A pain in the rear.

Tuberculosis is an endemic disease in Senegal. Cutaneous forms are rare and are characterized by their clinical polymorphism. They account for 2% of the extrapulmonary locations of tuberculosis [1, 2]. We report an observation of a tuberculous gumma of the buttock that led to the discovery of an active pulmonary localization in an immunocompetent adult. A 47-year-old man was admitted for a painful swelling of the right buttock that had been developing for four years. The physical examination noted an indurated, multinodular, and polyfistulized plaque, with confluent yellowish pus emission, on the inferomedial face of the right buttock, associated with bilateral inguinal lymphadenopathy. Cutaneous tuberculosis was found in the histology, which showed TB granuloma, and the gastric tube fluid was positive for acid-fast bacilli. Thoracoabdominopelvic CT showed multiple basal acinar micronodules in both lungs. Serology was negative for both HIV and HBV. All signs of tuberculosis disappeared after six months of treatment. In endemic zones, cutaneous tuberculosis is characterized by its clinical polymorphism. It must also be looked for in any perineal abscess. Early management greatly improves the prognosis.

[Epidemiological, clinical and etiological profile of tinea capitis in adult patients in Dakar, Senegal]. / Profil épidémio-clinique et étiologique des teignes du cuir chevelu chez l'adulte à Dakar (Sénégal).

OBJECTIVE: To determine the epidemiological and etiological profile of tinea capitis in adults in Dakar (Senegal). PATIENTS AND METHODS: A 9-month prospective, multicenter, descriptive and analytic study. Patients included were aged over 18 years. Mycological tests were used to confirm the diagnosis. RESULTS: 121 patients were included with a mean age of 36.1 years and a hospitalisation frequency of 0.8%. The age range of 64.4% of patients was between19 and 38 years. 51% of patients were housewives. A low socioeconomic level was found in 72.8% of cases. In 3.3% of patients, the disease began in childhood. 31.4% of patients had already consulted a traditional healer. Similar familial cases were noted in 60.3% of patients. Contact with a sheep was noted in 32.2% of cases, deliberate skin lightening in 64% of women, hair salon attendance in 46.7% of women, and immunosuppression in 17.3% of patients, while itching was present in 95.5%. Dermatologic examination showed scaled plaques and a diffuse form, with 92.6% and 64% (n=75) respectively. Wood's light examination was positive in 40.2% of patients. A positive culture test was found in 71%. The most frequently encountered species were: T. soudanense (65%), M. audouinii (21%), T. rubrum (4.7%), M. gypseum (3.5%), T. violaceum (2.3%), T. verrucosum (2.3%) and M. canis (1 case). The clinical course was favorable under treatment with griseofulvin or terbinafine. CONCLUSION: Tinea capitis in adults mainly affects young women. The diffuse form is the most common. The most frequently encountered species was T. soudanense.

Non-tubercular caseous adenopathy in Senegal.

The authors report the case of a 22-year-old man referred seven months after the onset of papulo-nodular skin lesions, lymphadenopathy, splenomegaly and hepatomegaly. Mycologic and histologic examination of skin lesions enabled the diagnosis of African histoplasmosis, by Histoplasma capsulatum var duboisii. The lymph nodes were caseous. The culture in Lowenstein-Jensen medium was negative.

Evaluation of the use of Home Emergency in a Sub-Sahara African hospital: Example of the Hospital Principal in Dakar.

Overloaded emergency departments are common around the world. This prospective, descriptive, and analytical study evaluates the reasons for emergency room use and describes the severity of the patients' conditions and how they reach the emergency department. It took place at the emergency department of the principal hospital of Dakar (the Armed Forces Teaching Hospital) over a one-week period (from August 23 to August 30, 2016) and included a sample of 219 patients of both sexes aged 15 years and older. Data were collected about social and demographic characteristics, reasons for choosing the emergency department rather than other care, time of day, day of the week, accessibility, means of transport, diagnosis, and severity. More than half of patients (55 %) were men, with a mean age of 42 +/- 18. Only 10 % of patients lived within 5 km of the hospital. Most (84.5 %) came from the Dakar region and lived between 5 and 35 km from the hospital. Most patients reached the hospital by their own means (83 %). Only 2 % were transported by the public emergency ambulance service. The reasons for choosing the emergency unit were the opportunity for additional tests in 41.1 % of cases ; the desire to be hospitalized in 26.9 % ; fear of death in 26.5 %, no waiting list in 14.2 %, and lack of money in 11 % of cases. Patients in truly serious condition accounted for only 5 % of cases. Most (88 %) returned home after stabilization, 12 % were hospitalized, and 0.5 % died. Good practices, good organization, and improved complementarity between public, private, and emergency services are needed to reduce the use of the latter.

Cutaneous leishmaniasis in Senegal: a series of 38 cases at the Aristide Le Dantec University Hospital in Dakar.

Our aims were to study the epidemiological, clinical, and parasitological aspects of cutaneous leishmaniasis in the dermatology department of the Aristide Le Dantec hospital. This retrospective study reviewed records of cases treated over a 4-year period (from April 2010 through April 2014) at the HALD Dermatology department. The study included all patients with cutaneous leishmaniasis during the study period. The diagnostic criteria were clinical, parasitological, and histological. The study included 38 patients, corresponding to 9.5 cases per year. Patients' average age was 25 years (4-65 years) and the sex ratio was 1.6. The mean time from symptom outset to consultation was 3.2 months. The disease was located in limbs in 23 cases (63.8%), the face in 6 cases (16.6%), and disseminated in 9 (19.6%). The clinical presentation was ulcerated and crusted in 17 patients (44.7%), sporotrichoid in 13 (28.9%), pseudo-lepromatous in 4 (10.5%), and lupoid in 3 cases (7.9 %). It included warts, mucosa, and tropical sores (Aleppo boils) in all cases. We observed 3 cases associated with HIV; one had a pseudo-lepromatous presentation and resulted from immune restoration syndrome, while two patients had clinical forms of associations: ulcerative and crusted lesions associated with mucosal leishmaniasis in a 55-year-old patient, and cutaneous ulcerative, lupoid, and crusted multifocal (cutaneous, medullary, and lymph nodes) lesions in a 4-year-old infected with Leishmania infantum. Crusted ulcerative cutaneous leishmaniasis is the predominant form of cutaneous leishmaniasis. Infection with HIV can be an important factor in clinical and parasitological atypia.

Cutaneous squamous cell carcinomas (SCC) associated with cosmetic skin whitening: 8 cases reported in Senegal.

BACKGROUND: The cosmetic use of bleaching products is common among women from sub-Saharan Africa. The most frequently used products are highly potent corticosteroids (clobetasol propionate) and hydroquinone. Herein, we report 8 cases of SCC in women using skin bleaching products for cosmetic purposes. Our aim is to describe the epidemiological, clinical and pathological aspects of the carcinomas observed during the course of skin lightening. METHODS: We conducted a descriptive multicentre study from August 2005 to January 2016 in three dermatology units in Senegal. We included all patients consulting for cutaneous squamous cell carcinoma associated with skin bleaching. Sociodemographic, clinical, paraclinical and therapeutic data were recorded. RESULTS: A total of 8 female patients were included. The mean age was 48.1 years (37-63 years). Topical hydroquinone and highly potent corticosteroids were the main products used over the whole body, for an average duration of 20.3 years. No pre-neoplastic skin disease was found in our patients. The clinical aspects of tumours were as follows: cauliflower-like (n=4), ulcerated (n=3) and nodular (n=1). The average development time before consultation was 6.75 months. All the cutaneous squamous cell carcinomas were localized to lichenoid lesions or exogenous ochronotic lesions on photo-exposed areas: face (n=1), neck (n=3) or upper back (n=4). The most common histopathological type was the infiltrating form and there was one case of in situ carcinoma. The outcome was favourable in six of eight patients after surgical resection. Two deaths occurred: one through tumour recurrence and the other through haemorrhagic shock. CONCLUSIONS: From 2005 to 2016, eight cases of cutaneous squamous cell carcinomas associated with cosmetic use of bleaching products were reported in Senegal. The mechanism was not fully elucidated and further studies are necessary. These observations provide an additional argument for combating this practice and including skin bleaching among known risk factors for squamous cell carcinoma.

Rare cutaneous tuberculosis in Sub-Saharan Africa developed on discoid lupus erythematous lesion.

Lupus vulgaris is a common presentation of cutaneous tuberculosis (TB), but its ulcerative or vegetating form also called vorax is rare.We report a case of lupus vulgaris in its vorax form, which occurred in a patient with discoid lupus erythematous. A 42-year-old patient monitored for chronic lupus erythematosus consulted again for a facial tumor and fever. Physical examination revealed painful ulcerative and crusted lesions on an old discoid lupus lesion and covered the entire upper lip. Similar lesions were noted on cheeks. Moreover, there were cervical lymphadenopathy, a bilateral pulmonary condensation syndrome, and dysphonia. Cutaneous histopathology had revealed a tuberculoid granuloma without caseating, and nucleic acid amplification tests (GeneXpert®) performed on sputum were positive. Thus, the diagnosis of multifocal TB with skin involvement of vorax type was confirmed. The outcome was favorable following TB treatment. Our observation is distinctive as it is a granulomatosis and ulcerative form of lupus vulgaris, which occurred on a discoid lupus erythematous lesion. This is a rare form of lupus vulgaris. This scarcity can be explained by diagnostic difficulties as there are numerous differential diagnoses and histopathology is not often helpful.

[Etiology of intertrigo in adults: A prospective study of 103 cases]. / Les étiologies des intertrigos chez l'adulte : étude prospective de 103 cas.

INTRODUCTION: The etiologies of intertrigo in adults are numerous and different. The objective of our work was to study the epidemiological, clinical and the risk factors of intertrigo in adults. METHODS: We conducted a prospective study for a period of seven months in two Dermatology Units in Dakar (Senegal). All adults patient with intertrigo seen during this period who gave consent were included. RESULTS: One hundred and three patients with intertrigo were diagnosed with a hospital prevalence of 2.54%. The sex -ratio was 0.63 and the average age was 41. The study of habits and lifestyles of the patients found a history of intensive skin lightening, sport, wearing synthetic clothes and smoking in 26, 22, 20 and 22 cases, respectively. Infectious complications mainly bacterial (3.88%) and viral (1.94%) were reported in nine cases (8.7%). A dry erythroderma was noted in 3 cases (2.9%). It was found that the intertigo was commonly caused by fungal infections with a prevalence of 48.5% followed by immuno-allergic reactions with a prevalence of 34.9%, suppurative hidradenitis and inverse psoriasis with the same prevalence of 2.9%. Fifty-eight percent of cases with tinea and 63% of cases with candidiasis were women. Thirty-five percent of tinea cases and 45% of candidiasis cases were found to have a history of intensive skin lightening. CONCLUSION: The cause of intertrigo in adults are mainly infectious, particularly fungi, infections and immuno-allergic diseases. There are predisposing factors and some professions are more at risk.

Infections sexuellement transmissibles chez les hommes ayant des rapports sexuels avec d'autres hommes suivis à l'Hôpital Institut d'Hygiène Sociale de Dakar

Introduction : Les relations sexuelles entre hommes, constituent un facteur de propagation des infections sexuellement transmissibles (IST) et du VIH/sida dans les pays en développement. L'objectif de notre étude était de déterminer les aspects épidémiologiques, cliniques et thérapeutiques des IST chez les hommes ayant des rapports sexuels avec d'autres hommes (HSH) suivis à l'IHS de Dakar. Malades et méthode : Il s'agissait d'une étude transversale et analytique effectuée sur une période de 4 mois à l'IHS. L'analyse des données était faite grâce au logiciel IBM Statistics SPSS 20. Résultats : Nous avons colligé 31 HSH avec IST symptomatiques, soit une prévalence de 15,65%. L'âge moyen était de 28,25 ans. Quarante-deux pour cent (n = 13) étaient connus séropositifs. Vingt-quatre étaient bisexuels (77,4%). Les types de rapport étaient : réceptifs (38,7% ; n = 12), insertifs (29% ; n = 9) et les deux (32,3% ; n = 10). Ils avaient eu, en moyenne, 5 partenaires occasionnels durant la dernière année. L'utilisation de préservatifs n'était systématique que chez 11 patients (35,5%). Une rémunération des rapports sexuels était notée chez 87% (n =27). Les signes d'IST retrouvés étaient : écoulement (74,2% ; n =23), condylomes (19,4% ; n = 6) et ulcération (16 % ; n = 5). La topographie était : anale (45% ; n = 14) et génitale (54,2% ; n = 17). Le traitement syndromique était efficace chez tous les HSH présentant un écoulement ou une ulcération.Conclusion : Notre étude montre une fréquence élevée des IST symptomatiques, de l'infection à VIH et de la bisexualité chez les HSH suivis à l'IHS. Ces résultats montrent que la lutte contre les IST et le VIH passe nécessairement, en partie, par le renforcement des attitudes préventives chez cette population-clé

[Cutaneous leishmaniasis due to Leishmania infantum associated with HIV]. / Leishmaniose cutanée à Leishmania infantum associée à une infection par le VIH.

BACKGROUND: In Senegal, reported cases of cutaneous leishmaniasis are often due to Leishmania major. Immunosuppression related to HIV infection contributes to the emergence of leishmaniasis in humans and to cutaneous localization of viscerotropic species. We report the first observed case in Senegal of opportunistic cutaneous leishmaniasis due to Leishmania infantum associated with HIV. PATIENTS AND METHODS: A 5-year-old boy presented crusted ulcerative lesions of the scalp and left forearm, together with axillary and cervical lymphadenopathy present for two months. Direct parasitological examination of the scalp and arm lesions, coupled with liquid aspiration of lymph nodes and bone marrow, enabled identification of amastigote forms of Leishmania. Polymerase chain reaction performed on skin, lymph node and bone marrow biopsy samples allowed identification of L. infantum. The child was positive for HIV1. Treatment of HIV infection and leishmaniasis resulted in clinical improvement. DISCUSSION: Co-infection with cutaneous leishmaniasis due to L. infantum and HIV is a complex combination in terms of the related therapeutic issues. The clinical and laboratory outcomes depend on restoration of immunity and on the efficacy, safety and availability of anti-leishmaniasis drugs.

[Multifocal histoplasmosis due to Histoplasma capsulatum var. duboisii in a 22 year-old Senegalese patient without proven immunodepression]. / Histoplasmose multifocale à Histoplasma capsulatum var. duboisii chez un Sénégalais de 22ans sans immunodépression prouvée.

The authors report a case of multifocal African histoplasmosis with polymorphic skin involvement occuring in a patient without proven immunosuppression. He was a young 22-year-old patient from eastern Senegal - but born in Ouganda - who presented with polymorphic skin lesions: ombilicated papulo-nodules, gums and ulcerative and budding lesions. He showed lymphadenopathies without clinical inflammation and with a cheesy appearance of the biopsy but without tuberculosis and also hepatosplenic and bone involvement. Mycological samples of the skin and lymph nodes biopsies revealed yeasts of Histoplasma capsulatum var. duboisii with a positive culture on Sabouraud medium. HIV serology, HTLV1et 2, the serum proteins electrophoresis were unremarkable. Treatment with amphotericin B was irregular because of its inaccessibility in the national territory and its cost. The patient died of sepsis together with the aggravation of his disease.

[Leg ulcers in sickle cell disease: A retrospective study of 40 cases]. / Ulcères de jambe au cours de la drépanocytose: étude rétrospective de 40 cas.

BACKGROUND: In Africa, studies primarily devoted to chronic leg ulcer due to sickle cell disease are rare. The objectives of the study were to determine the epidemiology, diagnosis and progression of chronic leg ulcers in sickle cell disease. PATIENTS AND METHODS: A 5-year multicentre, retrospective study was conducted in three university hospitals in Dakar. We included all patients with chronic leg ulcers occurring in a setting of sickle cell disease. RESULTS: We identified 40 cases of chronic leg ulcers associated with sickle cell disease, representing 3.4% of the current population of sickle cell patients in our institutions. The average patient age was 25.9 years and the sex ratio was 2.33. Chronic leg ulcer was the presenting feature enabling diagnosis of sickle cell disease in one third of the cases. The average time to consultation from onset was 5.4 years. Pain was reported in 22 cases (48%). Ulcers were isolated in 76% and multiple in 24% of cases. The most common site was the medial malleolus (39%). A CBC allowed identification of anaemia in 35 cases. Haemoglobin electrophoresis was performed and homozygous sickle cell SS disease was identified in 39 cases and heterozygous SC disease in 1 case. Local treatments included physiologic serum, topical antibiotics and skin grafting. Systemic treatment included supplementation with folic acid in all patients, blood transfusion in 16 cases, vasodilators in 11 cases and antibiotics in 25 cases. The outcome was favourable in 61.8% of cases. DISCUSSION: In Dakar, sickle cell disease is a common cause of chronic leg ulcer and is frequently revealed by chronic leg ulcer.

[Surgery in black grain mycetoma: about 44 patients treated at aristide le dantec hospital (Dakar, Senegal) from December 2008 to March 2013]. / Chirurgie des mycétomes fongiques à grain noir. À propos de 44 patients pris en charge à l'Hôpital Aristide le Dantec de Dakar (Sénégal) de décembre 2008 à mars 2013.

Black-grain mycetomas are fungal and cannot be healed by antifungals only.We conducted this study to determine the interest of carcinologic surgery only in the management of those black-grain mycetomas.We led a retrospective study concerning 44 patients over a period of 52 months. The mean age of patients was 32.5 years. The main location of mycetomas was the foot (21 cases), the ankle (10 cases), the knee (8 cases), the leg (3 cases), the chest, the back and the pulp of the fourth finger once each. The bone was affected in 21 cases. The surgery consisted in a carcinologic excision or amputation depending on the extension of the lesion and the degree of bony infringement, with ganglionic cleaning out in case of lymphadenopathy. In the average retrospect of 25.5 months, we noted 8 cases of recurrences among which 2 on the amputated patients and 6 on the patients treated by carcinologic excision. The surgery constitutes the main therapeutic issue of the fungal mycetomas.

Origine géographique et aspects cliniques de 87 cas de leishmaniose cutanée suivis dans un hôpital de Dakar

Introduction : La leishmaniose cutanée est une anthropozoonose dont l'épidémiologie est en grande partie déterminée par des facteurs écologiques. Notre objectif était d'étudier les aspects épidémiologiques et cliniques récents de la leishmaniose cutanée à l'Institut d'Hygiène Sociale de Dakar. Malades et méthode : Il s'agit d'une étude transversale, sur une période de dix ans, effectuée au service de dermatologie de l'IHS de Dakar. Les malades étaient recrutés à partir des registres de consultation et d'hospitalisation. Résultats : Quatre-vingt-sept cas de leishmaniose cutanée ont été colligés, soit une fréquence hospitalière de 0,07%. Le sex-ratio était de 1,38 et l'âge moyen de 59 ± 17,83 ans, avec des extrêmes de 9 mois à 75 ans. Les formes cliniques étaient : ulcéro-croûteuses dans 46% (n = 23), sporotrichoïdes dans 18% (n = 9), ulcéro-surinfectées dans 18% (n = 9) et autres dans 18% (n = 9). Les localisations étaient essentiellement : membres supérieurs dans 64% des cas et membres inférieurs dans 34% et tête et tronc dans 18% des cas. Le nombre moyen de lésions étaient de 2.6 ± 1.86. Les corps de Leishman étaient retrouvés dans 22,58%. Les cas provenaient de Matam dans 32,55% des cas, Tambacounda dans 27,9%, Fatick dans 13,95%, Thiès dans 9,30% et Dakar dans 1 cas. Discussion : Notre étude montre un probable élargissement de l'aire géographique de la leishmaniose cutanée vers la capitale sénégalaise. Ceci pourrait être dû à un bouleversement écologique secondaire à l'urbanisation galopante et anarchique

[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.

Negative cutaneous effects of medicinal plants in Senegal.

Use of medicinal plants is common and widespread throughout Africa, including in Senegal. Because efficacy has been demonstrated, public policies have been instituted that have allowed plant-based therapies to have an important role in general primary care. However, little is known about the cutaneous safety of many plant-based therapies. In this 6-month prospective study all cases of dermatitis induced or aggravated by exclusive use of medicinal plants were evaluated via skin allergy testing. The results were classified and compared with the available literature. Forty-three cases of plant-therapy-associated cutaneous reactions were identified, including worsening of existing conditions (56%), recurrence of a previously resolved condition (16%) and new dermatitis arising spontaneously (28%). In the cases where the condition was new, generalized exfoliative dermatitis occurred in 42% of cases with an average time of onset of 9 days. Specific plants were identified in 65% of cases and included 18 varieties. The frequency and severity of plant-induced cutaneous reactions should be the basis for the creation of a phytovigilance programme and re-evaluation of how traditional medicine is used in the general population. When irritation occurs, identification of the responsible plant and allergy testing should be the first steps towards relieving symptoms.

[Thoracic tumor-like fungal mycetoma: interest of large surgery with terbinafine]. / Un mycétome fongique tumoral dorsal: intérêt de la chirurgie large associée à la terbinafine.

Fungal mycetoma are inflammatory pseudo-tumors of subcutaneous tissues and possibly bones due to exogenous fungi. They have a chronic course, often poly-fistulated with an emission of fungal grains. We report the case of a 65-year-old farmer with a thoracic fungal mycetoma discovered incidentally, associated with bone involvement. The diagnosis was confirmed by the positive culture to Madurella mycetomatis. The outcome was favorable with terbinafine 1g per day for 12 months associated with complete excision of oncologic type followed by a skin graft.

[Tuberculoid leprosy revealed by active ulcerative colitis: a case report]. / Une rectocolite hémorragique révélant une lèpre tuberculoïde.

Leprosy is endemic in Senegal. In 2011, there were 73 new cases reported in Dakar. The circumstances of discovery are often dermatologic or neurologic. Few case reports describe an association with chronic inflammatory colitis, probably fortuitous. We report the case of a 30-year-old woman who had a tuberculoid leprosy revealed by active ulcerative colitis. Treatment according to the WHO protocol of leprosy, combined with corticosteroids and then methotrexate, resulted in healing of the leprosy and remission of the colitis.