Mycobacterium ulcerans (Buruli) skin ulceration in Nigeria.

Twenty-two of 24 cases of Mycobacterium ulcerans infection in Ibadan are reviewed. The patients included Africans, Caucasians, and Indians. There were no differences between races in the manifestations of the disease. The average age of the patients was higher than that in other reports in the literature. The fact that most cases were originally wrongly diagnosed reemphasizes the need to search for M. ulcerans in cases of "tropical" ulcer that fail to respond to adequate therapy. Early recognition and surgery are the mainstay of treatment. Comexazole seems more effective than clofazimine in the treatment of these ulcers.

Sarcoidosis in Africans: 12 cases with histological confirmation from Nigeria.

During a 2 year-period 12 Nigerians with sarcoidosis were diagnosed at the chest and dermatology clinics of the University College Hospital, Ibadan, Nigeria. Intrathoracic involvement was the commonest presentation followed by the skin, lymph nodes and liver. Histological diagnosis was obtained in all cases either from skin biopsy, transbronchial lung biopsy, lymph node or liver biopsy where applicable. This study suggests that sarcoidosis is not as rare as previous literature on the subject portrays.

Coexisting malignant melanoma and vitiligo in a Nigerian.

A case of malignant melanoma associated with vitiligo in a middle aged Nigerian is presented. The Association has been well documented in some other parts of the world, but this is the first of its type in the West African subregion. The occurrence of vitiligo in melanoma patients is generally believed to be beneficial, and has been well recognised to presage long time survival for the patient. The course of events in our patient is still being observed.

Lichen planus in tropical Africa.

The pattern of Lichen Planus seen among 95 Nigerians seen over a 3 year period is described. They constituted 5% of all skin cases, with females slightly more affected than males. A younger age group is predominantly affected. In most patients (68%), the lesions are widespread all over the body. Large papules, scaly patches and hypertrophic verrucous lesions in the legs are frequent findings. Patients having lesions in the mouth are few. Seasonal variations of the disease do occur, the peak being during the rainy season, April-September (65%). Pruritus is a constant feature. Lesions do heal with marked residual hyperpigmentation. There is no report so far of the "subtropical" (actinic) Lichen Planus in West Africa. It is suggested that drugs, weather and the hard native sponge may play a role in the causation of the disease in tropical Africa.

Cutaneous sarcoidosis and tribal scarifications in West Africa.

Sarcoidosis is quite common in American and West Indian blacks. In America, the incidence in blacks could be up to 10 times higher than in whites. Sarcoidosis is generally believed to be rarer in African blacks and especially along the West African coast from which the American blacks trace their ancestry. The difference in incidence may be due to environmental influences, poor reporting system from inadequate local awareness of the presentation, confusion with tuberculosis, and lack of the Kveim antigen. Diagnosis of sarcoidosis is most commonly made from the pulmonary and skin manifestations. Since the skin manifestation presents readily for observation without the need for costly devices like x-ray machines, the present study focused on and analyzed the seven cases seen in the skin clinic within a period of 2 years (an incidence of 0.85%), showing that the commonest presentation was as scar-sarcoid on longstanding tribal marks. Tribal scarification is common in West Africa, and one should investigate any change in a longstanding scar. This heightened awareness in areas where scarification is or was practiced could end the belief of the rarity of sarcoidosis in the West African subregion.

Burli (mycobacterial) ulcers in Caucasians in Nigeria.

Seven Caucasians with Buruli ulcers have been treated. The disease did not behave differently in them from its behaviour in Africans nor has liability to infection any racial basis. Surgical removal with or without skin grafting is the treatment of choice.

Stevens-Johnson syndrome following anticonvulsant therapy in penetrating head injury.

Five cases of Stevens-Johnson syndrome are described in patients with penetrating head wounds who were treated with Penicillin, streptomycin, sulphadiazine and the anticonvulsant drugs, epanutin and phenobarbitone. One patient who continued to have only his anticonvulsants after the appearance of his skin eruption, died. In two other cases, epanutin and phenobarbiton each was responsible for the Stevens-Johnson syndrome.