cqvip:Background. Atopic dermatitis (AD) is a common pruritic, eczematous s kin diso rder that runs a chronic and relapsing course. In Nigeria, it is currently on th e increase, particularly amongst infants, and has created cost burdens for families. It occurs in association with a personal or family history of asthm a, allergic rhinitis and conjunctivitis. Major and minor criteria exist as guide lines for arriving at a diagnosis of AD, and surveys from Western countries have shown that these features, in particular the minor features, vary with ethnicit y and genetic background and can be used to aid diagnosis. African dermatologist s have also voiced concern that the much used Hanifin criteria for diagnosis of AD may need some adaptation for use in Africa. Objective. To document the featur es and disease outcomes of AD seen amongst dermatology hospital patients in Enug u, south-eastern Nigeria, with a view to reflecting current features amongstNi gerianBlacks. Methods. Aprospective study of AD patients seen over a 2-year pe riod at a tertiary referral dermatology clinic (University of Nigeria Teaching H ospital, Enugu, Nigeria) was carried out. A total of 1019 patients aged between 4 weeks and 57 years were included in the study. Results. The prevalence of AD w as 8.5% , which is much higher than the prevalence of AD reported in various pa rts of Nigeria 15 years ago. AD occurred before the age of 10 years in 523 (51.3 % ) patients, whilst 250 (24.5% ) had onset after 21 years. The earliest age o f onset in infants was in the first 6 weeks of life, and this was found in 129 p atients (12.7% ). Education and occupation of household headswere the most sign ificant (P < 0.001) factors associated with seeking proper health care for the c hild’s AD. Four hundred and forty-one (43.3% ) patients presented with suba cute atopic eczema and 326 (32% ) patients with severe impeteginized eczema. Fo ur hundred and twenty-five patients (41.7% ) had at least one first-degree family member with AD (16.7% ), allergic rhinitis (10.3% ), asthma (14.6% ) a nd allergic conjunctivitis (2.1% ), while 55 (13.3% ) of controls had a positi ve family history (P< 0.01) of allergy. A personal history of AD only, without c oncomitant respiratory allergies, was seen in 486 (47.7% ) patients. The face w as affected in 431 (42.3% ) patients. Inverse distribution of a flexural rash w as observed over the extensor aspect of the joints: the elbow in 502 patients (4 9.3% ), the wrist joint in 183 patients (17.9% ) and the knee joints in 354 pa tients (34.7). The commonly observedminor features included xerosis in 719 patie nts (71% ), papular lichenoid lesions in 547 patients (54.1% ), infraorbital f olds in 498 patients (49.2% ), palmar hyper linearity in 524 patients (51.8% ) and raised peripheral blood eosinophils in 519 patients(51% ), particularly fo r those with severe AD. Fissured heels, forehead lichenification, orbital darken ing, nail pitting, sand paper-like skin lesions on the elbows/knees/lateral ma lleolli, knuckle dermatitis of the hands, palmar erythema and pitted keratolysis occurred more uncommonly as minor features. Infective complications were very c ommon and included bacterial infections (folliculitis, impetiginized dermatitis and pyodermas) in 425 (41.7% ) patients, fungal infections in 377(37% ) patien ts, parasitic infections (scabies) in 90 (8.8% )-patients and viral infection (herpes simplex and molluscum contagiosum) in 29 (2.9% ) patients. Thirteen of these atopics were also HIV positive. Aggravating factors most commonly reporte d included heat intolerance, excessive sweating, humidity, grass intolerance, th ickwoollen clothing and drug reactions. Only three patients had food intolerance . Three hundred and ten patients (30.4% ) recalled their AD being worse in the hot humid periods and 383(37.6% ) could not recall any periods of relief or rem ission. Conclusions. The prevalence of AD amongst south-eastern Nigerian Black s is on the increase, as in other areas, although it is still lower here than in other parts of the world.
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