Clinical and aetiologic profile of patients with chronic urticaria at the outpatient clinic of a tertiary hospital in Lagos, Nigeria: a cross-sectional observational study

Chronic urticaria is a condition characterized by recurrent wheals associated with itching lasting longer than six weeks. The condition tends to run a chronic course with significant morbidity. Several factors have been explored in the cause, yet the aetiology is still uncertain. We documented the clinical profile and assessed the possible aetiologic factors in patients with chronic urticaria. Clinical profile of sixty consecutive patients with chronic spontaneous urticaria was assessed with possible precipitants identified using a structured questionnaire. The complete blood count with erythrocyte sedimentation rate, antithyroid peroxidase (antiTPO), hepatitis B surface antigen (HBsAg), antihepatitis C virus screening (AntiHCV), stool for ova and parasites and helicobacter pylori were carried out. Controls without a history of urticaria were recruited in a 1:1 ratio for stool for parasites and H. pylori because of the high prevalence rates reported in this environment. Data analysis was carried out with Statistical Packages for Social Sciences (SPSS) version 22. Sixty patients with chronic urticaria and sixty age and sex matched controls were enrolled in the study. Females presented more often with urticaria with a M:F ratio of 1:2.5. The mean age of onset of urticaria was in the third decade of life. Precipitants were identified in close to a third of patients. The investigated antigenic aetiology was not found to play a role. The presentation and clinical profile of patients in this environment is similar to previously documented studies. History still remains the cornerstone of management as precipitants and triggers may be identified. Management of patients should therefore be individualized

Pattern of skin disorders in a rural community in Lagos State, Nigeria

Background: Skin disorders are commonly found in the community. In most circumstances, they are easily treatable and preventable. Social and environmental factors play a key role in the epidemiology of skin disease. It is important to assess the dermatological needs of a community as this will help address specific needs. The objective of this study was to identify the skin disorders in a rural community.Methods: This was a cross-sectional study carried out in Epeme, a rural community in Lagos state, South west Nigeria. All consenting adults and children with parental consent that presented for the screening programme were recruited. A self-reported questionnaire was administered by face-to face interview. Socio-demographic data were collected. All those with a skin disease or complaint were further questioned and a clinical examination carried out and findings recorded.Results: There were 263 individuals screened; 156 adults and 107 children. Mean age of adults was 38.04 ± 13.04 years and children 9.50 ± 4.67 years. Thirty adults (19.2%) and 27 (25.2%) children had a skin disorder identified clinically. Among the adults the following categories of skin disorders were found: infection 12 (7.6%), disorders of sebaceous glands 5 (3.2%), pigmentary disorders 2 (1.2%) and pruritus 1 (0.6%). Among children, 21 (19.6%) had skin infections, 2 (1.8%) each with eczema and sebaceous gland disorder. Majority of the infections in children were of fungal aetiology.Conclusion: Infections still remain the major skin disorders in rural communities in Nigeria where dermatologic healthcare is not readily available and accessible.Keywords: pattern, skin disorders, skin infection, rural, community, Nigeri

Prospective assessment of the risk of obstructive sleep apnea in patients attending a tertiary health facility in Sub-Saharan Africa

Introduction: The impact of Obstructive sleep apnea (OSA) in worsening outcomes is profound,  especially in the presence of comorbid conditions. This study aimed to describe the proportion of patients at a high risk of OSA in our practice setting.Methods: The STOP BANG questionnaire and the Epworth Sleepiness scale were used to assess for OSA  risk and excessive daytime sleepiness respectively. Hospitalized patients and out-patients were  recruited. Intergroup differences in continuous variables were compared using the analysis of variance. The proportion of patients with high risk of OSA and excessive daytime sleepiness was presented as frequencies and group differences compared with the Pearson χ2 test. Independent risk predictors for OSA were assessed in  multivariate logistic regression analysis. Results: A total of 1100 patients (53.4% females) participated in the study. Three hundred and ninety nine  (36.3%) had a high risk of OSA, and 268 (24.4%) had excessive daytime sleepiness. Of the participants with high OSA risk, 138 (34.6%) had excessive daytime sleepiness compared to 130 (18.5%) of those with low OSA risk (p). Conclusion: A significant proportion of patients attending our tertiary care center are at high risk of OSA.Key words: Obstructive sleep apnea, excessive day time sleepiness, tertiary hospital, Nigeria

Atopic Dermatitis in Adults: Epidemiology, Risk Factors, Pathogenesis, Clinical Features, and Management

Atopic dermatitis (AD) is an itchy chronic relapsing inflammatory skin condition mostly affecting children than adults. Eczematous conditions are common worldwide with increase in the prevalence in both developed and developing countries. AD in adults is of two types – the first type starts as AD in childhood and gradually progresses to adulthood (Persistent AD) and the second type results from AD developing in adulthood (Adult-onset AD). The article reviews and discusses this condition in adults considering the epidemiology, risk factors, pathogenesis, diagnostic criteria, and management of this condition

Chronic Urticaria in Blacks: Is Autoimmunity An Important Etiological Factor?

Background: The etiology and pathophysiology of chronic urticaria is poorly understood with several implicated factors. The role of autoimmunity has been explored by several studies with such studies on chronic urticaria lacking in the black population despite the significant morbidity caused by chronic urticaria. Aim: We assessed the possible contribution of autoimmunity in the etiology of chronic urticaria using autologous serum skin testing (ASST). Materials and Methods: Sixty consecutive patients with chronic spontaneous urticaria (CSU) with age‑ and sex‑matched controls in a ratio of 2:1 had ASST done for comparison. Student’s t‑test and Chi‑square were used to compare means and percentages, respectively. Results: The male:female ratio of CSU was 1:2.5 with females presenting more often. The ASST was noted to be significantly positive in patients compared to controls with a positivity rate of 68.3% in the former compared to 16.7% in the latter (P = 0.0001). A higher incidence of angioedema was also documented in patients with a positive ASST in association with urticaria (23/28, P = 0.04). Conclusion: Overall, we conclude from our study that autoimmunity may be a possible cause of chronic urticaria in Nigerians which may also be extrapolated to other black population. Patients with positive ASST may have more severe disease which may be important when educating and counselling the patients about the course of the disease. This study is the first to assess the possible role of autoimmunity in a predominantly black population and will serve as a baseline for future studies