[Newborns dermatitis: about 116 cases collected in a university hospital in abidjan]. / Les dermatoses neonatales : a propos de 116 cas colliges dans un hopital universitaire d'abidjan.

AIMS: To determine the epidemiological profile of newborn dermatitis and to describe the different clinical aspects of the observed neonatal dermatitis. PROCEDURE: The study took place at the University Hospital of Cocody (Abidjan). The study was cross-sectional, descriptive and analytical, carried out on the basis of prospective recruitment. The study included newborns who were seen in outpatient or inpatient settings by 4 april 2018 to 23 August 2018 and in whom the pediatrician had observed cutaneous and/or mucosal lesions. The diagnosis was made with the collaboration of a dermatologist. RESULTS: During the study period, 116 newborns were identified. The age of the patients seen in pediatrics with dermatitis varied from 1 to 28 days, with a mean of 16.86 ± 8.4 days. The median age was 19 days. The most representative age range (32.8%) was 24-28 days. The sex ratio (M/F) was 1. In almost 2/3 of the cases, the children were born at term, 29.3% were premature and 5.2% were born after term. In almost 2/3 of the cases (63.8%), the newborns had a birth weight of more than 2500 g. Only 3.4% of newborns seen in pediatric consultations were referred for a dermatitis. The age of the lesions at the time of consultation varied from 1 to 26 days, with a mean of 06.19 days ± 5.13. In more than half (53.5%) of the cases, the lesions had evolved for less than 5 days. Transient dermatitis was more frequent (51.7%), followed by infectious dermatitis (32.8%). Transient dermatitis of the newborn was dominated by sweaty miliaria (40%). Infectious dermatitis were mainly represented by mycotic (68.4%) and bacterial (31.9%) infections. Bacterial dermatitis were composed of neonatal impetigo (83.3%) and folliculitis (16.7%). In almost half of the cases (46.1%) the mycotic dermatitis were represented by candidosis intertrigo and in 38.5% of the cases there was oral candidiasis. The other neonatal dermatitis observed were dominated by diaper rash (64.3%) (Photo 2) and congenital nevi (21.5%). More than half (57.1%) of the cases of toxic erythema neonatorum occurred between days 6 and 10 of life. Nearly half (41.6%) of the cases of sudoral miliaria occurred between birth and day 5 of life. More than half (57.1%) of the cases of sebaceous hyperplasia occurred before the 5th day of life. All cases of neonatal scaling and mongoloid spots were already present between birth and day 5 of life. The mean age of patients with transient dermatitis was 14.31 days compared with 19.41 days for those with the other dermatitis. The difference in age was statistically significant (p < 0.05). The transient dermatitis predominated in male neonates while the other dermatitis predominated in females, however the difference observed at the level of sex was not statistically significant (p > 0.05). CONCLUSION: The diagnosis of neonatal dermatitis is not always obvious, especially on black skin where few publications have been published.

OBJECTIFS: Déterminer le profil épidémiologique des dermatoses du nouveau-né et de décrire les différents aspects cliniques des dermatoses néonatales observées. MATÉRIEL ET MÉTHODES: L'étude s'est déroulée au Centre hospitalier universitaire de Cocody (Abidjan). L'étude était transversale, à visée descriptive et analytique, réalisée sur la base d'un recrutement prospectif. Ont été inclus, les nouveau-nés ayant été vus en consultation externe ou en hospitalisationdu 4 avril 2018 au 23 août 2018 chez qui le médecin pédiatre avait observé des lésions cutanées et/ou muqueuses.Ensuite,le diagnostic était posé par le dermatologue référant de l'étude. RÉSULTATS: Pendant la période d'étude, 116 nouveau-nés ont été recensés. La moyenne d'âge était 16,86 ± 8,4 jours avec un âge médian de 19 jours. Lesex ratio (H/F) était de 1. Dans plus de la moitié (53,5%) des cas, les lésions évoluaient depuis moins de 5 jours. Une dermatose transitoire était diagnostiquée dans plus de la moitié des cas (51,7%) et dans près du tiers des cas (32,6%) une dermatose infectieuse. Les dermatoses transitoires du nouveau-né étaient dominées par la miliaire sudorale (40%), l'érythème toxique (23%), la desquamation néonatale (10,7%) et l'hyperplasie néonatale (10,7%).Les taches mongoloïdes représentaient3,3% des cas. Les dermatoses infectieuses étaient essentiellement représentées par des infections mycosiques (68,4%) et bactériennes (31,6%). Les autres dermatoses néonatales observées étaient dominées par dermite du siège (64,3%) et les nœvi congénitaux (21,5%). Plus de la moitié (57,1%) des cas d'érythème toxique néonatal survenaient entre le 6e et le 10e jour de vie. L'âge moyen des patients présentant une dermatose transitoire était de 14,31 jours contre 19,41 jours pour ceux présentant les autres dermatoses. La différence observée au niveau de l'âge était statistiquement significative (p < 0,05). CONCLUSION: Les dermatoses néonatales sont multiples et variées. Certaines sont transitoires, ne nécessitant pas toujours de prise en charge thérapeutique. Leur diagnostic n'est pas toujours évident pour le pédiatre d'où la nécessité d'une étroite collaboration entre pédiatres et dermatologues afin d'améliorer la démarche diagnostique et parfois thérapeutique.

[Vitiligo occurring on dermal melanocytosis (nevus of Ota) in a dark-skinned patient]. / Vitiligo dévéloppé sur une mélanocytose dermique (nævus de Ota) chez une patiente à peau foncée.

BACKGROUND: Nevus of Ota is a rare disease most frequently found in Asians. It presents clinically as a bluish gray hyperpigmentation of one side of the face. Transformation into melanoma and glaucoma are the main risks. The appearance of vitiligo lesions with poliosis within a nevus of Ota is exceptional. PATIENTS AND METHODS: A 22-year-old female patient with a nevus of Ota consulted for depigmentation of the eyelashes. Physical examination revealed hyperpigmentation in the right orbitofrontal part of her face, achromic macules and eyelash poliosis. A diagnosis was made of vitiligo developing on a nevus of Ota. Ophthalmologic examination showed hyperpigmentation of the sclera. Regular dermatologic and ophthalmologic follow-up was instituted. DISCUSSION: Vitiligo is a condition characterized by the development of depigmented lesions secondary to chronic degradation of the melanocytes of the epidermis and the follicles. Its occurrence on congenital nevus and melanoma has already been reported. However, its appearance in dermal melanocytosis is very rare. Since the first observation of this association in 1979, only 4 other cases have been reported. The pathogenic mechanisms of this association are still poorly understood. Histopathological examination generally shows a loss of epidermal melanocytes, especially in the basal layer, while dermal melanocytes remain unaffected. In this context, vitiligo developed on dermal melanosis appears to result from the difference between the properties of normal (epidermal) melanocytes and ectopic (dermal) melanocytes. CONCLUSION: Association of vitiligo with nevus of Ota is rare. Herein, we report a new case in a dark-skinned subject.

[Umbilical endometriosis mimicking a keloid in a young black woman: A case report]. / Endométriose ombilicale simulant une chéloïde chez une patiente à peau foncée.

BACKGROUND: Most umbilical tumors are diagnosed as benign tumors, umbilical metastases of abdominal and pelvic tumors, or Sister Marie Joseph nodule. Herein, we report a case of cutaneous umbilical endometriosis mistaken for a keloid. PATIENTS AND METHODS: A young black woman aged 26 consulted for a painful umbilical tumefaction. She had noted the appearance of a nodule of the umbilicus 10 months ago with bleeding during her menstrual periods. Skin examination revealed a firm and painful umbilical nodule 2.5cm in diameter. She was treated with corticosteroid injections for one month for umbilical keloid. Given that the symptoms recurred regularly at the time of menstruation, we suspected umbilical endometriosis. This diagnosis was finally confirmed by histopathological examination and hormone therapy was instituted on gynecological advice before scheduled surgical excision. CONCLUSION: In a setting of an umbilical tumor simulating a keloid associated with cyclical symptoms in a black woman, the diagnosis of umbilical endometriosis should not be overlooked by the dermatologist.

Efficacité du Dakin Cooper Stabilisé® dans la prise en charge des plaies drépanocytaires

Objectif : Apprécier l'efficacité et la tolérance du Dakin Cooper Stabilisé® dans le traitement des plaies drépanocytaires.Patients et méthodes : Il s'agit d'une étude prospective descriptive sur 35 patients, ayant des plaies drépanocytaires, recrutés au centre de Dermatologie de Treichville (Abidjan, Côte d'Ivoire) de janvier 2010 à déceRésultat : La douleur a disparu chez 91,4% des patients, une semaine après le début du traitement. La guérison est survenue chez 80% des patients après six semaines.Conclusion : Le Dakin Cooper Stabilisé® est efficace en six semaines dans le traitement des plaies drépanocytaires et est bien toléré

[Squamous cell carcinoma secondary to Buruli ulcer in West Africa]. / Carcinomes épidermoïdes sur cicatrices d'ulcère de Buruli en Afrique de l'Ouest.

BACKGROUND: Buruli ulcer is an infection caused by Mycobacterium ulcerans occurring in tropical areas. In West Africa, it is an emerging threat mainly affecting children aged under 15years. This chronic disease is complicated by dystrophic scars in which squamous cell carcinoma can occur in the long term. PATIENTS AND METHODS: This is a retrospective study of squamous cell carcinomas in Buruli ulcer scars seen at the Treichville University Hospital (Abidjan, Ivory Coast) over a five-year period. RESULTS: During the study period, 8cases were observed and concerned young adults presenting Buruli ulcer in their childhood. Tumours were restricted to the limbs, with loco-regional invasion. Treatment was primarily surgical. Four of the patients died. DISCUSSION: The risk of recurrence of cancer in these scars remains poorly evaluated, highlighting the importance of long-term monitoring strategies for human patients in order to ensure rapid identification of any changes in Buruli ulcer scars.

[Risk factors associated with leg erysipelas (cellulitis) in sub-Saharan Africa: A multicentre case-control study]. / Facteurs de risque associés à l'érysipèle de jambe en Afrique subsaharienne: étude multicentrique cas-témoins.

BACKGROUND: Acute bacterial cellulitis of the leg (erysipelas) is a common problem involving considerable morbidity in dermatology practice in Africa. Previous studies conducted in Europe and North Africa have highlighted lymphoedema and toe-web intertrigo as independent factors associated with leg erysipelas. The aim of this case-control study was to identify risk factors associated with leg erysipelas in sub-Saharan Africa, within a different socio-economic and culture context. PATIENTS AND METHODS: We conducted a prospective case-control study in hospital dermatology departments in 8 sub-Saharan African countries over a 12-month period (October 2013 to September 2014). Each case of acute leg cellulitis was matched with 2 controls for age (±5 years) and sex. We analysed the general and local factors. RESULTS: During the study period, 364 cases (223 female, 141 male) were matched with 728 controls. The mean age was 42.15±15.15 years for patients and 42.11±36 years for controls. Multivariate analysis showed the following to be independent risk factors associated with leg erysipelas in our study: obesity (odds ratio [OR]=2.82 ; 95% confidence interval: 2.11-3.76), lymphoedema (OR=3.87, 95%CI: 2.17-6.89), voluntary cosmetic depigmentation (OR=4.29, 95%CI: 2.35-7.83), neglected traumatic wound (OR=37.2, 95%CI: 24.9-57.72) and toe-web intertrigo (OR=37.86, 95%CI: 22.27-64.5). CONCLUSION: The results of this study confirms the major role of local risk factors (toe-web intertrigo, lymphoedema) previously identified in other geographical settings. However, the originality of our study consists of the identification of voluntary cosmetic depigmentation as a risk factor for leg erysipelas in sub-Saharan Africa.

[Clinical-epidemiological profile of severe cutaneous drug reactions in children in Abidjan (Côte d'Ivoire)]. / Profil épidémio-clinique des toxidermies bulleuses chez l'enfant à Abidjan (Côte d'Ivoire).

Severe cutaneous drug reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life threatening in adults. They seem to be less common in children. The purpose of this study was to describe the epidemiological, clinical and etiological profile of these drug reactions in African child. It was about a retrospective study carried on for 10 years at the Dermatology center of University Hospital of Treichville, Abidjan (Cote d'Ivoire).Were included all children aged 0-15 years hospitalized for severe cutaneous drug reaction. They represented 14.1% (27 cases) with an estimated hospital rate of 0.01%. The sex ratio (M/F) was 1.2. The mean age was 10.3 years. 19 children were suffering from SJS (63%) and 9 children (33.3%) from TEN. Sulfonamides were the most commonly used drugs with sulfadoxin-pyrimethamin (25.9%), used for malariae, and cotrimoxazole (22.2%). Self-medication was practiced by 70.4% of parents. The average time to onset of lesions from drug intake was 8.2 days. Only one child was HIV infected. Three children affected by TEN (11.1%) died.

[Bifocal Buruli ulcer: multiple cephalic lesions after initiation of medical treatment]. / Ulcère de Buruli à début bifocal: multiples lésions céphaliques après instauration du traitement médical.

BACKGROUND: Buruli ulcer (BU) denotes a cutaneous infection by Mycobacterium ulcerans endemic in certain tropical and subtropical regions. Treatment may be either medical and surgical or else purely medical for early lesions. The literature contains reports of several cases of transient aggravation of BU following initiation of medical treatment. We report a case observed in the Ivory Coast, one of the areas with the highest prevalence of BU worldwide. The distinguishing features of our case are the early onset of this paradoxical reaction and the multiple cephalic site of lesions. PATIENTS AND METHODS: A 4-year-old child with no prior medical history was referred for two painless ulcerative cutaneous nodules. Incubation of samples from the edges of these lesions revealed the presence of acid-alcohol resistant bacilli (AARB), which were shown by PCR to be M. ulcerans, the causative agent in BU. Treatment consisted of levofloxacin (100mg/d) and rifampicin (150mg/d) for 8weeks. After 7days of medical treatment, seven painless nodules appeared on the patient's scalp. Further PCR for these lesions confirmed the presence of M. ulcerans. The same medical therapy was maintained and after 54days of treatment, all lesions had been healed. DISCUSSION: The originality of this case rests on two features: the bifocal aspect of the lesions, which is uncommon, and the early development of cephalic predominance that occurred after the start of drug treatment. While cases of lesions secondary to initiation of medical therapy have already been described, such lesions generally occurred after at least 2months of treatment and did not involve the head.