73
APPENDIX 1
74
ASSESSMENT OF CUTANEOUS DISEASE IN CLD
(1) How long ago were you diagnosed to have liver disease?
(a) Less than <1 month ( ) (b) 2-6 months ( ) (c) 7months – 1year ( ) (d) 1 -3 years ( ) (e) 4 -10 years ( ) (f) more than 10 years ( )
(2) Are you on any treatment? (a) Yes ( ) (b) No ( )
(3) If yes, mention...
(4) Have you noticed any skin changes following the diagnosis of liver disease?
(a) Yes ( ) (b) No ( )
(5) If yes can you describe these skin changes...
(6) How long after the diagnosis of the liver disease did you notice the skin changes?
(a) Less than <1 month ( ) (b) 2-6 months ( )
(c) 7months – 1year ( ) (d) 1 -3 years ( ) (e) 4 -10 years ( ) (f) more than 10 years ( ) GENERAL PHYSICAL EXAMINATION
Height... Weight... BMI...
BP...
SIGN PRESENT ABSENT
Jaundice Pallor
Parotid fullness Gynaecomastia Pedal edema Others (specify)
PIGMENTARY CHANGES
SIGN LOCATION
PERIORBITAL PERIORAL AREOLAR PALMAR PLANTAR GENERALIZED OTHER SITES
Hyperpigmentation Hypopigmentation Others
HAIR CHANGES
75
SIGN PRESENT ABSENT
Fluffy hair Alopecia
Change in axillary and pubic hair pattern
Others (specify) NAIL CHANGES
SIGN PRESENT ABSENT
Onycholysis Leuconychia Terry nails Others (specify)
VASCULATURE CHANGES
SIGN PRESENT/ABSENT LOCATION PRESENT/ABSENT LOCATION Palmar
erythema Vasculitis Caput medusae Spider nevi Others
OTHER DERMATOSES
SIGN PRESENT ABSENT Pruritus
Prurigo nodularis Xerosis
ABDOMINAL EXAMINATION
SIGN PRESENT ABSENT
76
Prominent abdominal wall veins
Ascites
Others (specify)
MUCOUS MEMBRANE CHANGES
...
...
...
...
Summary of dermatological findings
...
...
Investigation results
...
...
...
Childs –Pugh score...
77
APPENDIX II
INFORMED CONSENT FORM Serial number …………..
In order for you to participate in this research study, it is necessary that you give your informed consent.
By signing this informed consent form you are indicating that you understand the nature of the research study and your role in that research and that you agree to participate in the research.
Please consider the following points before signing:
I understand that I am participating in a research.
I understand that my participation will be anonymous (that is my name will not be linked with the data.) and that all information provided will remain confidential.
I understand that I will be provided with an explanation of the research in which I am participating in.
I understand that my participation in this research is voluntary, and that I may refuse participating further at any time without having to offer an explanation.
I understand that blood samples will be taken from me and pictures of the area affected taken when necessary
………
Signature\thumbprint of participant
………
Signature of investigator/ Date
78
APPENDIX III
79
APPENDIX IV
80
PALMAR ERYTHEMA IN ONE OF THE SUBJECTS
81
ALOPECIA AREATA IN ONE OF THE SUBJECTS
82
ETHICAL CONSIDERATIONS
Approval will be obtained from the research and ethical committee of Obafemi Awolowo University Teaching Hospital, Ile – Ife. The patient that gives consent after being briefed about the study shall be included in this study.
1. Right to decline or withdraw from the study.
Study participants are free to decline or withdraw from the study at any time during the study without loss of benefit.
2. Confidentiality of Data
Confidentiality shall be ensured by assigning a code number as an identifier to each participant.
3. Beneficence to participants
Investigations required for the purpose of the study would be at no cost to the participants.
4. Non malfecience
All procedures carried out on the participants would be done with all carefulness for the patient to ensure that no harm is done and their right is not infringed upon.
83
103 Vine L, McCracken N, Needs S, Ryley N, George K. Cutaneous stigmata of chronic liver disease: What do they mean? Gut. 2014; 63: A90.
104 Sayal SK, Gupta CM, Das AL, Chattwal PK. A comparative study of liver disorders with and without cutaneous manifestations. Indian J Dermatol Venereol Leprol 1997; 63:
15-19.
105El faki AMH. Aetiology, complications, and preventive measures of liver cirrhosis;
Elobeid Hospital; West Sudan. Sud J Med Sci. 2008; 3: 25-28.
106 Iloh GU, Ikwudinma AO. Seroepidemiology of hepatitis BSurface antigenaemia among adult Nigerians with clinical features of liver diseases attending a primary-care clinic in a resource constrained setting of eastern Nigeria. North Am J Med Sci 2013; 5:
293-300.
107 Lesi OA, Kehinde MO, Anomneze EE. Chronic liver disease in lagos: A clinicopathological study. Niger Postgrad Med J 2004; 11: 91- 96.
108 Emechebe GO, Emodi IJ, Ikefuna AN, Ikechukwu GC, Igwe WC, Ejiofor OS et al.
Hepatitis B virus infection in Nigerians- A review. Niger Med J 2009; 50: 18 -26.
109 Igetei R, Otegbayo JA, Ndububa DA, Lesi OA, Anumudu CI, Pierre H et al.
Detection of p53 codon 249 mutation in Nigerian patients with hepatocellular carcinoma.
Annals Hepatology 2008; 7: 339-344.
110Adeniji KA, Anjorin AS. Histopathologic assessment of the pattern of liver cirrhosis in a tropical population. West Afr J Med Sci 2002; 31: 367-369.
110 Jaka H, Mshana SE, Rambau PF, Masalu N, Chalya PL, Kalluya SE. Hepatocellular carcinoma: clinicopathological profile and challenges of management in a resource- limited setting. World J Surgical Oncology. 2014; 12: 246- 255.
112 Lawal OA, Bakarey AS, Uche LN,Udeze AO, Okonko IO. HBV infection among intending blood donors who incidentally tested positive to HIV antibody in two blood banks in Ibadan, Nigeria. World Applied Sci J 2009; 7: 1269-1274.
113
114
113 Shim M, Han SHB. Extrahepatic manifestations of chronic hepatitis B. Hep B Annual 2006; 3: 128-154.
112 Kocchar AM, Reddy BSN. Cutaneous manifestations of Hepatitis B and C virus infections: A study of 100 cases. Ind J Dermatol 2003; 48: 73-77.
84
118 Ogunbiyi AO,Daramola OO, Alese OO. Prevalence of skin diseases in Ibadan, Nigeria. Int J Dermatol 2004; 43: 31-36.
119 Onayemi O, Isezuo SA, Njoku CH. Prevalence of different skin conditions in an outpatients setting in northestern Nigeria. Int J Dermatol 2005; 44: 7-11.
120 Olasode OA, Henshaw EB, Akpan NA, Agbulu RE. The pattern of dermatoses in a skin clinic in calabar, Nigeria: A baseline study. Clinical Medicine Insights: Dermatology 2011; 12: 1-6.
121 Rawlings AV. Ethnic skin types: are there differences in skin structure and function.
Int J Cosmetic Sci. 2006; 28: 79-93.
114 Morsy M, Yousef B, Elshahat FA. Cutaneous manifestations in chronic hepatitis C patients: A prospective study from Egypt. Gulf J Dermatol Venereol 2011; 18: 27-32.
123 Achinge IG, Malu AO, Okeke EN, Agaba EI, Misauno MA. Prevalence of oesophageal varices in newly diagnosed chronic liver disease patients at the Jos University Teaching Hospital, Jos. Niger Med J 2011; 52: 128-132.
124 Paoletti V. Prevalence and clinical features of skin diseases in chronic HCV infection. A prospective study in 96 patients. Panminerva medica 2002; 44: 349-352.
125 Gavli J, Dubey AK, Alex A, Jain RK. A clinical study of cutaneous manifestations in liver diseases. J Evolution Med Dental Sci 2013; 39: 7523- 7529.
117 Onyekwere CA, Ogbera AO, Hameed L. Chronic liver disease and hepatic encephalopathy: clinical profile and outcomes. Niger J Pract 2011; 14: 181-185.
127 Kamal A, Khattak S, Khattak AM. Clinical spectrum of non-alcoholic cirrhosis.
Biomedica 2007; 23: 49-53.
128 Olubuyide IO, Ola OS. Clinical feminization and sex hormone concentrations in Nigerian menwith cirrhosis with and without hepatocellular carcinoma. British JClin Prac 1994; 48:70-72.
116 Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol. 2010; 24: 649-654.
130 Wiwanitkit S, Wiwanitkit V. Alopecia due to Hepatitis virus infections. Turk J Dermatol 2014; 2: 101-103
131 Olokoba AB,Aderibigbe SA, Kayode OO. A community survey of awareness and risk perception for liver disease in Ilorin metropolis. Eur J Soc Sci 2010; 1 4: 109- 115.
APPENDIX 1
85
PROFORMA
DERMATOLOGICAL FEATURES IN PATIENTS WITH CLD AT OAUTHC, ILE-IFE.
BIODATA
Serial number………. Hosp. Number... Date interviewed...
1. Age (at last birthday (in years))………..
2. Gender Female ( ) Male ( ) 3. Occupation
a. Unemployed ( ) d. Civil servant ( ) b. Applicant/Apprentice/Schooling ( ) e. Others ( )
c. Unskilled labour ( )
4. Contact Address...
5. Place of domicile> 10 years...
7. State of Origin...
8. Educational qualification
a. None ( ) c. Secondary ( ) b. Primary ( ) d. Tertiary ( ) 9. Marital status
a. Single ( ) b. Married ( )
c. Divorced/Separated ( ) 10. Religion
a. Islam ( ) c. Traditional ( ) b. Christianity ( ) d. Others (Specify)...
11. Date of first presentation in this hospital
ASSESSMENT OF CUTANEOUS DISEASE IN CLD (1) How long ago were you diagnosed to have liver disease?
(a) Less than <1 month ( ) (b) 2-6 months ( ) (c) 7months – 1year ( )
86
(d) 1 -3 years ( ) (e) 4 -10 years ( ) (f) more than 10 years ( )
(2) Are you on any treatment? (a) Yes ( ) (b) No ( )
(3) If yes, mention...
(4) Have you noticed any skin changes following the diagnosis of liver disease?
(a) Yes ( ) (b) No ( )
(5) If yes can you describe these skin changes
...
(6) How long after the diagnosis of the liver disease did you notice the skin changes?
(a) Less than <1 month ( ) (b) 2-6 months ( )
(c) 7months – 1year ( ) (d) 1 -3 years ( ) (e) 4 -10 years ( ) (f) more than 10 years ( )
GENERAL PHYSICAL EXAMINATION
Height... Weight... BMI...
BP...
SIGN PRESENT ABSENT
Jaundice Pallor
Parotid fullness Gynaecomastia Pedal edema Others (specify)
87
PIGMENTARY CHANGES
SIGN LOCATI
ON PERIOR BITAL
PERIO RAL
AREO LAR
PAL MAR
PLAN TAR
GENERA LIZED
OT HER SIT ES HYPERPIGME
NTATION HYPOPIGME NTATION OTHERS
HAIR CHANGES
SIGN PRESENT ABSENT Fluffy hair
alopecia
Change in axillary and pubic hair pattern
Others (specify)
NAIL CHANGES
SIGN PRESENT ABSENT
Onycholysis Leuconychia Terry nails Others (specify)
88
VASCULATURE CHANGES
SIGN PRESENT/ABSENT LOCATION PRESENT/ABSENT LOCATION PALMAR
ERYTHEMA VASCULITIS CAPUT
MEDUSAE SPIDER NEVI OTHERS
OTHER DERMATOSES
SIGN PRESENT ABSENT Pruritus
Prurigo nodularis Xerosis
ABDOMINAL EXAMINATION
SIGN PRESENT ABSENT
89
Prominent abdominal wall
veins ascites
Others (specify)
MUCOUS MEMBRANE CHANGES
...
...
...
...
Summary of dermatological findings
...
...
Investigation results
...
...
...
Childs –Pugh score...
90
APPENDIX 2
INFORMED CONSENT FORM Serial number …………..
In order for you to participate in this research study, it is necessary that you give your informed consent.
By signing this informed consent form you are indicating that you understand the nature of the research study and your role in that research and that you agree to participate in the research.
Please consider the following points before signing:
I understand that I am participating in a research.
I understand that my participation will be anonymous (that is my name will not be linked with the data.) and that all information provided will remain confidential.
I understand that I will be provided with an explanation of the research in which I am participating in.
I understand that my participation in this research is voluntary, and that I may refuse participating further at any time without having to offer an explanation.
I understand that blood samples will be taken from me and pictures of the area affected taken when necessary
………
Signature\thumbprint of participant
………
Signature of investigator/ Date