Evaluation of the tele-expertise project in the management of common dermatoses in Togo / Évaluation du projet de téléexpertise dans la prise en charge des dermatoses courantes au Togo

Introduction: Tele-expertise in dermatology represents an opportunity to change medical practice in response to the need for cost savings in the health sector. The aim of this study was to evaluate the medical activities of the pilot phase of the tele-expertise project in Togo. Method: A cross-sectional study was conducted in October 2020 on the 20 sites of the pilot phase. This evaluation consisted of a literature review and analysis of data posted on the tele-expertise platform. Results: A total of 738 (10.8%) of the 6810 dermatological consultations were posted on the tele-expertise platform. Of the 738 cases, the dermatologist's expertise did not allow a diagnosis to be made in 119 cases (16.1%). This expertise confirmed the single clinical hypothesis proposed by the health worker in 275 cases (37.3%) and allowed a diagnosis to be made among several clinical hypotheses in 30 cases (4.1%). On the contrary, the dermatologist's diagnosis was not included in the health worker's hypotheses in 201 cases (27.2%), and no clinical hypothesis was formulated in 113 cases (15.3%). The concordance between the clinical hypothesis proposed by the health worker and the diagnosis of the dermatologist was 48.8%. Regarding the acceptability of the tele-expertise, only one refusal was recorded. All patients were very satisfied with this practice. Conclusions: The results show the feasibility and acceptability of tele-expertise by health care personnel and patients. The diagnostic concordance of 48.8% shows the relative efficiency of task delegation.

Introduction: La téléexpertise en dermatologie représente une piste pour modifier l'exercice médical en réponse aux besoins d'économies de la santé. Le but de cette étude était d'évaluer les activités médicales de la phase pilote du projet de téléexpertise en dermatologie au Togo. Méthode: Il s'agit d'une étude transversale menée en octobre 2020 sur les 20 sites de la phase pilote. Cette évaluation consistait en une revue documentaire et l'analyse des données postées sur la plateforme de téléexpertise. Résultats: Au total, 738 (10,8 %) des 6 810 consultations dermatologiques ont été postées sur la plateforme de téléexpertise. Sur les 738 cas, l'expertise du dermatologue n'a pas permis de poser un diagnostic dans 119 cas (16,1 %). Cette expertise a confirmé l'hypothèse clinique unique proposée par l'agent de santé dans 275 cas (37,3 %) et a permis de conclure à un diagnostic parmi plusieurs hypothèses cliniques dans 30 cas (4,1 %). Au contraire, le diagnostic du dermatologue ne figurait pas dans les hypothèses de l'agent de santé dans 201 cas (27,2 %), et aucune hypothèse clinique n'avait été formulée dans 113 cas (15,3 %). La concordance entre l'hypothèse clinique proposée par l'agent de santé et le diagnostic du dermatologue était de 48,8 %. Concernant l'acceptabilité de la téléexpertise, un seul refus a été enregistré. Tous les patients étaient très satisfaits de cette pratique. Conclusions: Les résultats montrent la faisabilité et l'acceptabilité de la téléexpertise par les personnels de santé et les patients. La concordance diagnostique de 48,8 % montre la relative efficacité de la délégation de tâches.

Multiple Squamous Cell Carcinoma in a Patient Using Skin Bleaching Products in Togo.

Background: The cosmetic use of skin bleaching products is common among women in sub-Saharan Africa despite numerous reported cutaneous and systemic complications. We report the first case of squamous cell carcinoma in a woman using skin bleaching products in Togo. Case Report. A 65-year-old woman with a 30-year history of skin bleaching products use consulted in dermatology for a tumor of the neck that had been evolving for 2 years. There was no personal or family history of cancer. The patient was obese (BMI = 38.3 kg/m2) and had high blood pressure. Clinical examination noted multiple ulcerative and cauliflower tumors of the neck. The presence of stretch marks, skin atrophy, and ochronosis was noted in the examination of the rest of skin. There were no lymph nodes. HIV serology was negative. Histology of a tumor biopsy concluded to an invasive skin squamous cell carcinoma. The cervical, thoracic, abdominal, and pelvic TDM revealed pulmonary metastases. The patient underwent complete surgical removal of the right latero-cervical tumor. The left latero-cervical tumors were not removed because they infiltrated the large vessels. Chemotherapy before surgery was prescribed but not honored for financial reasons. The patient died 2 months after her first consultation in respiratory distress. Conclusion: Squamous cell carcinoma is one of the complications of skin bleaching in sub-Saharan Africa. It is necessary to intensify awareness campaigns on the complications of this practice, in order to reduce their incidence, in our context where this practice is very frequent.

Prevalence of skin Neglected Tropical Diseases and superficial fungal infections in two peri-urban schools and one rural community setting in Togo.

INTRODUCTION: Skin neglected tropical diseases (NTDs), are endemic and under-diagnosed in many lower-income communities. The objective of this study was to determine the prevalence of skin NTDs and fungal infections in two primary schools and a community setting in rural Togo. METHOD: This was a cross-sectional study that took place between June-October 2021. The two primary schools are located on the outskirts of Lomé, the capital city. The community setting was Ndjéi, in north-east Togo. Study sites were purposively selected. Dermatologists examined the skin of study participants. Diagnosis of skin NTDs were made clinically. RESULTS: A total of 1401 individuals were examined, 954 (68.1%) from Ndjéi community, and 447 (31.9%) were children in the schools. Cutaneous skin infections were diagnosed in 438 (31.3%) participants, of whom 355 (81%) were in community settings. There were 105 observed skin NTDs (7.5%). Within the school setting, there were 20 individuals with NTDs (4.5% of 447 participants), and 85 NTDs (8.9%) from 954 community participants. Across all settings 68/1020 (6.7%) NTDs were in children, and 37/381 (9.7%) in adults. In addition, there were 333 observed mycoses (23.8% prevalence). The main cutaneous NTDs diagnosed were scabies (n = 86; 6.1%) and suspected yaws (n = 16, 1.1%). The prevalence of scabies in schools was 4.3%, and 7.0% in the rural community. One case of leprosy was diagnosed in each school and the rural community, and one suspected Buruli Ulcer case in the community. In the school setting, five (6%) children with a skin NTD reported being stigmatised, four of whom had refused to attend school because of their dermatosis. In Ndjéi, 44 (4.6%) individuals reported having experienced stigma and 41 (93.2%) of them missed at least one day of school or work. CONCLUSION: This study shows that the burden of scabies and skin infections such as superficial mycoses is high in the school and rural community settings in Togo, with associated presence of stigma. Improved health promotion and education across institutional and community settings may reduce stigma and encourage early reporting of skin infection cases to a health facility.

Factors influencing student's specialty choices in Lomé faculty of medicine (Togo).

BACKGROUND: The choice of specialty in medicine is an important decision for the individual, but also for health system. This choice combined personals reasons, professional desires and needs of the health system. The number of specialists in the country depends of this choice. Very few studies have focused on factors influencing the choice of specialties among medical students in Africa. Also, in the absence of specialist needs planning in Togo. This study, aims to determine the factors influencing the choice of specialty among students at the Faculty of Health Sciences of the University of Lomé (FSS-UL). METHODS: This was a descriptive cross-sectional study that took place from June 1 to June 30, 2019 with medical students of the doctoral cycle and doctors in specialization studies in the various Diploma of Special Study (DSS) available at the FSS-UL. Data collection was done at the surveyed's training sites. Pre-established and pre-tested fact sheets were giving and explained to the students by data collection team. Data collection team return at the surveyed's training sites 72 h after to collect pre-established fact sheets. Following variables study including: factors (individual; related to the medical curriculum); the advantages and attractiveness of the specialty that can influence students' choice. Data analysis was carried out using Epi Info 6.0 software. The significance threshold was 5%. RESULTS: At the time of the survey, the FSS-UL had 147 doctoral students and 211 specialty students. A total of 251 participants responded to the questionnaires. These included 140 doctoral students and 111 specialty students. The choice of specialties requiring night work such as gynecology, surgery was significantly associated with the male sex (p = 0.001). There was significant association between having financial support (p = 0.001), remuneration related to the specialty (p = 0.0001) and the decision to beginning specialty studies immediately completing general medical studies. Interest in lectures (p = 0.003), teacher support as a mentor in the specialty (p = 0.01) and easy accessibility to teachers (p = 0.008) were medical curriculum factors significantly associated with specialty choice. Facility to work in public and private sector was mentioned by 55.3% of respondents who chose gynecology (p = 0.03). Interest in lectures (p = 0.003), was significantly associated with choice of fundamental sciences; and work in international fields was significantly associated with the choice of pediatric and public health (p = 0.0001). CONCLUSION: Factors influencing the choice of certain specialty were balance between family and professional life; financial support to studies, the remuneration opportunities related to the specialty, access to university career. Intervention on these factors will allow a balance between the numbers of doctors trained in the different specialties.

Skin cancers in people with albinism in Togo in 2019: results of two rounds of national mobile skin care clinics.

BACKGROUND: In people with albinism (PWA), the deficiency of melanin increase the risk of skin cancers. The aim of this study was to determine the prevalence of skin cancers and characteristics of these detected skin cancers (histological types, localization) in PWA in 10 cities in Togo in 2019. METHODS: This is a cross-sectional study of medical records of PWA systematically examined during two mobile skin care clinics in 2019, as part of a programme for the prevention and management of skin cancers in these subjects. RESULTS: During the study period, 280 (95.2%) of the 294 PWA consulted, had developed skin lesions. Of the 280 PWA, the pathological reports from the medical records of 33 patients (11.8%; (95%CI = [8.2-16.2]) had concluded to non-melanoma skin cancers. The mean age of these 33 patients was 38.6 ± 15.2 years and the sex-ratio was 1. Their occupations were mainly resellers (21.2%), traders (15.2%) and farmers (12.2%). In the 33 patients, 54 cases of non-melanoma skin cancers were identified, with some patients having more than one tumor, and some of them having more than one (histologically confirmed) diagnosis. These 54 non-melanoma skin cancers were divided into 21 cases of invasive squamous cell carcinomas, 2 cases of Bowen's disease and 31 cases of basal cell carcinomas. These non-melanoma skin cancers mainly occurred in the head and neck (33 cases; 61.1%), the upper limbs (15 cases; 27, 8%) and the trunk (4 cases; 7.4%). CONCLUSION: The results of this study show a high prevalence of skin cancers among PWAs in Togo in 2019, only non-melanoma skin cancers. In addition, they illustrate the role of ultraviolet rays with regard to the localization of skin cancers and the occupations of patients. Popularization and compliance with photo protection measures, systematic and regular examination of the skin of these PWAs will allow early detection and treatment of these skin cancers.

Factors Associated with Skin Cancers in People with Albinism in Togo.

OBJECTIVE: The aim of this study was to identify the factors associated with skin cancers in people with albinism (PWA) in Togo. METHOD: This is a retrospective analytical study of the records of PWA examined during five dermatological consultation campaigns from 2019 to 2021. RESULTS: During the study period, 517 PWA were seen. Sixty-four (12.3%) of these PWA had presented with 137 cases of skin cancer. The sex ratio (M/F) was 0.9. The average age of PWA with skin cancer was 39.69 ± 15.61 years and that of PWA without skin cancer was 19.17 ± 15.24 years (p ≤ 0.001). The 137 cases of skin cancers were dominated by basal cell carcinomas (45.9%). These skin cancers were located preferentially in the cephalic region (77 cases; 56.2%), followed by the upper limbs (33 cases; 24.1%). In multivariate analysis, the risk factors for skin cancers in PWA were age over 39 years (p ≤ 0.001) and the presence of actinic keratoses (p ≤ 0.001). In contrast, the presence of ephelides (p=0.018) was a protective factor. CONCLUSION: This study confirms that advanced age and actinic keratoses are risk factors for skin cancer in PWA, in connection with the cumulative role of solar radiation. Its originality lies in the identification of ephelides as a protective factor. The knowledge and consideration of these risk factors will make it possible to optimise strategies for the prevention of skin cancers in PWA.

Acne keloidalis nuchae and hypertension in black subjects: a case-control study.

OBJECTIVE: The aim of this case-control study was to look for an association between hypertension and acne keloidalis nuchae (AKN) in black subjects. RESULTS: We recruited 303 consenting subjects comprising 101 patients with AKN and 202 controls, case-matched by age (± 5 years). The mean patients age was 34.9 ± 10.7 years versus 35.6 ± 11.2 years for controls. The average duration of AKN progression in cases prior to consultation was 1831 days (5 years). The most frequently observed AKN lesions were papules (73/101; 72.3%), fibrous scars (42/101; 41.6%) and folliculitis/pustules (41/101; 40.6%). In terms of quality of life, the mean score of dermatology life quality index was 8.3 ± 5.2 (extremes: 0 to 22). In multivariate analysis, having a BMI of 25 kg/m2 or more (OR = 4.91; p < 0.001) and having systolic hypertension (OR = 1.22; p = 0.010) were associated with AKN.

A Histopathological Study of Skin Lesions in Individuals with Oculocutaneous Albinism in Togo in 2019.

OBJECTIVE: The aim of this study was to study the histopathological patterns of skin lesions in persons with albinism (PWA) in Togo in 2019. METHOD: During two mobile skin care clinics in 2019, biopsies/excisional biopsies were performed in PWA in case of clinical doubt or in front of lesions suspected to be cancerous for histological examination. Anatomopathological reports were thus analysed. RESULTS: During the two mobile skin care clinics, 115 biopsies/excisional biopsies were carried out in 79 PWA, with a mean age of 24 ± 16.1 years. Histological examination led to a diagnosis in 110 cases (95.6%) and was inconclusive in 5 cases (4 cases of uncertain histological diagnosis and one case of nonspecific histological lesions). Fourteen different histological diagnoses were made, with a frequency ranging from 0.9% (one case) to 26.9% (31 cases). The four most frequent diagnoses in descending order were basal cell carcinomas (BCCs) (31 cases; 26.9%), invasive squamous cell carcinomas (SCCs) or Bowen's disease (23 cases; 20%), keratosis (20 cases; 17.3%), and cysts (seven cases; 6.1%). The 54 skin carcinomas were diagnosed in 33 (41.8%) of the 79 patients who underwent skin biopsies/excisional biopsies. The BCC/SCC ratio was 1.3. No cases of cutaneous melanoma had been diagnosed. CONCLUSION: Skin cancers represent the main histological diagnosis in PWA (46.9%) in Togo in 2019. The pattern of cutaneous malignancies in PWA shows the same trend as that seen in Caucasians with a predominance of basal cell carcinomas.

Dermatological and epidemiological profile of patients with albinism in Togo in 2019: results of two consultation campaigns.

BACKGROUND: People with albinism (PWA) are targets of prejudice and social exclusion and have limited access to specialized medical care and resources. Our study aimed to describe the epidemiological and dermatological profile of PWA in Togo. METHOD: We carried out a cross-sectional study of 294 medical records of PWA systematically examined during two mobile skin care clinics in 2019. RESULTS: The mean age of the patients was 22 ± 16.5 years, and the gender ratio (M/F) was 1. A family history of albinism was reported in 27.9% of cases, and consanguinity between the parents was found in 24.1% of PWA. Dermatological lesions on physical examination were present in 95.2% of PWA. These lesions were elastosis/wrinkles (82.9%), ephelides (79.6%), actinic keratoses (60.0%), actinic cheilitis (50.0%), and cutaneous carcinomas (11.8%). The mean age of PWA with skin carcinomas was 38.6 years. Fifty-four cases of cutaneous carcinomas had been diagnosed (31 cases of basal cell carcinoma, 21 cases of squamous cell carcinoma, and 2 cases of Bowen's disease) and were located mainly in the cephalic region (61.1%) and upper limbs (27.8%). Cryotherapy and/or excisional biopsies were the treatments for premalignant and malignant lesions. All PWA were sensitized on sun protection. CONCLUSIONS: This study shows the basic picture of dermatological characteristics of PWA with a high frequency of photo-induced lesions and skin cancers. The popularization and respect of photoprotection measures and regular skin examination of these PWA for early detection and management of lesions will reduce their morbidity and mortality.

Prevalence and Clinical Characteristics of Aquagenic Pruritus among Medical and Pharmacy Students in Lomé (Togo).

OBJECTIVE: The aim of this study was to determine the prevalence and clinical characteristics of aquagenic pruritus (AP) in medical students in Lomé (Togo). METHODS: This was a prospective and descriptive study conducted among medical students in Lomé from June 1st to August 30th, 2019. The data collection questionnaire was anonymous composed of sociodemographic variables, bathing habits, and history of allergy responding to the concept of aquagenic pruritus and its characteristics. RESULTS: In our study, 129/591 medical students had AP, giving a prevalence of AP to 21.8%. The average age of students with AP was 23.9 years, and the M/F sex ratio was 1.5. AP was not present after each bath in 100% of the medical students who suffered from it and lasted an average of 9.09 minutes. It was characteristically pruritic (60.5%) or tingling (38.0%) and localized (45.0%) or generalized (55.0%) in respondents with history of AP. There was a significant association between the presence of AP and a personal history of allergic rhinitis (p < 0.01) and the presence of AP and a family AP (p < 0.01). Twenty-six (20.2%) respondents with AP feared taking a bath. Bathing with warm or lukewarm water (29.5%) or applying menthol ointment (27.1%) were the main precautions taken to reduce AP. CONCLUSION: Aquagenic pruritus is a common condition in medical students in Togo. It occurs mainly in males and can be familial.

Paraneoplastic pyoderma gangrenosum associated with adenocarcinoma of the rectosigmoid junction: a case report.

INTRODUCTION: Pyoderma gangrenosum is a rare, idiopathic, inflammatory, neutrophilic dermatitis characterized by sterile skin ulceration. It can be associated with an underlying pathology, especially inflammatory bowel disease and hematological malignancies. Its association with a malignant pathology in the context of a paraneoplastic syndrome is more commonly described in hematological malignancies, with solid tumors being rare. CASE REPORT: We report a case of a 39-year-old West African man with pyoderma gangrenosum that developed 6 months before the clinical expression of rectosigmoid junction cancer. The removal of the cancer resulted in the patient's recovery. CONCLUSION: Recurrent pyoderma gangrenosum lesions may be the expression of colonic adenocarcinoma in paraneoplastic syndrome and require colonoscopy, especially in at-risk patients.