Vitiligo in Ibadan, Nigeria

The incidence of vitiligo at the University College Hospital, Ibadan, Nigeria, was 6% for the period from 1980-1983. Approximately 70% were not older than 30 years of age. Sixty-three percent of the lesions were in exposed areas. No family history was obtained. Leucoderma from cosmetics needs to be differentiated from vitiligo. Mercuric iodide-containing "germicidal" soap, antiseptics with phenolic derivatives, and hydroquinone-containing cosmetics have become endemic and are contributing to the former type of hypomelanosis. More worrisome is the use of topical corticosteroids as adjuncts with hydroquinone for lightening the skin tone. Oral and topical psoralens are not available in Nigeria, and management of this already complex disease with other modalities of treatment remains unsatisfactory.     

Vitiligo in children: a clinical-epidemiologic study in Jordan

Two thousand consecutive children were analyzed in a 2-year period to establish a clinical and epidemiologic profile of vitiligo in Jordan; 71 had vitiligo, with the prevalence increasing with age (0.45% <1 yr, 1% aged 1-5 yrs, 2.1% aged 5-12 yrs). Nonsegmental-type vitiligo was seen in 67 of the patients (92.9%).     

Lactobacillus vaginal microbiota of women attending a reproductive health care service in Benin city, Nigeria

OBJECTIVE: The objective of this study was to determine whether Lactobacillus species found in African women differ substantially to those of white decent, described in previous studies. The vaginal microbiota play an important role in female health, and when the naturally dominant lactobacilli are displaced resulting in bacterial vaginosis (BV), the host is more at risk of acquiring sexually transmitted diseases, including HIV. METHODS: Vaginal samples were collected from 241 healthy, premenopausal Nigerian women, which were then Gram-stained for Nugent scoring. Microbial DNA was extracted, amplified using polymerase chain reaction (PCR) and Lactobacillus primers, and processed by denaturing gradient gel electrophoresis (DGGE). Lactobacillus species were identified by DNA sequencing and BLAST algorithm. RESULTS: Of the samples, 207 (85.8%) had PCR products for lactobacilli, whereas 34 (14.2%) showed absence of lactobacilli, which correlated to the BV Nugent scores. On sequencing of amplicons, 149 subjects (72%) had sequence homologies to lactobacilli. Most women (64%) were colonized by L. iners as the predominant strain, similar to previous findings in Canadian and Swedish women. L. gasseri was found in 7.3% samples, followed by L. plantarum, L. suntoryeus, L. crispatus, L. rhamnosus, and other species. CONCLUSION: The findings indicate that even with geographic, racial, and other differences, the predominant vaginal Lactobacillus species is similar to species in women from Northern countries.     

Lichen planus in African children: a study of 13 patients

Abstract  Lichen planus is an uncommonly encountered dermatosis in children, reported worldwide, however in sub-Saharan Africa there is paucity of data on Lichen planus among children. The aim of this study was to document the clinical types of Lichen planus observed in children in South East Nigeria from 1998 to 2001; and to highlight any differences and similarities with adult disease. In all, 13 patients (eight boys and five girls) aged between 3 and 15 years were diagnosed with Lichen planus. The limbs were the most common sites of involvement for nine (69.2%) children. Classic Lichen planus was the commonest clinical variant in eight (61.5%), while extensive hypertrophic plaques were observed in three (23.1%), linear lesions in two (15.4%) and eruptive generalized Lichen planus in two (15.4%). Koebner phenomenon was documented in five (38.5%); mucosal involvement, which is very uncommon in children affected by this disease, occurred in three (23.1%). Only one child had pterygium formation in all 20 nails (total nail dystrophy). No child had scalp or palmoplantar involvement. Despite the endemicity of hepatitis B surface antigen in our environment, this study also revealed that liver function tests were not significantly different between children with Lichen planus and hepatitis B surface antigen and those who were negative for this antigen; while anti-hepatitis C virus seropositivity was not recorded in any of these children.     

Incidence of penicillinase producing Neisseria gonorrhoeae (PPNG) strains and susceptibility of gonococcal isolates to antibiotics in Benin City, Nigeria.

Of 53 strains of Neisseria gonorrhoeae isolated in Benin City, Nigeria, in February 1983 to October 1984, 46 (87%) produced penicillinase. The minimum inhibitory concentrations (MICs) of penicillin G and ampicillin for these isolates were between 1 mg/l and and 50 mg/l. About 48% (22/46) of the penicillinase producing strains were also resistant to streptomycin, cotrimoxazole, and ampicillin and cloxacillin. All 53 isolates were sensitive to tetracycline, erythromycin, amoxycillin and clavulanic acid, nalidixic acid, spectinomycin, and the penicillinase stable cephalosporins. The high incidence of resistance may have been the result of indiscriminate and unsupervised use of antibiotics before patients presented for proper treatment in clinics and hospitals.     

Vitiligo prevalence study in Shaanxi Province, China

BACKGROUND: Recent publications, especially those based on population surveys, show that the presumed vitiligo prevalence of 1-2% is overestimated. OBJECTIVE: To obtain the vitiligo prevalence in Shaanxi Province, China, through a population survey. METHODS: Approximately one-thousandth of the 36.05 million people in Shaanxi Province, China, were selected through stratified four-stage cluster sampling. They lived in 180 investigation units and all were investigated in a door-to-door survey. Vitiligo and suspected vitiligo patients were marked in the basic questionnaire. They were encouraged to complete a well-prepared questionnaire and send it back to the investigation center. The questionnaire assigned to the investigators contained questions about vitiligo characteristics, such as the area affected, number of areas, and whether or not the affected areas were covered by scurf. Professional dermatologists verified these results. RESULTS: There were 42,833 people in 180 investigation units. The sex, residence, and educational level of these individuals were representative of the population of Shaanxi Province. The investigation team reported 43 vitiligo patients and 14 with suspected vitiligo. During the verification period, three patients and all those with suspected vitiligo were excluded. In total, there were 40 patients (17 women and 23 men). Eleven lived in urban areas and 29 in rural areas. CONCLUSIONS: The prevalence of vitiligo in Shaanxi Province is 0.093% (95% confidence interval, 0.067-0.127%). No significant difference was found between males and females or between urban and rural residents.     

Vitiligo: a retrospective comparative analysis of treatment modalities in 500 patients

The major non-surgical re-pigmenting therapies for vitiligo include psoralens and corticosteroids, used both topically and systemically. In an attempt to determine the best therapeutic option, we compared the efficacy of various treatment regimens used in our department for the treatment of vitiligo. We report herein our results with six different regimens used in our clinic. Data from five hundred vitiligo patients who attended the pigmentary disorders clinic at the Nehru Hospital, PGI, Chandigarh, was analysed. For the purpose of analysis, patients were arbitrarily divided into two groups based upon the body surface area (BSA) involved: Group A (<10% BSA involved) and B (>10% BSA involved). Group A was further divided into three subgoups of patients depending upon what treatment they received: R-I [topical clobetasol propionate+sun exposure]; R-II [topical psoralen+sun exposure (topical PUVASOL)]; R-III [topical psoralen+UVA (topical PUVA)]. Group B was also subdivided into three subgroups of patients who received: R-IV [oral dexamethasone pulse therapy + sun exposure]; R-V [systemic psoralen + sun exposure (systemic PUVASOL)]; R-VI [systemic psoralen + UVA (systemic PULVA)]. Patients who had undergone, one of the above mentioned regimens and had a regular monthly follow up until total re-pigmentation or for at least one year, whichever was earlier, were included in the final assessment of the therapeutic efficacy of that regimen. At the end of the study in Group A, 207 (89%) patients out of 232 on R-I; 73 (93%) out of 78 on R-II, and 15 (79%) out of 19 patients on R-III showed moderate to excellent re-pigmentation, respectively. In group B, 45 (81%) patients out of 55 on R-IV, 48 (84%) out of 57 on RV, and 22 (84%) patients out of 26 on R-VI showed moderate to excellent re-pigmentation. Statistically, in Group A, R-I & II were significantly better than R-III. However in Group B, there was no significant difference in the responses to R-IV, V, and VI. A positive family history of vitiligo did not seem to affect the response rate. Potent topical steroids used along with sun exposure and topical PUVASOL were the most effective forms of therapy for localised vitiligo. For the generalised form of the disease, we concluded that all the systemic modalities, oral steroids, PUVASOL and PUVA, are equally efficacious over a period of one year. Phototoxic reactions were, however, more common with PUVASOL.     

Vitiligo : a study of 998 cases attending KEM Hospital in Pune

Background : Vitiligo is a condition of major social and cosmetic concern in India. An epidemiological study of large number of patients from India was indicated.     

Vitiligo: clinical findings in 1436 patients.

We retrospectively analyzed the clinical and epidemiological profiles of patients with vitiligo attending the pigmentary dermatoses clinic. One thousand four hundred and thirty-six patients were seen between 1989 and 1993. Males constituted 54.5% of the group and females 45.5%. Mean age of the patients was 25 years, and average disease duration at the time of hospital visit was 3.7 years. Vitiligo vulgaris was the commonest form of the disease in 1002 (69.8%) patients followed by focal vitiligo in 214 (14.9%) and segmental vitiligo in 72 (5.0%). The sites of onset were the face, trunk, and legs in descending order of frequency. Less than 20% body area involvement was seen in 1356 (94.4%) of the patients. Leukotrichia was present in 165 (11.5%), and Koebner's phenomenon was observed in 72 (5.0%). Twenty nine (2.0%) patients had associated halo nevi. Of the various diseases associated with vitiligo, atopic/nummular eczema was seen in 20 (1.4%) patients, bronchial asthma in 10 (0.7%), diabetes mellitus in 8 (0.6%), thyroid disease in 7 (0.5%), and alopecia in 6 (0.4%). A family history of vitiligo was present in 165 (11.5%) patients.     

Vitiligo: a review of the published work

Vitiligo is a common depigmenting skin disorder, characterized by acquired, idiopathic, progressive, circumscribed hypomelanosis of the skin and hair, with total absence of melanocytes microscopically. It occurs worldwide, with an incidence rate of between 0.1% and 2%. Vitiligo is an important skin disease having a major impact on the quality of life of the patient suffering from it. The causes of this condition are uncertain but seem to be dependent on the interaction of genetic, immunological and neurological factors. Vitiligo coexists with other autoimmune disorders, Sutton or halo nevus, and malignant melanoma. The substantial disfigurement associated with vitiligo can cause serious emotional stress for the patient, which necessitates treatment. Because its pathogenesis is still not understood, there is a plethora of different treatments. Among them, topical steroids and narrowband ultraviolet B monotherapy were the most common as current treatments for localized and generalized vitiligo, respectively. Cosmetic improvement can be achieved by camouflage products and self-tanning dyes. The course of vitiligo is unpredictable, but often progressive. Spontaneous repigmentation may occur in a few people (10–20%), mainly in children, but this tends to be only partial and on sun-exposed areas. In this article, we review vitiligo as a whole, including epidemiology, pathogenesis and etiology, histopathology, clinical manifestations, classification, clinical variants, diagnosis and differential diagnoses, specific investigation, treatment, prognosis, psychosocial view and its association with other disorders.     

Vitiligo is more than skin deep: a survey of members of the Vitiligo Society

Background. Vitiligo is a common, largely acquired skin disease of unknown aetiology, which causes a variable amount of skin and hair depigmentation in affected people. It affects over half a million people in the UK alone, and a massive 50 million people worldwide. Aim. To quantify the psychosocial burden of vitiligo in the UK, by estimating its effect on daily life. Methods. All members (n = 1790) of the Vitiligo Society, a UK national patient support group, were sent a questionnaire. Survey questions included demographics, disease‐related characteristics, effect of vitiligo on daily life, and psychosocial support measures for patients with vitiligo. Results. In total, 520 (29% of members) responded, of which 354 (68%) were women. Vitiligo affected the hands in 414 (80%) and the face in 394 (76%) of the respondents. Over half (56.6%) of respondents indicated that vitiligo moderately or severely affects their quality of life (QOL). Finding a cure or effective lasting treatment was the main priority for most affected respondents. Most respondents obtain information about their disease from nonmedical sources: 431 (83%) from the Vitiligo Society and 129 (25%) from the internet, compared with 61 (12.5%) from dermatologists. Conclusion. Vitiligo is a skin condition that moderately or severely affects the QOL of most patients. Although most patients look for a cure or long‐lasting treatment, only 12.5% of respondents to our survey had obtained information from a dermatologist. Vitiligo is a common condition that affects more than the skin, and has profound psychosocial implications for affected patients.     

Vitiligo: a sign of systemic disease

Vitiligo reflects a systemic process that has important implications beyond the skin. These include other autoimmune diseases and ocular and neurological abnormalities. Alezzandrini syndrome and Vogt-Koyanagi-Harada syndrome particularly exemplify this relationship. In addition, vitiligo may be confused with other systemic disorders, including tuberous sclerosis, progressive systemic sclerosis (scleroderma), melanoma, and, in endemic regions, leprosy. We describe these associations and emphasize the importance of depigmenting disorders.