Vitiligo on black skin: epidemiological and clinical aspects in dermatology, Cotonou (Benin).

BACKGROUND: Vitiligo is unsightly on darkly pigmented skin and leads important stigmatization because of the mix-up with leprosy. PATIENTS AND METHODS: We analyzed retrospectively the epidemiological and clinical patterns of vitiligo on darkly pigmented skin between 1988 and 2008 in the Department of Dermatology in Cotonou (Benin). The diagnosis was made based on the clinical characteristics of vitiligo. RESULTS: Two hundred and forty-six patients were seen, representing 0.9% of new consultations. The gender ratio was 1 : 1, and the mean age of patients was 25.9 years. The mean duration of the lesions was 30.9 months. Among the 246 patients, an associated pathology was found in 26% of cases. These included atopy (23.2%), diabetes (1.6%), thyroid disease (0.8%), and alopecia (0.4%). A family history of vitiligo was present in 1.2% of cases. The sites of the lesions were in descending order of frequency: head (60.6%), lower limbs (40.2%), upper limbs (33.3%), trunk (22.4%), genitals (13.0%), and neck (8.9%). On the head, the most common sites affected were the lips (65.1%), cheek (20.8%), and ears (16.8%). According to the different clinical forms, vitiligo was achromic (76%), speckled (12.6%), and trichromic (11.4%). Vitiligo vulgaris was the commonest form of the disease (52.4%), followed by localized vitiligo (36.2%), segmental vitiligo (9.8%), and vitiligo universalis (1.6%). Triggering factors were identified in 4.5% of patients. CONCLUSION: Our survey shows that the patterns of vitiligo are similar to that reported from other African countries with a few distinguishing particularities.

Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa: a multicentric study in four countries.

OBJECTIVE: The purpose of this study was to document the clinical profile, etiologies, and outcomes of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in hospitals in four sub-Saharan African countries. PATIENTS AND METHODS: A retrospective study on cases of SJS/TEN treated in dermatology departments and/or intensive care units in four sub-Saharan African countries (Benin, Burkina Faso, Central African Republic, and Togo) from 2000 to 2010. The study focuses on variables such as age, sex, type of SJS/TEN, epidermal detachment of the skin surface, HIV status, drug(s) involved, and outcomes (death and sequelae). RESULTS: This study identified 177 cases of SJS/TEN from 2000 to 2010: 129 with SJS; 37 TEN; and 11 overlapping SJS/TEN. The average age of patients was 32.3 ± 15.4 years, and the sex ratio (M/F) was 0.6. HIV serology was positive in 69 (54.8%) of the 126 patients tested. Antibacterial sulfonamides (38.4%) were the most commonly used drugs followed by nevirapine (19.8%) and tuberculosis drugs (5.6%). We recorded 22 deaths (i.e. six cases of SJS, 15 of TEN, and one of overlapping SJS/TEN). Of the 22 patients who died, 16 were infected with HIV; among them, seven had an opportunistic infection (four cases of cerebral toxoplasmosis and three of pulmonary tuberculosis). Twenty-seven cases of sequelae were noted with a large part of eye complications. CONCLUSION: This study has highlighted: (i) the high proportion of patients infected with HIV among patients who had SJS/TEN in sub-Saharan Africa; (ii) the high frequency of antiretroviral drugs as new SJS/TEN causes in sub-Saharan Africa; and (iii) the impact of HIV infection on morbidity and mortality of these affections.

Les condylomes acuminés génitaux chez un nourrisson de sexe masculin: abus sexuel ou non ?

Nous rapportons un cas de condylomes acuminés chez un nourrisson de sexe masculin âgé de 16 mois. Les condylomes acuminés constituent la plus fréquente des Infections Sexuellement Transmissibles.Si un abus sexuel est fortement suspecté chez notre patient, il n'en demeure pas moins que ces lésions peuvent être également manu portées ou de contamination per partum. Les condylomes d'origine sexuelle sont habituellement retrouvés chez les enfants de sexe féminin et à un âge plus avancé que celui de notre patient qui est de sexe masculin

Skin cancers at the National University Hospital of Cotonou from 1985 to 2004.

BACKGROUND: Skin cancer is the most common form of cancer occurring in adults in Europe and the USA. A low incidence has been reported in the black American population and in Africa, however. This study investigates the incidence of melanoma and epidermoid and basocellular carcinoma at Cotonou in Benin. METHODS: Over 20 years, 19 patient records were collected, 16 of which were the subject of a retrospective epidemiologic study. RESULTS: The main characteristic of skin cancer in the Department of Dermatology, Cotonou, Benin was its extreme rarity. The frequency was 0.00066%, with a male to female ratio of 1.28 and a mean age of 54.81 years. The mean ages at diagnosis for epidermoid carcinoma, melanoma, and basocellular carcinoma were 61.66, 59.40, and 54.56 years, respectively. The mean duration of epidermoid carcinoma was 6-10 times longer than that of melanoma and basocellular carcinoma. Of the 16 patients included in the study, five were albinos. In this group, the frequency was 31.25%. DISCUSSION: The extreme rarity of skin cancers in our series cannot be the result of recruitment bias alone. It reflects the actual situation. All of our cases of melanoma were in a plantar location. This inconsistency with other studies is probably a result of the size of our series. The duration of disease in our cases of carcinoma was comparable with the results obtained in a previous study in Dakar, Senegal. In our study, oculocutaneous albinism was the main preneoplastic factor. CONCLUSION: This study confirms the low incidence of skin cancer in the black population, the fact that basocellular carcinoma affects a relatively young population, and the predilection of melanoma for acral locations in black individuals.

Keloid acne of the neck: epidemiological studies over 10 years.

BACKGROUND Acne keloidalis nuchae is a chronic condition affecting young adult males of African origin. The frequency of the condition is low but its occurrence has a significant impact on the patient's quality of life. PATIENTS AND METHODS We performed a retrospective study on data collected over a period of 10 years in the Department of Dermatology and Venereology at the Centre National Hospitalier et Universitaire (CNHU) in Cotonou, Benin. We examined 90 files covering the period from 1993 to 2002 in terms of the epidemiologic, clinical and therapeutic features and course of the disease. RESULTS The frequency of acne keloidalis nuchae in patients attending the department for consultations over this period was 0.7%. All patients were male, and their mean age was 29 years. The mean period between disease onset and initial consultation in the department was 29 months. Of the patients diagnosed, 82.22% were seen at the stage when the keloid lesions were small. Lesion size did not appear to depend on the duration of the disease. The mean duration of follow up for the 34 patients reviewed was 22 weeks. In nine cases the lesions had spread and in five cases they had resolved. The treatment proposed depended on the type of lesion, but no effective therapeutic guidelines exist. CONCLUSIONS The study has demonstrated that, once the clinical stage of purely inflammatory lesions has passed, delay in consultation has a negligible effect on the course of the disease, which remains chronic and recurrent. A preventive approach using Information Education Communication (IEC) would be preferable.