Background and objective The incidence of skin diseases in south-east Nigeria during the present decade was analyzed and compared with results from other parts of Nigeria, particularly those in the same zone, obtained more than 30 years ago. This study was carried out to update the recent clinical picture of skin diseases in our environment in view of the rapid development, urbanization and advances in the region. were included in this prospective study. Only cases seen and examined by the author were included in this study to ensure uniformity of diagnosis. Patients and methodsResults A total of 2871 patients were observed within the study period. Adults accounted for 69.7% and were aged between 18 and 73 years, while the male : female ratio was 1.3 : 1.Allergic skin diseases (24.9%) were the commonest skin disorders identified, as opposed to infestations which accounted for an extremely high result of 33.7% (for the same region between 1968 and 1971). In second place was infections / infestations (19.1%). A reversal of picture was thus observed. Within the allergic disorders; eczemas /dermatitis were found to be the most prevalent followed by follicular (13.7%) and pigmentary disorders (11.1%). Sexually transmitted diseases and HIV/AIDs have increased significantly and accounted for 5.4%. Blistering diseases (1.1%) and malignancies (0.5%) occurred less frequently, similar to results found in resent decades for the same region. ConclusionThe current picture of skin diseases in south-east Nigeria has changed significantly from mere infections to allergic skin, follicular and pigmentary disorders. Cutaneous lesions secondary to STDs and HIV/AIDs have also increased. Skin lesions related to malnutrition, kwashiorkor and starvation were not observed nor were cutaneous tuberculosis, yaws or pediculosis, while blistering disorders and malignancies remained almost the same.The current picture is similar to that in other developing and Afro-Caribbean countries. Primarycare physicians and health-care providers in Nigeria /Africa need to be aware of the globally changing pattern of skin diseases in the region to enable the allocation of necessary resources (financial, material and human) to manage these skin diseases.

Cryptococcus skin lesions occurred at low CD4+ counts of 200 cells/mm(3 )and as an early skin manifestation within our environment. Campaign for the skin as an important clinical organ for assessment, prediction of immune status, and management of HIV/AIDS, particularly for hard-to-reach and resource-limited health facilities, has to be undertaken.

The prevalence of AD amongst south-eastern Nigerian Blacks is on the increase, as in other areas, although it is still lower here than in other parts of the world. Many conventional minor features were found, but some occurred less frequently than in other countries, which may be attributed to ethnicity. Further studies will be required to confirm the ethnic differences in these features of AD amongst Nigerians and other Africans, to clarify the features of AD that are peculiar to Africans.

Commonly occurring hair loss in children in our region is mainly acquired, and the clinical course is related to the parent's attitude to treatment, particularly for tinea capitis.

Fixed drug eruption (FDE) causes cosmetic embarrassment in Nigerian patients, particularly when the characteristic hyperpigmented patches affect the face and lips. Drugs that have been implicated in the etiology of FDE, and the sites of lesions, may vary from country to country. Antimalarials, such as Fansidar, Fancimef, Maloxine, Amalar, and Metakelfin, were the most common offending agents, accounting for 38% of FDEs, followed by trimethoprim + sulfamethoxazole (co-trimoxazole) (28%), dipyrones (10%), Butazolidin (6%), thiacetazone (6%), metronidazole (4%), paracetamol (3%), and naproxen (3%). Lesions induced by the combination of sulfadoxine and pyrimethamine (in antimalarials) mainly involved the face and lips. In most cases, patients took these sulfa-containing antimalarials in combination with numerous other drugs, particularly analgesics. Unlike chloroquine-induced pruritus, which affects most Africans, the association between antimalarials and FDE has not been well documented in our region. Co-trimoxazole was associated more often than antimalarials with FDEs involving the mucocutaneous junctions of the genitalia and lips. Males with genital lesions on the glans penis represented 11 (48%) of those with co-trimoxazole hypersensitivity. The trunk and limbs were affected mainly by pyrazoles and Butazolidin, respectively; however, solitary lesions on the trunk were usually due to co-trimoxazole, whereas solitary lesions on the limbs were associated with Butazolidin.