Predictive value of sebrrheic dermatitis for HIV infection in Lagos, Nigeria.

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Pyoderma gangrenosum: a case report

Pyoderma gangrenosum (PG) is a rare necrotizing, persistent ulcerative cutaneous condition of unknown etiology. We report a 32-year-old female Nigerian with PG. Prior to presentation at the Lagos University Teaching Hospital, she had a skin graft which failed to take and the donor site also healed with great difficulty. She also had a pathergic response at the site of intravenous canulla and delayed wound healing following caesarean section. She had recurrent gastrointestinal (GIT) symptoms and the GIT contrast studies showed duodenal ulcers and diverticulum. Serum electrophoresis did not show a gammopathy. Haematologic parameters showed a leukocytosis but normal differential count, and an elevated ESR 120mm/hr westergreen. The wound eventually healed on high dose prednisolone. The patient was counselled not to subject herself in future to skin graft, biopsy of the wound, nor invasive surgical debridement in case of any recurrence. Keywords: pyoderma gangrenosum, no biopsy, no skin graft Nigerian Medical Practitioner Vol. 49(4) 2006: 85-8

Lipedema: a case report

Lipedema, variously termed fat edema, or mucoid pseudoedema is characterized by diffuse, bilaterally symmetrical swelling of any of the extremities. We report a 65 year-old man with lipedema. He presented with bilateral massive, painful swelling of both legs, sparing the feet. There was no history of repeated antecedent cellulitis of the legs nor other risk factors. There was also no known family history of leg swelling. Elevation of the legs made no appreciable difference to the swelling. The notable differential diagnosis of lipedema is lymphedema. In lipedema, the feet or hands are usually spared, unlike lymphedema. In lipedema there is a shart cut off between involved and uninvolved skin at the ankle or wrist. There is hypothermia of the overlying skin in lipedema, and the chronic skin changes of hyperkeratosis are usually absent in lipedema except complicated by lymphedema. There are usually no abnormal laboratory values. Keywords: lipedema-lymphedema-different Nigerian Medical Practitioner Vol. 49(6) 2006:169-17

Hansen's disease (HD): unusual presentations

Although leprosy has well defined clinical presentations which make early diagnosis possible, and curable treatment instituted promptly, new cases continue to emerge with unusual presentations which may lead to delayed diagnosis and treatment. This is a descriptive report of five patients. All the patients were seen at the Lagos University Teaching Hospital. The diagnosis was clinical and confirmed through pathology (skin-biopsy) and laboratory (peripheral smear) measures. Five patients with unusual presentations of mulitbacillary HD are described. One patient with apparently normal skin had non-healing and progressive episiotomy, colostomy and cystostomy wounds; the second patient had HD lesions co-existing with classical sarcoidal lesions; the third patient developed diffuse infiltration of the skin in the puerperium; the fourth patient, a physician, with apparently normal skin asked to be screened because he was caring for his father who had HD; and the fifth patient had halo nevi (Sutton's nevi) on the sites of erythema nodosum leprosum. The clinical presentations of HD seem inexhaustible. Unusual presentations continue to occur and there is need for sustained awareness of this serious but curable disease if diagnosed early. Nigerian Medical Practitioner Vol. 49(1&2) 2006: 14-1