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.

Severe bullous systemic lupus erythematosus successfully treated with low dose rituximab: a case report from sub-Saharan Africa.

Bullous systemic lupus erythematosus (BSLE) is a blistering skin condition occurring in lupus patients. Although cutaneous manifestations are common in lupus (59-85%), BSLE is rare, affecting <5% of lupus patients with very few reported cases among Africans. Dapsone is effective in mild to moderate cases, but off-label standard-dose rituximab (1,000 mg 2 weeks apart) has led to good outcomes in refractory cases. We report the case of a 39-yearold African lady with BSLE, who was successfully treated with low-dose rituximab (500 mg 2 weeks apart), healing her skin lesions at one year post-treatment. Low-dose rituximab may be as effective as standard dosing for the treatment of severe bullous SLE and is recommended in low resource settings.

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.