Nigeria has no statistics on albinos – Dermatologist

Consultant physician dermatologist at the Lagos State University Teaching Hospital, Ikeja, Dr. Frances Ajose, in this interview with Ramon Oladimeji,  dispels myths and misconceptions about albinism

Is albinism a disease?

If we accept the definition of a disease as a disorder of structure or function of any part of the body, then albinism is a disease because it is a disorder of function of the skin and eyes resulting from a genetic abnormality.

What is the scientific basis for albinism?

Albinism is a very complex inherited genetic disorder in which a child is born with sub-optimal pigment in the skin, hair and eyes resulting in poor vision and skin that is unprotected from the carcinogenic effect of sunlight. The parents are often normally- pigmented but both are carriers of the same albinism gene (of which there are about 15 different types). Two albino parents who have the same albinism gene will produce an albino child but if two albino parents have different albinism genes, they may produce a normally, pigmented child. Two normally-pigmented parents who carry different albinism genes will not produce an albino child.

How early can it be determined that a child is an albino?

Diagnosis of albinism is possible in utero (pregnancy) by 17 weeks of gestation by gene analysis (which is not yet available in Nigeria).At birth, genetic analysis can also be done.

But in Africa, albinos are so strikingly different from their peers that mere skilled observation at birth may be sufficient for accurate phenotype diagnosis. Mark that I said phenotype diagnosis because two albinos may look alike but have different genetic compositions and hence different genetic diagnoses. Remember that I said albinism is a complex disorder with up to 15 different genetic variants. Because we have not done any genetic study in Nigeria on albinos, we do not yet know the prevalent genetic variants in our population. We are just guessing at the moment,

The other diagnostic test is Visual Evoked Potential which is an eye test that detects a characteristic visual abnormality peculiar to albinos. Again this is not readily available.

 It’s been said that the two major challenges that albinos have are poor sight and susceptibility to skin cancer, how can they be prevented?

Preventive measures for skin cancer for the albino child starts at birth and the vision care starts as soon as the child starts to read. So the enormous responsibility for the welfare of the albino child rests with the parents. From the hospital, the parents must be educated in the choice of skin cleansing agents and appropriate moisturisers and sun protection measures.

It is important that agents that increase sun sensitivity be avoided in drugs, foods, toiletries and cosmetics.

Drugs like griseofulvin for ringworm, sulpha-containing antibiotics, antimalarials and antihypertensives must be used in albinos with utmost caution. Toilet soaps, toothpaste and cosmetics containing lime and lemon or Retinoic acid, foods that contain psoralens should be avoided.

Sun avoidance and sun protection are the main preventive measures for skin cancer throughout the life of an albino. These involve outdoor restrictions, modification of home and car windows, appropriate dressing and garment colour.

The colour black is advised as outer garment because it absorbs all sun rays (ultraviolet radiation) and prevents these skin cancer-producing rays from reaching their skin whereas white reflects the rays and this reflection may target their face. The albino in Africa must have a hat on his head at all times when outdoors. And a pair of dark eye glasses when out in the sun.

    There is a belief that albinos should not take table salt as part of their diet, is there any scientific basis for this?

At the moment there is no scientific evidence that salt intake is detrimental to the health of albinos.

 What can the government do to assist albinos?

At the moment there is nowhere in hospital birth records to indicate that a child is an albino, therefore, it is impossible to assess the prevalence of albinism in the country. We must have birth records to indicate albinism. Government should consider including albinism in the disability register because they are, to a significant extent, disabled inAfrica.

Also, educating an albino is expensive. Whereas the albino is intellectually sound, poor vision makes him slow at learning. The required telescopic lens cost in the region of N150,000.00 to N250,000.00. Consequently, an albino born to a poor family, no matter how brilliant, ends up as a dropout. Left with no choice, many albinos engage in  menial jobs which expose them to the unkind African sun and they soon develop skin cancer in their 20s and die by age 30.

They need additional one hour longer than their peers at a competitive examination like the West African Senior Certificate Examinations, National Examinations Council and the Unified Tertiary Matriculation Examination.

Though the Federal Government makes available free skin cancer radiotherapy treatment at the National Hospital at Abuja, it does not provide transport and accommodation support and the majority cannot access this benefit. Besides, it would be appropriate for government to subsidise chemical sun screens for albinos as a sun protection measure that would prevent cancer.

At the moment neither the nursing curriculum nor the teaching curriculum has any component of albinism, this should be addressed.

PUNCH.