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.

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.

International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis

Importance

A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide.

Objective

To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics.

Design, Setting, and Participants

Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience).

Main Outcomes and Measures

In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree.

Results

Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients.

Conclusions and Relevance

In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.

Clinical, epidemiological characteristics and associated factors of hair greying in Lagos, Nigeria

Objective

To document the epidemiological, clinical characteristics, believed triggers and associated behaviour in hair greying.

Design

A community based cross-sectional descriptive study was conducted in February 2020 following ethical approval and written informed consent from participants. All participants were clinically evaluated for hair greying, its pattern and location on the scalp. Socio-demographic data were documented. Data was entered and analyzed using the IBM statistics software version 22. Numerical and categorical variables are presented.

Setting

The study was conducted at an urban market in Lagos, Nigeria.

Participants

The study participants comprised 307 adult traders.

Results

The mean age of the 307 participants studied was 42.7±12.8 years. The prevalence of hair greying was 47.6% (51% in males and 45.9% in females). The median (IQR) age of those with grey hair was 52 (44, 59) years. The prevalence of hair greying was 14.8% in those aged 30–34 years and 97.2% in those aged 60 years and above. The prevalence of premature greying was 17.7% and greying before friends and family members was reported at 19.9% and 13%, respectively. Grey hair was diffuse in 81.5%; localized to the frontal area of the scalp in 55.5%. Use of hair dye was noted in 15.8%.

Conclusion

Hair greying is common in the study population. The age at onset is 30 years. Premature hair greying is uncommon in Nigeria. More epidemiological studies of hair greying especially of premature hair greying are needed.

Funding

Funding for this study was provided by the L'Oreal African Hair & Skin Research Grant.

Clinical and aetiologic profile of patients with chronic urticaria at the outpatient clinic of a tertiary hospital in Lagos, Nigeria: a cross-sectional observational study

Chronic urticaria is a condition characterized by recurrent wheals associated with itching lasting longer than six weeks. The condition tends to run a chronic course with significant morbidity. Several factors have been explored in the cause, yet the aetiology is still uncertain. We documented the clinical profile and assessed the possible aetiologic factors in patients with chronic urticaria. Clinical profile of sixty consecutive patients with chronic spontaneous urticaria was assessed with possible precipitants identified using a structured questionnaire. The complete blood count with erythrocyte sedimentation rate, antithyroid peroxidase (antiTPO), hepatitis B surface antigen (HBsAg), antihepatitis C virus screening (AntiHCV), stool for ova and parasites and helicobacter pylori were carried out. Controls without a history of urticaria were recruited in a 1: 1 ratio for stool for parasites and H. pylori because of the high prevalence rates reported in this environment. Data analysis was carried out with Statistical Packages for Social Sciences (SPSS) version 22. Sixty patients with chronic urticaria and sixty age and sex matched controls were enrolled in the study. Females presented more often with urticaria with a M: F ratio of 1: 2.5. The mean age of onset of urticaria was in the third decade of life. Precipitants were identified in close to a third of patients. The investigated antigenic aetiology was not found to play a role. The presentation and clinical profile of patients in this environment is similar to previously documented studies. History still remains the cornerstone of management as precipitants and triggers may be identified. Management of patients should therefore be individualized.

Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology

The global burden of the endemic mycoses (blastomycosis, coccidioidomycosis, emergomycosis, histoplasmosis, paracoccidioidomycosis, sporotrichosis, and talaromycosis) continues to rise yearly and these infectious diseases remain a leading cause of patient morbidity and mortality worldwide. Management of the associated pathogens requires a thorough understanding of the epidemiology, risk factors, diagnostic methods and performance characteristics in different patient populations, and treatment options unique to each infection. Guidance on the management of these infections has the potential to improve prognosis. The recommendations outlined in this Review are part of the "One World, One Guideline" initiative of the European Confederation of Medical Mycology. Experts from 23 countries contributed to the development of these guidelines. The aim of this Review is to provide an up-to-date consensus and practical guidance in clinical decision making, by engaging physicians and scientists involved in various aspects of clinical management.

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.

African oils in dermatology

Plant and seed oils have been used for centuries and possibly millennia in Nigeria and Africa for the maintenance of healthy skin and the traditional treatment of skin disorders. In recent times, some of these oils have regained popularity due to their availability and affordability coupled with concerns about the side effects of commercially processed skin care products. This is to assess the chemical properties, current knowledge, source of procurement, indications for topical use, benefits, and possible adverse effects of six plant oils and one animal fat commonly used in Nigeria. This is a literature review and interview with traditional healers and alternative health practitioners to document the traditional, medical, cosmetics, and other usage of oils for skin and scalp care in the African context. Literature review was done on the biochemical and pharmacological properties of each of the seven oils. Searches were made from PubMed, African Journal online, Medline, and Google scholar. Medical subject heading terms used in the search include shea butter, coconut oil, palm kernel oil, palm oil, soy oil, Baobab oil, and python oil. Plant and seed oils used locally in Nigeria and other African countries for skin care and treatment have several benefits due to the constituents of the plant oils (free fatty acids, triglycerides, ceramides, phospholipids, vitamins and antioxidants) which have been shown to promote healthy skin barrier function, wound healing and have anti-inflammatory and antimicrobial effects. They are however not without adverse effects, which may be mainly due to processing and storage hygiene. Further studies are required on these oils in view of their potential in the development of novel skincare products and dermatological therapies.

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.

Electronic supplementary material

The online version of this article (10.1007/s10067-020-04934-7) contains supplementary material, which is available to authorized users.

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.

Pattern of skin diseases amongst children attending a dermatology clinic in Lagos, Nigeria

INTRODUCTION

Skin diseases constitute a major health problem affecting a large proportion of the population including children causing distress and disability. This study aimed to document the spectrum and frequency of skin diseases of children who attended the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) Lagos, Nigeria.

METHODS

A cross-sectional study of children (18 years old and below) who attended the dermatology clinic between January 2004 and December 2016. Data obtained from the medical records of the patients included age, gender, clinical features, laboratory features and diagnosis. Skin diseases were classified into various groups.

RESULTS

There were 6373 children included in the study with a male to female ratio of 1:1.13. The most common disease categories were infections 1795 (26.1%), Eczematous conditions 1711 (24.9%), Infestations 936 (13.6%), papulosquamous disorders 547 (8.0%) and Bullous disorders 254 (3.7%). With respect to individual skin diseases, atopic dermatitis (AD) 1042 (15.1%) was the most common skin condition followed by papular urticaria 705 (10.2%) and tinea capitis 554 (8.1%). Infections were most common among infants and adolescents. Acneiform eruptions were common among adolescents while eczematous disorders were most common among children less than 5 years.

CONCLUSION

The study highlights the common dermatoses seen in children in a specialized dermatology clinic in a developing country such as Nigeria. Most of the skin diseases observed can be controlled by proper environmental sanitation, adequate nutrition, reducing overcrowding, and promoting good health-seeking behavior among parents and caregivers. Information obtained from the study may guide training in dermatology especially among pediatricians.

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.

Prevalence of Tinea Capitis Infection Among Primary School Children in a Rural Setting in South-West Nigeria

Dermatophyte infection is a common skin disorder. Tinea capitis, infection of the scalp and hair shaft, is the most common dermatophytosis in children aged between six months and pre-pubertal age. The aim of the study was to determine the prevalence, causative agents and to identify predisposing factors among primary school children in a rural community in Sagamu, Ogun state, Nigeria. This was a descriptive cross sectional study. Interviewer administered questionnaire was used. Following a physical examination, children with a clinical diagnosis of tinea capitis had scalp and hair scrapings for microscopy and culture. Tinea capitis was confirmed in 15.4%. Trichophyton mentagrophyte (51.7%) and Microsporum aoudouinii (20.7%) were the most prevalent organisms in this study. The most common predisposing factors were carrying of objects on the scalp; sharing of hair clippers, scissors, combs, towels and fomites. Low socioeconomic status coupled with overcrowding and poor hygiene was the major determinant of tinea capitis among the children. Tinea capitis remains a common infection among Nigerian school children. Health promotion and health education interventions are recommended to promote good hygiene, better living conditions, early identification and treatment.

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.

Routine patch testing in a dermatology clinic of a teaching hospital in Nigeria

INTRODUCTION

Allergic Contact Dermatitis (ACD) poses a great diagnostic challenge to the dermatologist as it mimics many common dermatoses. Patch test (PT) is used to establish the diagnosis of ACD and to exclude suspected allergens.

AIM

This study reviewed the clinical presentations and patch test results of consecutive patients with the diagnosis of allergic contact dermatitis seen at the skin clinic of the Lagos University Teaching Hospital (LUTH).

METHODS

This was a prospective study of all patients that presented with features of allergic contact dermatitis at the skin clinic of LUTH between September 2003 and October 2004. One hundred and two patients with ACD and 100 controls were patch tested and included in the sample size.

RESULTS

Allergic contact dermatitis accounted for 7.7% of patients that presented at the dermatology clinic of LUTH during the study period. There was a slight female preponderance and the highest number of patients presented between the ages of 21 and 40. Features of chronic eczema were found in 71.4% of patients. Sixty patients (58.3%) and 26 controls (26%) had positive patch test responses. There was a statistically significant difference between the patch test responses in patients and controls. The specificity of the patch test procedure was 74% and the sensitivity was 58.8%.

CONCLUSION

Patients with allergic contact dermatitis will benefit from routine patch test for aetiological diagnosis and to prevent chronicity.