Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs. PATIENTS AND METHODS: We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors. RESULTS: During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21-3.42), diabetes (OR=3.97; 95% CI: 1.95-6.13), nicotine addiction (OR=5.07; 95% CI: 2.20-11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60-14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19-3.73). CONCLUSION: Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.

[Place of theses and dissertations in the scientific publications of dermato-venereology teachers of the University of Lome (Togo)]. / Place des thèses et mémoires dans les publications scientifiques des enseignants de dermato-vénéréologie de l'université de Lomé (Togo): Ce travail a fait l'objet d'une communication orale lors des 5e journées dermatologiques de Ouagadougou (Burkina Faso) en octobre 2017.

The aim of this study was to situate the place of theses and dissertations (senior healthcare technicians, D.E.S or master) in the scientific publications of dermato-venerology teachers at the University of Lomé (Togo). We listed the theses and dissertations on dermato-venerology between 1990 and 2016, in three institutions of the University of Lomé and consulted databases (Medline, Inist, registers of the service) to search for publications by teachers during this period. A total of 41 theses and 50 dissertations were completed, on infectious dermatoses and STI/HIV (46.1%), immunoallergic dermatoses (11.0%) and tumour dermatoses (8.8%). Of these 91 works, 56 (including 28 theses) were published in indexed (21 theses and 26 dissertations) or non-indexed (7 theses and 2 dissertations) journals. These 56 publications represented 27.7% of the 202 publications made by the dermato-venerology teachers at the University of Lomé during this period. Of the 28 published theses, the MD student was the first author in one case (3,6%) This work shows that theses and dissertations in dermato-venerology represent almost one third of the publications in this discipline in Togo.

[Risk factors associated with acne keloidalis nuchae, in black subjects: A case-control study]. / Facteurs de risque associés aux folliculites fibrosantes de la nuque chez le sujet noir : étude cas-témoins.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with acne keloidalis nuchae (AKN), seen in a dermatology clinic in Lomé (Togo). PATIENTS AND METHODS: This was a case-control study conducted from January to December 2018. Patients were recruited at outpatients dermatological clinics and controls were recruited at outpatients dermatological clinics and then in other hospital departments. RESULTS: We recruited 303 consenting subjects, comprising 101 patients with AKN and 202 controls case-matched by age (±5 years). The mean patient age was 34.9±10.7 years vs. 35.6±11.2 years for controls. The most frequently observed AKN lesions were papules (73/101; 72.2%), fibrous scars (42/101; 41.5%) and folliculitis/pustules (41/101; 40.6%). In multivariate analysis, the following factors were associated with AKN: excess weight (adjusted odds ratio=4.8; 95% CI=[2.3-11.7]) or obesity (OR=9.2; 95% CI=[2.1-34.2]), bleeding during hairdressing either occasionally (aOR=13.9; 95% CI=[5.1-40.0]) or systematically (aOR=22.1; 95% CI=[6.2-40.7]), hairdressing procedures less than once per week (aOR=10.1; 95% CI=[3.2-50.8]), and extremely close cropping of hair (aOR=4.9; 95% CI=[2.8-15.5]). CONCLUSION: AKN is common in young adults. Excess weight or obesity, bleeding during hairdressing, and frequency and style of hairdressing are all associated factors. The results of this study stress the importance of limiting injury during hairdressing, and of refraining from shaving or cropping hair without a trimmer. Since management of AKN is extremely difficult, identification of associated risk factors allows suitable preventive approaches to be adopted.

[Atypical Localization of a Case of Leprosy in Lomé (Togo)]. / Localisation atypique d'un cas de lèpre à Lomé (Togo).

This was a 50-year-old woman with a selling activity living in Lomé who came for a consultation in March 2016 for a facial flushing that had been going on for 2 months without pain or pruritus. On examination, there was a single, erythemato-squamous closet of the right hemiface. There was no infiltration of the right ear. There was moderate cutaneous heat compared to the left hemiface which was without any lesion. Examination of nails, hair, palms and plants was normal. There was no hypertrophy of the peripheral nerves (superficial cervical plexus, ulnar, median). The face was not fixed. Complementary examinations noted a normal blood count and negative HIV status. Histology performed on a biopsy fragment concluded tuberculoid leprosy. The patient was first put on WHO multidrug therapy during 6 months. But one month after stopping this treatment, the lesions resumed. She was referred to a multibacillary leprosy protocol during one year. She had been seen 4 months after stopping treatment, without recurrence. It is important not to ignore leprosy in case of atypical erythema of the face even in the absence of other evocative signs and to perform a biopsy to the slightest doubt.

Il s'agit d'une femme de 50 ans, revendeuse, résidant à Lomé qui a consulté en mars 2016 pour une rougeur du visage évoluant depuis 2 mois sans douleur, ni prurit. À l'examen, on notait un placard unique érythémato-squameux de l'hémiface droit avec une bordure infiltrée. Il n'y avait pas d'infiltration du pavillon de l'oreille droite. Il y avait une chaleur cutanée modérée par rapport à l'hémiface gauche qui était sans aucune lésion. L'examen des ongles, des cheveux, des paumes et plantes était normal. On notait une absence d'hypertrophie des nerfs périphériques (plexus cervical superficiel, cubital, médiane). Le visage n'était pas figé. Les examens complémentaires notaient un hémogramme normal et une sérologie VIH négative. L'histologie réalisée sur un fragment biopsique a conclu à une lèpre tuberculoïde. La patiente a d'abord été mise sous le protocole de polychimiothérapie de l'OMS pendant 6 mois. Mais un mois après l'arrêt de ce traitement, les lésions ont repris. Elle a été remise sous un protocole de lèpre multibacillaire pour une durée d'un an. Elle a été revue 4 mois après l'arrêt du traitement, sans récidive. Il importe de ne pas méconnaître une lèpre devant un érythème atypique du visage même en l'absence d'autres signes évocateurs et de réaliser une biopsie au moindre doute.

Pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo : retrospective study from 1997 to 2017.

OBJECTIVE: The aim of this study was to describe the epidemiological, clinical, and therapeutic profile as well as the outcome and to document the causes of pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo. METHODS: This retrospective study examined the records of patients seen for outpatient consultation and/or hospitalization in the three public dermatology departments of Lomé from January 1997 to September 2017. RESULTS: During the study period, 178 (0.4%) of 47,219 patients seen in these dermatology departments consulted for pellagra or pellagra-like erythema; 159 (89.3%) had pellagra-like erythema. The patients' mean age was 45.8±16 years, and the sex ratio (M/F) 1.8. All patients had at least one site of cutaneous involvement, nearly always erythematous or pigmented lesions in the photo-exposed areas (99.4% of cases). Gastrointestinal and neurological signs were dominated respectively by diarrhea (12.4 % of cases), peripheral neuropathies (8.4% of cases) and insomnia (8.4% of cases). The main causes identified were alcoholism (42.1% of cases) and nutritional deficiency (6.7% of cases). Five of 178 patients were infected with HIV. All patients were treated with nicotinamide and multivitamin supplementation. No deaths were recorded during follow-up. CONCLUSION: Our results document the extreme rarity of pellagra-like erythema/pellagra. Its two main causes remain alcoholism and nutritional deficiency. Moreover, its prognosis is good when treated quickly and adequately.

[Clinical Spectrum of Herpes Zoster in Lomé (Togo), and Factors Associated with HIV Infection]. / Zona en milieu hospitalier à Lomé (Togo) : profil et facteurs associés à l'infection VIH.

We have studied the epidemiological and clinical profile of herpes zoster in patients consulting at different hospitals in Lomé (Togo). This is a retrospective study of the records of the patient consulting for herpes zoster in the dermatology departments of these hospitals from 2009 to 2018. Of the 20,548 patients seen in the different departments, 254 (1.2%) had herpes zoster. The mean age of the patients was 41.6 ± 16 years, and the sex-ratio (M/F) was 0.81. Thirty-one (12.24%) patients were known to be HIVpositive and 105 (41.33%) agreed to be tested for HIV after admission. Thirty-five (33.3%) of these 105 patients were found to be HIV positive. Factors associated with HIV infection in 136 patients with the known HIV status were as follows: history of herpes zoster (P < 0.01, compared with the seronegatives), hemorrhagic lesions (P < 0.001), multimetameric location (P < 0.0001), and involvement of the cephalic extremity (P < 0.0001). Post-herpetic pain was observed in 32 (12.6%) patients.

Nous avons étudié le profil épidémiologique, clinique et thérapeutique du zona en milieu hospitalier à Lomé (Togo). Il s'agit d'une étude rétrospective portant sur les dossiers des patients consultant pour un zona dans les services publics de dermatologie de 2009 à 2018. Parmi les 20 548 patients vus dans les différents services, 254 (1,24 %) ont consulté pour un zona. L'âge moyen des patients était de 41,6 ± 16 ans et le sex-ratio (M/F) de 0,81. Trente et un (12,2 %) patients étaient connus séropositifs pour le VIH et 105 (41,33 %) ont accepté de faire le test de dépistage du VIH. Le zona était révélateur de l'infection à VIH chez 35 (33,3 %) des 105 patients dépistés. Les facteurs associés à la séropositivité VIH chez les 136 patients testés pour le VIH étaient : un antécédent de zona (p < 0,01, comparé aux séronégatifs), l'aspect hémorragique des lésions (p < 0,001), le caractère multimétamérique de l'atteinte (p < 0,0001) et l'atteinte de l'extrémité céphalique (p < 0,0001). Une douleur postzostérienne était observée chez 32 (12,6 %) des patients.

Reasons for inpatient admissions to the dermatology department in Lomé, Togo : Trends between 1992 to 2005 and 2005 to 2016.

The aim of this study was to report the frequency of and reasons for dermatology admissions in Lomé (Togo) between 2005 and 2016. This retrospective study examined records from August 2005 to December 2016 from the dermatology departments of the two teaching hospitals in Lomé, Togo. During the study period, 454 (1.1%) of the 40,231 new patients who consulted in dermatology were hospitalized, with a total of 460 separate admissions (mean dermatology hospitalizations per year: 42). Patients' mean age was 43±17.6 years and the sex ratios (M/F) was 0.6. The main reasons for hospitalization were Stevens-Johnson syndrome (SJS), also known as erythema multiforme majus, and toxic epidermal necrolysis (TEN) (28.9%), followed by bullous erysipelas (21.4%), connective tissue disease (10.3%), and Kaposi sarcoma-associated herpes virus (9%). The average length of stay in hospital was 15±13.7 days. The diagnosis that accounted for the longest mean length of stay was deep fungal infections (63.5 days) (P<0.0001). We recorded 39 deaths, for a death rate of 8.6%. Death rates were highest for deep fungal infections (37.5%) and SJS/TEN (12.2%). Our study confirmed the low rate of inpatient admissions in dermatology and revealed a change in the reasons for hospitalization and a decrease in mortality in dermatology in Lomé, compared with the previous 13 years. This decrease in mortality may be attributed to the improvement of hospital care provided to patients but also by the generalization of antiretroviral treatment in Togo that began more than 10 years ago.

Profile of erythroderma in children in hospital dermatology departments in Lomé, Togo : study of 28 cases.

The aim of this study was to describe the epidemiological, clinical, and therapeutic profile as well as the outcomes of children with erythroderma (also known as exfoliative dermatitis) in hospital dermatology departments in Lomé, Togo. This retrospective descriptive study examined the records of patients aged 0 to 15 years who were treated for erythroderma in dermatology departments in Lomé from January 1997 to December 2016. The study included 28 patients, with a mean age of 6.3 ± 5 years. The mean duration of progression of erythroderma before the consultation was 39.2 days. Pruritus was present in 60 % of the children, fever in 13.3 %, and impairment of general status in 3.3 %. Among the children aged 3 months and older, 84.2 % had dry squamous erythrodermic dermatosis, and among those younger than 3 months, 15.8 %. Among those with erythrodermic dermatosis, atopic dermatitis (70.6 %) was the most frequent dermatosis. No cause was found in 32.1 % cases. Course and outcome were favorable in 53.3 % of cases; one child died, and the rate of loss to follow-up was 43.3 %. Erythroderma is a rare disease in children in hospital dermatology departments in Lomé. Erythrodermic dermatosis, particularly atopic eczema, remains the most frequent cause.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)-induced Stevens-Johnson syndrome and gynecomastia in an HIV-infected child: A case report.

BACKGROUND: Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are antiretroviral drugs often used in the first-line treatment regimen of HIV1 infection worldwide. We report a case of successive gynecomastia and Stevens-Johnson syndrome (SJS) respectively induced by efavirenz and nevirapine in a single patient. CASE REPORT: A 16-year-old boy, HIV1-infected since birth, was started on antiretroviral treatment (ART) in August 2015 and was taking a regimen comprising abacavir, lamivudine and efavirenz. In April 2016, when his weight reached 35kg, abacavir was replaced with tenofovir. Bilateral breast enlargement, previously hidden by the patient, was diagnosed two years after the start of ART. History-taking, physical examination and laboratory tests ruled out known causes of gynecomastia, and efavirenz was thus considered the most likely cause. This drug was then withdrawn and replaced with nevirapine in July 2017. Thirty-three days after the patient started nevirapine treatment, a skin rash appeared. Physical examination revealed erythematous macules and flaccid bullae with estimated skin detachment of 10%. There were also conjunctival, buccal and genital lesions. A diagnosis was made of SJS induced by nevirapine. Three months after withdrawal of efavirenz, breast size decreased by 3cm on the left breast and 2cm on the right breast; two months after the SJS, cutaneous sequelae alone persisted, such as diffuse hyperchromic macules. DISCUSSION: Recognition of gynecomastia as a side-effect of efavirenz is important to allow the condition to be treated while it is still potentially reversible. Moreover, when efavirenz is replaced, a protease inhibitor should be preferred to nevirapine.

Lichenoid dermatoses in hospitals in Lomé, Togo: 959 cases.

The aim of this study was to describe the epidemiologic, clinical, and therapeutic profiles of cases of lichenoid dermatosis in Lomé, together with their outcomes. This retrospective descriptive study reviewed records of patients receiving care for lichenoid dermatosis from January 1997 to December 2016 in the dermatology departments of Lomé. In total, 959 (2.2%) cases of lichenoid dermatoses including 813 (84.8%) of lichen planus and 123 (12.8%) of lichen striatus were recorded. The mean age of the patients was 29.60 +/- 14 years and the sex ratio (M/F) was 0.7. Lichen planus was papular and found most often on the lower limbs (56.0%). Lichen striatus was banded along the lines of Blaschko, mainly on the lower limbs (55.3%). There were 23 patients with lichen nitidus lesions, most often on the trunk (47.8%). The treatment was based on corticosteroid therapy. Recurrences were noted in 40 (11.6%) cases of lichen planus and 4 (3.2%) of lichen striatus. This study shows that the principal lichenoid dermatoses in Lomé are lichen planus, and their management is based on corticosteroid treatment.

Stevens-Johnson and Lyell syndromes in children in a hospital setting in Lomé, Togo, from 2000 to 2015.

OBJECTIVE: The aim of this study was to document the profile of children with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, also called Lyell syndrome) in hospital settings in Lomé, Togo. METHOD: This descriptive retrospective study examined the records of children aged 0 to 15, seen and/or hospitalized in the dermatology department of CHU-SO Lomé and diagnosed with SJS/TEN between 2000 and 2015. RESULTS: Records were identified for 14 children with these diagnoses during the study period. Their average age was 10.9 ± 3.9 years. The average time between taking the apparently causal medication and the onset of symptoms was 10.5 days (range: 4 to 21 days). SJS accounted for 64.3% of the cases. Six children with SJS and one with TEN had ocular involvement. Antibacterial sulfonamides were the main drug involved for 43% of children, followed by anticonvulsants for 14/3%. CONCLUSION: Our results show that SJS/TEN is rare but serious in children. The antibacterial sulfonamides used for the treatment of malaria and anticonvulsants are their most frequent cause.

Cutaneous parasitosis in dermatology in Lomé: series of 1217 cases.

The aim of this study was to determine the epidemiological and clinical profile of cutaneous parasitosis in Lomé, Togo. Of the 71422 patients seen in 3 dermatology departments during the study period, 1217 (1.7%) had cutaneous parasitosis, 98% of them ectoparasitosis.

Morbidity and mortality in HIV-infected children on antiretroviral therapy in Togo.

the aim of this study was to evaluate the mortality and morbidity of HIV-infected children on highly active antiretroviral treatment (HAART) in Togo. this is a retrospective study of HIV-infected children on HAART in the 25 largest centers of HIV/AIDS care in Togo. the study included 1861 children (sex-ratio=0.99). Among them, 35.6 % were in WHO clinical stages 3 or 4 at the beginning of HAART. The most common opportunistic infections were coughing and pneumonia (37.1 %), gastroenteritis (11.3 %), various bacterial infections (10.4 %), and pruritus (10.4 %). The incidence of death was estimated at 4.5 per 100 person-years. Mortality was highest during the first year of antiretroviral therapy. The survival rate at 12 months of ART was 92.6 %. Children who began HAART at WHO clinical stage 4 had a significantly lower survival rate than the others (P<0.0001). The presence of a side effect of HAART (P=0.041), and hospitalization (P<0.001) were significantly associated with death in these children. although the new recommendations for medical care require early initiation of HAART, the improved performance of programs to prevent maternal-infant transmission remains crucial in reducing morbidity and mortality of children on HAART in Togo.

[Factors associated with the severity of acute ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa]. / Facteurs de risque associés à la sévérité de l'atteinte oculaire au stade aigu du syndrome de Stevens-Johnson et de la nécrolyse épidermique toxique en Afrique subsaharienne.

AIM: The purpose of this study was to identify risk factors associated with the severity of acute ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) in sub-Saharan Africa. PATIENTS AND METHOD: A retrospective study was carried out at the dermatology department in collaboration with the ophthalmology department for SJS/TEN patients between January 2000 and December 2016 in Lomé (Togo). The severity of acute ocular involvement was evaluated using the Power classification, and the drug eruption score was assessed using de Bastuji-Garin classification. RESULTS: A total of 107 cases of SJS/TEN (84 cases of SJS, 20 cases of TEN and 3 cases of overlap syndrome) were analyzed. There were 71 women and 36 men, with an average age of 32.3±12.5 years (range: 5 to 75 years). Sulfonamides (37.4%) were the most commonly used drugs followed by nevirapine (22.4%). HIV serology was positive in 46 (58.2%) of the 79 patients tested. A total of 54 (50.5%) patients had acute ocular involvement, which was mild in 29.9% of patients, moderate in 13.1% and severe in 7.5%. In multivariate analysis, exposure to sulfadoxine was the sole factor associated with moderate or severe acute ocular involvement in SJS/TEN (adjusted odds ratio=3.3; 95% CI=[1.1; 10.2]). CONCLUSION: Exposure to sulfadoxine was identified in our study as a risk factor associated with the severity of acute ocular involvement in SJS/TEN. Multicenter studies should be conducted in sub-Saharan Africa to confirm this associated risk factor.

[Retrospective Study of Leprosy in Togo (2000-2014): about 2,630 cases]. / Étude rétrospective de la lèpre au Togo (2000­2014) : à propos de 2 630 cas.

The aim of this retrospective study carried out from January 2000 to December 2014 was to determine and map the epidemiological evolutionary trends and the clinical forms of leprosy cases notified in Togo. All the 2,630 new leprosy cases notified by all districts to the National Leprosy/Buruli Ulcer Control Program (PNLLUB-Togo) were included. The mean annual incidence was 175 cases with extremes of 73 to 266 cases. The median age of patients was 40 years, and the sex-ratio was 1.13. Children aged 0 to 15 accounted for 5.5% of the cases. The plateau region in the center of the country had the highest annual incidence (around 800 cases). Multibacillary forms accounted for 74.2% of cases. All patients were treated with multidrug therapy (MDT). WHO grade 2 disease was found in 15% of patients and 9.5% were lost to follow-up. Our results confirm that leprosy is no longer a major public health problem in Togo. However, the high incidence of leprosy in some areas of the country, could permit a resurgence of the disease.

Le but de cette étude était de déterminer les tendances épidémiologiques et les formes cliniques des cas notifiés de lèpre au Togo. Il s'agit d'une étude rétrospective portant sur les cas de lèpre notifiés par l'ensemble des districts sanitaires au Programme national de lutte contre la lèpre, l'ulcère de Buruli et le pian du 1er janvier 2000 au 31 décembre 2014. Deux mille six cent trente nouveaux cas de lèpre ont été notifiés. L'incidence annuelle moyenne était de 175 cas avec des extrêmes de 73 et 266 cas. L'âge médian des patients était de 40 ans, et le sex-ratio de 1,13. Les enfants âgés de 0 à 15 ans représentaient 5,5 % des cas. La région des Plateaux dans le centre du pays cumulait l'incidence annuelle la plus élevée (environ 800 cas). Sur le plan clinique, les formes multibacillaires représentaient 74,2 % des cas. Tous les patients étaient traités par polychimiothérapie. L'infirmité de grade 2 de l'OMS était retrouvée chez 15 % des patients, et 9,5 % étaient perdus de vue. Nos résultats confirment que la lèpre n'est plus un problème majeur de santé publique au Togo. On note une incidence élevée de la lèpre dans certaines régions du pays, pouvant faire craindre une recrudescence de la maladie.