Skin diseases in Nigeria: the Calabar experience

Awareness and knowledge of scabies and ringworm among parents of school-age children in Calabar, Cross River State, Nigeria: Implications for prevention of superficial skin infestations

Context

Risk factors for the persistence of superficial skin infestations are prevalent in humid tropical environments, which are favorable for breeding of the causative vector mite Sarcoptes scabiei (ectoparasite) and dermatophyte fungi.

Aim

This study aimed at assessing the awareness and knowledge of childhood scabies and ringworm infestations among parents in Calabar, a highly humid rainforest tropical environment.

Settings and Design

Cross-sectional study design and systematic random sampling were used to recruit school-age children in selected primary schools in Calabar.

Materials and Methods

Researcher-driven administration of a structured questionnaire was conducted to obtain quantitative data from parents of recruited children.

Statistical Analysis Used

: Chi-square was used to assess factors associated with ever hearing or seeing scabies and ringworm infestations. Statistical significance was set at P < 0.05.

Results

One hundred and eighty-two (56.7%) and 218 (67.9%) of the respondents had heard of or seen scabies and ringworm infestation. Among respondents that were aware of scabies, 53.3% knew of the cause, 50.5% were aware of the risk factors while 68.1% and 78.0% knew their treatment and prevention, respectively; 98.6%, 60.6%, 76.6%, and 80.7% of respondents knew the cause, risk factors, treatment, and prevention of ringworm infestation, respectively. Fathers with at least secondary school literacy level and sharing beds were significantly associated with awareness of scabies.

Conclusion

There is a suboptimal level of awareness and knowledge of two of the most common superficial skin infestations among parents of primary school children in the study setting. There is a need to redouble our effort at sensitization of parents toward improved awareness of these common infestations.

Trends in dermatology consultations in the COVID‐19 era in Cameroon

Introduction

With the advent of COVID‐19, a highly infectious viral pandemic, first declared in Cameroon in March 2020, access to expert dermatology care was postulated to decrease. We carried out a descriptive study to understand the epidemiology of skin diseases amongst patients consulting at an outpatient dermatology clinic and its variations with the onset of COVID‐19.

Methods

We conducted a retrospective database study over a period of 2 years at Laquintinie hospital, Cameroon. Two periods were distinguished: 1 March 2019 to 29 February 2020 (pre‐COVID‐19 era) and 1 March 2020 to 28 February 2021 (COVID‐19 era).

Results

Overall, 5946 patients with one or more clinical conditions were analysed. The most common age group described was young adults (18–40 years). Females consulted twice as much as males (M/F ratio; 1:1.7). The mean age was 28.9 (±18.0) years with an age range of 1 month to 89 years. Infectious dermatoses predominated. However, the single most prevalent dermatologic condition was acne. There was a 35.6% drop in consultation frequency in the COVID‐19 era.

Conclusion

Three in four patients consulting at dermatology clinic are below 40 years, with a female predominance. Epidemiological profile of dermatoses in Cameroon is similar to that in the rest of Africa. Consultation frequency decreased in the COVID‐19 era but trends in consultations were rather unaltered except for patients above 50 years where eczema and scabies increased. More studies should be conducted to understand these trends better at a national level and envisage training of health personnel on prevalent dermatoses.

Prevalence of skin infections, infestations, and papular urticaria among adolescents in secondary schools in Calabar, Nigeria

Background

Acne is an inflammatory disorder of the pilosebaceous gland, and the most common dermatosis in adolescents globally. Infectious dermatoses are common in the tropics, but due to the paucity of epidemiologic surveys, not much is known about the prevalence and common types found in different sub-populations including adolescents. It is however presumed that the prevalence will be high and the pattern diverse. We therefore conducted a school-based survey to ascertain the prevalence and pattern of infectious dermatoses, infestations, and papular urticaria (insect bite reactions) in teenage adolescents in Calabar, Nigeria.

Methods

A cross sectional observational survey of adolescents aged 13–19 years attending randomly selected secondary schools in Calabar, Nigeria. It involved the use of questionnaires and subsequent whole body examination.

Results

A total of 1447 senior secondary school students were examined. Infectious dermatoses, infestations, and papular urticaria (IDIP) were observed in 505 (34.9%) persons, among whom were 269 (53.3%) males, and 236 (46.7%) females (X²=34.87, p=<0.001). Fungal dermatoses constituted more than 90% of the diseases, the bulk of which was contributed by pityriasis versicolor [430 (79.6%)]. The six most common dermatoses in descending order of frequencies were Pityriasis versicolor, tinea, papular urticaria, candidiasis, furuncles, and viral warts.

Conclusion

A high prevalence of cutaneous infections exists among teenage adolescents in Calabar, Nigeria. Males have a higher predisposition to fungal dermatoses. Control of the predominant cause of cutaneous infections — pityriasis versicolor, will significantly affect the prevalence of infectious dermatoses, and invariably, the burden of skin disorders in adolescents in Calabar, Nigeria.

Funding

Self sponsored

Epidemiologic Trends of Viral Skin Infections in Egypt: A Cross-Sectional Hospital-Based Study

Viral skin infections (VSIs) were ranked among the top 50 prevalent diseases in 2010. The objective of this study was to determine the epidemiologic features of VSIs in patients attending a dermatology clinic in Egypt from June 2010 to May 2011. Patient's residence, occupation, housing data, and family history of similar conditions were recorded. Categorical data were recorded as frequencies and percentages and were compared by Chi square test. P value < 0.05 was significant. Diagnosis of VSIs was made in 1000/20322 (4.9%) patients. Out of the 1000 patients with VSIs, 580 (58.0%) were residents of rural areas and 420 (42.0%) were residents of urban areas (p = 0.02). Out of the 1000 patients, 489 (48.9%) were females and 511 (51.1%) were males (p = 0.25). The breakdown of 1000 patients with VSIs indicated diagnosis of viral warts in 673 (67.3%), chickenpox (CP) in 200 (20.0%), herpes simplex (HS) facialis in 50 (5.0%), herpes zoster (HZ) in 42 (4.2%), molluscum contagiosum (MC) in 27 (2.7%.0), and anogenital warts in 8 (0.8%) cases. Overcrowding (sharing a bedroom by more than 3 persons) was recorded in 652/1000 (65.2%) of the patients with VSIs [165/200 (82.5.3%) in CP, 36/50 (72%) in HS facials, 427/673 (63.4%) in viral warts, 14/27 (51.9%) in MC, and 10/42 (23.8%) in HZ]. Family history of a similar condition was positive in 329/1000 (32.9%) of the patients with VSIs [142/200 (71.0%) in CP, 177/673 (26.3%) in viral warts, 5/27 (18.5%) in MC, and 4/50 (8%) in HS facialis]. In conclusion, viral warts and CP were the commonest VSIs diagnosed in patients who attended a dermatology clinic in Egypt. Viral skin infections were more prevalent among patients who lived in rural areas and under crowded conditions. These data may have important public health implications particularly in developing countries.

Impact of Weather Conditions on Atopic Dermatitis Prevalence in Abuja, Nigeria

BACKGROUND

Climatic conditions may trigger subclinical disease in predisposed individuals and also exacerbate eczematous symptoms resulting in persistence or increased frequency of atopic dermatitis (AD) flares. The aim of this study is to assess the impact of tropical weather conditions on the frequency at which atopic dermatitis patients present at the dermatology clinic of a tertiary hospital in Abuja, Nigeria; and, to find out which component of these conditions exerts the most significant effects.

METHODS

Medical records of all new patients seen at the clinic within July 2015 and June 2017 was obtained. Data for monthly temperature, humidity, precipitation, cloud cover and UV index of Abuja during this period was obtained from worldweatheronline. Univariate analyses and multiple regressions were used to assess the associations between monthly prevalence of AD and the above-mentioned meteorological variables.

RESULTS

Patients had a 1.6 times odds (95% CI: 1.03-2.56, p = 0.038) of presenting with AD in the dry season as compared to wet season. Dry season was associated with higher temperatures and UV index and lower precipitation, humidity and cloud cover, p<0.001. Multivariate logistic regression modelling adjusting for precipitation, humidity, cloud cover and age group demonstrated that precipitation (OR = 1.01, 95% CI: 1.00-1.02, p = 0.002), humidity (OR = 1.03, 95% CI:1.01-1.05, p = 0.015) and cloud cover (OR = 0.92, 95% CI: 0.88-1.02, p = 0.002) exert the most significant effects. Also infants had 4.4 times odds of AD than adults (95% CI: 2.04-9.69, p<0.001).

CONCLUSION

Exposure to tropical season meteorological variables can influence the presentation of AD.

Dermatology in Ghana: a retrospective review of skin disease at the Korle Bu Teaching Hospital Dermatology Clinic

Introduction

Ghana is currently developing its provision of dermatology services. Epidemiologic studies of the skin diseases seen by Ghanaian dermatologists are needed to guide these efforts. We aimed to describe the skin conditions seen by and management practices of Ghanaian dermatologists in a specialized clinic.

Methods

We conducted a chart review of new patients presenting to the Korle Bu Teaching Hospital dermatology clinic during 2014.

Results

Among the 529 patients studied, 700 discrete diagnoses were made. The most commonly diagnosed skin conditions were infections (24.6%) and dermatitis (24.6%); atopic dermatitis (8.4%), acne vulgaris (5.3%) and scabies (5.1%) were the most common specific diagnoses. Among infants, children, and adolescents, the most common diagnosis was atopic dermatitis (31.7%, 30.0%, and 14.9%, respectively). Acne vulgaris (12.0%) was the most common skin condition diagnosed in young adults. Irritant contact dermatitis (6.9%) was most common among adults. Lichen planus (9.9%) was the most commonly diagnosed skin condition in the senior population. Diagnoses made by dermatologists differed from the referral diagnosis documented by primary care providers for 65.8% of patients. The most frequently recommended treatments were antihistamines (47.8%) and topical steroids (38.4%). Only 18 diagnostic biopsies were performed.

Conclusion

Our study summarizes the skin diseases seen and management practices of Ghanaian dermatologists in a specialized clinic at a large public teaching hospital. The results of this study can help to guide future dermatology education and development efforts in Ghana.

Differential Diagnosis of Skin Ulcers in a Mycobacterium ulcerans Endemic Area: Data from a Prospective Study in Cameroon

Background

Clinical diagnosis of Buruli ulcer (BU) due to Mycobacterium ulcerans can be challenging. We aimed to specify the differential diagnosis of skin lesions in a BU endemic area.

Method

We conducted a prospective diagnostic study in Akonolinga, Cameroon. Patients presenting with a skin ulcer suspect of BU were included. M. ulcerans was detected using swabs for Ziehl-Neelsen staining, PCR and culture. Skin punch biopsies were taken and reviewed by two histopathologists. Photographs of the lesions were taken and independently reviewed by two dermatologists. Final diagnosis was based on consensus, combining the results of laboratory tests and expert opinion.

Results/ Discussion

Between October 2011 and December 2013, 327 patients with ulcerative lesions were included. Median age was 37 years (0 to 87), 65% were males, and 19% HIV-positive. BU was considered the final diagnosis for 27% of the lesions, 85% of which had at least one positive laboratory test. Differential diagnoses were vascular lesions (22%), bacterial infections (21%), post-traumatic (8%), fistulated osteomyelitis (6%), neoplasia (5%), inflammatory lesions (3%), hemopathies and other systemic diseases (2%) and others (2%). The proportion of BU was similar between HIV-positive and HIV-negative patients (27.0% vs. 26.5%; p = 0.940). Half of children below 15 years of age were diagnosed with BU, compared to 26.8% and 13.9% among individuals 15 to 44 years of age and above, respectively (chi2 p<0.001). Children had more superficial bacterial infections (24.3%) and osteomyelitis (11.4%).

Conclusion

We described differential diagnosis of skin lesions in a BU endemic area, stratifying results by age and HIV-status.

In some areas of Africa, Australia or Japan, a specific skin infection presents as a wound which progressively increases in size in children and people of any age. The agent which causes this infection is named Mycobacterium ulcerans, close to the tuberculosis agent. This wound, also named Buruli ulcer (BU), may be confused with other common cutaneous diseases. During two years in Akonolinga, Cameroon, we evaluated the wounds of all patients who presented with suspected BU. This wound presentation was most frequently recorded in young children and males. Buruli ulcer was indeed the most frequent diagnosis in this area. However, with the help of laboratory and radiological techniques, we found that many of those patients not diagnosed with BU were suffering from: vascular insufficiency (older persons), benign superficial infections and bone infections (children). This observation is important and should help improve the diagnosis and treatment of patients with skin ulcers in Africa.

Severity and impact of acne vulgaris on the quality of life of adolescents in Nigeria

BACKGROUND

Acne vulgaris is a common skin condition, which affects most adolescents at some point in their lives. It has been found to have a significant impact on their psychological well-being and has been associated with depression and suicide ideation. Many studies have assessed the impact of acne vulgaris on the quality of life (QoL) in different population subgroups around the world, but there is a dearth of reports from the African subcontinent. This study thus seeks to assess the severity of acne vulgaris and determine its effect on the QoL of adolescents in Lagos, Nigeria.

METHODS

In a cross-sectional survey employing a two-stage sampling method, the severity of acne vulgaris and its impact on the QoL of adolescents attending a senior secondary school in Lagos, Nigeria was assessed using the Global Acne Grading Scale (GAGS) and the Cardiff Acne Disability Index (CADI), respectively. The correlation between the results of the GAGS and CADI was also determined.

RESULTS

One hundred and sixty adolescent students with acne were recruited, with males accounting for 51.9% and females 48.1%. The mean and standard deviation of the GAGS severity scores were 11.3±5.4 for males and 11.9±5.4 for females. Only one student had severe acne vulgaris (GAGS, 31-38), 10% moderate (GAGS, 19-30), and 89.4% mild (GAGS, 1-18). The overall CADI score was 3.4±3.0, which suggests mild impairment in QoL; however, the solitary student with severe acne had severe QoL impairment. There was a weak positive correlation between the GAGS and the CADI score.

CONCLUSION

Most adolescents in our study had mild acne vulgaris, and the overall impact on their QoL was mild. However, the correlation between the psychosocial impact and acne severity was weak. There is a need for similar studies in other parts of the country and for further studies to determine the adequacy of the existing instruments in assessing the impact of acne vulgaris in Nigerian adolescents.