[Management of chromoblastomycosis, a challenge for limited-resource countries such as Madagascar]. / Prise en charge de la chromoblastomycose : un défi dans les pays à ressources limitées comme Madagascar.

INTRODUCTION: Chromoblastomycosis (CBM) is a chronic fungal infection of the skin and subcutaneous tissue caused by dematiaceous fungi. CBM lesions are recalcitrant and extremely difficult to eradicate. We report three cases of CBM with difficulties in therapeutic management. OBSERVATION: Three men aged 36, 50 and 67 years, all farmers, presented for between three and ten years with hyperkeratotic, scaly plaques with black dots on the right thigh and left leg, respectively. For all patients, mycological examination showed fumagoid cells, all of which were pathognomonic for CBM. PCR identified Fonsecaeanubica in one patient and Cladophialophoracarrionii in two patients. All patients received itraconazole 200mg/day for over 18 months. Two patients required combined therapy with terbinafine for seven months, which improved lesions; however, relapse occurred in one patient during the 5th month of this combined therapy and five months after the end of this treatment in the other. The patient on monotherapy (itraconazole) also presented recurrence of lesions five months after the end of treatment. DISCUSSION: Itraconazole is the standard therapy for CBM, with cure rates ranging from 15 to 80%. Success with itraconazole after eight to twelve months was reported by several authors. Fonsecaea and Cladophialophora are the most common species found in Madagascar, and while these organisms are susceptible to triazoles in vitro, clinical response is not so clear-cut. CONCLUSION: Although unavailable in Madagascar, posaconazole and isavoconazole appear to be effective in treating chromoblastomycosis.

Epidemiology and associated factors of atopic dermatitis in Malagasy children.

BACKGROUND: Little is known about the epidemiology and associated factors of childhood AD in the markedly different, low-income, tropical environment like Madagascar. METHODS: We aim to assess the epidemiology and associated factors of AD in individuals fewer than 15 years of age in Antananarivo Madagascar. It was a retrospective and descriptive study over a period of 7 years (2010 to 2016) in children 6 months to 14 years in the Department of Dermatology, Joseph Raseta Befelatanana Antananarivo Madagascar. The diagnosis of AD was based on clinical data. RESULTS: The prevalence of AD was 5.6% in children aged 6 months to 14 years. The details of 151 cases of atopic dermatitis were analyzed. The mean age of patients was 4 years. There was a female preponderance (sex ratio: 0.7). A family history of AD was noted in 56 cases (37%). No association between breast-feeding and AD was found. The age of onset of AD was before the age of 3 months in 7.5% and between 6 months to 5 years in 70%. Children born in March (dry season) had the highest risk of AD. Consultations for AD increased during the winter (from July to October; p = 0.005). However, the prevalence of AD was similar in urban and rural areas. CONCLUSION: Weather may have an impact on the prevalence of atopic dermatitis in Madagascar. No significant correlation was found between the duration of breastfeeding and AD, as well as urbanization.

Vitiligo Associated with Melanoma in a Malagasy Woman.

Malignant melanoma is the first fatal skin cancer. Vitiligo is a leukoderma or a multifactorial depigmentation acquired but especially of autoimmune origin. We report the first Malagasy case affected by both melanoma and Vitiligo. The appearance of Vitiligo during a melanoma could testify to an immunological response against melanocytes. Despite the association of melanoma and Vitiligo, the prognosis of melanoma is still fatal.

Les urgences dermatologiques au service de dermatologie du Centre Hospitalier Universitaire Joseph Raseta Befelatanana

Introduction : L'urgence dermatologique constitue une face cachée de la dermatologie. Elle constitue une partie non négligeable en urgence médi-cale car sa méconnaissance entraînerait des conséquences désastreuses. Notre objectif était de décrire le profil épidémio-clinique et évolutif des situations d'urgences en dermatologie. Matériels et Méthodes : Une étude rétrospective, descriptive était menée dans les deux services de Dermato-logie du Centre Hospitalier Universitaire Joseph Raseta de Befelatanana, Antananarivo, de 2015 à 2017. Etaient inclus tous les patients hospitalisés présentant une urgence dermatologique vraie ou relative de tout âge. Résultats : Sur 634 patients hospitalisés, 113 patients présentaient une urgence dermatologique, soit 17,82%. Les pathologies observées étaient : les toxidermies (37%), les dermatoses infectieuses (20%), les maladies systé¬miques compliquées (11,7%), les dermatoses bulleuses auto-immunes (8%) et les réactions lépreuses (8%). Le taux de mortalité était de 7,8%. Con¬clusion : La toxidermie est la première pathologie grave en Dermatologie. La connaissance de ces principales urgences dermatologiques serait une aide précieuse pour les praticiens travaillant loin des centres hospitaliers de Dermatologie

Misuse of Topical Corticosteroids for Cosmetic Purpose in Antananarivo, Madagascar.

This cross-sectional study was conducted in Antananarivo, Madagascar, from June to September 2012. We aim to evaluate the misuse of TC on the face for cosmetic purpose and the adverse effects due to its application. A questionnaire-based analysis was done among females who use topical corticosteroids on the face for cosmetic purpose. Of the 770 women questioned, 384 (49,8%) used topical corticosteroids for cosmetic purpose whose mean age was 38 years (range 16-73 years). Two hundred and sixty-one females (68%) used TC combined with handcrafted cosmetics, and 123 (32%) used TC alone. "Pandalao," which contains salicylic acid, peppermint oil, lanolin, powder of Juanes de Vigo (mercury powder), and Vaseline, is the most handcrafted cosmetic combined with TC in our study (used by 29,4% respondents). Only one (0,26%) had obtained the TC by physician's prescription, 234 (61%) from cosmetic retailers, 92 (23%) directly from local pharmacies, 49 (12%) from beauticians, and 15 (4%) from unspecified sources. Lightening of skin color was the main reason for using TC in 44,8% of respondents in the absence of any primary dermatosis. Pigmentation disorders (63,2%) and cutaneous atrophy (52,1%) were the most adverse effects noted.

Chromoblastomycosis and sporotrichosis, two endemic but neglected fungal infections in Madagascar.

Chromoblastomycosis and sporotrichosis are endemic fungal infections of tropical and subtropical regions, including Madagascar. The causal fungi develop in the soil or on plants and infect humans through wounds, either directly (wounding by the plant, through thorns, for example), or through the contact of an existing wound with contaminated soil. For this reason, the lesions predominantly occur on the limbs, and these fungi principally infect people working outside with bare hands and/or feet. The subcutaneous lesions of chromoblastomycosis are initially nodular, subsequently becoming warty, tumoral, cauliflower-like and pruriginous, which promotes dissemination. The chronic nature of the infection and its progression over long periods lead to highly disabling lesions in essentially rural and agricultural populations. The lesions of sporotrichosis are also nodular, but more ulcerous, and they form an extended chain following the route of the lymph vessels. Pus, squamous or skin biopsy specimens are used for the mycological examination of these mycoses. Treatment depends on the severity and form of the lesions and is based on antifungal drugs sometimes combined with physical methods. There has been no study of these infections for more than two decades in Madagascar, despite the large numbers of cases seen by doctors in all parts of the island. The nature, diversity and distribution of the plants responsible for contamination have not been described in Madagascar. In this review, we described these two endemic mycoses in terms of their epidemiological, mycological, clinical and therapeutic characteristics, focusing particularly on Madagascar, which is one of the leading foci of these two infections worldwide.

Pulmonary Tuberculosis and Lepromatous Leprosy Coinfection.

Simultaneous occurrence of leprosy and pulmonary tuberculosis is reported infrequently in the modern era. We report a case of pulmonary tuberculosis diagnosed in patient being treated with glucocorticoids for complications of leprosy (type II reaction). Physicians should recognize that the leprosy patients treated with glucocorticoid may develop tuberculosis.