[Extrapodal mycetomas in Senegal: epidemiological, clinical and etiological study of 82 cases diagnosed from 2000 to 2020]. / Les mycétomes extrapodaux au Sénégal : étude épidémiologique, clinique et étiologique de 82 cas diagnostiqués de 2000 à 2020.

Objectives: Although the foot remains the main localization of mycetomas, extrapodal attacks, which are rarely studied, are also possible and occur either initially or following an extension. The objectives were to describe the epidemiological, clinical and etiological features of extrapodal mycetomas in Senegal. Methodology: Cross-sectional and retrospective study with multicentric enrollment in four reference department, two of which are in dermatology and two in orthopedics and traumatology. We included the files of patients with extrapodal mycetoma followed from January 2000 to December 2020. The data were analysed with SPSS software. Any p less than or equal to 0.05 was statistically significant. Results: We collected 82 cases representing 39% of mycetoma cases (n = 210). The average age was 41.9. The sex ratio was 3.1. Professionally, most patients were active farmers in 51% of cases (n = 33), pastoralists and housewives in 9 % (n = 6) respectively. The mean duration of evolution was 7.5 years. Exclusively extrapodal topographies were noted in 84% of cases (n = 69). Foot and extrapodal locations were concomitant in 16% of cases (n = 13). Mycetoma foci were distributed as follows: 59 in the trunk, 47 in the lower limbs, 9 in the upper limbs, 1 in the scalp and 1 in the neck. The etiology was actinomycotic in 46% of cases (n = 38), fungal in 38% (n = 31). It was not specified in 16% of cases (n = 13). Bone involvement occurs after 5 years (p = 0.001) unrelated to the etiology (p = 0.6). Conclusion: Extrapodal mycetomas are secondary to direct inoculation. However, extension to bone is exclusively due to diagnostic delay. Periodic consultations in endemic areas combined with training of resident health personnel are necessary for early diagnosis in order to improve the prognosis.

[Epidemiological and anatomoclinical features of scalp tumors in black Africans]. / Aspects épidémiologiques et anatomo-cliniques des tumeurs du cuir chevelu chez le noir africain.

INTRODUCTION: In Senegal, the studies on scalp tumors are almost non-existent. The purpose of our study was to determine the epidemiological and anatomoclinical features of scalp tumors in dermatology. METHODS: We conducted a prospective descriptive and analytical study in both Department of Dermatology at Dakar over a period of 16 months (01 March 2014-30 June 2015). Histopathological examination was used to confirm the diagnosis. RESULTS: We collected data from the medical records of 36 patients, of whom 14 had malignant tumors and 22 benign tumors. Sex ratio was 1.1, the average age of patients with malignant tumors was 51 years while the average age of patients with benign tumors was 39 years. Hospitalization rate was 0.18%. The average time of consultation in patients with malignant tumors was 14 months, while in patients with benign tumors was 52 months. In 11 patients with malignant tumors, first treatment was based on traditional therapy. Malignant tumors included: squamous cell carcinoma (n=8), basal-cell carcinoma (n=3), lymphoma, hidradenocarcinoma and Darier-Ferrand dermatofibrosarcoma (one case for each type). Benign tumors included: botriomycoma (n=5), trichilemmal cyst, sebaceous hamartoma, cylindroma and lipoma (2 cases for each type), heloid, syringocystadenoma papilliferum, schwannoma, neurofibroma and nevus (one case for each type). Tumor malignancy was associated to ulcero-budding appearance (p=0.003), diameter >4 cm (p=0.05), pain (p=0.009) and bleeding (p= 0.006). CONCLUSION: Scalp tumors in black people are usually benign. Squamous cell carcinoma is the most common malignant form.

[Primary cutaneous localization revealing leukemia/T-cell lymphoma associated with chronic HTLV-1 infection in a adult. A case presentation]. / Localisation cutanée révélatrice d'une leucémie/lymphome T de l'adulte.

Adult T-cell leukemia/lymphoma (ATLL) is a rare medical condition and a diagnosis that ought to be considered for patients living in an area endemic for the HTLV-1 virus (human T-lymphotrophic virus) where a T-cell lymphoproliferative diagnosis has been made. The cutaneous clinical forms may be the first manifestation of the disease. We report here an observation in a 60-year-old Senegalese woman whose skin lesions were sampled to reveal the ATLL immunophenotypic profile CD4+, CD25+, FoxP3-, and CD7-. HTLV-1 seropositivity confirmed the histopathological diagnosis, and should be corroborated by demonstration of a molecular clonal rearrangement by PCR (Polymerase Chain Reaction). This is a problem because such techniques are not always available in Africa.

[Leprosy in children in the region of Thiès, Senegal: study determining whether or not it is a signal of recrudescence]. / La lèpre de l'enfant à Thiès/Sénégal: signal d'une recrudescence?

Leprosy is an infectious and transmissible disease. According to the WHO, the number of new cases of leprosy in children in Senegal has risen moderately since 2013. This study aimed to analyze the epidemiological, clinical, therapeutic and evolutionary features of leprosy in children in the geographical areas of two social rehabilitation villages in the region of Thiès. We conducted a retrospective study over a period of 3 years (2013-2015). All new cases of Hansen's disease aged 0 -15 years were included. Over the three year period, 39 children were included in the study, with a boy predominance (n=23, 59%). Among these children, 27 (66.7%) came from a social rehabilitation village for leprosy patients. One family member was affected by leprosy in 27 cases (69.2%). More than half of the children (23 cases, 58.9%) had multibacillary leprosy (lepromatous-lepromatous). All children underwent a 12-month treatment, at the end of which thirty-six (92.3%) children were healed. Leprosy is still present in Senegal despite the efforts made by the national programme to combat leprosy. In the light of these results, it is important to emphasize the role of active screening strategy targeted to children, which seems to have shown its effectiveness in the region. Early detection, contact tracing and early treatment are important factors in the reduction of the contagiousity of leprosy.

[Pityriasis versicolor in infants: unusual clinical presentation and role of corticosteroids used as depigmenting agent for cosmetic purposes in the mother]. / Pityriasis versicolor chez des nourrissons: aspect clinique inhabituel et rôle de la dépigmentation cosmétique par des corticoïdes chez la mère.

We report two cases of Pityriasis versicolor (PV) in infants aged 12 and 18 months. The latter were brought to medical attention because of hypochromic and achromic, round macules involving the limbs and the face. Physical examination of their mothers showed voluntary depigmentation for cosmetic purposes due to the use of corticosteroids and hydroquinone, on average, over a 5-year period. The scotch tape test performed in one of the infants and his mother showed short filaments and clusters of spores. Treatment was based on ketoconazole. After 8 weeks, all patients reported favorable outcomes despite the persistence of some hypochomic macules. The peculiarities of this study are, on the one hand the topography of the lower limbs and on the other hand a positive family history of PV whose occurrence is favored by the use of depigmenting agents based on corticosteroids. Corticosteroids favor the atrophic and achromic feature of the lesions. Indeed, achromic lesions on the lower limbs were described in adults undergoing artificial depigmentation.

Regression of cutaneous xerosis with emollient treatment in sub-Saharan African patients.

Emollients have proven effective in improving cutaneous xerosis in various populations; however, no clinical data are available for African patients. The observational study "Xerafrica" was conducted by dermatologists in seven sub-Saharan countries to assess the evolution of xerosis after an 8-week treatment with an emollient. Patients were children above 3 years or adults. Secondary objectives were to assess pruritus, improvement in symptoms, quality of life, satisfaction, and tolerance. An analysis of 185 patients was made. After 8 weeks of emollient treatment, the relative reduction of the "Scaling Roughness Redness Cracks" (SRRC) score was -83.9% and -80.4% in children and adults, respectively. The effect was significantly stronger when topical steroids were co-prescribed with the emollient and in patients with co-dermatosis. To a lesser extent, the effect of emollient was also observed at week 4. Similarly, pruritus and quality of life strongly improved during follow-up. Skin lesions improved in almost all patients, with a high level of satisfaction noted by both dermatologists and patients. The "Xerafrica" study addressed, for the first time, the treatment of xerosis by emollients in an African population. In this specific context, the emollient markedly reduced xerosis as soon as 4 weeks and resolved it almost totally by 8 weeks. The study confirms, under real-life conditions, the efficacy and tolerability of an emollient in improving xerosis.

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.

Behçet's disease in black skin. A retrospective study of 50 cases in Dakar.

INTRODUCTION: Although Behçet's disease is well-documented in Eastern populations, epidemiologic data in Sub-Saharan African population is scarce. The aim of this study was to define the epidemiologic and therapeutic aspects as well as clinical course of Behçet's disease in African black population. RESULTS: The study included 50 patients with Behçet's disease. The average age was 32 (18-67) years. A total of 31 patients were men and 19 were women. Two patients had a positive family history of Behçet's disease. The oral and genital aphthous lesions were present in 100% of patients. The pathergy test was positive in 16 patients (32%). Following skin conditions were observed: pseudofolliculitis in 15 patients (30%), acneiform papules in 6 patients (12%), erythema nodosum in 4 patients (8%) and leg ulcers in one patient. Ocular involvement was reported in 22 patients (44%) and joint involvement in 20 patients (40%). Neurological abnormalities were noted in 12 patients (24%). Gastrointestinal involvement with wide and deep ulcerations in the ileocecal region was observed in a patient. As treatment, a combination of oral corticosteroids and colchicine was used in 97% of our patients. Thalidomide was introduced in 3 patients and anticoagulation treatment in 19 patients. Clinical improvement was noted in 25 patients (50%), recurrence in 14 patients (28%) and 3 patients were lost to follow (6%). CONCLUSION: The Behçet's disease is not uncommon in black skin and generally affects young adults. Severe aphthous ulcers of the oral cavity and genital area are the most consistent finding.

[Endemic Kaposi's sarcoma in Dakar: 29 cases]. / Maladie de kaposi endemique a Dakar: etude de 29 cas.

INTRODUCTION: There is a lack of data on endemic Kaposi's sarcoma in sub-Saharan Africa. The goal of this study was to clarify its epidemiological, clinical and therapeutic aspects in that region. PATIENTS AND METHODS: A 7-years retrospective study, including all patients with endemic Kaposi's disease diagnosis was carried out. RESULTS: We identified 29 cases of endemic Kaposi's representing 1.2% of total hospitalizations and an incidence of 4.4. The mean age and the sex ratio were 63.2 years 2.22 respectively. The average delayed time to seek for medical care was 6.75 months. Cutaneous manifestations were dominated by angiomatous papulonodular lesions in 15 cases (51.72%) ulcerated lesions in 8 cases (27.58%), lymphedema in 5 cases (17.24%), a sarcomatous degeneration in 2 cases and verrucous papules in one case. Mucosal involvement was observed in 7 cases (24.13%). The extracutaneous lesions were noted in 18 cases, with 6 cases of bone, 5 cases of lymph nodes, 5 cases of gastrointestinal and 2 cases of lung involvement. The outcome was favorable for single-agent chemotherapy with bleomycin in more than half of the cases. Recurrences were observed in 2 patients, 2 cases were died and 7 cases never came back. CONCLUSION: Endemic Kaposi's disease is more frequent in elderly people with a higher frequency of extracutaneous involvement and florid forms.

INTRODUCTION: En Afrique sub-saharienne il existe peu de données concernant la maladie de kaposi endémique. L'objectif de ce travail, était de préciser ses aspects épidémiologiques, cliniques et thérapeutiques. MALADES ET MÉTHODES: Une étude rétrospective d'une durée de 7 ans, recensant tous les malades présentant une maladie de kaposi endémique. RÉSULTATS: Nous avions recensé 29 cas de maladie de kaposi endémique représentant 1,2% des hospitalisés soit une fréquence annuelle de 4,14 cas par an. La moyenne d'âge était de 63,2 ans et le sex-ratio de 2,22. Le délai moyen de consultation était de 6.75 mois. Les manifestations cutanées étaient dominées par les lésions papulo-nodulaires angiomateuses dans 15 cas (51,72%), de lésions ulcérées dans 8 cas (27,58 %), d'un lymphœdème dans 5 cas (17,24%), une dégénérescence sarcomateuse sans 2 cas et des papules verruqueuses dans un cas. Les localisations muqueuses étaient notées dans 7 cas (24,13%). Les atteintes extracutanées notées dans 18 cas, étaient osseuses dans 6 cas, ganglionnaires dans 5 cas, digestives dans 5 cas et pulmonaires dans 2 cas. L'évolution était favorable sous monochimiothérapie à la bléomycine dans plus de la moitié des cas. Les récidives étaient observées chez 2 malades, des perdus de vus dans 7cas et 2 cas de décès. CONCLUSION: La maladie de kaposi endémique prédomine chez les personnes âgées avec une fréquence élevée des atteintes extracutanées et des formes florides.

The vitiligo in senegal.

The aim of our study was to determine the epidemiological and clinical aspects of vitiligo in the largest dermatology department of Senegal. A cross-sectional and descriptive study in a period of 5 months was performed covering all the vitiligo cases. Fifty patients were identified (26 women and 24 men). The mean age was 26.5 years. A family history of vitiligo was found in 11 cases and a psychoaffective disturbance in 6 cases. The clinical forms distinguished were generalized vitiligo (n = 33), localized vitiligo (n = 16), vitiligo universalis (n = 4), and segmental vitiligo (n = 1). The Koebner phenomenon was found in 7 cases. Associated diseases were atopic dermatitis (n = 2), contact dermatitis (n = 1), diabetes (n = 1), and Graves' disease (n = 1). The disgraceful character of Vitiligo was the predominance of generalized forms and the elective localization in sun-exposed areas. The family character, the psychoaffective disturbances, the Koebner phenomenon increased by the lifestyle and the itching dermatosis were the aggravating factors.

Epidemiologic and clinicopathologic aspects of Leprosy in Dakar; evaluation of 73 new cases.

Hundreds of new leprosy cases are still diagnosed in Dakar despite all the efforts in the struggle by the national program for elimination of leprosy by the Institute of Applied Leprosy in Dakar. The aim of our study was to evaluate the epidemiological, clinicopathological and outcome of new cases of leprosy. A prospective study was conducted over a period of one year listing all new cases of leprosy based on clinical diagnosis, bacteriology and histology. 73 new cases were recorded. The sex ratio was 1.5 and the mean age of 39.5 years. Children aged from 0 to 15 years old represented 12%. The clinical forms were rated in order of decreasing frequency Borderline 47.94%, 30.13% lepromatous lepromatous, indeterminate 8.21, borderline lepromatous 6.84, TT: 5.47%, 1.36 and neurological bb%. Neurological signs were enlarged nerve in 50 cases, a neurological deficit in 16 cases and a sensitive deficit in 16 cases. The complications were burns and ulcerations in 10 cases, a claw in 7 cases, a reversal reaction in 7 cases, erythema nodosum in 4 cases and neuritis in 8 cases. The number of new cases mutilated was 24.65%. The smear was positive in 42% and histology contribution in 91.37% of cases. Our study highlights the significant number of patients with multibacillary contagious, affected children, the high proportion of disability grade 2/OMS reflecting the delay in diagnosis. This delay is due to ignorance, to traditional treatments and low socio-economic status and lack of trained diagnostic teams in different areas apart from referral centres.

[Skin disease in Koranic schools in Dakar (Senegal)]. / La prevalence des dermatoses dans les ecoles coraniques a Dakar (Senegal).

The koranic schools are in poor socio-economical conditions in Dakar and skin diseases are common in these conditions. The goal of our descriptive study was to determine the prevalence of skin diseases occurring in these situations. One hundred five boys from four koranic schools of Dakar were examined. Eighty percent of the examined boys were with unless one skin disease. Tinea capitis (42.66%), scabiosis (13.33%), pyoderma (15.33%), plantar keratodermia (100%) were the skin diseases. In 34.52% these skin disease were associated and antecedents of skin infections diseases were reported in 89.5% of boys. Atopic dermatitis was in 2.38% cases, keloid in 1.19%. The other frequent diseases were abdominal parasitosis (71.42%), umbilical hernia (6.66%). All skin diseases were improved only in 50% of cases after two months of treatment. Tinea capitis was cured in 4 months after treatment. The high prevalence and the chronicity of the skin disease were due to poor socio-economical conditions.

Aesthetic problems associated with the cosmetic use of bleaching products.

BACKGROUND AND AIM: The use of skin bleaching products for cosmetic purposes is a frequent practice (25-96%) in women from sub-Saharan Africa. The dermatologic complications associated with this practice have been comprehensively reported. The aim of this work was to study the epidemiologic, clinical, and cosmetic aspects of these complications in order to produce better therapeutic guidelines for their management. METHODS: This was a prospective, descriptive study performed over a 6-month period. All women aged between 15 and 50 years, who consulted a dermatologist (Le Dantec Hospital or Institute of Social Hygiene), experienced a complication associated with artificial depigmentation, and agreed to take part in the study, were included. The data were input and analyzed using Epi info version 6.0. RESULTS: Eighty-six female patients were included, with a mean age of 29.34 years (range, 16-49 years). The breakdown by level of education was as follows: primary (48.8%), secondary (18.3%), and higher (8.5%) education. Twenty-two per cent of our population had not attended school. The mean monthly cost of skin bleaching products was 6.22 euros. The initial skin tone before using skin bleaching products was black in 41.5% of patients, light in 32.9%, and intermediate in 25.6%. The mean duration of exposure was 6.7 +/- 5 years (range, 1-30 years). The breakdown by skin bleaching products showed that topical corticosteroids were the most frequently used (78%), followed by hydroquinone (56%), products based on vegetable extracts (31.7%), caustic products (8.5%), and, finally, products of unknown composition (41.4%). Two components or more were frequently combined (86.5%). The aesthetic complications of artificial depigmentation were the reason for consulting a dermatologist in 10 patients (12%). Nineteen types of aesthetic complication were reported in our sample. Hyperpigmentation of the joints was the most frequently found complication (85.4%), followed by striae atrophicae (72%) and skin atrophy (59.8%). The number of aesthetic complications found in the patients varied from one to nine. Patients frequently presented (71.9%) with other complications associated with artificial depigmentation. CONCLUSIONS: Aesthetic complications associated with artificial depigmentation are common, but rarely the reason for consulting a dermatologist. In the absence of suitable therapeutic agents, prevention, based on informing women of the damaging effects of artificial depigmentation, is the only way forward.

[Occupational allergic contact dermatitis in Dakar]. / Les eczemas de contact professionnels a Dakar.

Occupational dermatitis, mainly allergic contact dermatitis and skin irritations are increasing because of new allergens and diversity of the industrial procedures. In Senegal occupational contact dermatitis are currently observed and they are not declared at our social security institution. The aim of our trial was to determinate the frequency of occupational allergic contact dermatitis, the allergens responsible and the exposed occupations. We included in a one year lasting prospective trial, all patients with occupational contact dermatitis confirmed by positive cutaneous allergological tests. Among 201 cases of contact dermatitis, 27 (12,91%) were included and predominant occupational sectors were building, mechanics, health, cleaning and trade. Main responsible allergens were dichromate of potassium (7), N-isopropyl N-phenylparaphenylenediamine (3), fragrance mix (3), thiuram mix (3), colophane (3), formaldehyde (2), nickel sulphate (2), Chalk (2). Building sector was the most frequent source because of high use of dichromate of potassium in cement and formaldehyde in painting-glue. In mechanics, N-isopropyl N-phenylparaphenylenediamine is present in rubbers and fragrance mix in oils. Occupational dermatitis in health workers are due to presence of thiuram mix in the gloves, and dichromate of potassium found in antiseptics. To decrease the incidence of occupational contact dermatitis in our country, we have to promote prevention among workers by using individual protective outfits and increasing workers medical survey and information about risks and means of prevention.