Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs. PATIENTS AND METHODS: We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors. RESULTS: During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21-3.42), diabetes (OR=3.97; 95% CI: 1.95-6.13), nicotine addiction (OR=5.07; 95% CI: 2.20-11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60-14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19-3.73). CONCLUSION: Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.

[Risk factors associated with acne keloidalis nuchae, in black subjects: A case-control study]. / Facteurs de risque associés aux folliculites fibrosantes de la nuque chez le sujet noir : étude cas-témoins.

OBJECTIVE: The aim of this case-control study was to identify risk factors associated with acne keloidalis nuchae (AKN), seen in a dermatology clinic in Lomé (Togo). PATIENTS AND METHODS: This was a case-control study conducted from January to December 2018. Patients were recruited at outpatients dermatological clinics and controls were recruited at outpatients dermatological clinics and then in other hospital departments. RESULTS: We recruited 303 consenting subjects, comprising 101 patients with AKN and 202 controls case-matched by age (±5 years). The mean patient age was 34.9±10.7 years vs. 35.6±11.2 years for controls. The most frequently observed AKN lesions were papules (73/101; 72.2%), fibrous scars (42/101; 41.5%) and folliculitis/pustules (41/101; 40.6%). In multivariate analysis, the following factors were associated with AKN: excess weight (adjusted odds ratio=4.8; 95% CI=[2.3-11.7]) or obesity (OR=9.2; 95% CI=[2.1-34.2]), bleeding during hairdressing either occasionally (aOR=13.9; 95% CI=[5.1-40.0]) or systematically (aOR=22.1; 95% CI=[6.2-40.7]), hairdressing procedures less than once per week (aOR=10.1; 95% CI=[3.2-50.8]), and extremely close cropping of hair (aOR=4.9; 95% CI=[2.8-15.5]). CONCLUSION: AKN is common in young adults. Excess weight or obesity, bleeding during hairdressing, and frequency and style of hairdressing are all associated factors. The results of this study stress the importance of limiting injury during hairdressing, and of refraining from shaving or cropping hair without a trimmer. Since management of AKN is extremely difficult, identification of associated risk factors allows suitable preventive approaches to be adopted.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)-induced Stevens-Johnson syndrome and gynecomastia in an HIV-infected child: A case report.

BACKGROUND: Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are antiretroviral drugs often used in the first-line treatment regimen of HIV1 infection worldwide. We report a case of successive gynecomastia and Stevens-Johnson syndrome (SJS) respectively induced by efavirenz and nevirapine in a single patient. CASE REPORT: A 16-year-old boy, HIV1-infected since birth, was started on antiretroviral treatment (ART) in August 2015 and was taking a regimen comprising abacavir, lamivudine and efavirenz. In April 2016, when his weight reached 35kg, abacavir was replaced with tenofovir. Bilateral breast enlargement, previously hidden by the patient, was diagnosed two years after the start of ART. History-taking, physical examination and laboratory tests ruled out known causes of gynecomastia, and efavirenz was thus considered the most likely cause. This drug was then withdrawn and replaced with nevirapine in July 2017. Thirty-three days after the patient started nevirapine treatment, a skin rash appeared. Physical examination revealed erythematous macules and flaccid bullae with estimated skin detachment of 10%. There were also conjunctival, buccal and genital lesions. A diagnosis was made of SJS induced by nevirapine. Three months after withdrawal of efavirenz, breast size decreased by 3cm on the left breast and 2cm on the right breast; two months after the SJS, cutaneous sequelae alone persisted, such as diffuse hyperchromic macules. DISCUSSION: Recognition of gynecomastia as a side-effect of efavirenz is important to allow the condition to be treated while it is still potentially reversible. Moreover, when efavirenz is replaced, a protease inhibitor should be preferred to nevirapine.

Systemic complications during voluntary cosmetic depigmentation among women in Togo: A case-control study.

OBJECTIVE: The aim of our study was to document the systemic complications of skin bleaching among women in Togo. METHODS: This was a case-control study conducted between December 2009 and December 2013. Cases comprised of women using skin-bleaching products for at least 6 months and age-matched with non-users (±3 years). RESULTS: We recruited a total of 150 women using skin-bleaching and matched them with 300 controls. Univariate analysis revealed a correlation between systolic hypertension (OR=2.56; 95% CI: 1.68-3.92), diastolic hypertension (OR=1.89; 95% CI: 1.17-3.05), hyperglycaemia (OR=1.5; 95% CI: 1.2-9, 65) and obesity (OR=1.68; 95% CI: 1.08-2.62) with the use of skin-bleaching products. Multivariate analysis revealed a correlation between skin bleaching and both systolic hypertension (OR=3.94; 95% CI: 1.59-3.75) and obesity (OR=2.88; 95% CI: 1.23-5.69). CONCLUSION: The results of our study show the existence of a correlation between voluntary cosmetic depigmentation, hypertension and obesity in Togo.

[Knowledge, attitudes and practices about prevention of mother to child transmission of HIV (PMTCT) among pregnant women in antenatal clinic at 2010 in Togo]. / Connaissances, attitudes et pratiques en matière de prévention de la transmission mère-enfant du VIH chez la femme enceinte vue en consultation prénatale en 2010 au Togo.

PURPOSE: The purpose of this study carried out among pregnant women in antenatal clinics in Togo was to evaluate knowledge, attitudes and practices related to prevention of mother-to-child transmission of HIV (PMTCT). METHODS: A qualitative cross-sectional study was conducted in 22 antenatal clinics. Data were collected by interviewing all pregnant women examined from January 18th to February 4th, 2010. RESULTS: A consecutive series of 210 pregnant women was compiled. The women identified sexual relations (93.8%), objects soiled with blood (80.5%) and transmission from mother to child (27.1%) as routes of HIV transmission. A large majority (77.1%) agreed that unprotected sexual relations raised the risk of HIV transmission to the child and most (61%) expressed willingness to use condoms during pregnancy or breastfeeding, A high percentage (68.1%) believed that contamination during pregnancy increased the risk of HIV transmission to the child, and 61% knew that the risk of HIV transmission to the child was higher for mixed breastfeeding than for exclusive breastfeeding. The acceptance rate for HIV testing was 92.4%. The percentage of women who never used condoms (male or female) was 51% and the percentage considering that HIV-positive woman should not have children was 29.5%. CONCLUSION: The results of this study indicate that pregnant women in Togo have fairly good knowledge about HIV/AIDS. Attitudes towards PMTCT were generally positive but some behaviors such as condom use still require improvement.

[Atypical Localization of a Case of Leprosy in Lomé (Togo)]. / Localisation atypique d'un cas de lèpre à Lomé (Togo).

This was a 50-year-old woman with a selling activity living in Lomé who came for a consultation in March 2016 for a facial flushing that had been going on for 2 months without pain or pruritus. On examination, there was a single, erythemato-squamous closet of the right hemiface. There was no infiltration of the right ear. There was moderate cutaneous heat compared to the left hemiface which was without any lesion. Examination of nails, hair, palms and plants was normal. There was no hypertrophy of the peripheral nerves (superficial cervical plexus, ulnar, median). The face was not fixed. Complementary examinations noted a normal blood count and negative HIV status. Histology performed on a biopsy fragment concluded tuberculoid leprosy. The patient was first put on WHO multidrug therapy during 6 months. But one month after stopping this treatment, the lesions resumed. She was referred to a multibacillary leprosy protocol during one year. She had been seen 4 months after stopping treatment, without recurrence. It is important not to ignore leprosy in case of atypical erythema of the face even in the absence of other evocative signs and to perform a biopsy to the slightest doubt.

Il s'agit d'une femme de 50 ans, revendeuse, résidant à Lomé qui a consulté en mars 2016 pour une rougeur du visage évoluant depuis 2 mois sans douleur, ni prurit. À l'examen, on notait un placard unique érythémato-squameux de l'hémiface droit avec une bordure infiltrée. Il n'y avait pas d'infiltration du pavillon de l'oreille droite. Il y avait une chaleur cutanée modérée par rapport à l'hémiface gauche qui était sans aucune lésion. L'examen des ongles, des cheveux, des paumes et plantes était normal. On notait une absence d'hypertrophie des nerfs périphériques (plexus cervical superficiel, cubital, médiane). Le visage n'était pas figé. Les examens complémentaires notaient un hémogramme normal et une sérologie VIH négative. L'histologie réalisée sur un fragment biopsique a conclu à une lèpre tuberculoïde. La patiente a d'abord été mise sous le protocole de polychimiothérapie de l'OMS pendant 6 mois. Mais un mois après l'arrêt de ce traitement, les lésions ont repris. Elle a été remise sous un protocole de lèpre multibacillaire pour une durée d'un an. Elle a été revue 4 mois après l'arrêt du traitement, sans récidive. Il importe de ne pas méconnaître une lèpre devant un érythème atypique du visage même en l'absence d'autres signes évocateurs et de réaliser une biopsie au moindre doute.

Pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo : retrospective study from 1997 to 2017.

OBJECTIVE: The aim of this study was to describe the epidemiological, clinical, and therapeutic profile as well as the outcome and to document the causes of pellagra and pellagra-like erythema in a hospital setting in Lomé, Togo. METHODS: This retrospective study examined the records of patients seen for outpatient consultation and/or hospitalization in the three public dermatology departments of Lomé from January 1997 to September 2017. RESULTS: During the study period, 178 (0.4%) of 47,219 patients seen in these dermatology departments consulted for pellagra or pellagra-like erythema; 159 (89.3%) had pellagra-like erythema. The patients' mean age was 45.8±16 years, and the sex ratio (M/F) 1.8. All patients had at least one site of cutaneous involvement, nearly always erythematous or pigmented lesions in the photo-exposed areas (99.4% of cases). Gastrointestinal and neurological signs were dominated respectively by diarrhea (12.4 % of cases), peripheral neuropathies (8.4% of cases) and insomnia (8.4% of cases). The main causes identified were alcoholism (42.1% of cases) and nutritional deficiency (6.7% of cases). Five of 178 patients were infected with HIV. All patients were treated with nicotinamide and multivitamin supplementation. No deaths were recorded during follow-up. CONCLUSION: Our results document the extreme rarity of pellagra-like erythema/pellagra. Its two main causes remain alcoholism and nutritional deficiency. Moreover, its prognosis is good when treated quickly and adequately.

Morbidity and mortality in HIV-infected children on antiretroviral therapy in Togo.

the aim of this study was to evaluate the mortality and morbidity of HIV-infected children on highly active antiretroviral treatment (HAART) in Togo. this is a retrospective study of HIV-infected children on HAART in the 25 largest centers of HIV/AIDS care in Togo. the study included 1861 children (sex-ratio=0.99). Among them, 35.6 % were in WHO clinical stages 3 or 4 at the beginning of HAART. The most common opportunistic infections were coughing and pneumonia (37.1 %), gastroenteritis (11.3 %), various bacterial infections (10.4 %), and pruritus (10.4 %). The incidence of death was estimated at 4.5 per 100 person-years. Mortality was highest during the first year of antiretroviral therapy. The survival rate at 12 months of ART was 92.6 %. Children who began HAART at WHO clinical stage 4 had a significantly lower survival rate than the others (P<0.0001). The presence of a side effect of HAART (P=0.041), and hospitalization (P<0.001) were significantly associated with death in these children. although the new recommendations for medical care require early initiation of HAART, the improved performance of programs to prevent maternal-infant transmission remains crucial in reducing morbidity and mortality of children on HAART in Togo.

Cutaneous parasitosis in dermatology in Lomé: series of 1217 cases.

The aim of this study was to determine the epidemiological and clinical profile of cutaneous parasitosis in Lomé, Togo. Of the 71422 patients seen in 3 dermatology departments during the study period, 1217 (1.7%) had cutaneous parasitosis, 98% of them ectoparasitosis.

Lichenoid dermatoses in hospitals in Lomé, Togo: 959 cases.

The aim of this study was to describe the epidemiologic, clinical, and therapeutic profiles of cases of lichenoid dermatosis in Lomé, together with their outcomes. This retrospective descriptive study reviewed records of patients receiving care for lichenoid dermatosis from January 1997 to December 2016 in the dermatology departments of Lomé. In total, 959 (2.2%) cases of lichenoid dermatoses including 813 (84.8%) of lichen planus and 123 (12.8%) of lichen striatus were recorded. The mean age of the patients was 29.60 +/- 14 years and the sex ratio (M/F) was 0.7. Lichen planus was papular and found most often on the lower limbs (56.0%). Lichen striatus was banded along the lines of Blaschko, mainly on the lower limbs (55.3%). There were 23 patients with lichen nitidus lesions, most often on the trunk (47.8%). The treatment was based on corticosteroid therapy. Recurrences were noted in 40 (11.6%) cases of lichen planus and 4 (3.2%) of lichen striatus. This study shows that the principal lichenoid dermatoses in Lomé are lichen planus, and their management is based on corticosteroid treatment.

Profile of erythroderma in children in hospital dermatology departments in Lomé, Togo : study of 28 cases.

The aim of this study was to describe the epidemiological, clinical, and therapeutic profile as well as the outcomes of children with erythroderma (also known as exfoliative dermatitis) in hospital dermatology departments in Lomé, Togo. This retrospective descriptive study examined the records of patients aged 0 to 15 years who were treated for erythroderma in dermatology departments in Lomé from January 1997 to December 2016. The study included 28 patients, with a mean age of 6.3 ± 5 years. The mean duration of progression of erythroderma before the consultation was 39.2 days. Pruritus was present in 60 % of the children, fever in 13.3 %, and impairment of general status in 3.3 %. Among the children aged 3 months and older, 84.2 % had dry squamous erythrodermic dermatosis, and among those younger than 3 months, 15.8 %. Among those with erythrodermic dermatosis, atopic dermatitis (70.6 %) was the most frequent dermatosis. No cause was found in 32.1 % cases. Course and outcome were favorable in 53.3 % of cases; one child died, and the rate of loss to follow-up was 43.3 %. Erythroderma is a rare disease in children in hospital dermatology departments in Lomé. Erythrodermic dermatosis, particularly atopic eczema, remains the most frequent cause.

[Retrospective Study of Leprosy in Togo (2000-2014): about 2,630 cases]. / Étude rétrospective de la lèpre au Togo (2000­2014) : à propos de 2 630 cas.

The aim of this retrospective study carried out from January 2000 to December 2014 was to determine and map the epidemiological evolutionary trends and the clinical forms of leprosy cases notified in Togo. All the 2,630 new leprosy cases notified by all districts to the National Leprosy/Buruli Ulcer Control Program (PNLLUB-Togo) were included. The mean annual incidence was 175 cases with extremes of 73 to 266 cases. The median age of patients was 40 years, and the sex-ratio was 1.13. Children aged 0 to 15 accounted for 5.5% of the cases. The plateau region in the center of the country had the highest annual incidence (around 800 cases). Multibacillary forms accounted for 74.2% of cases. All patients were treated with multidrug therapy (MDT). WHO grade 2 disease was found in 15% of patients and 9.5% were lost to follow-up. Our results confirm that leprosy is no longer a major public health problem in Togo. However, the high incidence of leprosy in some areas of the country, could permit a resurgence of the disease.

Le but de cette étude était de déterminer les tendances épidémiologiques et les formes cliniques des cas notifiés de lèpre au Togo. Il s'agit d'une étude rétrospective portant sur les cas de lèpre notifiés par l'ensemble des districts sanitaires au Programme national de lutte contre la lèpre, l'ulcère de Buruli et le pian du 1er janvier 2000 au 31 décembre 2014. Deux mille six cent trente nouveaux cas de lèpre ont été notifiés. L'incidence annuelle moyenne était de 175 cas avec des extrêmes de 73 et 266 cas. L'âge médian des patients était de 40 ans, et le sex-ratio de 1,13. Les enfants âgés de 0 à 15 ans représentaient 5,5 % des cas. La région des Plateaux dans le centre du pays cumulait l'incidence annuelle la plus élevée (environ 800 cas). Sur le plan clinique, les formes multibacillaires représentaient 74,2 % des cas. Tous les patients étaient traités par polychimiothérapie. L'infirmité de grade 2 de l'OMS était retrouvée chez 15 % des patients, et 9,5 % étaient perdus de vue. Nos résultats confirment que la lèpre n'est plus un problème majeur de santé publique au Togo. On note une incidence élevée de la lèpre dans certaines régions du pays, pouvant faire craindre une recrudescence de la maladie.

[Vascular Cutaneous Abnormalities in Togo: a 120-Case Study]. / Anomalies vasculaires cutanées au Togo : étude de 120 cas.

The purpose of this study was to describe the epidemio-clinical profile, and treatment of vascular cutaneous abnormalities in Togo. It was a retrospective study of patients recorded in dermatology for vascular cutaneous abnormality between 1998 and 2017. During the study period, 120 (0.1%) of 88,869 patients received in dermatology have consulted for vascular cutaneous abnormalities. Their mean age was 25.3 months and the sex-ratio (M/F) 0.4. The most recurring vascular cutaneous abnormalities were vascular tumors (97 cases; 80.8%), mainly infantile hemangioma (IH) (93 cases; 77.5%). The mean time of onset of IH after birth was 2.9 months. The IH (54 cases; 50.5%) and port wine stains (8 cases, 53.3%) were predominantly localized at the cephalic region and Klippel-Trenaunay syndrome cases on lower limbs. We opted for a therapeutic abstention in the majority of the patients (50 cases of IH, 16 cases of simple vascular abnormalities, all Klippel-Trenaunay syndrome cases and telegiectasia cases). Of the 43 IH cases treated, the main drugs used were corticosteroids (23 cases of which 17 between 1998 and 2011 and 6 from 2012) followed by propranolol (11 cases from 2012). We had a favorable response in 9 of the 15 patients seen again. Cutaneous vascular abnormalities are very rare in dermatology in Togo and are dominated by IH with female predominance. In IH treatments, propranolol use, started in 2012 in Togo, is increasing when corticotherapy has declined.

L'objectif de cette étude était de décrire le profil épidémioclinique et thérapeutique des anomalies vasculaires cutanées au Togo. Il s'agit d'une étude rétrospective portant sur les dossiers des patients reçus en dermatologie pour une anomalie vasculaire cutanée entre 1998 et 2017. Durant la période d'étude, 120 (0,1 %) des 88 869 patients reçus en dermatologie ont consulté pour une anomalie vasculaire cutanée. L'âge moyen des patients était de 25,3 mois et le sex-ratio (H/F) de 0,4. Les anomalies vasculaires les plus recensées étaient les tumeurs vasculaires (97 cas ; 80,8 %), principalement les hémangiomes infantiles (HI) [93 cas ; 77,5 %]. Le délai moyen d'apparition des HI après la naissance était de 2,9 mois. Les HI (54 cas ; 50,5 %) et les angiomes plans (8 cas, 53,3 %) étaient localisés de façon prépondérante à la région céphalique et les cas de syndrome de Klippel-Trenaunay aux membres inférieurs. Nous avons opté pour une abstention thérapeutique chez la plupart des patients (50 cas d'HI, 16 cas de malformations vasculaires simples, tous les cas de syndrome de Klippel-Trenaunay et le cas de télangiectasies). Sur les 43 cas d'HI traités, les principaux médicaments utilisés étaient les corticoïdes (23 cas dont 17 entre 1998­2011 et 6 à partir de 2012) suivis du propranolol (11 cas à partir de 2012). Nous avions noté une réponse favorable chez 9 des 15 patients revus. Les anomalies vasculaires cutanées sont très rares en dermatologie au Togo et sont dominées par les HI, avec une prédominance féminine. Dans le traitement des HI, l'usage du propranolol, débuté en 2012 au Togo, est en augmentation pendant que celui de la corticothérapie baisse.

Scleroderma in hospital settings in Lomé: 50 cases.

The aim of this study was to document the epidemiological and clinical profile, treatment used, and outcome of patients with scleroderma in hospital settings in Lomé. This descriptive study examined the records of all patients seen as outpatients or admitted for scleroderma in hospital dermatology and rheumatology departments in Lomé during the 20-year period of 1993-2012. During the study period, 50 (0.04%) of the 121,021 patients seen in these departments had scleroderma. There were 29 cases of localized scleroderma and 21 systemic cases, predominantly women (sex-ratio=0.2). The patients' mean age was 36 years. All patients with systemic scleroderma had speckled achromia (100%), and most (90.48%) had cutaneous sclerosis. After a mean follow-up period of 43.5 days, 71.43% of the patients had been lost to follow-up. All of the patients with localized scleroderma had cutaneous sclerosis, and the rate of loss to follow-up (after a mean of 17 days) was 96.55%. The results of this study confirm the extreme rarity of scleroderma in the teaching hospitals in Lomé and a clear female predominance. It points out the difficulty of management, which both influences and is aggravated by the high rate of loss to follow-up.

[Skin disease and HIV infection among inmates in Lomé, Togo: a study of 194 prisoners]. / Pathologie cutanée et infection à VIH chez les détenus à Lomé, Togo: étude de 194 cas.

OBJECTIVE: The aim of this work was to study the prevalence of skin diseases among inmates in Lomé (Togo) and its relation to their HIV status. PATIENTS AND METHODS: This cross-sectional descriptive study took place from November 14 to December 5, 2011, in the civil prison of Lomé and included prisoners who agreed to have an HIV screening test. RESULTS: In all, 194 prisoners, all men (median age: 29 years), were examined during the study period. The group aged younger than 30 years accounted for 51% of the population. Overall, 166 (85.6%) of the 194 prisoners examined had cutaneous lesions; 153 reported that these had developed after their imprisonment. HIV serology was positive in 21 (10.8%) of the 194 prisoners tested. The most common cutaneous diseases were pruritus (n = 62), fungal infections (n = 45), boils (n = 26), eczema (n = 21), and scabies (n = 20). The frequency of skin disorders did not differ significantly between HIV-infected prisoners and those who were not infected (p>0.05). CONCLUSION: This study shows a potential for high prevalence of HIV infection and an existing high prevalence of infectious dermatosis among these prisoners. It is essential to reduce the overpopulation and crowding in prisons to decrease the prevalence of these skin disorders.