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.

[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.

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.

[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.

Systemic complications during voluntary cosmetic depigmentation among women in Togo: A case-control study.

OBJECTIVE: The aim of our study was to document the systemic complications of skin bleaching among women in Togo. METHODS: This was a case-control study conducted between December 2009 and December 2013. Cases comprised of women using skin-bleaching products for at least 6 months and age-matched with non-users (±3 years). RESULTS: We recruited a total of 150 women using skin-bleaching and matched them with 300 controls. Univariate analysis revealed a correlation between systolic hypertension (OR=2.56; 95% CI: 1.68-3.92), diastolic hypertension (OR=1.89; 95% CI: 1.17-3.05), hyperglycaemia (OR=1.5; 95% CI: 1.2-9, 65) and obesity (OR=1.68; 95% CI: 1.08-2.62) with the use of skin-bleaching products. Multivariate analysis revealed a correlation between skin bleaching and both systolic hypertension (OR=3.94; 95% CI: 1.59-3.75) and obesity (OR=2.88; 95% CI: 1.23-5.69). CONCLUSION: The results of our study show the existence of a correlation between voluntary cosmetic depigmentation, hypertension and obesity in Togo.

[Risk factors associated with leg erysipelas (cellulitis) in sub-Saharan Africa: A multicentre case-control study]. / Facteurs de risque associés à l'érysipèle de jambe en Afrique subsaharienne: étude multicentrique cas-témoins.

BACKGROUND: Acute bacterial cellulitis of the leg (erysipelas) is a common problem involving considerable morbidity in dermatology practice in Africa. Previous studies conducted in Europe and North Africa have highlighted lymphoedema and toe-web intertrigo as independent factors associated with leg erysipelas. The aim of this case-control study was to identify risk factors associated with leg erysipelas in sub-Saharan Africa, within a different socio-economic and culture context. PATIENTS AND METHODS: We conducted a prospective case-control study in hospital dermatology departments in 8 sub-Saharan African countries over a 12-month period (October 2013 to September 2014). Each case of acute leg cellulitis was matched with 2 controls for age (±5 years) and sex. We analysed the general and local factors. RESULTS: During the study period, 364 cases (223 female, 141 male) were matched with 728 controls. The mean age was 42.15±15.15 years for patients and 42.11±36 years for controls. Multivariate analysis showed the following to be independent risk factors associated with leg erysipelas in our study: obesity (odds ratio [OR]=2.82 ; 95% confidence interval: 2.11-3.76), lymphoedema (OR=3.87, 95%CI: 2.17-6.89), voluntary cosmetic depigmentation (OR=4.29, 95%CI: 2.35-7.83), neglected traumatic wound (OR=37.2, 95%CI: 24.9-57.72) and toe-web intertrigo (OR=37.86, 95%CI: 22.27-64.5). CONCLUSION: The results of this study confirms the major role of local risk factors (toe-web intertrigo, lymphoedema) previously identified in other geographical settings. However, the originality of our study consists of the identification of voluntary cosmetic depigmentation as a risk factor for leg erysipelas in sub-Saharan Africa.

[Profile of Buruli ulcer treated at the National Reference Centre of Togo: a study of 119 cases]. / Profil de l'ulcère de Buruli pris en charge au Centre national de référence du Togo: étude de 119 cas.

The purpose of this study was to describe the epidemiological, clinical, therapeutic profile and the outcome of Buruli ulcer (BU) in the National Reference Center for Buruli ulcer treatment (NRCBUT) in Togo. It was a retrospective and descriptive study of records of patients treated for BU in the NRCBUT between June 2007 and December 2010. During the study period, 119 patients (56.3% males) were treated in the NRCBUT for BU. The median age of patients was 14 years. The proportion of children (< 15 years) was 56.3%. On admission, 85 patients were at ulcer stage and 34 patients at the pre-ulcer stage. BU wounds were mainly located on lower limbs (50.4%), followed by upper limbs (32.6%) and trunk (13.3%). The location of the wounds on the lower limbs were more frequent in patients older than 15 years (P < 0.001), while those on the upper limbs (P = 0.002) and trunk (P = 0.03) were more frequent in patients aged less than 15 years. All patients had received medical treatment which was based on rifampicin-streptomycin combination for eight weeks. This treatment was coupled to surgery in 30 cases. The outcome was punctuated by complications in 7 patients, limb amputation in 3 patients, and sequels in 10 patients. This study confirmed that the BU is the prerogative of young subjects and the exposed areas in the skin facilitates transmission. Apart from these classic features, some unique aspects including the age-dependent distribution are related to the pathogenesis of this disease.

[Rapid regression of infantile haemangioma with 2% propranolol ointment]. / Régression rapide d'un hémangiome infantile sous propranolol topique à 2 %

BACKGROUND: Oral propranolol produces dramatic results in severe infantile haemangioma. We report a case of rapid and significant regression of an infantile haemangioma in infant treated topically with 2% propranolol ointment. PATIENTS AND METHODS: A female infant aged 11 weeks was seen as an outpatient for two infantile haemangiomas on the front of the left knee and the vulva. After parental consent was given, the child was treated with a topical preparation of 2% propranolol ointment prepared by the pharmacy. Regression was rapid and on the 45th day, lesion size had been reduced by an estimated 75%. No adverse effects were observed. DISCUSSION: Topical propranolol appears to be effective and safe for the treatment of superficial haemangiomas. Clinical trials are required to determine the optimal dosage and pharmaceutical form, method of use and treatment duration.

[Fixed drug eruption in dermatology setting in Lomé (Togo): a retrospective study of 321 cases]. / Érythème pigmenté fixe en pratique dermatologique à Lomé (Togo): étude rétrospective de 321 cas.

The aim of this study was to determine the frequency and list of drugs responsible for fixed drug eruption (FDE) in Lomé (Togo). A descriptive retrospective study of patients with FDE treated from January 2006 to November 2011 in dermatology service at the teaching hospital of Lomé (Togo) was conducted. During the study period, 321 cases of FDE were reported among 472 cases of toxidermia observed. Mean age of the patients was 31.27 ± 14.01 years and sex-ratio (M/F) was 1.01. One hundred thirty-three (41.4%) of 321 patients had a previous FDE, against 58.6% who were in their first attack. The most common form was the hyperpigmented form (247 cases/321). The main locations of the lesions were the trunk (N = 127) followed by the lower limbs (N = 85), the upper limbs (N = 81) and external genital organs (N = 53). A drug was incriminated in 163 (50.8%) of the 321 patients, in whom 109 patients took their drug by self-medication. Antibacterial sulfonamides were the first drug involved (70.5%), followed by nonsteroidal anti-inflammatory drugs (9.8%), antimalarial drugs (7.4%) and antibiotics (3.7%). All patients received a banned drug. In addition, 111 patients were treated with antihistamines, 69 with corticosteroids, and 58 with topical antiseptics. During follow-up, 42 of 321 patients have been seen; all had a favorable outcome. Our study confirms the frequency of FDE and the role of antibacterial sulfonamides as the cause of FDE in Africa and documents the effects of self-medication in toxidermia in Togo.

[Opportunistic infections of the HIV/AIDS in adults in hospital settings in Togo]. / Infections opportunistes du VIH/sida chez les adultes en milieu hospitalier au Togo.

The objective of this study is to determine the main opportunistic infections (OI) and those strongly linked to high death rate in hospital settings in Togo. It is a descriptive study conducted from June to November 2008 in 22 public and private settings of all medical specialties throughout the entire Togolese territory. Hospitalized patients with OI and HIV positive data were collected. The study was started after getting patient approval. Of 7,361 hospitalized patients, 1,764 were tested, giving a screening rate of 23.7%. We registered 714 HIV-infected patients (HIVIP), 40.5% of the patients tested. The most common OI encountered were buccal candidiasis (49.7% of HIVIP), genital candidiasis (9.1%), meningeal cryptococcosis (2.9%), bacterial infections (48.2%), cerebral toxoplasmosis (11.2%) and pulmonary tuberculosis (11.3%). OI strongly linked to a high death rate were meningeal cryptococcosis (61.9%) and cerebral toxoplasmosis (46.3%). OI constitute a major reason of hospitalization for HIVIP in Togo. This study allows a better orientation of strategies for screening and taking care of HIVIP in Togo.

[Evaluation of the treatment of Kaposi's sarcoma with vinblastine in Togo: a study of 23 cases]. / Évaluation du traitement de la maladie de Kaposi par la vinblastine au Togo: étude de 23 cas.

The aim of this study was to evaluate the efficacy of treatment of AIDS-related and non AIDS-related Kaposi's sarcoma (KS) using vinblastine (Velbé®). A retrospective study was conducted between January 1990 and December 2009 in the Department of Dermatology at the Lomé teaching hospital. The therapeutic protocol is the administration of 10 injections of vinblastine every 15 days. Evaluation was done at 10 weeks, 5 months, 11 months and 17 months. Twenty-three patients including 11 cases of non AIDS-related KS and 12 cases of AIDS-related KS were included in our study. The average age of patients was 39.3 ± 11.2 years. The sex-ratio (M/F) was 6:7. At ten weeks, partial remission was 26% and failure rate was 74%. Side effects as a result of the first five injections were dominated by anemia. At 5 months, complete remission was 17% including 3 cases of non AIDS-related KS, partial remission was 26% including 4 cases of non AIDS-related KS. Side effects of the last five injections were dominated by anemia and nervous toxicity. At 11 months, one patient was lost to follow-up and complete remission persisted in 13% of the patients. At 17 months, complete remission persisted in 9% of the patients against 4% of relapses. No long-term side effects were identified. Our study shows a poor efficacy of vinblastine in the treatment of AIDS-related and non AIDS-related KS and confirms the hematologic and nervous toxicity of this drug. The efficacy is better in the non AIDS-related KS than in the AIDS-related KS.

[Early guttate leukoderma in Darier's disease in a patient with black skin]. / Leucodermie en gouttes précoce au cours de la maladie de Darier chez un sujet à peau noire.

BACKGROUND: The clinical manifestations of Darier's disease are polymorphic and diverse. Guttate leukoderma has been described in around twenty patients with genetically pigmented skin. We report a case of widespread guttate leukoderma several years before the classic signs of Darier's disease in a patient with black skin. CASE REPORT: A 19-year-old woman consulted for characteristic signs of Darier's disease evolving for the previous four years. Examination revealed perifollicular, non-confluent hypopigmented macules and papules in small drop size (1-5mm in diameter) scattered on the trunk, limbs and the jaw and chin. These hypopigmented lesions had been present since the age of six years. Histology of the keratotic papules confirmed the diagnosis of Darier's disease. Histological inspection of a hypopigmented lesion showed hyperkeratosis, acantholysis and a considerable reduction of epidermal melanin pigment. DISCUSSION: Our observation suggests that a guttate leukoderma could be an early sign, readily accessible to dermatologists, in the diagnosis of Darier's disease in black-skinned patients.

[Prevalence of methicillin-resistant Staphylococcus aureus in community-acquired skin infections in Lomé, Togo]. / Prévalence de Staphylococcus aureus résistant a la méticilline (SARM) au cours des infections cutanées communautaires a Lomé (Togo).

PURPOSE: To determine the prevalence of methicillin-resistant Staphylococcus aureus in community-acquired skin infections in Lomé, Togo. PATIENTS AND METHODS: A prospective study including 90 cases of skin infection observed in dermatological outpatients at the teaching Hospital of Lomé was carried out from 1st June 2003 to 30th May 2005. A bacteriological sample with antibiograms was obtained from all patients. RESULTS: Mean patient age was 21 years (extremes, 6 months to 78 years). The male-to- female ratio was 0.84. Infection was primary in 80% of cases including impetigo in 42.2%, follicular infection in 28.9%, and abscess in 8.9% and secondary in 20% of cases including eczema in 8.9%, mycosis in 3.3%, and other in 7.8%. Staphylococcus aureus strains were isolated in a total of 84 cases (93.3%). Staphylococcus aureus occurred alone in 79 cases (87.8%) or in association with other bacteria in 5. A total of 30 of the 84 Staphylococcus aureus strains (35.7%) isolated were methicillin-resistant. Resistant strains were associated with primary infection in 24 cases and secondary infection in 6. CONCLUSION. Staphylococcus aureus is the most common cause of community-acquired skin infections in Lomé. One third of Staphylococcus aureus strains are methicillin-resistant. These findings should be taken into account in daily practice for prescription of antibiotics to patients presenting these infections.

[Knowledge, attitudes and practices about prevention of mother to child transmission of HIV (PMTCT) among pregnant women in antenatal clinic at 2010 in Togo]. / Connaissances, attitudes et pratiques en matière de prévention de la transmission mère-enfant du VIH chez la femme enceinte vue en consultation prénatale en 2010 au Togo.

PURPOSE: The purpose of this study carried out among pregnant women in antenatal clinics in Togo was to evaluate knowledge, attitudes and practices related to prevention of mother-to-child transmission of HIV (PMTCT). METHODS: A qualitative cross-sectional study was conducted in 22 antenatal clinics. Data were collected by interviewing all pregnant women examined from January 18th to February 4th, 2010. RESULTS: A consecutive series of 210 pregnant women was compiled. The women identified sexual relations (93.8%), objects soiled with blood (80.5%) and transmission from mother to child (27.1%) as routes of HIV transmission. A large majority (77.1%) agreed that unprotected sexual relations raised the risk of HIV transmission to the child and most (61%) expressed willingness to use condoms during pregnancy or breastfeeding, A high percentage (68.1%) believed that contamination during pregnancy increased the risk of HIV transmission to the child, and 61% knew that the risk of HIV transmission to the child was higher for mixed breastfeeding than for exclusive breastfeeding. The acceptance rate for HIV testing was 92.4%. The percentage of women who never used condoms (male or female) was 51% and the percentage considering that HIV-positive woman should not have children was 29.5%. CONCLUSION: The results of this study indicate that pregnant women in Togo have fairly good knowledge about HIV/AIDS. Attitudes towards PMTCT were generally positive but some behaviors such as condom use still require improvement.