Main Article Content
Vitiligo: Clinical Associations and Trend in South East Nigeria
Abstract
Background: Vitiligo is a cosmetically disfiguring disease, of which the psychological impact can be of paramount importance in deeply pigmented races, particularly Africans. This sharp contrast usually carries severe social stigma. The natural course of the disease is unpredictable, and several studies have dealt with epidemiological features, prevalence, familial aggregation, sex, age distribution, clinical presentation and associations, which have been reported mainly from white populations. Not many of such studies have been performed in African blacks, to show the clinical associations and disease trends observed in the region.
Aim: To document the trends, associations, percentage of body surface involvement, status of disease activity, and response to treatment options offered; as seen in South East Nigeria, West Africa.
Methodology: A prospective study of 751 consecutive vitiligo patients was carried out at the Dermatology clinic of the University of Nigeria Teaching Hospital over a two-year period. Diagnosis was accomplished by direct clinical examination, followed by examination of the depigmented areas under Wood's light. Full blood count, random blood sugar/ fasting blood sugar levels, thyroid function tests and investigations for common circulating autoantibodies such as ANA (anti-nuclear antibodies) and lupus erythematosus cell (LE) test, were carried out to rule out any associations with vitiligo. Skin biopsies were carried out for standard pathologic examination to help confirm the diagnosis in 11 cases. A control group of 350 normal patients without vitiligo were selected from patients attending the general outpatient department of the same teaching hospital.
Results: The incidence of vitiligo was 5.8%. Family history of vitiligo was present in 17 (2.3%). Fifteen (1.9%) suffered from diabetes mellitus, 9 (1.2%) thyroid disease, 10(1.3%) atopic dermatitis, 3 (0.4%) sarcoidosis, while 7(1%) had lepramatous leprosy. Kobners phenomenon was observed in 57.3% (430 patients). Sixty- seven percent of the lesions were on exposed areas. It was purely acral in 47(6.3%), acrofacial in161 (21.5%), segmental in 50 (6.6%), pure mucosal in 13 (1.7%) and generalized in 20(2.6%). The extent of involvement was 1% or less in 180(32.8%) and 75% and above in 9(1.2%) patients. The disease progression was continuously slow in 411(54.7%), slow with periods of rapid exacerbation in 138(18.4%), rapid in 67 (8.9%), and in 59(7.9%) patients the disease had been static for more than 6 months within the study period. Koebner's phenomenon, a family history of vitiligo and mucous membrane involvement showed more progression of vitiligo. Trigger factors also recorded included cosmetics, concoctions, rubber, pregnancy and psychological stress only in a few.
Conclusions: The pattern of vitiligo observed in our environment is similar to that reported elsewhere. Clinical characteristics such as family history, clinical type, duration of disease, Koebner's phenomenon, and mucous membrane involvement, were relevant in predicting the progression/ prognosis of vitiligo in South Eastern Nigeria.
Key Words: Vitiligo, associations, treatment, Nigeria
Journal of College of Medicine 2005: 9(2): 125-128
Aim: To document the trends, associations, percentage of body surface involvement, status of disease activity, and response to treatment options offered; as seen in South East Nigeria, West Africa.
Methodology: A prospective study of 751 consecutive vitiligo patients was carried out at the Dermatology clinic of the University of Nigeria Teaching Hospital over a two-year period. Diagnosis was accomplished by direct clinical examination, followed by examination of the depigmented areas under Wood's light. Full blood count, random blood sugar/ fasting blood sugar levels, thyroid function tests and investigations for common circulating autoantibodies such as ANA (anti-nuclear antibodies) and lupus erythematosus cell (LE) test, were carried out to rule out any associations with vitiligo. Skin biopsies were carried out for standard pathologic examination to help confirm the diagnosis in 11 cases. A control group of 350 normal patients without vitiligo were selected from patients attending the general outpatient department of the same teaching hospital.
Results: The incidence of vitiligo was 5.8%. Family history of vitiligo was present in 17 (2.3%). Fifteen (1.9%) suffered from diabetes mellitus, 9 (1.2%) thyroid disease, 10(1.3%) atopic dermatitis, 3 (0.4%) sarcoidosis, while 7(1%) had lepramatous leprosy. Kobners phenomenon was observed in 57.3% (430 patients). Sixty- seven percent of the lesions were on exposed areas. It was purely acral in 47(6.3%), acrofacial in161 (21.5%), segmental in 50 (6.6%), pure mucosal in 13 (1.7%) and generalized in 20(2.6%). The extent of involvement was 1% or less in 180(32.8%) and 75% and above in 9(1.2%) patients. The disease progression was continuously slow in 411(54.7%), slow with periods of rapid exacerbation in 138(18.4%), rapid in 67 (8.9%), and in 59(7.9%) patients the disease had been static for more than 6 months within the study period. Koebner's phenomenon, a family history of vitiligo and mucous membrane involvement showed more progression of vitiligo. Trigger factors also recorded included cosmetics, concoctions, rubber, pregnancy and psychological stress only in a few.
Conclusions: The pattern of vitiligo observed in our environment is similar to that reported elsewhere. Clinical characteristics such as family history, clinical type, duration of disease, Koebner's phenomenon, and mucous membrane involvement, were relevant in predicting the progression/ prognosis of vitiligo in South Eastern Nigeria.
Key Words: Vitiligo, associations, treatment, Nigeria
Journal of College of Medicine 2005: 9(2): 125-128
