Accelerating the healing of hard-to-heal wounds with food supplements: nutritional analysis in the Côte d'Ivoire.

OBJECTIVE: Hard-to-heal wounds are an important, yet often neglected, public health issue in low- and middle-income countries (LMICs). Malnutrition has been identified as a risk factor for prolonged healing times. However, nutritional supplements are not routinely provided for patients with hard-to-heal wounds, and so this study aimed to investigate their benefits. METHOD: This 9-month study was conducted in the Taabo Health and Demographic Surveillance System in the south-central part of Côte d'Ivoire. Patients with wounds (≥30mm2) were recruited. Treatment was standardised for inpatients (72%) and outpatients (28%). There were three intervention groups: supplemented with soy; orange flesh sweet potato (OFSP); or both. Another group was included without supplement, serving as control. General linear models were employed to assess the effects of log initial wound size, type of wound, food treatment group, haemoglobin, sex, age, place of treatment and body mass index on the rate of wound closure. RESULTS: The cohort consisted of 56 patients, 41 of whom were placed in intervention groups, and the remainder as controls. Within the cohort, 37 (66%) patients suffered from Buruli ulcer, 15 (27%) from traumatic wounds and four (7%) from erysipelas. We found a significant effect (p=0.004) of diet supplemented with OFSP on the wound healing rate. CONCLUSION: OFSP is a nutritional rehabilitation supplement, characterised by a high content of beta-carotene and carbohydrates. It is associated with shortened wound healing times, reduced discomfort and reduced cost of wound care. Further research should investigate the effect of a diet rich in beta-carotene, in combination with standard medical care, on hard-to-heal wound healing in LMICs.

An mHealth App (eSkinHealth) for Detecting and Managing Skin Diseases in Resource-Limited Settings: Mixed Methods Pilot Study.

BACKGROUND: In sub-Saharan Africa, the disease burden from skin diseases, including skin-related neglected tropical diseases (skin NTDs), is extremely high. These diseases often are overlooked due to limited access to health care stemming from, for example, remote geographical locations and a lack of experts. To address these gaps, we developed a mobile health app, eSkinHealth, which is a field-adapted platform to serve as a portable electronic patient chart and for teledermatology. OBJECTIVE: The purpose of the study is to evaluate the usability and effectiveness of the app in rural Côte d'Ivoire for diagnosing and managing skin NTDs and other skin diseases. METHODS: A 2-arm trial with local health care providers and patients with skin diseases was implemented over a 3-month period. The providers were assigned to an intervention receiving the eSkinHealth app or control with usual care. Four nurses and 8 community health care workers participated in each arm. The training was provided on the use of the app to the intervention arm only, while both arms were trained on skin diseases. For the usability study, we evaluated our approach with the System Usability Scale (SUS) and in-depth interviews. For the effectiveness study, our primary outcome was to evaluate the detection and management of 5 skin NTDs as our targeted diseases, namely, Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws, using the eSkinHealth app. Procedures of our methods were reviewed and approved by the institutional review board of the Ministry of Health and by Tulane University. RESULTS: The mean age of our participants (providers) was 40.5 and 42.5 years for the intervention and control arms, respectively, and all were male (n=24). The average SUS scores taken from the intervention arm at baseline, the midpoint (6 weeks), and the end of study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including 4 dermatologists and program managers, were satisfied with the app. Especially community health care workers felt empowered by being equipped with the tool. A total of 79 cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (P=.002). Besides the skin NTDs, more skin diseases and conditions were reported from the control than from the intervention arm (P<.001). However, 100 cases (66%) were not given any particular diagnosis in the control arm and were documented only as a "dermatosis." In the intervention arm, 151 cases (72.9%) were diagnosed within the eSkinHealth platform, and the remaining were diagnosed on-site by dermatologists. CONCLUSIONS: The study provided evidence for the usability and effectiveness of the eSkinHealth app embedded into our surveillance approach to improve the detection and management of skin NTDs and other skin diseases in Côte d'Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin diseases in resource-limited settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT05300399.

Squamous Cell Carcinoma Associated with Cosmetic Use of Bleaching Agents: About a Case in Ivory Coast.

Voluntary skin depigmentation is defined as a set of procedures for obtaining skin clarification for cosmetic purposes. Skin cancers are possible complications, but rarely reported. We describe a case observed in Ivory Coast. A 52-year-old Ivorian woman consulted the Dermatology Department of the University Hospital of Treichville, Abidjan for an ulceration of the middle third of the right clavicle evolving for 10 months. A diagnosis of squamous cell carcinoma (SCC) was confirmed by histological examination of the tumour biopsy. Retroviral serology (HIV) was negative. An excision of the tumour was performed. The postoperative consequences were simple. We report a case of SCC following long-term use of depigmenting cosmetic products in a female phototype VI. SCC is the most common skin cancer among black Africans. It is secondary to precancerous lesions or takes place on a damaged skin. Concerning our patient, the onset of this carcinoma could be associated with the carcinogenic effect of hydroquinone and topical corticoids used for a long time. In addition, no precancerous lesion or preexisting condition were found. The chronic evolution without healing was in favour of a neoplastic origin achieved through the analysis of the biopsy sample.

Squamous Cell Carcinoma in African Children with Xeroderma Pigmentosum: Three Case Reports.

INTRODUCTION: Xeroderma pigmentosum is a rare autosomal recessive genetic disease. This disease predisposes patients to early-onset skin cancers, particularly squamous cell carcinoma. Here, we report 3 pediatric cases, including 2 deaths. OBSERVATION: The subjects included 2 boys and 1 girl with skin type VI. All subjects were from consanguineous marriages, and the average age was 7.6 years. The patients all had ulcerative budding tumor lesions in the cephalic region, and the mean disease duration was 18 months. In all 3 cases, the diagnosis of xeroderma pigmentosum was made before the poikilodermal appearance of sun-exposed areas and photophobia. Neurological-type mental retardation was noted in 1 case. Histology confirmed squamous cell carcinoma in all 3 cases. The evolutions were marked by the death of 2 children (cases 1 and 3). In one case, the outcome was favorable following cancer excision and subsequent chemotherapy with adjuvant radiotherapy. CONCLUSION: Squamous cell carcinoma is a serious complication related to xeroderma pigmentosum in Sub-Saharan Africa. Prevention is based on the early diagnosis of xeroderma pigmentosum, black skin photoprotection, screening and early treatment of lesions, and genetic counseling.

[Cutaneous depigmentation in black female population for cosmetic purposes: results of a KAP survey conducted in Abidjan (Ivory Coast)]. / Dépigmentation cutanée cosmétique des femmes noires: résultats d'une enquête CAP à Abidjan (Côte d'Ivoire).

INTRODUCTION: Cutaneous depigmentation for cosmeticis purposes is a widespread practice among black African women. It has many complications that have been well documented for decades. However, the reasons of practitioners are not well known. The aim of our study was to understand the motivating reasons of these women in order to conduct a communication campaign for behavior change. METHODS: We performed a cross-sectional KAP survey (Knowledge/Attitudes/Practices) at the Dermatology Department of the University Hospital of Treichville (Abidjan) Data were analyzed using Epi Info 3.5.1. and 6.04 software. RESULTS: Practitioners were mostly young urban single, literate and professionally active women (20-40 years). Cutaneous depigmentation and its consequences were known to women, however, they thought that women with the lightest complexion were more attractive. They were influenced by media and friends. The most frequently observed complications were exogenous ochronosis and stretch marks. The local means of communication remained what essentially sustained the information needs of these women, because they help them to change their behavior. CONCLUSION: The development of local communication strategies for behavior change seems necessary to stop the phenomenon of cutaneous depigmentation for cosmetic purposes in black female population in Abidjan.

Allergy to Red Meat: A Diagnosis Made by the Patient and Confirmed by an Assay for IgE Antibodies Specific for Alpha-1,3-Galactose.

We report the first case of allergy to red meat observed in Ivory Coast. A 49-year-old male presented with pruritus. The diagnosis of allergy to red meat was confirmed by an assay for IgE antibodies specific for alpha-1,3 galactose. Interestingly, the disease was considered a spell to the patient who was suspected of being a sorcerer by the community.

Epidemiological, Clinical, and Paraclinic Aspect of Cutaneous Sarcoidosis in Black Africans.

The specific objectives were to identify the epidemiology of cutaneous sarcoidosis and describe the clinical and laboratory aspects of the disease. Materials and Methods. We performed a descriptive cross-sectional study involving 24 referred cases of cutaneous sarcoidosis in 25 years (1990-2014) collected at Venereology Dermatology Department of the University Hospital of Treichville (Abidjan) both in consultation and in hospitalization. Results. The hospital frequency was one case per year. The average age was 42 years, ranging from 9 to 64. The sex ratio was 1. The shortest time interval between the appearance of the skin lesion and consultation of Dermatology Department at CHU Treichville was 3 months. The elementary lesions were represented primarily by a papule (18 cases), placard (3 cases), and nodule (2 cases) and mainly sat on the face and neck in 8 cases (38%). Extra cutaneous lesions were dominated by ganglion and respiratory involvement with 5 cases each followed by musculoskeletal damage in 3 cases. Chest radiography showed abnormality in 13 cases (54%). The pulmonary function test performed in 13 patients found 7 cases (54%) having restrictive ventilatory syndrome and 6 cases (46%) being normal. A tuberculin anergy was found in 11 cases (61%).

[Nosocomial chickenpox (varicella) in health care staff at an infectious diseases unit]. / Varicelle nosocomiale chez le personnel soignant à propos de quatre cas observés dans le service d'infectiologie du CHU de Treichville.

OBJECTIVE: To report cases of nosocomial chickenpox in medical staff at an infectious diseases unit in Abidjan. CASES: Four medical students, aged 24, 25, 27 and 30 years, all in contact with an index case at the infectious diseases unit and with one another, developed chickenpox. All had risk factors for chickenpox: no vaccination and no previous contact with the varicella zoster virus. The diagnosis was essentially clinical, and treatment was symptomatic and successful in all cases. CONCLUSION: Nosocomial chickenpox in non-immunocompromised adults illustrates the problems of lack of vaccination and poor hospital hygiene in resource-limited settings.