %) et un diamètre variable des poils (60 %). Conclusion: L'alopécie androgénétique est peu fréquente chez la femme. Lorsqu'elle est présente, on note qu'elle est sévère. Les caractéristiques de la trichoscopie chez les femmes africaines au Nigeria sont comparables aux caractéristiques de la trichoscopie dans les études d'autres parties du monde. Mots clés: Alopécie androgénétique féminine, Trichoscopie, Prévalence, Gravité, Gradation.

Unravelling the Diagnosis - The Role of Histopathology in Mycosis Fungoides.

Mycosis fungoides is an extra-nodal indolent non-Hodgkin lymphoma of T- cell origin that is characterized by skin involvement. The course of the disease is typically slowly progressive with non-specific clinical and histopathologic features which may evade diagnosis for years. Chemo-therapeutic agents to control the disease are effective if employed early, but the prognosis and therapy is dependent on the stage of the disease at presentation. We report a case of a 25-year old man with a clinical diagnosis of Tinea incognito and histologic features of non-specific dermatitis at first presentation. With poor hospital attendance and inconsistent therapy, his clinical features and histology reports over the next couple of years were consistent with psoriasis, then mycosis fungoides. He is currently stable on chemotherapeutic agents. With different histopathology results over a three- year span, it is possible that the patient had both diseases occurring separately. It is also possible that psoriasis was a harbinger of mycosis fungoides and the change in clinical presentation which necessitated repeated biopsies eventually revealed the picture.

Acne Vulgaris in an Undergraduate Population in Nigeria.

BACKGROUND: Acne vulgaris is a chronic inflammatory disease of the pilo-sebaceous unit. It affects teenagers and young adults. Factors which can provoke or aggravate acne include cosmetic agents, medications, and sunlight. Acne has been associated with intense emotional and psychological distress. AIMS: This study aimed to describe predisposing factors, clinical characteristics and the quality of life of students with acne in an undergraduate community. METHODS: This is a cross sectional descriptive study of students of Babcock University, located in the South-Western Nigeria. Data was collected at the residential halls using structured questionnaire which consists of students' demographic data, symptoms, predisposing factors, previous treatment, Cardiff Acne Disability Index; and examination findings to document the presence of acne and clinical characteristics. RESULTS: Acne vulgaris was documented in 391 students (88.5%). Age range of respondents was between 15 and 35, and mean age was 19.51 + 2.25 years. The mean duration of symptoms was 47.46 + 38.27 months. Factors perceived to precipitate acne include food, stress, cleansers and sugary drinks. The mean CADI score for all respondents was 3.27 +3.07 which represents a mild effect on the quality of life. There was no significant difference in the severity of acne in males and females. CONCLUSION: This study documents a high prevalence of acne, although it has only a mild effect on the quality of life of the students. In view of the high percentage of students with acne, it should be penned down for public health intervention to prevent mismanagement, progression and complications.

International league of associations for rheumatology recommendations for the management of psoriatic arthritis in resource-poor settings.

BACKGROUND: Psoriatic arthritis (PsA) is a challenging heterogeneous disease. The European League Against Rheumatism (EULAR) and the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) last published their respective recommendations for the management of PsA in 2015. However, these guidelines are primarily based on studies conducted in resource replete countries and may not be applicable in countries in the Americas (except Canada and USA) and Africa. We sought to adapt the existing recommendations for these regions under the auspices of the International League of Associations for Rheumatology (ILAR). PROCESS: The ADAPTE Collaboration (2009) process for guideline adaptation was followed to adapt the EULAR and GRAPPA PsA treatment recommendations for the Americas and Africa. The process was conducted in three recommended phases: set-up phase; adaptation phase (defining health questions, assessing source recommendations, drafting report), and finalization phase (external review, aftercare planning, and final production). RESULT: ILAR recommendations have been derived principally by adapting the GRAPPA recommendations, additionally, EULAR recommendations where appropriate and supplemented by expert opinion and literature from these regions. A paucity of data relevant to resource-poor settings was found in PsA management literature. CONCLUSION: The ILAR Treatment Recommendations for PsA intends to serve as reference for the management of PsA in the Americas and Africa. This paper illustrates the experience of an international working group in adapting existing recommendations to a resource-poor setting. It highlights the need to conduct research on the management of PsA in these regions as data are currently lacking.Key Points• The paper presents adapted recommendations for the management of psoriatic arthritis in resource-poor settings.• The ADAPTE process was used to adapt existing GRAPPA and EULAR recommendations by collaboration with practicing clinicians from the Americas and Africa.• The evidence from resource-poor settings to answer clinically relevant questions was scant or non-existent; hence, a research agenda is proposed.

Onychomycosis: updates and management challenges. A review.

Onychomycosis is a fungal infection which affects the nail unit. It was previously thought to be just a cosmetic problem, but presently, it is regarded as a major public health issue because of the impact on the quality of life of the patients.A etiologic factors identified in onychomycosis include increasing age,immunosuppression, occupation and genetics. Management of onychomycosisis both pharmacological and non pharmacological. Pretreatment counseling is important in patients with fungal nail infections and this should include probable length of therapy, possible side effects of treatment and the expenses involved.Patients should be educated on proper nail care and the fact that no treatment isI 00% effective. Presently, combination therapy is advocated for the management of onychomycosis. This is a review of the epidemiology, clinical types,investigations and current considerations in the management of onychomycosis.

Pityriasis amiantacea: a case report.

Pityriasis amiantacea (PA) is a papulosquamous condition of the scalp,characterized by asbestos - like thick scales attached to the hair shaft. It is thought to represent a reaction pattern to inflammatory skin disorders like psoriasis, seborrhoeic dermatitis, tinea capitis, atopic dermatitis and lichen planus, rather than a distinctive disease. The scaling may be localised or generalised, depending on the underlying condition and its duration.This report highlights the clinical features of pityriasis amiantacea secondary to atopic dermatitis and the differential features of other papulo-squamous scalp disorders such as scalp psoriasis, seborrhoeic dermatitis and lichen planus.Scalp psoriasis and seborrhoeic dermatitis are the commonest causes of PA as well as the closest differentials hence should be excluded in all cases. The longterm sequelae of PA include scalp fibrosis and permanent hair loss hence should be identified and treated promptly. The management modalities of PA will also be discussed.

Overview of dermatophyte infections at the dermatology outpatient clinic of a tertiary institution in Nigeria.

BACKGROUND: Dermatophytes are the commonest organisms causing superficial fungal infections. Earlier epidemiologic studies in Nigeria revealed dermatophyte infection as one of the top three reasons for visiting the dermatologists. OBJECTIVE: To determine the frequency, characteristics and predisposing factors to dermatophyte infections at the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) from March 2003 to September 2009. METHODS: The clinic records and case notes of patients were reviewed. Patients' data which includes demographic details, characteristics of disease, predisposing factors and clinical presentation findings were entered on Excel spreadsheets and analyzed using SPSS 15. Results were displayed using frequency tables. RESULTS: Dermatophyte infections were found in 8.39% of patients attending the dermatology outpatient clinic of LUTH. Tinea pedis was the most frequently seen, occurring in 33.6% of patients; followed by tinea corporis (20%), tinea manuum (18.6%) and tinea capitis (14.8%). Dermatophyte infection was most frequently seen in the 3rd and the 4th decades of life, except tinea capitis seen predominantly in the 1st decade of life and tinea intertrigo in the 5th decade. CONCLUSION: Dermatophyte infections occur at all age groups, although frequency of occurrence differs with age group and site of the body affected.

Skin tumors at the Lagos University Teaching Hospital, Nigeria.

INTRODUCTION: Skin tumours can be malignant or benign. Skin cancer is the most common malignancy among Caucasians and noted to be rare in Africans and negroid skin. In view of the rarity of skin cancers in Africans, there is delayed diagnosis; and consequent advanced presentation and poor prognosis. OBJECTIVE: This is to document the frequency of skin tumours (benign and malignant) from a 7-year review (January 2001 to December 2007) of histology reports of all skin samples seen at the pathology department of the Lagos University Teaching Hospital. METHODS AND MATERIALS: Reports of all skin samples seen at the pathology department between January 2001 and December 2008 were reviewed. The frequencies of various skin tumours (both benign and malignant) were determined and the result displayed using frequency tables. RESULTS: Skin tumours represented 19.8% of all reports made on skin during the study period. One hundred and twenty one (68.7%) were benign tumours while 55 (31.2%) were malignant tumours. There is a female preponderance for both malignant and benign tumours. The male to female ratio was 1:1.28 for benign tumours and 1:1.39 for malignant tumors. Squamous cell carcinoma (SCC) was the commonest malignant tumor, followed by malignant melanoma, Kaposi's sarcoma and dermatofibrosarcoma protuberans. Cutaneous papilloma was the commonest benign tumour. CONCLUSION: A wide range of skin tumours, benign and malignant were documented; hence there is need for more vigilance in order to diagnose them early.

The pityriasis rosea calendar: a 7 year review of seasonal variation, age and sex distribution.

BACKGROUND: The most accepted aetiologic factor for Pityriasis Rosea (PR) is viral infection and the evidences for this include the seasonal variation of the disease; intolerance to ampicillin; rarity of second attack; occasional household clustering of cases; and response to acyclovir in the early stage of the eruption. OBJECTIVE: This is a review of the seasonal variation, age and sex distribution of patients who presented with Pityriasis Rosea at the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) between January 2000 and December 2006. METHODS: Data was extracted from the clinic records and patients' records. The diagnosis of PR was made clinically based on the typical history, identification of the herald patch and characteristic 'Christmas tree' distribution of the exanthematic rash. RESULTS: The diagnosis of Pityriasis Rosea was made in 427 patients (3.7%) of the 11,535 patients seen during the study period. The highest number of patients was seen in October (49 patients--11.5%); followed by August (48 patients--11.2%), March (46 patients--10.8%) and September (40 patients--9.4%). The least number of patients with PR were seen in January (21 patients--4.9%) and February (23 patients--5.4%). Pityriasis Rosea was seen predominantly in persons between the ages 10 and 29 (255 patients--59.7%) with a male to female ratio of 1: 1.55. CONCLUSION: Pityriasis Rosea can be described as a disease of the rainy season found predominantly in the teenagers and young adults, with a female predilection.

Characteristics of vitiligo in Lagos, Nigeria.

BACKGROUND: Vitiligo is disfiguring in the darker racial ethnic group as a result of the sharp contrast between the normal skin and the depigmented skin. OBJECTIVE: To describe the epidemiology and clinical profile of vitiligo patients at the dermatology clinic of an urban tertiary hospital of Lagos University Teaching Hospital. METHODS: All consecutive patients with a diagnosis of vitiligo seen at the Dermatology Clinic between October 2003 and October 2006, were included in the study. The diagnosis of vitiligo was made based on the clinical findings of depigmented macules or patches with a sharp margin, normal texture, intact sensations and no scaling. RESULTS: The diagnosis of vitiligo was made in 186 (2.8%) patients, with a slight female preponderance. Vitiligo affected all age groups: the youngest presented at age one and the oldest at eighty six years of age. The face and the limbs were the most affected parts of the body. Fifteen (0.81%) patients presented with features suggestive of associated autoimmune disease like, Type 1 Diabetes. CONCLUSION: The frequency of vitiligo in this study is similar to those obtained in previous studies from different parts of Nigeria. The patients will benefit from other modalities of management apart from the medical management offered hence a designated centre for management of vitiligo will be a respite to them.