Management Outcomes of Hand Dermatitis in a Tertiary Hospital in Southwest Nigeria.

BACKGROUND: Hand dermatitis (HD) is inflammation of the skin of the hands. It ranges in severity and has a significant impact on quality of life (QoL). The physical and psychosocial burden of the disease is comparable with psoriasis in impairment of the QoL of the patient and depression. Quality of life correlates with disease severity. AIM: To evaluate the management outcome of HD with a disease severity tool by the physician and quality of life index. MATERIALS AND METHODS: This was a cross-sectional study of a cohort of patients with HD over 24 weeks in the dermatology clinic of a tertiary hospital in Nigeria. Disease severity and quality of life were measured using the physician global assessment (PGA) and dermatology life quality index (DLQI), respectively. These were re-administered 6 weeks after treatment. Results were collated and analyzed. RESULTS: One hundred and seventy-seven (13.3%) of 1,329 patients had HD with F/M ratio of 1.2: 1; a mean age of 34.6 ± 7.4 years. Comparing PGA scores at baseline and 6 weeks, a statistically significant improvement was noted P < 0.001. The mean DLQI score at baseline was 10.38 and reduced to 3.02 post-treatment. The difference between the two means of the DLQI was ≥5 from baseline signifying improved quality of life. The domain of symptoms and feelings was the most affected at baseline and most improved afterward. CONCLUSION: HD has a significant impact on its sufferers and this correlates with disease severity. Appropriate management improves disease outcome and patients' quality of life.

Fungal Nail Infections amongst Cassava Farmers and Processors in Southwest Nigeria.

INTRODUCTION: Onychomycosis has been documented as an occupational dermatosis and dermatophyte infection of the nail is the most common infection amongst farmers. This study aims to determine the prevalence of fungal nail infections amongst cassava farmers and processors and identify causative organisms. METHODS: Consenting individuals engaged in the processing of raw cassava into 'garri' meal in Odogbolu local government area of Ogun State were included. Questionnaires contained demographic details, clinical descriptions, classification, and the presence of fungal infections in other parts of the body. Nail clippings were collected for direct microscopy using 40% Potassium hydroxide solution to break down nail keratin. Specimens were inoculated onto Sabouraud's dextrose agar with chloramphenicol and gentamicin incorporated, and incubated at 26°C and 35°C. RESULTS: Clinical features of onychomycosis were found in 119 (68.4%) participants. Distal subungual onychomycosis (68-57.1%) was the most common clinical type, followed by total dystrophic onychomycosis (49-41.2%), candida onychomycosis (34-28.6%), proximal subungual onychomycosis (14-11.8%) and superficial white onychomycosis (9-7.6%). One hundred and one (84.9%) respondents with clinically described onychomycosis had positive results in mycology studies. The non-dermatophyte molds (Aspergillus and Penicillium spp.) were found in 130 samples (78.8%); dermatophytes in 31 (18.8%) and yeast in 7 (4.2%). CONCLUSION: Non-dermatophyte molds, traditionally thought to be contaminants of nail cultures, were the main causative agents of primary fungal nail infections. Garri processors will benefit from public health intervention geared towards automation of some of these processes to minimize contact with soil and water, and health education on the use of protective materials.

INTRODUCTION: L'onychomycose a été documentée comme une dermatose professionnelle, et l'infection dermatophyte de l'ongle était l'infection la plus courante chez les agriculteurs. Cette étude vise à déterminer la prévalence des infections fongiques des ongles chez les cultivateurs et les transformateurs de manioc et à identifier les organismes responsables. MÉTHODES: Des individus consentants engagés dans la transformation du manioc brut en farine de 'garri' dans la zone de gouvernement local d'Odogbolu de l'Etat d'Ogun ont été inclus. Les questionnaires contenaient des détails démographiques, des descriptions cliniques, une classification et la présence d'infections fongiques dans d'autres parties du corps. Des coupures d'ongles ont été prélevées pour une microscopie directe en utilisant une solution d'hydroxyde de potassium à 40% pour décomposer la kératine de l'ongle. Les spécimens ont été inoculés sur de la gélose dextrose de Sabouraud avec du chloramphénicol et de la gentamicine incorporés, et incubés à 26°C et 35°C. RÉSULTATS: Des caractéristiques cliniques d'onychomycose ont été trouvées chez 119 (68,4%) participants. L'onychomycose sousunguéale distale (68­57,1 %) était le type clinique le plus fréquent, suivie par l'onychomycose dystrophique totale (49 à 41,2 %), l'onychomycose à candida (34 à 28,6 %), l'onychomycose sousunguéale proximale (14 à 11,8 %) et l'onychomycose blanche superficielle (9 à 7,6 %). Cent un (84,9 %) répondants présentant une onychomycose décrite cliniquement ont eu des résultats positifs dans les études mycologiques. Les moisissures non dermatophytes (Aspergillus et Penicillium spp.) ont été trouvées dans 130 échantillons (78,8%) ; les dermatophytes dans 31 (18,8%) et les levures dans 7 (4,2%). CONCLUSION: Les moisissures non dermatophytes, traditionnellement considérées comme des contaminants des cultures d'ongles, étaient les principaux agents causaux des infections fongiques primaires des ongles. Les transformateurs de garri bénéficieront d'une intervention de santé publique axée sur l'automatisation de certains de ces processus afin de minimiser le contact avec le sol et l'eau, et d'une éducation sanitaire sur l'utilisation de matériaux de protection. Mots clés: Onychomycose, 'garri', transformateurs de manioc, moisissures non dermatophytes, dermatophytes, levures.

Occupational Hand Dermatitis amongst Cassava Processors in Rural Communities in Southwest Nigeria.

BACKGROUND: Hand dermatitis (HD) is an inflammatory disorder of the hand. Agricultural industries (farming) have been reported as one of the leading occupation predisposing workers to health risks. Practices such as dumping cassava peels in farm environment, removal of heaps of peels, soaking of cassava and clearing of ditches have been identified as potentially harmful. These processes, which are wet works, are often done with bare hands predisposing cassava processors to HD. AIMS: This study aimed to determine the prevalence, predisposing factors and characteristics of HD amongst cassava processors in some rural communities in Southwest Nigeria. METHODOLOGY: This was a cross-sectional prospective study involving females engaged in farming and processing of raw cassava into 'garri' meal using the traditional methods. Four hundred and twenty-six female cassava processors were included. The questionnaire used was an adaptation of the Nordic Occupational Skin Questionnaire (NOSQ-2002) which is used to document work related skin diseases of the hand and forehand, and exposures to environmental factor. RESULTS: The mean age was 38.7 years and age range 13 - 70 years. Fifty-seven (13.4%) participants presented with HD within 12 months. Itching was the most common symptoms reported by 44 (10.3%) participants followed by pain 26 (6.1%) and small bumps 23 (4.9%) . The palmar surface of the right hand was most affected. None of the participants who use gloves regularly reported any symptoms of HD. CONCLUSION: Cassava processors have been shown to be at potential risk of occupational HD; hence, health education and use of protective materials are important measures for prevention.

CONTEXTE: La dermatite des mains (DH) est un trouble inflammatoire de la main. Les industries agricoles (agriculture) ont été signalées comme l'une des principales professions prédisposant les travailleurs à des risques pour la santé. Des pratiques telles que le déversement des épluchures de manioc dans l'environnement agricole, l'enlèvement des tas d'épluchures, le trempage du manioc et le curage des fossés ont été identifiées comme potentiellement dangereuses. Ces processus, qui sont des travaux humides, sont souvent effectués à mains nues, ce qui prédispose les transformateurs de manioc aux HD. OBJECTIFS: Cette étude visait à déterminer la prévalence, les facteurs de prédisposition et les caractéristiques de la DH chez les transformateurs de manioc dans certaines communautés rurales du sud-ouest du Nigeria. MÉTHODOLOGIE: Il s'agissait d'une étude transversale prospective impliquant des femmes engagées dans l'agriculture et la transformation du manioc brut en farine 'garri' en utilisant les méthodes traditionnelles. Le questionnaire utilisé était une adaptation du Nordic Occupational Skin Questionnaire (NOSQ-2002). RÉSULTATS: Quatre cent vingt-six femmes transformatrices de manioc ont été incluses. L'âge moyen était de 38,7 ans et la fourchette d'âge de 13 à 70 ans. Cinquante-sept (13,4 %) participantes ont présenté une DH dans les 12 mois. Les démangeaisons étaient les symptômes les plus courants rapportés par 44 participants, suivis par la douleur (26) et les petites bosses (23). La surface palmaire de la main droite était la plus touchée. Aucun des participants qui utilisent régulièrement des gants n'a signalé de symptômes de MH. CONCLUSION: Il a été démontré que les transformateurs de manioc sont exposés à un risque potentiel de MH professionnelle ; par conséquent, l'éducation sanitaire et l'utilisation de matériaux de protection sont des mesures importantes pour la prévention. Mots clés: Dermatite des mains, Manioc (garri), Agriculture, Profession, Transformateurs de manioc, Épluchures de manioc, Mains nues, Nordic Occupational Skin Questionnaire (NOSQ­2002).

Covid 19: A Prospective Observational Study on the Cutaneous Manifestations of Patients in Lagos, Nigeria.

BACKGROUND: Cutaneous manifestations of COVID-19 have been documented from Europe, USA, and China but none from Africa to date. Skin findings among Africans differ from Caucasians and it is important to report these in Nigerians with COVID-19. METHODS: A prospective observational review involving patients seen at the Emergency triage, and Isolation wards of the Lagos University Teaching Hospital. Demographic and clinical data were captured; skin and appendages were examined by a dermatologist between 0800hrs and 1600hours to minimise visual errors of artificial light masking cutaneous lesions. RESULTS: Of 235 participants, 17 (7.23%) had recent onset skin rash, with 7 (41.2%) experienced itching and 11 confirmed with COVID-19. There was a male: female ratio of 97:43 (2.3:1) among COVID-19 patients. Cutaneous findings were seen in 12 (5.1%) participants, with the face and trunk mostly affected and acne plus papular eruptions predominating. There was no significant relationship between COVID-19 and recent onset skin rash (χ2, p = 0.87). Only 2 of the 17 participants had a previously existing dermatoses ((χ2, p = 0.84). There was no significant relation between use of medications and onset of rashes (χ2, p = 0.72) or between those with co-morbidities and onset of rashes (χ2, p = 0.51). CONCLUSION: Cutaneous manifestations were found among Nigerian patients with SARS-CoV-2 infection. Most presented with pruritus and papular eruptions and no morphologic pattern was demonstrated. Physicians and dermatologists need to be aware and look out for skin changes in SARS-CoV-2 infection as they may be early pointers to COVID-19. Keywords: Cutaneous findings, manifestations, Skin, COVID-19, Nigeria.

CONTEXTE: Des manifestations cutanées du COVID-19 ont été documentées en Europe, aux Etats-Unis et en Chine, mais aucune en Afrique à ce jour. Les manifestations cutanées chez les Africains diffèrent de celles des Caucasiens et il est important de les signaler chez les Nigérians atteints de COVID-19. MÉTHODES: Une étude observationnelle prospective impliquant des patients vus au triage des urgences et dans les services d'isolement de l'hôpital universitaire de Lagos. Les données démographiques et cliniques ont été saisies ; la peau et les appendices ont été examinés par un dermatologue entre 8h00 et 16h00 pour minimiser les erreurs visuelles de la lumière artificielle masquant les lésions cutanées. RÉSULTATS: Sur 235 participants, 17 (7,23 %) ont présenté une éruption cutanée d'apparition récente, dont 7 (41,2 %) ont eu des démangeaisons et 11 ont été confirmées par le COVID-19. Il y avait un rapport hommes/femmes de 97:43 (2,3:1) parmi les patients atteints de COVID-19. Des signes cutanés ont été observés chez 12 (5,1 %) participants, le visage et le tronc étant les plus touchés, avec une prédominance de l'acné et des éruptions papuleuses. Il n'y avait pas de relation significative entre le COVID-19 et les éruptions cutanées d'apparition récente (χ2, p = 0,87). Seulement 2 des 17 participants avaient une dermatose déjà existante ((χ2, p = 0,84). Il n'y avait pas de relation significative entre la prise de médicaments et l'apparition d'éruptions cutanées (χ2, p = 0,72) ou entre les personnes présentant des comorbidités et l'apparition d'éruptions cutanées (χ2, p = 0,51). CONCLUSION: Des manifestations cutanées ont été constatées chez les patients nigérians atteints d'une infection par le SRAS-CoV-2. La plupart d'entre eux présentaient un prurit et des éruptions papuleuses et aucun modèle morphologique n'a été mis en évidence. Les médecins et les dermatologues doivent être attentifs et rechercher les modifications cutanées dans l'infection par le SRAS-CoV-2, car elles peuvent être des signes précurseurs du COVID-19. MOTS CLÉS: Résultats cutanés, manifestations, Peau, COVID-19, Nigéria.

Unravelling the Diagnosis - The Role of Histopathology in Mycosis Fungoides.

Mycosis fungoides is an extra-nodal indolent non-Hodgkin lymphoma of T- cell origin that is characterized by skin involvement. The course of the disease is typically slowly progressive with non-specific clinical and histopathologic features which may evade diagnosis for years. Chemo-therapeutic agents to control the disease are effective if employed early, but the prognosis and therapy is dependent on the stage of the disease at presentation. We report a case of a 25-year old man with a clinical diagnosis of Tinea incognito and histologic features of non-specific dermatitis at first presentation. With poor hospital attendance and inconsistent therapy, his clinical features and histology reports over the next couple of years were consistent with psoriasis, then mycosis fungoides. He is currently stable on chemotherapeutic agents. With different histopathology results over a three- year span, it is possible that the patient had both diseases occurring separately. It is also possible that psoriasis was a harbinger of mycosis fungoides and the change in clinical presentation which necessitated repeated biopsies eventually revealed the picture.

Pityriasis amiantacea: a case report.

Pityriasis amiantacea (PA) is a papulosquamous condition of the scalp,characterized by asbestos - like thick scales attached to the hair shaft. It is thought to represent a reaction pattern to inflammatory skin disorders like psoriasis, seborrhoeic dermatitis, tinea capitis, atopic dermatitis and lichen planus, rather than a distinctive disease. The scaling may be localised or generalised, depending on the underlying condition and its duration.This report highlights the clinical features of pityriasis amiantacea secondary to atopic dermatitis and the differential features of other papulo-squamous scalp disorders such as scalp psoriasis, seborrhoeic dermatitis and lichen planus.Scalp psoriasis and seborrhoeic dermatitis are the commonest causes of PA as well as the closest differentials hence should be excluded in all cases. The longterm sequelae of PA include scalp fibrosis and permanent hair loss hence should be identified and treated promptly. The management modalities of PA will also be discussed.

Overview of dermatophyte infections at the dermatology outpatient clinic of a tertiary institution in Nigeria.

BACKGROUND: Dermatophytes are the commonest organisms causing superficial fungal infections. Earlier epidemiologic studies in Nigeria revealed dermatophyte infection as one of the top three reasons for visiting the dermatologists. OBJECTIVE: To determine the frequency, characteristics and predisposing factors to dermatophyte infections at the dermatology outpatient clinic of the Lagos University Teaching Hospital (LUTH) from March 2003 to September 2009. METHODS: The clinic records and case notes of patients were reviewed. Patients' data which includes demographic details, characteristics of disease, predisposing factors and clinical presentation findings were entered on Excel spreadsheets and analyzed using SPSS 15. Results were displayed using frequency tables. RESULTS: Dermatophyte infections were found in 8.39% of patients attending the dermatology outpatient clinic of LUTH. Tinea pedis was the most frequently seen, occurring in 33.6% of patients; followed by tinea corporis (20%), tinea manuum (18.6%) and tinea capitis (14.8%). Dermatophyte infection was most frequently seen in the 3rd and the 4th decades of life, except tinea capitis seen predominantly in the 1st decade of life and tinea intertrigo in the 5th decade. CONCLUSION: Dermatophyte infections occur at all age groups, although frequency of occurrence differs with age group and site of the body affected.