A facility and community-based assessment of scabies in rural Malawi.

BACKGROUND: Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. METHODOLOGY/PRINCIPAL FINDINGS: From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. CONCLUSIONS/SIGNIFICANCE: Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control.

Peeling químico con ácido tricloroacético. Un peeling clásico de máxima actualidad / Chemical peeling with trichloroacetic acid. A classical peeling of maximum present time

El peeling o exfoliación química consiste en la destrucción de la epidermis y dermis papilar mediante la aplicación de una sustancia química corrosiva con la finalidad de conseguir una nueva epidermis y dermis superficial de mejores cualidades cosméticas. Entre ellos, el peeling de mediana potencia más utilizado en la práctica es el de ácido tricloracético en concentraciones del 11-35%, y a pesar de tener más de 50 años de historia sigue considerándose hoy como un estándar en este procedimiento. Se puede aplicar tanto en pincelación como en mascarilla y consigue resultados muy satisfactorios en cicatrices moderadas de acné, queratosis solares, manchas y léntigos faciales. Su principal inconveniente en personas de fototipo mediterráneo es la hiperpigmentación residual, que puede evitarse mediante la fotoprotección estricta (AU)

Granuloma facial. Tratamiento con láser de CO2 / Granuloma faciale. Treatment with CO2 laser

El granuloma facial es una rara enfermedad de origen desconocido que se caracteriza por presentar lesiones infiltradas localizadas fundamentalmente en la extremidad cefálica que muestran gran resistencia a los tratamientos médicos y quirúrgicos. Los modernos tratamientos láser permiten su extirpación con un daño mínimo a los tejidos circundantes. Los más utilizados han sido los de argón, dióxido de carbono y pulsado de colorantes. Se describe un caso de granuloma facial tratado con láser de dióxido de carbono superpulsado, con buenos resultados estéticos finales y ausencia de recidivas después de 2 años de control postoperatorio (AU)