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.

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.

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.

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.

Diabetic scleredema-a case report

A case of diabetic scleredema is described. As far as we are aware, this is the first such case to be reported in the West Indian medical literature (AU)

The pattern of childhood skin diseases in Jamaica

A review has been made of the skin disorders seen in children under 11 years of age at the Skin Clinic of the University Hospital of the West Indies during the 5-year period 1971 - 1975. Eczema (all types) was found to be the commonest condition (46.7 percent) followed by infections and infestations (25 percent). The third commonest disorder was papular urticaria (11 percent). The age pattern of the various diseases shows that infants are at greatest risk of developing skin diseases since 40 percent of all the disorders were seen during this age period. The possible factors responsible for the commoner skin diseases are discussed and suggestions are made for possible ways of dealing with them (AU)

Skin disease at the University Hospital of the West Indies (1970-1975) - abstract

The records of the Dermatology Clinic between 1970 and 1975 were analyzed in order to determine the pattern of skin diseases. The total number of patients seen was 4,708 and the number of diagnoses was 4,900: 80 percent were over the age of 11 years and 59 percent were females. The commonest 10 skin diseases in order of frequency were Eczema (all types) 32.3 percent; Scabies 7.1 percent; Acne vulgaris 5.4 percent; Dermatophyte infection 5.3 percent; Pityriasis veriscolor 4.08 percent; papular urticaria 3.2 percent; pityriasis rosea 3.1 percent; lupus erythematosus 2.9 percent; alopecia 2.9 percent and psoriasis 2.3 percent. Forty-five per cent of the eczemas were unclassified; atopic eczema and zeborrhoeic eczema were 20 percent and 12 percent respectively. Of the dermatophyte infections, tinea corporis was present in 23 percent, tinea cruruis in 20 percent and tinea capitis in 11.6 percent. The most striking finding is the high prevalence of eczema, a pattern more common in temperate countries. Atopic eczema was the most prevalent classified eczema and occurred mainly in children. The high prevalence of scabies must be a reflection of poor sanitation and is similar to that seen in London at the turn of this century. Acne occurred more frequently than is usually recorded in tropical countries and occurred in males at an average age of 21.4 years and in females 22.5 years. This analysis emphasizes the wide distribution of the kinds of skin diseases seen and emphasizes the areas in which Dermatology in Jamaica is different from elsewhere. The cause for this difference lies partly in the economic and socio cultural environment, and probably also in the mixed ethnic origins (AU)

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.

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.