RESUMO
BACKGROUND: Oculocutaneous albinism is disproportionately prevalent in Africa; however, the medical and psychosocial characteristics of people living with albinism (PWA) in Botswana have not been studied. OBJECTIVE: To characterize the demographics, health-related factors, sun-protective behaviors, and psychosocial challenges of PWA in Botswana. METHODS: Overall, 50 PWA and 99 patients without albinism (non-PWA) were recruited and surveyed. RESULTS: Higher proportions of PWA lived in rural villages compared with non-PWA (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.26-5.34). PWA reported limited access to health care more frequently compared with non-PWA (OR, 2.72; 95% CI, 1.11-6.62). High proportions of PWA adopted sun-protective measures, including sunscreen, clothing, and sunlight avoidance. Despite high rates of feeling accepted by family and peers, PWA had increased odds of feeling unaccepted by their community (OR, 15.16; 95% CI, 5.25-31.81), stigmatized by society (OR, 9.37; 95% CI, 3.43-35.62), and affected by stigma in social interactions (OR, 2.21; 95% CI, 1.08-4.54) compared with non-PWA. Three-quarters of PWA had witnessed mistreatment of PWA. LIMITATIONS: Study limitations include the small sample size, convenience sampling, and a non-validated survey instrument. CONCLUSION: PWA faced increased medical and psychosocial challenges compared with non-PWA in Botswana. Our findings can begin to inform public health strategies aimed at promoting improved health care, education, and social inclusion for this population in Botswana and other regions in Africa.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Prestação Integrada de Cuidados de Saúde , Infecções por HIV/complicações , Sarcoma de Kaposi/patologia , Neoplasias Cutâneas/patologia , África Subsaariana , Biópsia , Botsuana , Dermatologia , Saúde Global , Humanos , Quênia , Nigéria , Encaminhamento e Consulta , Sarcoma de Kaposi/diagnóstico , Neoplasias Cutâneas/diagnósticoRESUMO
The authors reviewed outpatients in a tertiary dermatology clinic in Botswana to expand knowledge on patterns of skin disease in this population with a high prevalence of human immunodeficiency virus (HIV). Approximately one-third of new and follow-up patients were HIV positive. Common dermatologic conditions included eczematous eruptions, viral and fungal infections, malignant neoplasms, vascular disorders, disorders of pigmentation, and mechanical/physical injury-related disorders. HIV has impacted patterns of dermatologic disease in Botswana, with Kaposi sarcoma being the most frequently biopsied condition. Given the shortage of dermatology specialists, resources should be allocated toward education and management of these most prevalent skin conditions.
Assuntos
Dermatite/epidemiologia , Infecções por HIV/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Vasculares/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Idoso , Biópsia/estatística & dados numéricos , Botsuana/epidemiologia , Criança , Pré-Escolar , Dermatite/diagnóstico , Dermatite/terapia , Dermatite Atópica/diagnóstico , Dermatite Atópica/epidemiologia , Dermatite Atópica/terapia , Feminino , Humanos , Lactente , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Discoide/epidemiologia , Lúpus Eritematoso Discoide/terapia , Masculino , Pessoa de Meia-Idade , Neurodermatite/diagnóstico , Neurodermatite/epidemiologia , Neurodermatite/terapia , Prevalência , Estudos Retrospectivos , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/epidemiologia , Sarcoma de Kaposi/terapia , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/terapia , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/terapia , Dermatopatias Vasculares/diagnóstico , Dermatopatias Vasculares/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Centros de Atenção Terciária , Verrugas/diagnóstico , Verrugas/epidemiologia , Verrugas/terapia , Adulto JovemRESUMO
People with albinism (PWA) in Africa suffer many challenges, including higher risk of skin cancers and deeply embedded stigma. We conducted interviews with PWA to determine factors influencing their quality of life (QOL) in Botswana. Physical concerns expressed included skin/eye health issues and limited access to health care. Psychosocial concerns included stigma/discrimination and myths/superstitions. Environmental concerns included barriers to personal development of education and employment, safety concerns, financial insecurity, and disability rights issues. Pervasive difficulty in obtaining equal rights to physical, psychosocial, and environmental health affected QOL. Education around albinism and disability rights are needed to improve QOL for PWA.
Assuntos
Albinismo Oculocutâneo/fisiopatologia , Albinismo Oculocutâneo/psicologia , Pessoas com Deficiência , Qualidade de Vida , Neoplasias Cutâneas/prevenção & controle , Queimadura Solar/prevenção & controle , Protetores Solares/uso terapêutico , Transtornos da Visão/fisiopatologia , Adulto , Idoso , Botsuana , Educação , Emprego , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Pesquisa Qualitativa , Discriminação Social , Estigma Social , Adulto JovemRESUMO
BACKGROUND: Primary cutaneous lymphoma (PCL) represents a heterogeneous collection of non-Hodgkin lymphomas originating in the skin. Our study describes the clinical and histological findings of cutaneous lymphoma within Botswana to expand the paucity of data on this rare disease in sub-Saharan Africa. METHODS: We conducted a retrospective review from the dermatology clinic at Princess Marina Hospital (Gaborone, Botswana) of patients evaluated by skin biopsy for cutaneous lymphoma between 2008 and 2017. Patients with initial diagnostic suspicion for cutaneous lymphoma had biopsies re-reviewed by experienced dermatopathologists and were given a final diagnosis of either (i) cutaneous lymphoma, (ii) atypical lymphocytic infiltrate (ALI), or (iii) a reactive cutaneous process. RESULTS: Thirty-eight cases were identified with a mean age of 50.0 years and a male:female (M:F) ratio of 13:6. Final diagnoses included: 27 cases of cutaneous lymphoma, eight cases of ALI, and three cases of reactive cutaneous processes. Subtypes of cutaneous lymphoma diagnosed included: mycosis fungoides (MF) (81.5%), plasmablastic lymphoma (7.4%), Epstein-Barr virus-positive T-cell lymphoma (3.7%), subcutaneous panniculitis-like T-cell lymphoma (3.7%), and peripheral T-cell lymphoma, not otherwise specified (3.7%). The most common immunohistochemical staining profile in MF cases was CD8 predominance over CD4. CONCLUSIONS: Primary cutaneous lymphoma causes significant morbidity and mortality globally. Given the limited resources in sub-Saharan Africa, it is essential to educate providers on the manifestations and histology of PCL. This study is an important step towards understanding the demographics, clinical presentation, histologic features, and mortality of patients diagnosed with PCL in Botswana and similar low-resource settings.
Assuntos
Linfoma não Hodgkin/diagnóstico , Neoplasias Cutâneas/diagnóstico , Botsuana , Feminino , Humanos , Imuno-Histoquímica , Linfoma não Hodgkin/terapia , Masculino , Estudos Retrospectivos , Neoplasias Cutâneas/terapiaAssuntos
Blastomicose/diagnóstico , Infecções por HIV/complicações , Infecções Cutâneas Estafilocócicas/diagnóstico , Staphylococcus aureus , Superinfecção/diagnóstico , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Blastomicose/tratamento farmacológico , Botsuana , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Superinfecção/tratamento farmacológicoRESUMO
PURPOSE: Kaposi sarcoma (KS) is an HIV-associated skin cancer that is highly prevalent in Botswana and associated with significant morbidity and mortality. Histopathology-confirmed diagnosis is required for chemotherapeutic interventions in Botswana, which creates barriers to care because of limited biopsy and pathology services. We sought to understand the role a dermatology specialist can play in improving KS care through quality improvement (QI) initiatives to reduce histologic turnaround times (TATs) for KS. METHODS: Employment of a dermatology specialist within a public health care system that previously lacked a local dermatologist generated quality improvements in KS care. Retrospective review identified patients diagnosed with KS by skin biopsy in the predermatology QI interval (January 1, 2015, to December 31, 2015) versus the postdermatology QI interval (January 1, 2016, to November 31, 2017). Histology TATs and clinical characteristics were recorded. A t test compared the median histology TATs in the pre- and post-QI intervals. RESULTS: A total of 192 cases of KS were diagnosed by skin biopsy. Nearly all (98.4%) were HIV-positive; and 52.8% of patients were male with a median age of 39 years. Median TAT in the postdermatology QI interval was 11 days (interquartile range, 12-23 days) compared with 32 days in the predermatology QI interval (interquartile range, 24-56 days; P < .00). CONCLUSION: Dermatology-led QI initiatives to improve multispecialty care coordination can significantly decrease histology TATs for KS. The reduction of diagnostic delays is a key first step to decreasing the morbidity and mortality associated with this cancer in resource-limited settings.
Assuntos
Sarcoma de Kaposi/diagnóstico , Adulto , Idoso , Botsuana , Dermatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Adulto JovemAssuntos
Transtornos de Fotossensibilidade/etiologia , Porfiria Cutânea Tardia/diagnóstico , Botsuana , Feminino , Soropositividade para HIV/complicações , Soropositividade para HIV/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Transtornos de Fotossensibilidade/terapia , Porfiria Cutânea Tardia/complicações , Porfiria Cutânea Tardia/terapia , Luz Solar/efeitos adversosRESUMO
A 24-year-old man with untreated human immunodeficiency virus (HIV) infection consulted our outreach clinic owing to the development of numerous asymptomatic nodules on his palms and fingers. Histopathologic evaluation revealed leukocytoclastic vasculitis and prominent fibrosis with a neutrophilic infiltrate consistent with erythema elevatum diutinum (EED). We referred the patient for initiation of antiretroviral therapy and started him on dapsone. The pathogenesis of EED is not completely understood, but it has been associated with numerous systemic conditions that may be infectious, inflammatory, or neoplastic. Only recently has EED been recognized as a defined reactive dermatosis of HIV. We present an exemplary case of HIV-associated EED and review the differential diagnosis, highlighting clinical features of EED that appear to be more frequently encountered in the HIV-infected population.
Assuntos
Anti-Infecciosos/uso terapêutico , Dapsona/uso terapêutico , Infecções por HIV/complicações , Vasculite Leucocitoclástica Cutânea/diagnóstico , Vasculite Leucocitoclástica Cutânea/tratamento farmacológico , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Vasculite Leucocitoclástica Cutânea/virologia , Adulto JovemAssuntos
Dermatomicoses/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Meningite Criptocócica/tratamento farmacológico , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Dermatomicoses/diagnóstico , Feminino , Fluconazol/uso terapêutico , Dermatoses da Mão/microbiologia , Humanos , Imunocompetência , Meningite Criptocócica/diagnóstico , PescoçoRESUMO
A two-year-old boy presented with a large, non-healing ulceration on his left buttock, which was originally noted as a brown patch present at birth. Punch skin biopsy was performed and histopathology revealed an atypical, pleomorphic, spindled proliferation in whorled fascicles replacing the dermis and trapping fat in the subcutis, consistent with a diagnosis of congenital/infantile fibrosarcoma. No evidence of metastatic spread was seen on imaging. The tumor was initially deemed unresectable owing to extent of local invasion. Neo-adjuvant chemotherapy caused significant tumor shrinkage and the patient underwent complete resection.