PECULIARITIES OF PSORIASIS IN A BLACK AFRICAN COHORT: A HISTOPATHOLOGIC STUDY.

Background: Clinical and histopathologic observations have indicated that psoriasis is not rare in our population as previously thought. The initial rarity also led to paucity of studies on the disorder including histopathologic features in our practice setting. To date, there is no report on the histopathologic features of psoriasis indigenous to our practice environment. Objective: To evaluate the frequency of occurrence of the various histopathologic features of psoriasis in patients from this environment and identify any peculiarities that exist in black African patients. Methods: A cross-sectional study of patients diagnosed clinically with psoriasis at the University College Hospital, Ibadan between January 2015 and October 2016. After baseline sociodemographic data, all patients had baseline clinical examination and were offered skin biopsy after obtaining informed consent. The biopsy specimen was examined for histopathologic features of psoriasis after routine processing and staining using a pretested proforma with the frequencies of each diagnostic feature reported in percentages. Results: Forty-four patients with plaque psoriasis were analyzed. The mean age of the patients studied was 39.84 ± 20.97 years with a male to female ratio of which was almost equal. The most consistent epidermal changes in decreasing other of frequency were acanthosis, hypogranulosis, hyperkeratosis followed by elongation of rete ridges while dermal features were dermal infiltration by inflammatory cells, and dilatation of superficial dermal vessels. Munro's microabscesses were found in less than half of the patients biopsied. Some of the patients were found to have atypical changes. Conclusion: Histopathological features of psoriasis in the study is similar to what has been previously established universally but typical features such as Munro's micro abscesses and Kogoj's spongiform pustules are less frequently seen than expected. Atypical changes such as dermal melanophages and periadnexal infiltration by inflammatory cells may also be seen.

The spectrum of Malassezia species isolated from students with pityriasis vesicolor in Nigeria.

Pityriasis versicolor (PV) is a common superficial fungal infection of the skin caused by Malassezia. Initially M. furfur was suggested as its main aetiological agent; however, more recent studies suggest M. globosa as the dominant species. The possibility of a variance in predominant species based on geographical basis has not been fully evaluated. The objective of this study was to identify the Malassezia species on affected and non-affected skin of students with PV who reside in a tropical environment (Abuja, Nigeria) and correlate them to clinical characteristics. In this study, the literature on prevalence of Malassezia genus in PV was also reviewed. Samples were taken from 304 PV lesions and 110 normal appearing skin. Microscopy, culture and identification of Malassezia species utilising polymerase chain reaction-restriction fragment length polymorphism analysis were performed. Three Malassezia species were detected in PV with the major species being M. furfur. On normal appearing skin, M. furfur (77.6%) and M. restricta (10.4%) were both detected. No case of M. globosa was identified in this study. There was no significant difference between species identified and clinical features of PV. M. furfur is probably still the most predominant species causing PV in the tropical environment.

Prevalence of dermatological lesions in hospitalized children at the University College Hospital, Ibadan, Nigeria.

OBJECTIVE: Skin disorders constitute a significant proportion of consultations in children's clinics; however, there is a paucity of data on the prevalence of dermatological lesions in hospitalized children in Nigeria. This study determines the prevalence of dermatological lesions in hospitalized children. MATERIALS AND METHODS: In this cross-sectional study, 402 children aged three months to twelve years admitted in the Pediatric wards of the University College Hospital, Ibadan, were enrolled over a six-month period. Examination of the skin and its appendages was done for each patient. Data on the socioeconomic status, hygiene, and health-related factors were also obtained using a structured questionnaire. RESULTS: Over 96% of the children had at least one identifiable skin lesion. The five leading skin lesions were post-inflammatory hyperpigmentation (49.5%), BCG scar (28.4%), Mongolian spots (27.1%), junctional melanocytic nevi (20.1%), and cafι-au-lait macules (18.4%). The leading infectious skin disease was pyoderma (13.4%), followed by tinea capitis (6.7%). Scarification marks (P=0.001), tinea capitis (P=0.014), plantar fissuring (P=0.001), and impetigo (P=0.016) were associated with low socioeconomic classes, while the presence of BCG scar (50.0%) was associated with the high socioeconomic class. CONCLUSIONS: This study shows that dermatologic lesions are common in hospitalized children. Identifying them will provide an opportunity for pediatricians to educate parents on the various causes as well as prevention of lesions.

The comparison of intelligence quotients of atopic and nonatopic children in ibadan, Nigeria.

BACKGROUND: Atopy-related illnesses such as atopic dermatitis and asthma are chronic illnesses, and children suffering from such illnesses are subjected to frequent absenteeism from school. Studies have shown that the performance of children with asthma was comparable to their healthy counterparts despite their absenteeism at school, in contrast to findings in other chronic illnesses like epilepsy. AIM: In the present study, we investigated the association between atopy and intelligence quotient (IQ) scores in a group of Nigerian children in Ibadan, a city in southwestern Nigeria. MATERIALS AND METHODS: This is a cross-sectional study of children in an urban elementary school. Questionnaires to ascertain the presence of atopy-associated conditions such as hay fever, atopic dermatitis, asthma, allergic rhinitis, and allergic conjunctivitis were administered to the parents of 128 pupils in the 3(rd) to 6(th) grades of elementary school. Based on the responses to the questionnaire, pupils were categorized as being atopic and nonatopic. All the pupils underwent the Standard Progressive Matrices IQ test. The IQ scores were then compared among these two groups of children. RESULTS: Out of the children studied, 26.6% were found to have atopy and after adjusting for factors such as age and sex, the IQ scores in this atopic group were not found to be statistically different from the scores in the nonatopic group (r = 2.122872, P = 0.009). CONCLUSION: IQ scores were not statistically significantly different for children with and without atopy. Thus, the presence of atopy does not appear to be associated with low IQ scores and hence, may not be related to poor school performance.

Diagnostic and treatment difficulties in systemic lupus erythematosus coexisting with sickle cell disease.

BACKGROUND: Patients with Sickle cell disease present with a wide range of symptoms and signs which overlap with other chronic illnesses. This often leads to a delay in diagnoses of the associated disorder. OBJECTIVE: In view of the high prevalence of SCD in our environment, it is important to know that this association can occur and should be considered when patients present with pyrexia, arthritis, seizures and a recurrent rash. CASE REPORT: We present an 8-year-old boy with sickle cell disease who presented with recurrent fever, back pains, and 'cutaneous eruptions' to multiple drugs. He had several admissions within two years due to above symptoms. Examination at the onset of the illness revealed a young boy with fever, no jaundice, and periorbital oedema and generalized lymphadenopathy. He had scanty fluffy hair and post inflammatory hyper pigmentation on the trunk and extremities. He also had a hepatomegaly. He was started on Ibuprofen and ceftraixone to which he reacted. He had corticosteroids and antimalarials and improved. During the 2-year-follow up period he was admitted for recurrent seizures, arthritis and a leg ulcer. On last visit to hospital, he developed a malar rash. Discoid rash with mouth ulcers. A diagnosis of SLE was made in the patient. CONCLUSION: There are only 23 reported cases of SLE occurring in patients with sickle cell disease in literature, suggesting that the association is rare, it should be considered in patients with sickle cell disease presenting with pyrexia, rash and seizures.

Nevus sebaceous syndrome with facial hemihypertrophy.

Nevus sebaceous syndrome is a member of the epidermal nevus syndromes group, and is characterized by extensive nevus sebaceous, seizures, and mental retardation. We present an affected 5-month-old boy who had facial hemi-hypertrophy and recurrent seizures.

Pityriasis versicolor: Current concepts in Aetiology and Management.

UNLABELLED: Pityriasis versicolor occurs commonly in this environment. It is characterised by fine scaly macular eruption and has a chronic relapsing nature. It is due to infection with malassezia. Recently with the aid of sequencing of the sub-unit rRNA and nuclear DNA complimentary studies, the malassezia species have been classified into seven. Malassezia (M) furfur, M. Symboidalis, M. Obtuse, M. globosa, M. restricta, M. sloofiae and M. pachydermatitis. M. globosa has been linked to development of pityriasis versicolor. Despite extensive work, factors which change the organism from its commensally to its pathogenic state are yet to be identified, although a genetic factor appears to be involved as familial cases occur. However factors such as hyper-hidrosis, depressed immunity, and occlusion of the skin, malnutrition and abuse of corticosteroids have been observed to be contributory. For many years topical therapy was the main stay of treatment that contributed to the high relapse after treatment. Presently management includes the use of both systemic and topical anti-fungals. Prophylactic treatment is now advocated in preventing relapses, which occurs commonly. KEYWORDS: pityriasis versicolor, current views, aetiology, management.

Prevalence of skin disorders in school children in Ibadan, Nigeria.

Although skin diseases are common in children, there are very few population-based studies in West Africa. Recently, there has been considerable emphasis on hygiene and socio-economic impact on the incidence of allergic disorders in children. We determined the prevalence of skin diseases in a public primary school in Ibadan (southwest Nigeria). A questionnaire for assessing factors associated with the prevalence of diseases was completed, and a complete physical examination was carried out on 1066 students. The study included 529 (49.6%) boys and 537 (50.4%) girls with a mean age of 8.8 +/- 2.5 years. The mean family size of the subjects was 6.7 +/- 2.3 while the mean number of rooms in their homes was 2.6 +/- 1.45. Infectious dermatosis was commonly observed. Of 375 children with a skin lesion, 162 (15.2%) had dermatophytosis, most often tinea capitis, 50 (4.7%) had pityriasis versicolor, and 50 (4.7%) had scabies. Other dermatoses observed included papular urticaria in 35 (3.3%) and angular cheilitis in 27 (2.5%) children. One or more melanocytic nevi were found in 40 (3.8%) children while 138 (12.9%) and 77 (7.25%) had tribal and scarification marks, respectively. Atopic eczema and viral warts were virtually absent. We concluded that fungal infections and scabies were the most common skin diseases in our study population, whereas allergic illnesses were nearly absent.

Hepatitis B virus in Nigerians with lichen planus.

BACKGROUND: [corrected] Lichen planus had been reported as one of the cutaneous manifestations of Hepatitis B virus (HBV) in the literature. The prevalence of HBV among Nigerians with lichen planus has not been documented in the literature despite the high prevalence of HBV in the community, and the reports of a possible relationship between lichen planus and HBV from this centre and from other regions. The aim of this study was to determine the prevalence of HBsAg amongst Nigerians with lichen planus. METHOD: Sixty Nigerians with lichen planus (LP group) and 30 patients with other dermatoses not reportedly associated with HBV (control group A) and 30 apparently normal subjects (control group B) were screened for the presence of HBsAg by second generation ELISA. RESULTS: Nine (15%) of the 60 LP group, 2 (6.2%) of the 30 control group A and 2 (6.2%) of the 30 control group B were HBsAg seropositive. CONCLUSION: This study found a higher prevalence of HBsAg in patients with lichen planus when compared with patients with other cutaneous dermatoses and apparently normal individuals. Although a causal relationship between HBV has not been established from this study, this report reiterates the importance of screening patients with lichen planus for the presence of HBV and instituting therapy in those found positive.

Focal dermal hypoplasia: a case report and review of literature.

A 14 year old girl was seen in the clinic with a huge vulvar wart, and warts on both tonsils. She also had poikiloderma. She had bony abnormalities, which included lobster claw abnormality of the right foot, a right cervical rib, and the right clavicle was lower than the left. There were fine parallel vertical radio-opaque lines in the distal femoral tibial metaphyses bilaterally (osteopathia striata). A diagnosis of Focal dermal hypoplasia was made. The huge vulvar wart and the warts on the tonsils were excised. She recovered promptly and she was discharged home.

Leukaemia cutis in a patient with acute myelogenous leukaemia: case report.

Leukaemia cutis is a specific lesion of leukaemia in which there is leukaemic cell deposit in the skin. There are few reports of this condition in our environment. Several mechanisms have been postulated for the pathogenesis of the disease. One of which is the tissue selective homing of a unique sub-population of malignant clone of cells. The presence of leukaemia cutis does not seem to worsen the prognosis as the acute myeloid leukaemia is an equally lethal disease. The fatality of the disease is compounded by the unavailability of the right regimen in our patient. This paper documents a case of leukaemia cutis in a patient initially diagnosed to have AML who developed skin lesion in remission. A skin biopsy was found helpful in diagnosing the first sign of relapse in a patient in haematological remission.

Hepatitis C virus and lichen planus in Nigerians: any relationship?

BACKGROUND: The association of lichen planus with Hepatitis C virus (HCV) has been widely reported in the literature. No such association, however, has been reported amongst black Africans in whom HCV is thought to be endemic. Lichen planus is a frequently encountered dermatosis in this racial group as well. The aim of this study was to determine the prevalence of anti-HCV amongst Nigerians with lichen planus. METHODS: Fifty-seven Nigerians with lichen planus (LP group) and 24 patients with other dermatoses not reportedly associated with HCV (control group A) and 24 apparently normal subjects (control group B) were screened for the presence of anti-HCV by second generation ELISA. RESULTS: Nine (15.8%) of the 57 LP group, 6 (25%) of the 24 control group A and none out of the 24 control group B were seropositive for anti-HCV. CONCLUSION: The prevalence of anti-HCV amongst Nigerian with lichen planus is lower than amongst patients with other dermatoses not associated with HCV but higher than amongst apparently normal control. It would appear that the prevalence of HCV is high in Nigeria and not necessarily in lichen planus as a specific entity.

Lichen planus following hepatitis B vaccination in an African girl.

Lichen planus is a papulosquamous disorder with distinctive clinical features. Until now the aetiology has been largely unknown, however, several postulations have been proposed. The immunopathogenic basis has been most favoured. We report a case of a 13-year-old girl who presented with Lichen planus after receiving the second dose of hepatitis B virus (HBV) vaccination. This report, similar to earlier reports, appears to support the immunopathogenic basis of Lichen planus.

Antiphospholipid antibody syndrome: two case reports and review of literature.

Antiphospholipid antibody syndrome (APAs) is an acquired multisystemic disorder characterised by hyper coagulation. It manifest clinically with arterial and venous thrombosis. It is not a rare phenomenon, but there are paucity of reports of this disorder in our environment. We present two cases of APAs with the hope that it will stimulate the awareness of clinicians in the recognition of this disorder in our environment.

Congenital poikiloderma with unusual hypopigmentation and acral blistering at birth.

Congenital poikiloderma is an uncommon hereditary disorder. It has been reported in association with various syndrome. No case has previously been reported from this environment. We report a case of congenital poikiloderma in a two and a half year old female Nigerian associated with unusual generalised hypopigmentation and acral blisters at birth. The child subsequently developed macular hyperpigmentation on an erythematous background and atrophy of the skin. Although she had some features which were suggestive of Rothmund-Thomson syndrome (RTS), the presence of hypopigmentation at birth, along with acral blistering, was noted to be peculiar to this child. We, therefore, feel that this case presents a distinct variant of congenital poikiloderma that has not been described previously.

Highlights of extranodal lymphomas in Ibadan, Nigeria.

OBJECTIVE: To find out the pattern, trend and site distribution of extranodal lymphomas in Ibadan. DESIGN: Case series. SETTING: Department of Pathology, University College Hospital. SUBJECTS: All cases of malignant lymphomas with extranodal manifestations between 1981 and 1998. MAIN OUTCOME MEASURES: Frequency and distribution of primary extranodal lymphomas. RESULTS: Extranodal lymphomas constituted 9.8% of non-Hodgkin's lymphomas(NHLs) during the period, increasing from 8.5% of NHLs from 1980 to 1990 to 12.4% from 1991 to 1998. During the entire 18 year period the nasal/nasopharynx, gastro-intestinal tract (GIT), tonsils and skin were the most commonly affected sites constituting 20.2%, 19.3%, 14.3% and 13.4%, respectively of all extranodal lymphomas. However, between 1980 and 1991 the GIT was the most commonly affected site (26.1%) followed by the nasal/nasopharyngeal region (11.6%). The involvement of the nasopharyngeal area during the second period of the study accounted for 32.0%. CONCLUSION: The reasons for this changing trend are unknown and the significance of HIV infection in this regard is uncertain.

The plantar reflex in young healthy adults.

The plantar reflex was empirically observed to be relatively absent in Africans about three decades ago. It was hypothesised that barefoot walking that was the custom of the patients studied at the time, might have made the soles of the feet insensitive to stimulation. In a sample of 193 young adults who do not walk barefoot and had no clinical evidence of hyperkeratosis or callosities on the soles, the plantar reflex was absent in 27%. This finding suggests that the absence of the reflex is not necessarily consequent on previous trauma to the soles in an African community. Lack of comparative data showing the pattern of the plantar reflex in different communities makes it difficult to judge whether the frequency found in this study is usual, high or relatively low.