RESUMEN
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.
Asunto(s)
Población Negra , Neoplasias Cutáneas/patología , Adolescente , Adulto , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Estudios Retrospectivos , Distribución por Sexo , Neoplasias Cutáneas/epidemiología , Adulto JovenRESUMEN
BACKGROUND: The WHO introduced the syndromic management to help in the control of STIs in resource-poor settings. This needs to be adapted to local settings taking into consideration the prevalence of the various organisms causing STIs. This has given rise to a need to validate the algorithm. The study aimed to correlate the syndromic management treatment algorithm for vaginal discharge with the aetiological diagnosis based on laboratory investigations. Specifically, the sensitivity, specificity and positive predictive values of the syndromic management against a gold standard laboratory diagnosis were evaluated. METHODS: A total of 195 consecutive patients presenting to the study sites with vaginal discharge were enrolled in the study. Information on sociodemographic data was obtained with the aid of questionnaires. Samples were taken and examined for candida, trichomonas, bacterial vaginosis (BV), chlamydia and gonorrheal infections, after speculum and vaginal examinations. RESULTS: The sensitivity and positive predictive values (PPV) of the syndromic management in detecting vaginal infections performed better than corresponding values for cervicitis. The algorithm for cervicitis improved on addition of speculum examination (36% and 32.1% for sensitivity and PPV respectively). CONCLUSION: The study shows that the syndromic diagnosis for vaginal discharge fares better for vaginitis, especially with addition of speculum examination. The application of syndromic diagnosis for cervicitis resulted in omission of patients who had evidence of cervical infections by bacteriologic examination.
Asunto(s)
Algoritmos , Cervicitis Uterina/microbiología , Excreción Vaginal/microbiología , Vaginosis Bacteriana/microbiología , Adolescente , Adulto , Distribución por Edad , Antiinfecciosos/uso terapéutico , Candidiasis Vulvovaginal/diagnóstico , Candidiasis Vulvovaginal/tratamiento farmacológico , Manejo de la Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Nigeria/epidemiología , Nistatina/uso terapéutico , Examen Físico , Prevalencia , Sensibilidad y Especificidad , Factores Socioeconómicos , Resultado del Tratamiento , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/tratamiento farmacológico , Cervicitis Uterina/diagnóstico , Cervicitis Uterina/tratamiento farmacológico , Cervicitis Uterina/epidemiología , Excreción Vaginal/tratamiento farmacológico , Excreción Vaginal/epidemiología , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/tratamiento farmacológico , Vaginosis Bacteriana/epidemiología , Adulto JovenRESUMEN
Background: Cutanenous lesions with high frequency in HIV/AIDS patients such as Kaposi's sarcoma; herpes zoster and generalised pruritic papular eruption have unequivocally proven valuable in Africa and elsewhere as predictive signs for HIV infection. Reports have associated a high prevalence of seborrheic dermatitis in HIV infected persons. Aim: To evaluate the predictive value of seborrheic dermatitis in the diagnosis of HIV/AIDS infection in Lagos University Teaching Hospital (LUTH) skin clinic.Methods: A prospective case-control study was conducted at the skin clinic of the Lagos University Teaching Hospital (LUTH) over a 23-month period (April 2001- February 2003). One hundred and eighteen patients with clinically diagnosed seborrheic dermatitis and one hundred and nine controls were tested for HIV seropositivity. Statistical analysis was performed using EPI info version 6.0. P values 0.05 was considered statistically significant. Results: Eleven patients with seborrheic dermatitis were HIV seropositive with a positive predictive value (PPV) of 9.3. Only one (0.9) of the control group was seropositive. It was also found that patients with seborrheic dermatitis who were seropositive were mainly in the older age group (40-59 years) and had more widespread lesions. Conclusion: Seborrheic dermatitis has significant positive predictive value for HIV/AIDS infection and corroborates existing literature. Routine screening of persons over 40 years of age with seborrheic dermatitis or those with widespread lesions is recommended
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Dermatitis , Infecciones por VIH , Hospitales , EnseñanzaRESUMEN
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.
Asunto(s)
Vitíligo/epidemiología , Vitíligo/patología , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Femenino , Hospitales de Enseñanza , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: In dermatology, it is known that there is a significant co-morbidity between dermatological disorders and psychological complications, and it has been estimated that in at least one-third of patients with skin diseases, their effective management involves consideration of associated emotional factors. In Africa, particularly Nigeria, despite the prevalent dermatological disorders with their possible attendant mental health complications, little or no work has been done in the field of psycho-dermatology, hence the rationale for this study. METHODS: A prospective study was carried out in the dermatology/venerology clinic of Lagos University Teaching Hospital (LUTH). Ethical clearance and consent were obtained to conduct the study. The subjects were selected by simple random sampling from adult patients that have had their dermatological disorders for at least six months before presentation in the clinic. Those with other co-existing chronic medical illness such as hypertension, diabetes, or haemoglobinopathy were excluded from the study. Controls were obtained to match for age and sex from apparently healthy workers in a nearby general hospital. Each subject was evaluated with a questionnaire to obtain necessary socio-demographic data: Psychache scale (PAS), and subscales C, D, and J of Symptom Check List (SCL-90). The data generated was analyzed to obtain means, and t-test was used to compare the means; p = 0.05 was taken as being significant. The analyses were done using SPSS version 10. RESULTS: Eighty subjects with dermatological disorders, and of equal sex distribution, were evaluated, with mean age of 33 +/- 12.1 years. Equal number of controls matched for sex and mean age of 34.6 +/- 7.3 years were also evaluated. Among the subjects, 16.3% had Acne, followed by Urticaria (13.8%), Vitiligo (12.5%), Tinea (11.3%), Hansen's disease (5%), and others (41.1%). From assessment with PAS and SCL subscales, the mean scores by the subjects were much higher than those of the controls and in each group the males scored slightly higher than their female counterparts. On assessment with PAS, the subjects had much higher mean score of 28.94 +/- 12.61 and the controls: 18.92 +/- 7.1 with "t" of 6.19*; and the difference was statistically significant at p < 0.05 and critical "t" of 1.66. On SCL; subscale C, the mean scores for the subjects and controls were: 7.89 +/- 7.69 and 5.02 +/- 5.23 respectively and the difference was statistically significant with "t" of 2.75*. For subscale D, the mean score by the subjects was 11.09 +/- 10.56, and the controls had 4.84 +/- 6.08; and statistically significant difference with "t" of 4.59*. On subscale J, the subjects' mean score was 4.68 +/- 5.44, the controls: 1.98 +/- 3.19 with statistically significant "t" of 3.83*. CONCLUSIONS: The results showed that subjects with dermatological disorders suffered from significant emotional pain when compared to the healthy controls; the males had higher mean scores on PAS and SCL subscales, hence more likely to suffer emotional pain than their female counterparts. Finally, the need to have consultation-liaison psychiatry in the dermatology facilities in Nigeria was emphasized.
Asunto(s)
Dolor/diagnóstico , Enfermedades de la Piel/epidemiología , Estrés Psicológico/diagnóstico , Adulto , Factores de Edad , Enfermedad Crónica , Grupos Control , Femenino , Estudios de Seguimiento , Humanos , Masculino , Nigeria/epidemiología , Dolor/epidemiología , Dolor/psicología , Inventario de Personalidad/estadística & datos numéricos , Estudios Prospectivos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Psicometría , Muestreo , Distribución por Sexo , Factores Sexuales , Enfermedades de la Piel/psicología , Estrés Psicológico/epidemiología , Estrés Psicológico/psicología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Seroprevalence studies of HIV-I and HIV-II that have been reported in Nigeria were among commercial sex workers and blood donors. There are no data from STD patients and dermatologic patients. METHODS: A seroprevalence study of HIV-I, HIV-II and HTLV-I was prospectively conducted among STD clinic attendees and among patients with dermatoses which have been linked with HIV disease. The studies were done in 1992 and 1994. RESULTS: Some patients had more than one seropositive type. In 1992, the percentages of seropositive results to HIV-I, HIV-II and HTLV-I were 31, 19 and 50, respectively, and in 1994 the percentages of HIV-I and HTLV-I were 65 and 35, respectively. CONCLUSIONS: Patients should be routinely screened for HTLV-I, in addition to HIV-I and HIV-II, among blood donors and also neurology clinic attendees in Nigeria. They should also be screened for retroviral infections when they present with dermatoses clinically suggestive of papular urticaria, onchodermatitis, or papulonecrotic tuberculids.
Asunto(s)
Infecciones por VIH/epidemiología , Seroprevalencia de VIH , VIH-1 , VIH-2 , Infecciones por HTLV-I/epidemiología , Virus Linfotrópico T Tipo 1 Humano , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adulto , Donantes de Sangre/estadística & datos numéricos , Western Blotting , Preescolar , Dermatitis/epidemiología , Ensayo de Inmunoadsorción Enzimática , Eosinofilia/epidemiología , Femenino , Foliculitis/epidemiología , Seropositividad para VIH/epidemiología , Hospitales de Enseñanza , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Nigeria/epidemiología , Estudios Prospectivos , Prurito/epidemiología , Trabajo Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de la Piel/epidemiologíaAsunto(s)
Trastornos Nutricionales/complicaciones , Enfermedades de la Piel/etiología , Acrodermatitis/genética , Anemia/etiología , Niño , Preescolar , Dieta , Humanos , Recién Nacido , Deficiencia Múltiple de Carboxilasa/complicaciones , Nigeria , Enfermedades Parasitarias/complicaciones , Desnutrición Proteico-Calórica/complicaciones , Factores Socioeconómicos , Deficiencia de Vitamina A/complicaciones , Deficiencia de Vitamina B/complicaciones , Zinc/deficienciaRESUMEN
We practise an integrated approach to the management of skin diseases, leprosy and sexually transmitted diseases because the latter diseases are still stigmatized and patients are unwilling to attend clinics so labelled. When approached by a patient with skin disease it is advisable to see the patient promptly, because any further delay encourages the use of assorted remedies which may lead to undesirable complications, physically, emotionally and financially. Since there is no health insurance scheme, it is also prudent to manage the patient as much as possible without admission to hospital and with minimal laboratory investigations, to save cost, so that the patient still has sufficient money to buy the required drugs. Family health workers treat patients at the primary health care (PHC) level. At this level, patients are managed by the use of specially prepared standing orders (SO), where checklists and flow charts are grouped by problems or complaints, to facilitate usage by an individual with minimal training in morphology. The SO presents, so far as is possible, the best treatment available for each condition, but which cannot be misused by the primary health care personnel. Before discussing the management of individual diseases, it is important for the reader to appreciate the milieu in which we practise which determines our approach to the patient with skin disease. Some of its features will be highlighted before the management of individual disorders is discussed.
Asunto(s)
Enfermedades de la Piel/terapia , Humanos , Nigeria , Fitoterapia , Enfermedades de la Piel/patologíaRESUMEN
Acquired facial hyperpigmentation is a common problem among African patients, particularly women, where the causes of the dermatoses are identified largely from circumstantial evidence of exposure to known agents. These include hydroquinone-induced exogenous ochronosis from skin-bleaching creams, mercury deposits from mercury-containing skin-lightening soaps and creams, sulfonamide-related drugs, antimalarials, fixed drug eruptions, clofazimine, and photosensitizing herbal concoctions. The differential diagnosis includes melasma and facial erythema ab igne (local cooks).
Asunto(s)
Dermatosis Facial/etnología , Trastornos de la Pigmentación/etnología , África/etnología , Dermatitis Profesional/etiología , Dermatosis Facial/inducido químicamente , Femenino , Humanos , Trastornos de la Pigmentación/inducido químicamenteRESUMEN
Many diseases are peculiar to the black race and most practicing physicians in Africa have limited access to histopathologists, therefore, diagnosis is largely clinical. A retrospective study of 10,000 consecutive patients seen at the skin clinic of the Lagos University Teaching Hospital, Nigeria, was conducted with the objective of identifying the notable dermatoses affecting various parts of the body. The face and the shins were observed to have a very broad spectrum of dermatoses. Useful clinical descriptions of these dermatoses are highlighted in a three part paper to help practicing physicians.
Asunto(s)
Población Negra , Dermatosis Facial/etnología , Adulto , África , Niño , Dermatosis Facial/patología , Femenino , Humanos , Pierna , Masculino , Estudios Retrospectivos , Enfermedades de la Piel/etnología , Enfermedades de la Piel/patologíaRESUMEN
The study is a retrospective analysis of the cutaneous manifestations of sarcoidosis in patients seen during a 10-year period at the skin and chest clinics of the Lagos University Teaching Hospital. Of the 43 patients with sarcoidosis 30% had skin lesions. The most common was sarcoidal infiltration of scarification marks. Facial macropapular lesions also were frequently present.
Asunto(s)
Sarcoidosis/patología , Enfermedades de la Piel/patología , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Estudios Retrospectivos , Sarcoidosis/epidemiología , Enfermedades de la Piel/epidemiologíaRESUMEN
With the rising cost of medical services, it was decided to reassess the relevance of routine bacteriology investigations to the management of the individual patient with pyoderma. In both prospective and retrospective studies, it was found that laboratory reports were simply confirmatory and did not contribute to the management of the individual patient. A call is made for physicians to continuously look for cheaper ways of managing patients without necessarily causing any disservice to the patient.
Asunto(s)
Piodermia/tratamiento farmacológico , Adolescente , Adulto , Niño , Preescolar , Técnicas de Laboratorio Clínico/economía , Quimioterapia/economía , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Piodermia/diagnóstico , Estudios RetrospectivosRESUMEN
Light-sensitive dermatoses do not constitute a major problem among the black people in Nigeria. In a 10-year study, only 64 cases (about 0.4% of all dermatologic patients) had light-sensitive dermatoses. Seven of the 10 patients with endogenous photodermatoses were albinos. Two patients with polymorphic light eruption were visiting Caucasians. Only one normally pigmented black Nigerian had xeroderma pigmentosum. Fifty-four patients had photodermatoses from exogenous causes, of which hydroquinone-induced exogenous ochronosis constituted the largest group of patients. Two women had estrogen-induced porphyria cutanea tarda.
Asunto(s)
Población Negra , Trastornos por Fotosensibilidad/etnología , Femenino , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Humanos , Hidroquinonas/efectos adversos , Masculino , Persona de Mediana Edad , Nigeria , Ocronosis/inducido químicamente , Trastornos por Fotosensibilidad/etiología , Estudios RetrospectivosRESUMEN
In a retrospective study of 4000 consecutive dermatologic patients seen at the Lagos University Teaching Hospital Skin Clinic, 268 patients (6.7%) had generalized pruritus without obvious skin diseases. Filariasis was responsible for the pruritus in 57% of these patients; 21% was bath-related pruritus, and the reasons for this were highlighted. In 6% of cases, pruritus was thought to be due to intolerance to environmental heat; 9.7% was due to miscellaneous causes. Pruritus from systemic diseases accounted for 3.7%. Causes for the pruritus were not elicited in 2.6% of the patients.
Asunto(s)
Prurito/etiología , Humanos , Nigeria , Prurito/diagnóstico , Prurito/tratamiento farmacológico , Estudios Retrospectivos , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/epidemiologíaRESUMEN
The incidence of atopic dermatitis among a recent group of 4000 consecutive dermatology patients was assessed; 3.1 percent of the patients had atopic dermatitis. The ratio of F:M was 1.3:1. Sixty-five percent gave family histories of atopic diathesis. Twenty-three percent of the patients were born and residing in temperate countries when the dermatitis started. Patients tend to report late because of widespread use of topical corticosteroid preparations. Secondary bacterial infections were common, and it is not advisable to avoid the use of soap in this environment.
Asunto(s)
Dermatitis Atópica/epidemiología , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , NigeriaRESUMEN
Nickel is the most important sensitizer in Lagos, with an incidence of 12.3% of 453 patients tested. There was no sex difference, as the wearing of necklaces and bracelets was equally fashionable among both sexes. Housewife eczema is not common, probably because of hardening. Dermatitis from additives in the processing of leather and rubber footwear was the next most common. Chromate sensitivity comes usually from leather or cement. Cultural and climatic factors are mainly responsible for differences in the incidence of contact dermatitis found in Lagos from other countries.