13.9.1 Pellagra
Is a disease caused by deficiency of a variety of specific factors, nicotinic acid being the most important. Cardinal signs: diarrhea, dermatitis (sites exposed to sun and pressure) and dementia.
Diagnostic Criteria
- Casal’s necklace; hyper-pigmented scaling involving the neck region
- Hyper-pigmented scaly lesions on sun exposed areas
Pharmacological Treatment
Treat both adults and children
C: Nicotinamide (PO) 500mg once daily for four weeks or until healing is complete; In children give 5mg/kg per day for four weeks or until healing is complete.
Note: The diet should be rich in deficient nutrients as well as protein (meat, groundnuts, and beans)
13.9.2 Vitiligo
Is a condition presenting with patchy depigmentation of skin.
Diagnostic Criteria
- Depigmented patches commonly on the face, neck, trunk and extremities
- Mucosal surfaces particularly oral and genital areas can also be depigmented
Pharmacological Treatment
- There is no cure for vitiligo, but there are a number of treatments that can improve the condition.
- Treatment options generally fall into the following groups:
o Sun blocks:
C: Sun Protective Factor (SPF) 30+ applied at 8 am and 2 pm
o Skin camouflage
o Topical steroids
B: Betametasone valerate ointment 0.1% 12 hourly for 2–4 months
Note: Counsel the patient about the condition
13.9.3 Pruritic Papular Eruption (PPE)
A skin condition characterized by itchy papular eruptions on the extensor area of the upper and lower limbs which is associated with HIV infection.
Diagnostic Criteria
- Papular lesions on the extensor areas
- Extremely itchy
- Excoriation
- Lesions heal with hyperpigmented scars
Pharmacological Treatment
C: Betamethasone valerate cream 0.025% 12 hourly for 3–4 weeks
OR
D: Dapsone 100 mg once a day for one month
13.9.4 Oculo-cutaneous Albinism
A congenital disorder characterized by the complete or partial absence of pigment (melanin) in the skin, hair and eyes.
Diagnostic Criteria
- Strabismus (crossed eyes)
- Photophobia (sensitivity to light)
- Nystagmus (involuntary rapid eye movements)
- Impaired vision or blindness.
- Astigmatism
Non-Pharmacological Treatment
- Genetic counseling is very important to prevent further occurrences of the condition.
- Protective clothing (long sleeved shirt, blouse, skirt and trousers and wide brimmed hats to prevent skin cancers)
- Sun protective glasses with special ultraviolet B (UVB) filters
- Advice on indoor income generating activities
Pharmacological Treatment
C: Sunscreen applications of SPF 30+ or above, applied twice a day at 8 am and noon
Referral: Refer the patient if suspected to have malignant lesions
