Psychodermatological Disorders in Patients With Primary Psychiatric Conditions: Cross-Sectional Study.

BACKGROUND: Psychodermatological disorders (PDs) and their associations with mental health problems are one of the most frequent research themes in dermatology outpatient settings. Surprisingly, very few studies have been conducted to evaluate PDs among patients with primary psychiatric conditions. As such, the relationship between preexisting psychiatric conditions and comorbid PDs is underrepresented in the literature. OBJECTIVE: This study examined the prevalence and distribution of PDs among adults with primary psychiatric conditions and determined their association with underlying psychiatric diagnoses. METHODS: We conducted a cross-sectional analysis at a tertiary health care facility in southwestern Nigeria. Comorbid PDs were identified and classified using preexisting classification systems. A bivariate analysis was conducted to determine the association between PDs and underlying psychiatric conditions. The level of statistical significance was set at P<.05. RESULTS: The study included 107 patients with mental health disorders, of whom 64 (59.8%) were female. The mean age of the patients was 40.73 (SD 13.08) years. A total of 75 (75/107, 70%) patients had at least one comorbid PD. The prevalence of PDs was highest in patients with affective disorders (15/20, 75%) and least in those with schizophrenia (45/66, 68%). PDs associated with delusions or hallucinations and somatoform symptoms were 9 and 13 times more frequent in patients with anxiety disorders compared to those with other psychiatric conditions (P=.01; odds ratio [OR] 9.88, 95% CI 1.67-58.34 and P=.003; OR 13.13, 95% CI 2.34-73.65), respectively. In contrast, patients with schizophrenia were significantly less likely to be diagnosed with dermatoses resulting from delusions or hallucinations (P=.002; OR 0.04, 95% CI 0.00-0.75). A weak but significant negative association was also found between psychophysiological PDs and anxiety disorders (ϕ=-0.236; P=.02). CONCLUSIONS: This study provides important insights into the overwhelming burden of psychodermatological conditions in patients with mental health disorders and specific associations with underlying psychiatric diagnosis.

Body dysmorphic disorder in patients attending a dermatology clinic in Nigeria: sociodemographic and clinical correlates.

BACKGROUND: Body dysmorphic disorder is a relatively common psychiatric disorder in the context of dermatology and cosmetic and plastic surgery but is underdiagnosed and underreported in Africa. OBJECTIVE: To evaluate the prevalence of body dysmorphic disorder and symptoms of anxiety/depression and determine their sociodemographic and clinical correlates. METHODS: A systematic random sampling design was made to recruit 114 patients with skin diseases. Sociodemographic and clinical data were obtained. The Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive-Compulsive Scale, Hospital Anxiety and Depression Scale was administered, and data were analyzed using SPSS 20. RESULTS: Mean age of participants was 37.70±17.47 years, and 67/114 (58.8%) were females. Prevalence of body dysmorphic disorder was 41/114 (36.0%), and prevalence of anxiety/depression symptoms was 35/114 (30.7%). Prevalence of body dysmorphic disorder in patients with anxiety/depression symptoms was 15/41 (36.6%), and patients with facial disorders expressed the highest burden of anxiety/depression symptoms, in 15/35 (42.9%). Factors associated with significantly higher mean body dysmorphic disorder include age<50years (p=0.039), and anxiety/depression (p<0.001), education below high school was associated with higher mean anxiety/depression score (P= 0.031). In a binary logistic regression model, presence of anxiety/depression symptoms was predictive of body dysmorphic disorder (OR=10.0, CI: 4.1-28.2, p<0.001). STUDY LIMITATIONS: the study is uncontrolled, conducted in a single source of care, thus limiting generalization to nonrelated settings. CONCLUSION: Prevalence of body dysmorphic disorder is high among dermatology patients and most prevalent in facial disorders. Facial diseases are associated with the highest burden of anxiety/depression symptoms. This is a clarion call for dermatologists to routinely assess for body dysmorphic disorder and appropriately refer affected patients to mental health care.

Body dysmorphic disorder in patients attending a dermatology clinic in Nigeria: sociodemographic and clinical correlates

Abstract: Background: Body dysmorphic disorder is a relatively common psychiatric disorder in the context of dermatology and cosmetic and plastic surgery but is underdiagnosed and underreported in Africa. Objective: To evaluate the prevalence of body dysmorphic disorder and symptoms of anxiety/depression and determine their sociodemographic and clinical correlates. Methods: A systematic random sampling design was made to recruit 114 patients with skin diseases. Sociodemographic and clinical data were obtained. The Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive-Compulsive Scale, Hospital Anxiety and Depression Scale was administered, and data were analyzed using SPSS 20. Results: Mean age of participants was 37.70±17.47 years, and 67/114 (58.8%) were females. Prevalence of body dysmorphic disorder was 41/114 (36.0%), and prevalence of anxiety/depression symptoms was 35/114 (30.7%). Prevalence of body dysmorphic disorder in patients with anxiety/depression symptoms was 15/41 (36.6%), and patients with facial disorders expressed the highest burden of anxiety/depression symptoms, in 15/35 (42.9%). Factors associated with significantly higher mean body dysmorphic disorder include age<50years (p=0.039), and anxiety/depression (p<0.001), education below high school was associated with higher mean anxiety/depression score (P= 0.031). In a binary logistic regression model, presence of anxiety/depression symptoms was predictive of body dysmorphic disorder (OR=10.0, CI: 4.1-28.2, p<0.001). Study limitations: the study is uncontrolled, conducted in a single source of care, thus limiting generalization to nonrelated settings. Conclusion: Prevalence of body dysmorphic disorder is high among dermatology patients and most prevalent in facial disorders. Facial diseases are associated with the highest burden of anxiety/depression symptoms. This is a clarion call for dermatologists to routinely assess for body dysmorphic disorder and appropriately refer affected patients to mental health care.

Risk factors associated with acquiring superficial fungal infections in school children in South Western Nigeria: a comparative study.

INTRODUCTION: Superficial fungal infections (SFI) are caused mainly by dermatophytes and yeasts. SFI is of major public health concern and is a common cause of skin disease among school children. OBJECTIVES: The aim of this study was to identify the risk factors associated with acquiring superficial fungal infections in school children in Ile-Ife, South West Nigeria as this will assist in instituting appropriate interventions. METHODS: A total of 560 children; 280 with superficial fungal infections as subjects and 280 age and sex matched school children as controls were recruited through multistage sampling method from 10 primary schools (private and public owned) in Ile-Ife, Nigeria. DISCUSSION: Pupils were aged 5-16 years with a mean age of 9.42±2.00. Risk factors documented in this study included poor living conditions, use of barbers' clippers, low socio-economic status, poor hygiene, attendance of public schools and not living with both parents. The last four factors remained significant on binary logistic regression. CONCLUSION: The study shows that the risk for acquiring superficial fungal infections remains high in school children and in communities with low socio-economic positions.

Frequency, pattern, and extent of skin diseases in relation to CD4+ cell count among adults with human immunodeficiency virus infection or acquired immunodeficiency syndrome in Osogbo, southwestern Nigeria.

BACKGROUND: Skin diseases characterize all stages of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) and contribute significantly to associated morbidity and mortality. OBJECTIVES: The aim of this study was to document the prevalences, patterns, and extents (severity) of skin diseases and their relationships with immunologic status in HIV/AIDS patients. METHODS: A total of 140 HIV/AIDS patients in different stages of HIV infection and 140 controls were recruited. Skin diseases were documented and CD4+ cell counts determined in all subjects. Severity was assessed according to the body surface area affected (using the Wallace rule of nines and the rule of palm) for lesions that tended to be widespread. The number of digits involved was counted for lesions involving the nails. Intensity of pain was graded for specific conditions such as herpes zoster. Chi-squared statistics and Pearson correlations were determined. RESULTS: Mean±standard deviation age was 35.04±8.83 years in the patient group and 32.21±8.30 years in the control group. The prevalences and patterns of skin diseases in HIV/AIDS patients were similar to those reported in previous studies. Most commonly found dermatoses were oral candidiasis (n=28, 20.0%), pruritic papular eruption (n=27, 19.3%), xeroderma (n=23, 16.4%), dermatophytosis (n=22, 15.7%), and fluffy hair (n=19, 13.6%). The presence of specific skin lesions represented a better correlate with immunosuppression than cutaneous extents. However, the extents of viral warts and multiple blue­black nails correlated significantly with CD4+ cell count. The presence of a lighter hair color phenotype signifies a lower CD4+ cell count than a softer hair phenotype. CONCLUSIONS: The presence of specific skin lesions correlates more strongly with a low CD4+ cell count than does the extent of their distribution, except in cases of viral warts. The presence of and higher numbers of nails affected with blue­black nail hyperpigmentation suggest severe immunosuppression.

The Prevalence and Pattern of Superficial Fungal Infections among School Children in Ile-Ife, South-Western Nigeria.

Fungal infections of the skin and nails are common global problems with attendant morbidity among affected individuals. Children are mostly affected due to predisposing factors such as overcrowding and low socioeconomic factors. The aim of this study was to determine the prevalence and the clinical patterns of superficial fungal infections among primary school children in Ile-Ife. A multistage sampling was conducted to select eight hundred pupils from ten primary schools in Ile-Ife. Data on epidemiological characteristics and clinical history was collected using a semistructured questionnaire and skin scrapings were done. The prevalence of superficial fungal infections among the 800 respondents was 35.0%. Male pupils constituted 51.0% of respondents while the females were 49.0%. The mean age for all the respondents was 9.42 ± 2.00. Tinea capitis was the commonest infection with a prevalence of 26.9% and tinea unguium, tinea corporis, and tinea faciei had a prevalence of 0.8%, 0.6%, and 0.5%, respectively. Tinea manuum had the least prevalence of 0.1%. Pityriasis versicolor had a prevalence of 4.4%. Microsporum audouinii was the leading organism isolated. The study shows that the prevalence of superficial fungal infection (SFI) among primary school children in Ile-Ife is high with tinea capitis as the commonest SFI.

The impacts of first line highly active antiretroviral therapy on serum selenium, CD4 count and body mass index: a cross sectional and short prospective study.

INTRODUCTION: The relationship that exists between body weights, serum selenium and immunological markers of HIV/AIDS continue to provoke more researches in the recent times. The objectives of this study were to examine baseline body mass index, CD4 count and serum selenium and to prospectively assess the impacts of HAART on same parameters 48 weeks post HAART among HIV patients. METHODS: A cohort comprising 140 newly diagnosed HIV positive were prospectively studied. Anthropometric measurements, serum selenium and CD4 count were assessed at diagnosis and 48 weeks post HAART. RESULTS: The mean age for patients was 35±8.8 years; 68% was female. Patients' mean weight was 56.79±10.22kg, BMI; 21.59±3.53, serum selenium; 0.55 ± 0.45µmol/L and CD4 count; 288.36 ± 232.23 at the baseline. At diagnosis, 47 (33.6%) were in stage 1, 49 (35.0%) in stage 2, 26 (18.6%) and 18 (12.9%) were in stage 3 and 4 respectively. Similarly, most patients had normal body mass index, 94 (67.14%), 26 (18.57%) were underweight, (12.86%) were overweight and two (1.43%) were obese at diagnosis. At 48 weeks post HAART, the mean weight, BMI, serum selenium and CD4 count were significantly increased. CONCLUSION: HAART repleted CD4 count and serum selenium, Post HAART overweight was associated with lesser CD4 count reconstitution and selenium repletion. A renew call for weight monitoring in HAART era.

Serum selenium and skin diseases among Nigerians with human immunodeficiency virus/acquired immune deficiency syndrome.

BACKGROUND: The role of selenium as an antioxidant micronutrient has garnered the unprecedented focus of researchers in recent times. No clinical study has related serum selenium concentration to skin diseases in human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. METHODS: In this study, 134 newly diagnosed HIV patients that satisfied the inclusion criteria were included. Skin diseases were clinically diagnosed and fasting venous blood was taken for assessment of serum selenium using an atomic absorption spectrophotometer. RESULTS: THE MEAN AGE OF HIV SUBJECTS WITH AND WITHOUT SKIN DISEASE WERE NOT SIGNIFICANTLY DIFFERENT: 32.72 ± 9.21 versus 35.86 ± 8.55 years, P = 0.077, respectively. The mean of serum selenium (0.51 ± 0.48 versus 0.81 ± 0.39), CD4+ count (228.06 ± 212.89 versus 446.41 ± 182.87), and body mass index (BMI; 21.09 ± 3.58 versus 23.53 ± 3.35) were significantly lower (P < 0.001) for HIV/AIDS participants with skin disease than those without skin disease. We found significant clustering of symptoms and signs: fever (P = 0.037), weight loss (P = 0.009), oral candidiasis (P = 0.038), pallor (P = 0.037) among HIV/AIDS subjects with skin diseases than those without. Low serum selenium concentration was significantly associated with primary skin disease of HIV/AIDS, such as pruritic papular eruption of AIDS (P = 0.003), xeroderma (P = 0.030), fluffy hair (P = 0.021), blue-black nail hyperpigmentation (P = 0.033) and secondary skin disease, such as oral candidiasis (P = 0.002). There was a significant association between low serum selenium concentration and increasing frequency of skin diseases (P = 0.002), but serum selenium was not significantly related to extents of distribution of skin diseases (P > 0.05). CONCLUSION: serum selenium concentration was lower among HIV subjects with skin diseases than those without skin disease. Pruritic papular eruption, xeroderma, fluffy hair, blue-black nail hyper pigmentation, and oral candidiasis were significantly associated with low serum selenium concentration.

Health-related quality of life and physical functioning in people living with HIV/AIDS: a case-control design.

BACKGROUND: Health-Related Quality of Life (HRQoL) and functional exercise capacity are important area of therapeutic interventions needed to improve the general health of People Living with HIV/AIDS (PLWH). However, the relationship between self-report and Performance-based Measure of Functional Capacity (PMFC) of PLWH is still obscure. This study compared the HRQoL and PMFC between a homogenous sample of clinical stage I PLWH and apparently healthy controls. METHODS: This case-control study involved 74 consenting participants (37 PLWH and 37 controls) who completed the self-report SF-12 questionnaire and PMFC assessment using Six Minute Walk Test (6MWT). PMFC was expressed in terms of Six-Minute Walk Distance (6MWD), Six-Minute Walk Work (6MWW) and Maximum oxygen uptake (VO2max). Data were analyzed using descriptive statistics of mean and inferential statistics of independent t-test, ANOVA and Pearson's product moment correlation. Alpha level was set at 0.05. RESULTS: There was no significant difference in the SF-12 Physical-health Component Score (PCS) of PLWH and the controls (p=0.782). However, the SF-12 Mental-health Component Score (MCS) of PLWH was higher than that of controls (p=0.040). 6MWD, 6MWW and VO2max were significantly lower for PLWH (p<0.05). Among PLWH, there was no significant gender differences in the PMFC (p>0.05) while PCS was higher among females. There was no significant correlation between PMFC variables and each of PCS and MCS for PLWH and controls (p>0.05) respectively. CONCLUSION: Self-report physical health of clinical stage 1 PLWH and controls was comparable, while self-report mental health capacity was higher in PLWH than the controls. PMFC of PLWH was significantly lower compared to healthy controls without gender bias. Overall, self-report and performance-based measure of physical functional capacity of PLWH was not inter-related. Therefore understanding the factors that may influence exercise capacity of PLWH may help to develop effective exercise programmes for PLWH.

Iron status in HIV-1 infection: implications in disease pathology.

BACKGROUND: There had been conflicting reports with levels of markers of iron metabolism in HIV infection. This study was therefore aimed at investigating iron status and its possible mediation of severity of HIV- 1 infection and pathogenesis. METHOD: Eighty (80) anti-retroviral naive HIV-1 positive and 50 sero-negative controls were recruited for the study. Concentrations of serum total iron, transferrin, total iron binding capacity (TIBC), CD4+ T -lymphocytes, vitamin C, zinc, selenium and transferrin saturation were estimated. RESULTS: The mean CD4+ T-lymphocyte cell counts, serum iron, TIBC, transferrin saturation for the tests and controls were 319 ± 22, 952 ± 57 cells/µl (P < 0.001), 35 ± 0.8, 11.8 ± 0.9 µmol/l (P < 0.001), 58.5 ± 2.2, 45.2 ± 2.4 µmol/l (P < 0.005) and 68.8 ± 3.3, 27.7 ± 2.2%, (P <0.001), respectively, while mean concentrations of vitamin C, zinc and selenium were 0.03 ± 0.01, 0.3 ± 0.04 (P < 0.001), 0.6 ± 0.05, 11.9 ± 0.26 µmol/l (P < 0.001) and 0.1 ± 0.01, 1.2 ± 0.12 µmol/l (P < 0.001) respectively. Furthermore, CD4+ T-lymphocyte cell count had a positive correlation with levels of vitamin C (r = 0.497, P < 0.001), zinc (r = 0.737, P < 0.001), selenium (r = 0.639, P < 0.001) and a negative correlation with serum iron levels (r = -0.572, P < 0.001). CONCLUSION: It could be inferred that derangement in iron metabolism, in addition to oxidative stress, might have contributed to the depletion of CD4+ T cell population in our subjects and this may result in poor prognosis of the disease.

Skin infections and infestations in prison inmates.

BACKGROUND: Skin infections and infestations are common in a prison environment. The prison is in dynamic equilibrium with the larger society. Hence, it serves as a reservoir of infections which can spread to the larger society. The study sets out to find out how rampant these infections might be in the prison and the factors responsible. MATERIALS AND METHODS: Inmates at a Nigerian prison in Ilesha, Osun State, were examined for skin infections. Personal hygiene and living conditions were critically examined. RESULTS: The overall prevalent rate of infectious dermatoses was 49.2% (150/305). There were 178 infections. Dermatophytes accounted for 64%, pityriasis versicolor 27%, bacterial infections 3.4%, and others 5.6%. Only frequency of soap use and accommodation arrangement significantly contributed to the overall prevalence. However, infectious dermatoses were significantly affected by prison status (PP = 0.04), frequency of bath (PP = 0.025), changing of clothing (PP = 0.05), accommodation arrangement (P = 0.0001), frequency of soap usage (P = 0.005), and toilet facility (P = 0.001). The HIV status of the inmates was unknown. Hence, effect of HIV infection cannot be ascertained. CONCLUSION: Skin infections and infestations are common in prison. A change in living conditions and personal hygiene will definitely help in reducing these infections.

Prevalence of different skin conditions in an outpatients' setting in north-western Nigeria.

BACKGROUND: Information on skin diseases in north-western Nigeria is scanty. We therefore conducted a prospective survey of 2611 new patients seen between August 1999 and July 2001 at the consultant medical/dermatology clinics of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. METHODS: The personal bio-data of all consecutive patients with skin diseases were documented. They were examined and the diagnoses, which were based on the history of presentation and physical examination, were recorded. Bacteriologic, mycologic, and histologic confirmations were obtained as appropriate. RESULTS: Seven hundred and forty-six patients (28.6%) had skin diseases. There were 407 male and 339 female patients aged between 0.17 and 90 years; the median age was 27 years. The median ages for male and female patients were 28 and 25 years, respectively. There were 900 skin diseases seen in the 746 patients. The majority of skin diseases were found amongst the younger age group, which represented over 85% of the patients. Infectious and parasitic skin diseases accounted for 44.4% of cases; eczema, acne, papulosquamous, and pigmentary skin disorders were observed in 14.1%, 7.0%, 6.4%, and 6.0% of cases, respectively. CONCLUSIONS: Preventable skin diseases are common in north-western Nigeria and predominantly affect individuals in the highly productive age group. Health education is therefore necessary to curb their spread, reduce the associated morbidity, and improve the health status of the population. A concerted effort should be made to train health workers in the diagnosis and treatment of the more common dermatologic conditions.