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 Table of Contents  
Year : 2022  |  Volume : 19  |  Issue : 3  |  Page : 71-72

The Dermatological Diseases as part of Internal Medicine Conditions

Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria

Date of Web Publication25-Aug-2022

Correspondence Address:
Dr. Olusola Olabisi Ayanlowo
Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcls.jcls_58_22

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How to cite this article:
Ayanlowo OO. The Dermatological Diseases as part of Internal Medicine Conditions. J Clin Sci 2022;19:71-2

How to cite this URL:
Ayanlowo OO. The Dermatological Diseases as part of Internal Medicine Conditions. J Clin Sci [serial online] 2022 [cited 2023 Jan 29];19:71-2. Available from: https://www.jcsjournal.org/text.asp?2022/19/3/71/354674

The skin is the largest organ of the body, about 15%–16% of the total body weight, approximately measuring 1.5–2.0 m2. The skin protects the body from noxious stimuli including physical trauma, chemicals, radiation, and infection. Other important physiologic functions of the skin include thermoregulation, sensation, water storage, absorption, synthesis of Vitamin D, and expression (beauty). The mobility and elasticity of the joints enable the joints to move as desired. The skin also forms a barrier against the lethal effect of ultraviolet radiation (a component of electromagnetic radiation) such as skin cancers, photoaging, and sunburn.[1]

Dermatology is a branch of internal medicine dealing with the skin, hair, and nail: the structures, functions, and diseases. A dermatologist is a medical doctor (an internal/specialist physician) who specializes in treating the skin, hair, and nails. Dermatologists care for people of all ages, from newborns to seniors. They are either trained in the Faculty of Internal Medicine, by the West African College of Physicians and National Postgraduate Medical College for 6 to 7 years in Nigeria. After the mandatory National Youth Service Corps by doctors, they are enrolled in the residency program of internal medicine after passing the primaries which is the entrance examination in basic medical science.

A community-based study in rural Lagos revealed a prevalence of skin disorders to be approximately 25.4%: one in every four individuals presented with a clinically diagnosed skin disease.[2] In both community and hospital-based surveys, across all age groups, the most common skin disorders are infections, eczemas, pruritic dermatoses, acne, papulosquamous disorders, and pigmentary diseases.[2],[3]

Specialized dermatology services started in Nigeria in the 1950s by George HV Clarke in Lagos, and later in Ibadan as a subspecialty at the University of Ibadan by Roger RM Harmann and GC Wells. The first indigenous set of dermatologists was Prof. Anezi Okoro, Prof. Femi Soyinka, Prof. Yetunde M Olumide, and Prof. Somorin.[4] There are 185 dermatologists (including specialist residents) catering to the current population of Nigeria is 214,563,041 based on projections of the latest United Nations data for 2022. More than 20% of this number are in the diaspora. Eighty percent of the locally available dermatologists are in tertiary centers and urban regions. To date, we can say that dermatology, as a subspecialty of internal medicine is underserved and underrepresented.

Certain skin disorders such as Stevens–Johnson syndrome, toxic epidermal necrolysis, and urticarial/angioedema/anaphylaxis are potentially life-threatening and present in medical emergencies.[5] Several other skin diseases though rarely morbid are indicators of debilitating internal diseases such as pretibial myxedema, erythema nodosum, and uremic frosts. Chronic liver disease, chronic kidney disease, chronic heart failure, endocarditis, and endocrine disorders all present skin markers that aid prompt investigations in the discerning physician.[6] Almost all systemic autoimmune rheumatic diseases and vasculitis present with pathognomonic skin diseases that aid in diagnosis and for clinicians with a good index of suspicion prevent waste of resources in unnecessary investigations and afford targeted investigations and prompt management.[6] The skin presents with a broad spectrum of genetic disorders from the well-known nevi, to hemangiomas, tuberous sclerosis, and neurofibromatosis among many other syndromes with systemic affiliation.[6]

Albinism is the most known genetic disorder of the skin with the highest prevalence in sub-Saharan Africa with prevalence ranging from 1 in 1000 to 1 in 15,000 people.[7] There is a total or partial deficiency in the tyrosinase enzyme which is the rate-limiting step in the formation of melanin pigment in the skin. Most people with albinism commonly have both skin and eye affectation hence the term oculocutaneous albinism (OCA). There are many genetic variants of OCA and variable clinical manifestations.[7],[8] The affected are sensitive to the ultraviolet radiation of the electromagnetic spectrum of the sun, hence presenting with photodamage of the skin seen clinically as photoaging (early aging of the skin) and photocarcinogenesis. Although potentially associated with normal physical health is known to be associated with life-threatening and invasive cancers of the skin (basal cell carcinoma, squamous cell carcinoma, and melanomas).[7]

The skin can also present with other types of cancers of undetermined etiology such as cutaneous lymphomas. Although predisposing factors may include chronic scars and immune suppression.[8] Human immunodeficiency syndrome, a scourge in sub-Saharan Africa is associated with a wide range of skin disorders and many indicator diseases are cutaneous or mucocutaneous. Cutaneous disorders associated with HIV may be infectious, allergic, and neoplastic with exaggeration and atypical manifestation. The skin presents with several clinical entities that are markers of systemic immune dysregulation like psoriasis and lichen planus associated with conditions such as metabolic syndromes and are markers of cardiovascular diseases.[9] Some of these disorders being chronic are causes of poor quality of life in the affected. Conditions like acne which affect teenagers and young adults have been associated with poor self-image, depression, and suicidal ideation.

The hair, nails, and eccrine glands are part of the skin appendages which can present with features associated with skin diseases and internal organs and also with an immense affectation on the quality of life of the affected. Many disorders of the hair are associated with hair care practices hence the need for a lot of public health intervention and educational campaigns.[10] The dark African skin is particularly prone to abnormal scars hence the high prevalence of keloids, hypertrophic scars, and atrophic scars.

There has been a lot of public health emphasis on infectious diseases and infestations. As part of the current beam on the noncommunicable disorders of immense mortality and morbidity, there is a need to pay attention to the disorders of the skin and appendages to improve the physical and mental health of the populace.

  References Top

McKnight G, Shah J, Hargest R. Physiology of the skin. Surgery (Oxford). 2022;40:8-12.  Back to cited text no. 1
Akinkugbe AO, Amira OC, Ozoh OB, Fasanmade O, Bandele E. Pattern of skin disorders in a rural community in Lagos state, Nigeria. Nigerian Health Journal. 2016;16:103-16.  Back to cited text no. 2
Ayanlowo O, Okesola O. Pattern of Skin disorders across age groups. Research Journal of Health Sciences. 2017;5:148-58.  Back to cited text no. 3
George AO, Daramola OO. Dermatology in Nigeria: evolution, establishment and current status. International journal of dermatology. 2004;43:223-8.  Back to cited text no. 4
Freiman A, Borsuk D, Sasseville D. Dermatologic emergencies. CMAJ. 2005;173:1317-9.  Back to cited text no. 5
Sampaio AL, Bressan AL, Vasconcelos BN, Gripp AC. Skin manifestations associated with systemic diseases–Part I. Anais Brasileiros de Dermatologia. 2022;96:655-71.  Back to cited text no. 6
Hong ES, Zeeb H, Repacholi MH. Albinism in Africa as a public health issue. BMC public health. 2006;6:1-7.  Back to cited text no. 7
Ayanlowo OO, Adegbulu AA, Cole-Adeife O. Cutaneous cancers in the Africans: Systematic review. Dermatological Reviews. 2022.10.1002/der2.132.  Back to cited text no. 8
Lanna C, Mancini M, Gaziano R, Cannizzaro MV, Galluzzo M, Talamonti M, et al. Skin immunity and its dysregulation in psoriasis. Cell Cycle. 2019;18:2581-9.  Back to cited text no. 9
Ayanlowo O, Otrofanowei E. Hair care practices, scalp disorders and psychological effects on women in Nigeria. In Mosby-Elsevier 360 Park Avenue South, New York, NY 10010-1710 USA; 2019. p. AB218–AB218.  Back to cited text no. 10


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