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Epidemiology International Journal Research Article 7 min read

Pattern of Skin Diseases in Ebonyi State University Teaching Hospital

Okoh NU*, Nnaji TO and Okoro AN
* Corresponding author
ISSN: 2639-2038  10.23880/eij-16000106  Received: May 17, 2018  Published: June 27, 2018
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Keywords
Epidemiology Africa Diagnosis Skin
Abstract

We report the pattern of skin diseases seen in the dermatology clinic of the Ebonyi State University Teaching Hospital, Abakaliki from November 1998 to December 2012. Four thousand and six (4006) new patients were seen during the study period. There were more females than males with a female/male ratio of 1.42:1. Infectious diseases accounted for 30.8% of all the skin disorders. This is consistent with early studies carried out in Nigeria and some other parts of Africa. Other top ranking skin diseases observed in decreasing order of frequencies include eczematous disorders (27.7%), urticaria/pruritus (7.7%), pilosebaceous disorders (5.4%), pigmentary disorders (5.1%) and papulosquamous disorders (5.0%). HIV related skin diseases accounted for 2.7% of disorders seen. The current pattern of diseases observed seemed to follow similar pattern observed in earlier studies and in contrast to recent studies. Infectious disorders ranked highest with eczematous disorders closely following

Introduction

Skin diseases are important and are a common cause of ill health in Africa [1]. In Africa, poor nutrition, inadequate portable water supply and poor environmental sanitation all add to the burden of disease [2]. The distribution of skin diseases varies from one country to another and between regions in the same country. There are various reports on the pattern of skin diseases in different areas of Nigeria with some Teaching Hospital observed differences [3, 4, 5, 6, 7]. With this study, we hope to identify the common skin disorders in our environment as this will assist in proper planning and management of these disorders.

Materials and Methods

This is a retrospective review of skin diseases in new patients presenting to the skin clinic of the Ebonyi State University Teaching Hospital in Abakaliki, Ebonyi state in South Eastern Nigeria between November 1998 and December 2012. Data was compared with findings from other geo-political zones. Ebonyi state was created in 1996 from old Abakaliki division of Enugu state and old Afikpo division of Abia state. It has a land mass of 5935 km2 sharing boundaries with Enugu on the West, Cross River in the East, Abia in the South-East and Benue in the North. The state has 13 local government areas (LGAs). It has an estimated population of 4.3 million. About 75% of the population are rural dwellers with farming as the predominant occupation [8]. The hospital, being a tertiary hospital receives referral from all hospitals in the state and neighbouring states. The patients age, gender and skin disease diagnosis were extracted from the medical records. The diagnosis in most instances was clinical and supplemented in few cases by histology. Other tests done were skin scraping for mycology tests, skin snip for microfilaria and slit skin smear for M.leprae. The Statistical Package for Social Sciences (SPSS) version 16 was used for data entry and analysis.

Ethical Considerations

This study was carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki).

Results

Four thousand and six (4006) new patients attended the skin clinic within the review period. Pure dermatological consultations accounted for 76.9% (3080) of the patients, while HIV and HIV related skin diseases accounted for 23.1% (926) of the patients. About 95(3.1%) had more than one dermatological diagnosis. There were more females 2353(58.7%) than males 1653(41.3%), with a female/male ratio of 1.42:1. Nine hundred and fifty nine (23.9%) were less than 16 years while 3047(76.1%) were more than 16 years. The ages of the patients ranged from 1 week to 90 years. The mean ± S.D of age was 27.65±13.96 years. Figure 1 below shows the age and sex distribution of all the new patients seen over this time frame, 1998- 2012.

Figure 1: Age and Sex Distribution of the Patients.
Click to enlarge
Figure 1: Age and Sex Distribution of the Patients.
Skin diseasesFrequency%
Infections/infestations98030.8
Dermatitis88327.7
Urticaria/pruritus2457.7
Pilosebaceous disorders1735.4
Pigmentary disorders1625.1
Papulosquamous disorders1605.0
Adverse drug reaction993.1
Disorders of keratinization993.1
HIV related skin diseases852.7
Fibrous tumours of the skin762.4
Neurocutaneous disorders321.0
Hair disorders311.0
Connective tissue disease190.6
Benign neoplastic disorders170.5
Bullous disorders170.5
Cutaneous malignancies130.4

Table 1: Main Disease Groups.

Lymphoedema120.4
Psychiatric disorders60.2
Miscellaneous772.4
Total3186100

Table 2: Main Disease Groups.

Infections/
Frequency%Group%Total
infestations
Fungal46046.914.4
Bacterial28829.49.0
Viral13413.74.2
Parasitic98103.1
Total98010030.8

Table 3: Infective Disorders.

Frequency%Group%Total
Dermatitis
Nonspecific-chronic dermatitis41947.413.1
Atopic dermatitis12714.44.0
Seborrheic dermatitis11112.63.5
Allergic contact dermatitis809.12.5
Lichen simplex chronicus/prurigonodularis495.51.5
Pompholyx293.20.9
Nummular dermatitis283.20.9
Exfoliative dermatitis232.60.7
Stasis dermatitis50.60.2
Breast eczema50.60.2
Photodermatitis40.40.1
Irritant contact dermatitis30.30.09
Group total88310027.7
Hidradenitis suppurativa21.150.05
Steatocystoma multiplex21.150.05
Group total1731005.4
Pigmentary disorders
Vitiligo9961.13.1
Albinism159.30.5
Postinflammatory hyperpigmentation159.30.5
Hypermelanosis148.60.4
Postinflammatory hypopigmentation95.60.3
Pellagra63.70.2
Idiopathic guttatehypomelanosis21.20.06
Chloasma10.60.03
Freckles10.60.03
Group total1621005.10
Papulosquamous disorders
Pityriasis rosea7546.92.4
Lichen planus5031.31.6
Psoriasis1911.90.6
Lichen nitidus53.10.12
Lichen striatus53.10.12
PLEVC42.50.1
Pityriasis rubra pilaris10.60.03

Table 4: Is the breakdown of the specific conditions.

PLEVA10.60.03
Group total1601005.0
Viral Infections
Viral warts4835.81.5
Herpes simplex2619.40.8
Herpes zoster2518.70.8
Molluscum contagiosum1611.90.5
Varicella118.20.4
Viral exanthem75.20.2
Miscellaneous10.80.03
Group total1341004.2
Adverse drug eruption
FDE7474.72.3
Nonspecific eruption1515.30.5
Acneiform eruption33.00.09
SJS22.00.05
Hypopigmentation22.00.05
Striae11.00.03
Hyperpigmentation11.00.03
Mazzoti reaction11.00.03
Group total991003.1
Disorders of keratinization
Follicular hyperkeratosis5252.51.6
Phrynoderma3131.31.0
Callosities/corns88.10.3
Ichthyosis77.10.2
Tylosis11.00.03
Group total991003.1
Parasitic infestations
Onchodermatitis49501.5
Scabies3939.91.2
Cutaneous leishmaniasis22.00.05
Tumbu fly11.00.03
Cutaneous larva migrans11.00.03
Others66.10.2
Group total981003.1
Nail disorders
Acute paronychia11.10.03
Chronic/candida paronychia2629.60.82
Tinea unguium/Onychomycosis6169.31.9
Group total881002.8
HIV related skin diseases
Papular pruritic eruption1821.20.6
Herpes zoster1618.80.5
Kaposi sarcoma1112.90.4
Bacterial infections1011.80.3
Dermatophytes78.20.2
Seborrheic dermatitis78.20.2
Chronic paronychia44.70.12
Herpes simplex33.50.09
Viral warts33.50.09
Pruritus22.40.05
Scabies22.40.05
Varicella11.20.03
Drug eruption11.20.03
Group total851002.7
Fibrous tumours of skin
Keloids4356.61.4
Naevus1621.10.5
Actinic keratosis67.90.2
Dermoid cyst45.30.12
Pyogenic granuloma33.90.09
Hypertrophic scars22.60.05
Sebaceous cyst22.60.05
Group total761002.4
Neurocutaneous disorders
Neurofibromatosis321001.0
Group total321001.0
Hair disorders
Alopecia areata2064.50.63
Acne keloidalisnuchae412.90.12
Alopecia412.90.12
Scarring alopecia39.70.09
Group total311001.0
Connective tissue diseases
DLE1263.20.4
Scleroderma421.00.12
Mixed connective tissue disease315.80.09
Group total191000.6
Benign neoplastic disorders
Dermatosispapulosanigra1588.20.47
Syringoma211.80.05
Group total171000.5
Bullous disorders
Erythema multiforme952.90.3
Dermatitis herpetiformis423.50.12
Pemphigus vulgaris317.60.09
Pemphigus foliaceus15.90.03
Group total171000.5
Cutaneous Malignancies
Endemic Kaposi sarcoma430.80.12
SCC430.80.12
BCC215.40.05
Malignant melanoma215.40.05
Basal cell epithelioma17.70.03
Group total131000.4
Lymphoedema
Lymphoedema121000.4
Group total121000.4
Psychiatric disorders
Trichotillomania233.30.05
Formication233.30.05
Dermatitis artefacta116.70.03
Venerophobia116.70.03
Group total61000.2
Miscellaneous771002.4

Table 5: Is the breakdown of the specific conditions.

Miscellaneous skin disorders:Frequency
Xanthelasma palpebrarum8
Haemangioma8
Miliaria6
Granuloma telangiectasia6
Post bleaching syndrome6
Striae distensae5
Granuloma annulare5
Panniculitis3
Erythema nodosum3
Xanthoma2
Hyperhidrosis2
Calcinosis cutis2
Dercums disease2
Cheilitis2
Postherpetic neuralgia2
Xeroderma2
Abrasions1
Atrophoderma1
Elastosis1
Morphoea1
Leg ulcer1
Lipodystrophy1
Lipomata1
Pagets disease1
Pearly penile papules1
Port wine stain1
Purpura1
Reiters syndrome1
Wound dehiscence1
Total77

Table 6: Miscellaneous Skin Disorders.

Discussion

We discovered that when considered together, infections and infestations were the commonest dermatoses (30.8%) in this study. The study in Ghana by Doe et al in 2000 also noted a high prevalence of infections (46.3%) [9] similar to findings by Husain, Atraide, Fekete and Onayemi [5, 6, 10, 11]. However recent studies by Ogunbiyi, Ukonu et al recorded a higher prevalence of eczematous disorders [3, 7]. The higher prevalence of infectious disorders may be due to poor environmental hygiene occurring among predominantly rural dwellers with low socio-economic status and low level of education as seen among our patients. Fungal skin disorders were the commonest form of infective skin disorder (46.9% of all infective causes and 14.4% of the total). Eczematous disorders ranked second in this study, with non-specific chronic dermatitis being the commonest in this group (47.1%) followed closely by atopic dermatitis (14.4%) and seborrheic dermatitis (12.6%). Chronic dermatitis seen in our patients may have arisen from the effect of treatment which modified the appearance of these dermatoses. In a prospective study by Ukonu, et al., in Benin, they recorded a prevalence of 15.3% for non–specific chronic dermatitis while contact dermatitis ranked highest for eczematous disorders (35.4%) [7]. The study in Port Harcourt recorded atopic dermatitis as the commonest form of eczematous disorders [6]. There was also an increase in the prevalence of contact dermatitis in Ibadan and Kaduna [3, 5]. Acne vulgaris was the commonest pilosebaceous disorder (94.2% of pilosebaceous disorders); similar to findings from other studies [4, 5, 6, 7]. Most of these patients were secondary and university undergraduates. Papular urticaria was the commonest urticarial lesion noted. This occurred in children and teenagers. It related to hypersensitivity to bites from insects. Patients presented with itchy papules, wheals with excoriations and sometimes with secondary bacterial colonization. A number presented with post- inflammatory hyperpigmented macules and papules. Vitiligo, albinism and post-inflammatory hypopigmentation were the commonest pigmentary disorders noted in this study. This is similar to previous studies conducted in Africa [4, 7, 12]. Some of the patients with vitiligo were erroneously labeled as Hansen’s disease by primary care physicians and referred to the leprosy treatment centre in the state before being properly evaluated and referred to the skin clinic. Papulosquamous disorders were also on the increase. The highest numbers were pityriasis rosea, lichen planus and psoriasis. These disorders reduce the overall quality of life due to the discomfort and unsightly cosmetic appearance they give to the patient. Pruritic papular eruption (PPE) was the commonest dermatoses seen in those with HIV/AIDS (occurring in 21.2% of all patients with HIV), followed by herpes zoster and Kaposi sarcoma. Similar studies in Port Harcourt and Kaduna, noted a higher prevalence of PPE [5, 6]. Seborrheic dermatitis was the most prevalent in the study by Nnoruka [4]. The patients with PPE who had itchy papules on the extremities resorted to the use of hydroquinone or steroid based creams for treatment with subsequent development of post-inflammatory hyperpigmented macules and papules. Cutaneous malignancies i.e. basal cell carcinoma, squamous cell carcinoma, malignant melanoma and basal cell epithelioma seen here occurred in those with albinism. The diagnosis was confirmed with the aid of histopathology. These patients were managed in consonance with the plastic surgeons. This finding highlights the need for patients with albinism to be properly educated on the dangers of skin exposure to the damaging effects of ultra-violet rays [13].

Conclusion

This review shows that infective skin disorders ranked highest in prevalence in contrast to more recent findings in other geopolitical zones, where eczematous disorders were the most prevalent. This information is important, as it would assist in proper health planning for management of dermatological conditions.

References

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  8. Official gazette (FGP.71/52007/2500 (0224). Legal notice on publication of the details of the breakdown of the National and State provisional totals. 2006 census. Federal republic of Nigeria. 2006 population census Abuja 2007: 1-10
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  10. Fekete E (1978) The pattern of diseases of the skin in the Nigerian Guinea Savannah. Int J Dermatol 17(4): 331-338.
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  13. Okoro AN (2006) Albinism in Nigeria: A clinical and social study. Br J Dermatol 92(5): 485-492_._
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@article{okoh2018,
  title   = {Pattern of Skin Diseases in Ebonyi State University Teaching Hospital},
  author  = {Okoh NU, Nnaji TO and Okoro AN},
  journal = {Epidemiology International Journal},
  year    = {2018},
  volume  = {2},
  number  = {1},
  doi     = {10.23880/eij-16000106}
}
Okoh NU, Nnaji TO and Okoro AN (2018). Pattern of Skin Diseases in Ebonyi State University Teaching Hospital. Epidemiology International Journal, 2(1). https://doi.org/10.23880/eij-16000106
TY  - JOUR
TI  - Pattern of Skin Diseases in Ebonyi State University Teaching Hospital
AU  - Okoh NU, Nnaji TO and Okoro AN
JO  - Epidemiology International Journal
PY  - 2018
VL  - 2
IS  - 1
DO  - 10.23880/eij-16000106
ER  -