Evaluation of the tele-expertise project in the management of common dermatoses in Togo / Évaluation du projet de téléexpertise dans la prise en charge des dermatoses courantes au Togo

Introduction: Tele-expertise in dermatology represents an opportunity to change medical practice in response to the need for cost savings in the health sector. The aim of this study was to evaluate the medical activities of the pilot phase of the tele-expertise project in Togo. Method: A cross-sectional study was conducted in October 2020 on the 20 sites of the pilot phase. This evaluation consisted of a literature review and analysis of data posted on the tele-expertise platform. Results: A total of 738 (10.8%) of the 6810 dermatological consultations were posted on the tele-expertise platform. Of the 738 cases, the dermatologist's expertise did not allow a diagnosis to be made in 119 cases (16.1%). This expertise confirmed the single clinical hypothesis proposed by the health worker in 275 cases (37.3%) and allowed a diagnosis to be made among several clinical hypotheses in 30 cases (4.1%). On the contrary, the dermatologist's diagnosis was not included in the health worker's hypotheses in 201 cases (27.2%), and no clinical hypothesis was formulated in 113 cases (15.3%). The concordance between the clinical hypothesis proposed by the health worker and the diagnosis of the dermatologist was 48.8%. Regarding the acceptability of the tele-expertise, only one refusal was recorded. All patients were very satisfied with this practice. Conclusions: The results show the feasibility and acceptability of tele-expertise by health care personnel and patients. The diagnostic concordance of 48.8% shows the relative efficiency of task delegation.

Introduction: La téléexpertise en dermatologie représente une piste pour modifier l'exercice médical en réponse aux besoins d'économies de la santé. Le but de cette étude était d'évaluer les activités médicales de la phase pilote du projet de téléexpertise en dermatologie au Togo. Méthode: Il s'agit d'une étude transversale menée en octobre 2020 sur les 20 sites de la phase pilote. Cette évaluation consistait en une revue documentaire et l'analyse des données postées sur la plateforme de téléexpertise. Résultats: Au total, 738 (10,8 %) des 6 810 consultations dermatologiques ont été postées sur la plateforme de téléexpertise. Sur les 738 cas, l'expertise du dermatologue n'a pas permis de poser un diagnostic dans 119 cas (16,1 %). Cette expertise a confirmé l'hypothèse clinique unique proposée par l'agent de santé dans 275 cas (37,3 %) et a permis de conclure à un diagnostic parmi plusieurs hypothèses cliniques dans 30 cas (4,1 %). Au contraire, le diagnostic du dermatologue ne figurait pas dans les hypothèses de l'agent de santé dans 201 cas (27,2 %), et aucune hypothèse clinique n'avait été formulée dans 113 cas (15,3 %). La concordance entre l'hypothèse clinique proposée par l'agent de santé et le diagnostic du dermatologue était de 48,8 %. Concernant l'acceptabilité de la téléexpertise, un seul refus a été enregistré. Tous les patients étaient très satisfaits de cette pratique. Conclusions: Les résultats montrent la faisabilité et l'acceptabilité de la téléexpertise par les personnels de santé et les patients. La concordance diagnostique de 48,8 % montre la relative efficacité de la délégation de tâches.

Pityriasis Versicolor Resistant to Antifungal Drugs in a Patient in Lomé (Togo).

Background: Pityriasis versicolor (PV) is a ubiquitous superficial skin mycosis that often affects young adults. It is often effectively treated with local or oral antifungal agents. Cases of PV resistance to antifungal agents have been reported rarely. We report a case of antifungal resistant PV. Observation. A 22-year-old patient was followed since the age of 17 years in a dermatology outpatient clinic for hyperpigmented scaly macular lesions of the trunk and upper limbs. The clinical diagnosis of PV was retained. The patient was treated by fluconazole 300 mg/week before being lost to follow-up. He was seen again in 2019 (about 2 years later) for the same symptomatology and treated again by fluconazole and ciclopirox olamine cream without improvement. He was again lost to follow-up and seen again six months later. A mycological sample was taken and Aspergillus niger was isolated. The patient was treated by itraconazole for 6 weeks. The evolution was marked by a clinical status quo. The patient was again put on salicylated petroleum jelly 10% associated with terbinafine cream and then lost to follow-up. Conclusion: The emergence of fungal resistance to antifungal drugs does not spare PV. It can therefore be resistant to several antifungal drugs, leaving clinicians and patients in despair.

Factors influencing student's specialty choices in Lomé faculty of medicine (Togo).

BACKGROUND: The choice of specialty in medicine is an important decision for the individual, but also for health system. This choice combined personals reasons, professional desires and needs of the health system. The number of specialists in the country depends of this choice. Very few studies have focused on factors influencing the choice of specialties among medical students in Africa. Also, in the absence of specialist needs planning in Togo. This study, aims to determine the factors influencing the choice of specialty among students at the Faculty of Health Sciences of the University of Lomé (FSS-UL). METHODS: This was a descriptive cross-sectional study that took place from June 1 to June 30, 2019 with medical students of the doctoral cycle and doctors in specialization studies in the various Diploma of Special Study (DSS) available at the FSS-UL. Data collection was done at the surveyed's training sites. Pre-established and pre-tested fact sheets were giving and explained to the students by data collection team. Data collection team return at the surveyed's training sites 72 h after to collect pre-established fact sheets. Following variables study including: factors (individual; related to the medical curriculum); the advantages and attractiveness of the specialty that can influence students' choice. Data analysis was carried out using Epi Info 6.0 software. The significance threshold was 5%. RESULTS: At the time of the survey, the FSS-UL had 147 doctoral students and 211 specialty students. A total of 251 participants responded to the questionnaires. These included 140 doctoral students and 111 specialty students. The choice of specialties requiring night work such as gynecology, surgery was significantly associated with the male sex (p = 0.001). There was significant association between having financial support (p = 0.001), remuneration related to the specialty (p = 0.0001) and the decision to beginning specialty studies immediately completing general medical studies. Interest in lectures (p = 0.003), teacher support as a mentor in the specialty (p = 0.01) and easy accessibility to teachers (p = 0.008) were medical curriculum factors significantly associated with specialty choice. Facility to work in public and private sector was mentioned by 55.3% of respondents who chose gynecology (p = 0.03). Interest in lectures (p = 0.003), was significantly associated with choice of fundamental sciences; and work in international fields was significantly associated with the choice of pediatric and public health (p = 0.0001). CONCLUSION: Factors influencing the choice of certain specialty were balance between family and professional life; financial support to studies, the remuneration opportunities related to the specialty, access to university career. Intervention on these factors will allow a balance between the numbers of doctors trained in the different specialties.

Skin cancers in people with albinism in Togo in 2019: results of two rounds of national mobile skin care clinics.

BACKGROUND: In people with albinism (PWA), the deficiency of melanin increase the risk of skin cancers. The aim of this study was to determine the prevalence of skin cancers and characteristics of these detected skin cancers (histological types, localization) in PWA in 10 cities in Togo in 2019. METHODS: This is a cross-sectional study of medical records of PWA systematically examined during two mobile skin care clinics in 2019, as part of a programme for the prevention and management of skin cancers in these subjects. RESULTS: During the study period, 280 (95.2%) of the 294 PWA consulted, had developed skin lesions. Of the 280 PWA, the pathological reports from the medical records of 33 patients (11.8%; (95%CI = [8.2-16.2]) had concluded to non-melanoma skin cancers. The mean age of these 33 patients was 38.6 ± 15.2 years and the sex-ratio was 1. Their occupations were mainly resellers (21.2%), traders (15.2%) and farmers (12.2%). In the 33 patients, 54 cases of non-melanoma skin cancers were identified, with some patients having more than one tumor, and some of them having more than one (histologically confirmed) diagnosis. These 54 non-melanoma skin cancers were divided into 21 cases of invasive squamous cell carcinomas, 2 cases of Bowen's disease and 31 cases of basal cell carcinomas. These non-melanoma skin cancers mainly occurred in the head and neck (33 cases; 61.1%), the upper limbs (15 cases; 27, 8%) and the trunk (4 cases; 7.4%). CONCLUSION: The results of this study show a high prevalence of skin cancers among PWAs in Togo in 2019, only non-melanoma skin cancers. In addition, they illustrate the role of ultraviolet rays with regard to the localization of skin cancers and the occupations of patients. Popularization and compliance with photo protection measures, systematic and regular examination of the skin of these PWAs will allow early detection and treatment of these skin cancers.

Factors Associated with Skin Cancers in People with Albinism in Togo.

OBJECTIVE: The aim of this study was to identify the factors associated with skin cancers in people with albinism (PWA) in Togo. METHOD: This is a retrospective analytical study of the records of PWA examined during five dermatological consultation campaigns from 2019 to 2021. RESULTS: During the study period, 517 PWA were seen. Sixty-four (12.3%) of these PWA had presented with 137 cases of skin cancer. The sex ratio (M/F) was 0.9. The average age of PWA with skin cancer was 39.69 ± 15.61 years and that of PWA without skin cancer was 19.17 ± 15.24 years (p ≤ 0.001). The 137 cases of skin cancers were dominated by basal cell carcinomas (45.9%). These skin cancers were located preferentially in the cephalic region (77 cases; 56.2%), followed by the upper limbs (33 cases; 24.1%). In multivariate analysis, the risk factors for skin cancers in PWA were age over 39 years (p ≤ 0.001) and the presence of actinic keratoses (p ≤ 0.001). In contrast, the presence of ephelides (p=0.018) was a protective factor. CONCLUSION: This study confirms that advanced age and actinic keratoses are risk factors for skin cancer in PWA, in connection with the cumulative role of solar radiation. Its originality lies in the identification of ephelides as a protective factor. The knowledge and consideration of these risk factors will make it possible to optimise strategies for the prevention of skin cancers in PWA.

Acne keloidalis nuchae and hypertension in black subjects: a case-control study.

OBJECTIVE: The aim of this case-control study was to look for an association between hypertension and acne keloidalis nuchae (AKN) in black subjects. RESULTS: We recruited 303 consenting subjects comprising 101 patients with AKN and 202 controls, case-matched by age (± 5 years). The mean patients age was 34.9 ± 10.7 years versus 35.6 ± 11.2 years for controls. The average duration of AKN progression in cases prior to consultation was 1831 days (5 years). The most frequently observed AKN lesions were papules (73/101; 72.3%), fibrous scars (42/101; 41.6%) and folliculitis/pustules (41/101; 40.6%). In terms of quality of life, the mean score of dermatology life quality index was 8.3 ± 5.2 (extremes: 0 to 22). In multivariate analysis, having a BMI of 25 kg/m2 or more (OR = 4.91; p < 0.001) and having systolic hypertension (OR = 1.22; p = 0.010) were associated with AKN.

A Histopathological Study of Skin Lesions in Individuals with Oculocutaneous Albinism in Togo in 2019.

OBJECTIVE: The aim of this study was to study the histopathological patterns of skin lesions in persons with albinism (PWA) in Togo in 2019. METHOD: During two mobile skin care clinics in 2019, biopsies/excisional biopsies were performed in PWA in case of clinical doubt or in front of lesions suspected to be cancerous for histological examination. Anatomopathological reports were thus analysed. RESULTS: During the two mobile skin care clinics, 115 biopsies/excisional biopsies were carried out in 79 PWA, with a mean age of 24 ± 16.1 years. Histological examination led to a diagnosis in 110 cases (95.6%) and was inconclusive in 5 cases (4 cases of uncertain histological diagnosis and one case of nonspecific histological lesions). Fourteen different histological diagnoses were made, with a frequency ranging from 0.9% (one case) to 26.9% (31 cases). The four most frequent diagnoses in descending order were basal cell carcinomas (BCCs) (31 cases; 26.9%), invasive squamous cell carcinomas (SCCs) or Bowen's disease (23 cases; 20%), keratosis (20 cases; 17.3%), and cysts (seven cases; 6.1%). The 54 skin carcinomas were diagnosed in 33 (41.8%) of the 79 patients who underwent skin biopsies/excisional biopsies. The BCC/SCC ratio was 1.3. No cases of cutaneous melanoma had been diagnosed. CONCLUSION: Skin cancers represent the main histological diagnosis in PWA (46.9%) in Togo in 2019. The pattern of cutaneous malignancies in PWA shows the same trend as that seen in Caucasians with a predominance of basal cell carcinomas.

Dermatological and epidemiological profile of patients with albinism in Togo in 2019: results of two consultation campaigns.

BACKGROUND: People with albinism (PWA) are targets of prejudice and social exclusion and have limited access to specialized medical care and resources. Our study aimed to describe the epidemiological and dermatological profile of PWA in Togo. METHOD: We carried out a cross-sectional study of 294 medical records of PWA systematically examined during two mobile skin care clinics in 2019. RESULTS: The mean age of the patients was 22 ± 16.5 years, and the gender ratio (M/F) was 1. A family history of albinism was reported in 27.9% of cases, and consanguinity between the parents was found in 24.1% of PWA. Dermatological lesions on physical examination were present in 95.2% of PWA. These lesions were elastosis/wrinkles (82.9%), ephelides (79.6%), actinic keratoses (60.0%), actinic cheilitis (50.0%), and cutaneous carcinomas (11.8%). The mean age of PWA with skin carcinomas was 38.6 years. Fifty-four cases of cutaneous carcinomas had been diagnosed (31 cases of basal cell carcinoma, 21 cases of squamous cell carcinoma, and 2 cases of Bowen's disease) and were located mainly in the cephalic region (61.1%) and upper limbs (27.8%). Cryotherapy and/or excisional biopsies were the treatments for premalignant and malignant lesions. All PWA were sensitized on sun protection. CONCLUSIONS: This study shows the basic picture of dermatological characteristics of PWA with a high frequency of photo-induced lesions and skin cancers. The popularization and respect of photoprotection measures and regular skin examination of these PWA for early detection and management of lesions will reduce their morbidity and mortality.

[Connective tissue diseases in the hospital setting in Lomé: a retrospective study of 231 cases]. / Les connectivites en milieu hospitalier à Lomé: étude rétrospective de 231 cas.

This study aimed to highlight the epidemiological , clinical, therapeutic and evolutionary profile of connective tissue diseases in the hospitals setting in Lomé. We conducted a retrospective and descriptive study from January 1, 1993 to December 30, 2012. We focused on the medical records of patients with connective tissue diseases hospitalized in five Departments of Dermatology and Rheumatology at the Hospitals in Lomé. During the study period, we identified 231 cases of connective tissue diseases in the five study centers, corresponding to a frequency of 0.19% of consultations. The average age of patients was 36,96±15 years, the sex-ratio was 0,2. Major connective tissue diseases included lupus disease (50.22%), sclerodermas (21,64%) and rheumatoid polyarthritis (20.35%). Clinically, the main clinical manifestations of connective tissue diseases included discoid lupus lesions (87.50%) and photosensitivity (82.50%) in patients with systemic lupus erythematosus, skin sclerosis (90.48%) in patients with systemic scleroderma and distal joint involvement (100%) in patients with rheumatoid arthritis. Treatment in patients with systemic lupus erythematosus (92.5%) and rheumatoid arthritis (73.47%) was based on systemic corticosteroids. Connective tissue diseases are rare in people living in Lomé, with a predominance of lupus disease. They are more frequent in young women. Treatment is based on systemic corticosteroids.

Basidiobolomycosis Simulating a Mycobacterium ulcerans Infection in a Togolese Rural Child.

BACKGROUND: Basidiobolomycosis is a deep mycosis which preferentially affects rural young people in tropical countries. We report an atypical case, with multiple ulcers, simulating a Buruli ulcer. CASE REPORT: A 5-year-old boy, living in a rural area, was seen for ulcers on the buttocks and at the back and right flank that had been in progress for 4 months. On examination, we found an infiltrated plaque with sharp edges, little painful, located on the buttocks, back, and the right flank. On this plaque, there were multiple ulcers with polycyclic contours and fibrinous bottom. There were inguinal inflammatory lymph nodes. The patient had an altered general condition. Examination of other organs was normal. The diagnosis of Buruli ulcer was evoked first; the search for Mycobacterium ulcerans by polymerase chain reaction was negative. Histology test performed revealed hypodermic granulomatous inflammation with predominant macrophage and eosinophils. The mycological culture was not done. The child was treated successfully with ketoconazole (10 mg/kg/day) during eight weeks. DISCUSSION: Our observation shows great clinical and epidemiological similarities between basidiobolomycosis and Buruli ulcer. It confirms the efficacy of ketoconazole in severe basidiobolomycosis infection with alteration of general condition. Histopathology is very important for differential diagnosis between these two diseases.

Evolution of HIV prevalence and behavioral factors among MSM in Togo between 2011 and 2015.

INTRODUCTION: The aim of this study was to assess sexual behavior and measure HIV prevalence among MSM in 2015, in Togo. METHODS: We conducted a cross-sectional study from February to March 2015 in nine major cities of Togo. The respondent-driven sampling method was used to recruit MSM. Behavioral data were collected by interviewer-administered questionnaires. The blood tests were then carried out among MSM to assess their HIV status. Data were inputted into an Epidata database and exported to STATA® 9.0 for analysis. Qualitative variables were compared using the chi-2. RESULTS: A total of 496 MSM were involved in this study, with 43.35% in the capital, Lome. Over the past 12 months, 88.9% of MSM had had sexual intercourse with men and 24.1% of them had had sex with women. The last sexual intercourse was with a casual partner among 52.9% of MSM. During the last 30 days preceding the survey, 68.5% of MSM had regularly used a condom during active anal intercourse and 71.9% had used it during passive anal intercourse. The national prevalence rate of HIV among MSM was 13.0%. The factors associated with HIV infection were age of MSM OR = 5.30 [1.85-15.1], HIV testing history OR = 2.63 [1.18-5.87] and the city of residence of MSM OR = 5.56 [2.90-10.64]. CONCLUSION: This study confirms that HIV prevalence among MSM is five times higher than in the general population (13% vs 2.5%). Thus, the need to rethink HIV sensitization and prevention strategies targeting hidden and stigmatized populations such as MSM.

Risk factors associated with abscess formation among patient with leg erysipelas (cellulitis) in sub-Saharan Africa: a multicenter study.

BACKGROUND: Abscess formation is a frequent local complication of leg erysipelas. In this study we aimed at identifying factors associated with abscess formation of leg erysipelas in patients in sub-Saharan African countries. METHOD: This is a multicenter prospective study conducted in dermatology units in eight sub-Saharan African countries from October 2013 to September 2014. We performed univariate and multivariate analysis to compare characteristics among the group of patients with leg erysipelas complicated with abscess against those without this complication. RESULTS: In this study, 562 cases of leg erysipelas were recruited in the eight sub-Saharan African countries. The mean age of patients was 43.67 years (SD =16.8) (Range: 15 to 88 years) with a sex-ratio (M/F) of 5/1. Out of the 562 cases, 63 patients (11.2%) had abscess formation as a complication. In multivariate analysis showed that the main associated factors with this complication were: nicotine addiction (aOR = 3.7; 95 % CI = [1.3 - 10.7]) and delayed antibiotic treatment initiation (delay of 10 days or more) (aOR = 4.6; 95 % CI = [1.8 - 11.8]). CONCLUSION: Delayed antibiotics treatment and nicotine addiction are the main risk factors associated with abscess formation of leg erysipelas in these countries. However, chronic alcohol intake, which is currently found in Europe as a potential risk factor, was less frequent in our study.

HIV prevalence and behavioral studies in female sex workers in Togo: a decline in the prevalence between 2005 and 2011.

INTRODUCTION: We determined the sero-prevalence of HIV among female sex workers (FSWs) in Togo identified their sexual risk behaviors. METHODS: We conducted a cross-sectional study from 17 to 27 December, 2011 on 1106 FSWs in Togo. Venous sample were collected to estimate HIV prevalence as per national algorithms. Behavior data were collected by interviewer-administered questionnaires. RESULTS: Of the 1106 FSWs (mean age = 27.6 years) surveyed, 17% and 63% had their first sexual intercourse before the age of 15 and 18 years respectively. Overall, 43.4% of the FSWs had more than seven clients per week. Most FSWs (95%) said they had sex using a condom in their lifetime while 8.8% had used a condom during their last sexual intercourse. About 79% of FSWs used a condom during their sexual encounters the previous week and 11.6% had used a condom during each of their sexual encounters the previous day. Most FSWs (62.2%) reported to have been tested for HIV. Of these, 145 (13.1%) were HIV positive. HIV sero-prevalence decreased from 19.4% in the south to 7.5% in the north of the country. Behaviors associated with FSW being HIV positive included: FSW having more than 7 clients per week (p < 0.001), not using condoms at every intercourse act (p = 0.003) or during the last sexual encounter (p = 0.006) and trading sex in brothels (p < 0.001). CONCLUSION: We estimate HIV sero-prevalence among FSWs in 2011 to be 13.1% in Togo, significantly lower than a prevalence of 29.5% estimated previously in 2005. Inconsistent use of condoms was identified as associated with high risk factor for acquiring HIV.

Is There an Association between Keloids and Blood Groups?

Objective. The aim of the study is to investigate the possible associations between the blood groups ABO and Rhesus systems and the presence of keloids in patients with black skin. Method. This case-control study was conducted between September 2007 and August 2011 comparing dermatologic outpatients with keloids to matched controls recruited in preanesthetic consultation at Tokoin Teaching Hospital of Lomé (Togo). Results. The distribution of different ABO blood groups and Rhesus blood groups in both groups (cases versus controls) was not significantly different. This distribution of different blood groups was superimposed on the general population of blood donors at the National Blood Transfusion Center of Lomé. Univariate analysis between each blood group and the presence of keloid does not yield any statistically significant association between blood groups and presence of keloids in the subjects. Conclusion. The study shows no significant association between blood groups and the presence of keloids in our patients. Further investigation needs to be conducted to elucidate this hypothesis further by conducting multicenter studies of several ethnic groups.