A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa).

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert's response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

[Giant verrucous nevus in a 15-year old girl: about a case]. / Nævus verruqueux géant chez une adolescente de 15 ans: à propos d'un cas.

Verrucous nevus is a benign tumor showing a linear pattern on Blaschko lines. It is caused by mosaic mutations of the receptor FGFR3 gene. It manifests as an aesthetic disfigurement, but individuals even experience functional complications due to itchiness. Lesions may be localized or extended (giant). In our context, the scarcity of specialized centers in dermatology is a cause of diagnostic delay inducing the patient to undertake unsuitable therapies responsible for infectious or degenerative complications. We report the case of a 15-year old girl with a history of keratotic papules showing a linear pattern along the neck, the right upper limb, the flank since childhood. Histological examination confirmed the diagnosis of verrucous nevus.

[Cutaneous tuberculosis in Bamako, Mali]. / Tuberculose cutanée à Bamako, Mali.

INTRODUCTION: Tuberculosis is the most common mycobacteriosis in sub-Saharan Africa. Cutaneous tuberculosis is rare and underdiagnosed due to its clinical polymorphism and to the smallness of technical equipment. This study aims to describe the epidemiological, clinical, histopathological aspects of cutaneous tuberculosis in Bamako (Mali). METHODS: We conducted a cross-sectional descriptive study from January 1991 to December 2008. The study was performed in the Department of Dermatology at the National Center for Disease Control and in the Department of Pneumophtisiology at the Hospital of Point G. The patients with tuberculosis confirmed by histological and/or biological examination were included in the study. RESULTS: Out of 4269 patients? medical records, 61 cases of cutaneous tuberculosis were identified (1.43%). Men accounted for 59% of the cases (36 patients) and women 41% (25 cases); sex-ratio was 1.44. The age of the patients ranged from 3 months to 61 years, with an average age of 27.56 ± 36 years. The average length of follow-up was 10.9 ± 10 months. The identified clinical forms were scrofuloderma (41 cases), ulcerative form (13 cases), verrucous form (4 cases), and tuberculous Lupus (3 cases). Tuberculosis was associated with HIV in 7 cases, with leprosy in 3 cases. CONCLUSION: Cutaneous tuberculosis is underdiagnosed in Mali. Efforts are needed to improve the accessibility and the technical equipment available in the Departments, in order to conduct an extensive interdisciplinary study on this pathology.

[Management of chronic hemodialysis patients with anemia: case study conducted in the Department of Nephrology and Hemodialysis at the University Hospital Point G in Mali]. / Gestion de l'anémie des patients hémodialysés chroniques: cas du Service de Néphrologie et d'hémodialyse du CHU du Point G au Mali.

INTRODUCTION: Anemia is a frequent complication of Chronic Kidney Disease CKD commonly found in chronic haemodialysis patients. Patients management is mainly based on erythropoietin administration and iron supplementation. This study aimed to evaluate the management of chronic hemodialysis patients with anemia in the Department of Nephrology and Hemodialysis at the University Hospital Point G in Mali. METHODS: We conducted a cross-sectional study from 1 to 31 August 2016. RESULTS: 63 patients out of a total of 174 participants were selected, 34 men and 29 women with a sex-ratio of 1.17 in favor of men. The average age of patients was 48,79 years ±11.59, the average duration of hemodialysis treatment time was 3,77years±2.6. Hospitalization rate for anemia in our dialysis patients was 84,12%. 92.1% of patients required blood transfusion, with an annual average of 5,81 blood bags ±5.91. 87.3% of cases required iron supplementation. Mean ferritin concentration and TSC were 1245 ng/ml±629,52 and 46,16%±19.12 respectively. Occasional administration of EPO doses not exceeding the 4000IU was reported by 79.4% of patients. The main difficulty in using EPO was its cost (74.6%). HCV infection was found in 60.1% of patients who were assessed. CONCLUSION: The management of chronic dialysis patients with anemia should be integrated into the framework of the national health policy.

[Geriatric dermatoses in patients hospitalized in the Department of Dermatology in Bamako (Mali)]. / Dermatoses gériatriques en hospitalisation dermatologique à Bamako (Mali).

INTRODUCTION: Skin diseases in the aging population vary and are a key concern for clinicians in terms of diagnosis, management and follow-up. This study aims to describe the epidemiological and clinical aspects of skin diseases among geriatric patients hospitalized in the Department of Dermatology at the National Center In Support Of Disease, Bamako. METHODS: We conducted a cross-sectional case study of patients with geriatric dermatoses hospitalized in the Department of Dermatology at the National Center In Support Of Disease from 1 January 2010 to 31 December 2014. Out of 398 patients hospitalized, 76 patients aged 60 years and over were included in the study. Data entry was accomplished using Epidata 3.1 software, while data analysis was performed using stata 14 software. RESULTS: The prevalence of skin diseases among hospitalized geriatric patients was 19.10%. The age of the patients varied from 60 to 95 years, with an average age of 68.85 years. We enrolled 29 men and 47 women, with a sex-ratio of 0,60. The main diseases reported were dermohypodermitis (44.74%), autoimmune bullous dermatitis (13.16%), toxidermia (10.53%), venous ulcers (6.58%), arterial ulcers (3.95%), malignant tumors (5.27%), diabetic wounds (3.95%). Four patients died (5,26%). CONCLUSION: This study has assessed a high prevalence of subjects aged 60 and over hospitalized in the Department of Dermatology in Bamako. Moreover, it has confirmed that dermohypodermitis are the most frequent skin diseases among geriatric patients hospitalized in Mali.

[Epidemio-clinical profile of dermatoses in children receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali)]. / Profil épidémio-clinique des dermatoses chez les enfants vus en consultation dermatologique dans le service de dermatologie du centre national d'appui à la lutte contre la maladie à Bamako (Mali).

INTRODUCTION: Skin diseases are a major public health problem in developing countries. In common practice, children represent the most affected segment of the population. This study aims to describe the epidemiological and clinical aspects of skin diseases in children aged 0-15 years receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali). METHODS: We conducted a cross-sectional study in the Department of Dermatology and Venereology at the National Center for Disease Control from 1 January 2009 to 31 December 2009.Out of a total of 16339 patients who had undergone a dermatological consultation 5149 children were included in the study. RESULTS: Dermatitis-frequency in hospital attending children was 31.51%. We enrolled 2838 boys (55,10%) and 2311 girls (44.90%), with a sex-ratio of 1,22. Patient age ranged from 03 days to 15 years with an average age of 8 ± 5.7 years. Infectious dermatoses accounted for 55.10% of all dermatoses, immuno-allergic dermatoses (32.5%), inflammatory dermatoses (11.85%). CONCLUSION: Our study highlights the severity of infectious and immuno-allergic pathologies and the necessity to promote simple preventive measures such as hygiene, buying a clipper for each child.