Cutaneous basidiobolomycosis: Seven cases in southern Benin.

BACKGROUND: Cutaneous basidiobolomycosis is the most common form of entomophthoramycosis. Herein we report seven cases of cutaneous basidiobolomycosis. PATIENTS AND METHODS: A retrospective observational study was conducted at the Buruli ulcer treatment centre in Pobè and at the national teaching hospital in Cotonou from 2010 to 2015. RESULTS: Seven cases of cutaneous basidiobolomycosis were diagnosed. The mean patient age was 9.53 years. There were 4 female and 3 male patients, all from southeast Benin. Clinically, the disease presented in all cases as a hard, well-defined, subcutaneous plaque with little inflammation, and which could easily be lifted from the deep structures but remained attached to the surface structures. The overlying skin was hyperpigmented. Plaques were localized to the buttocks or thighs. All patients had inflammatory anaemia with an accelerated erythrocyte sedimentation rate (30 to 70mm over the first hour), and a low haemoglobin count (8.7 to 11.4g/dL). Blood hypereosinophilia (650 to 3784elements/mm3) was present in six of the seven subjects. Histopathology (performed for 5 of the 7 subjects) showed granulomatous lesions with foreign-body giant cells, and inflammatory cells, with occasional eosinophils surrounding fungal hyphae (Splendore-Hoeppli phenomenon). Mycological analysis revealed Basidiobolus ranarum in three cases. The patients were treated with ketoconazole (5/7) and itraconazole (2/7), with good outcomes after 10 to 24 weeks of therapy. DISCUSSION: Cutaneous basidiobolomycosis is uncommon in southern Benin, with only seven cases being diagnosed over 6 years. The diagnosis of cutaneous basidiobolomycosis is a challenge in the field in Benin due to the non-specific clinical presentation, the lack of technical resources, and the existence of numerous differential diagnoses. CONCLUSION: Cutaneous basidiobolomycosis is an uncommon fungal infection in southern Benin chiefly affecting children.

[Ainhum and "African acral keratoderma": three cases]. / Aïnhum et « kératodermies acrales africaines ¼ : trois cas.

BACKGROUND: Ainhum, or spontaneous dactylitis, involves the formation of a gradual constriction in the digital-plantar fold of the fifth toe that leads, after several years, to autoamputation of the digit. This condition is classically distinguished from "true" ainhum, of unknown aetiology and affecting only subjects of African origin, from "pseudo-ainhum", resulting from different causes such as inflammatory constriction or constriction by a foreign body, and finally from ainhumoid palmoplantar keratoderma, which is of genetic origin and occurs for instance in Vohwinkel syndrome. Herein, we report three cases of ainhum in women of sub-Saharan African origin; in addition, all three subjects were also presenting various forms of hyperkeratosis of the hands and feet known to primarily affect subjects of African origin. PATIENTS AND METHODS: The three patients, aged 30, 48 and 44 years, were respectively from Mali, Guinea and Senegal. They had consulted a dermatologist for violent pain in the fifth toe, which frequently prevented sleep and was inexplicable despite several consultations, and even in one case in spite of surgical investigation. Once the diagnosis had been made, relief was promptly provided for all three patients through Z-plasty to remove the circular constriction around the toe in question. In addition to ainhum, the first patient was also presenting diffuse palmoplantar keratoderma, together with an aspect of acrokeratoelastoidosis on the edges of her hands and feet, and knuckle pads, while the second was presenting diffuse palmoplantar keratoderma and an aspect of marginal acrokeratoelastoidosis, and the third was presenting small knuckle pads. DISCUSSION: A recent study has confirmed the high incidence of several forms of palmoplantar keratoderma of African origin, as well as frequent association of these different varieties with one another. These consist of diffuse keratoderma having a relatively non-specific aspect, keratoderma punctata of the palmar creases, marginal keratoderma known also as focal acral hyperkeratosis, and acrokeratoelastoidosis, despite the absence of histological evidence, and finally, inverted keratoderma, i.e. affecting the dorsal aspects of the extremities, such as knuckle pads. In the three cases presented here, ainhum was associated with these different forms of acral keratoderma seen chiefly in subjects of African origin. CONCLUSION: So-called "true" ainhum may be included in a broader group of African acral keratoderma, further reinforcing the unity of this group. Genetic studies are required to enable validation and refinement of these clinical findings.

[Dissecting cellulitis of the scalp: a retrospective study of 7 cases confirming the efficacy of oral isotretinoin]. / Cellulite disséquante du cuir chevelu: étude rétrospective de 7 cas confirmant l'efficacité de l'isotrétinoïne per os.

BACKGROUND: Dissecting cellulitis of the scalp (DCS) is a rare and long-standing disease and its aetiopathogenesis remains unclear. Various therapeutic alternatives exist. We attempted to assess the efficacy of oral isotretinoin in a series of patients. PATIENTS AND METHODS: Seven cases of DCS followed and treated by one of the authors at the Sabouraud Centre in the Saint-Louis Hospital between 2007 and 2013 were retrospectively studied and the efficacy of oral isotretinoin was evaluated. RESULTS: The seven patients included were males aged between 22 and 39 years, with alopecic nodules on the occiput (two cases) or the top of the vertex (five cases). Most patients were given oral isotretinoin at a dosage of 0.75mg/kg/day for at least nine months. The outcome was satisfactory with complete healing of the lesions and good regrowth in all cases. Follow-up after recovery lasted between 16 and 42 months. CONCLUSION: Based on published studies and the results of the present study, oral isotretinoin at a dose of 0.75mg/kg/day may be proposed as first-line treatment for DCS.

[Reasons for consultation in a dermatology/venereology department in 2009 in Cotonou, Benin]. / Motifs de consultation en Dermatologie-Vénéréologie en 2009 a Cotonou, Bénin.

The purpose of this retrospective study was to determine the reasons for consultation in a Dermatology Venereology Department in Cotonou, Benin. A total of 1,070 new patients were included. The main reason for consultation was immunoallergic dermatosis.

[Mucocutaneous manifestations of human immunodeficiency virus infection in Cotonou, Benin]. / Manifestations cutanéo-muqueuses des personnes vivant avec le virus de l'immunodéficience humaine à Cotonou, Bénin.

The purpose of this study was to describe mucocutaneous manifestations observed in persons living with human immunodeficiency virus (PLHIV) in Cotonou, Benin. A transverse retrospective study was carried out on the records of PLHIV who underwent follow-up at the Military Teaching Hospital in Cotonou from February 2002 to September 2005. The files of all eligible adult patients examined by dermatologists prior to initiation of antiretroviral treatment were reviewed. Dermatologic manifestations were defined as any cutaneous or cicatricial lesion of the skin. Data was analyzed using the EPI INFO software package. (version 6.0). A total of 152 patient files were included. The sex ratio was 1.10 with a female predominance. Mean age was 37.8 years. HIV1 was predominant (98%). Two-thirds of patients were as stage 3 according to the WHO classification. A total of 276 dermatologic manifestations were identified. The most common manifestations were buccopharyngeal candidiasis (24.6%), prurigo (20.6%), shingles (11.6%), and dermatophytosis (10.5%). The mean CD4 lymphocyte level was 106 cells/mm3. The CD4 level was below 100 cells/mm3 in 52% of cases involving candidiasis and 60% of cases involving prurigo. Dermatologic findings in this study were identical to those described in most studies from Africa and Asia. However the low prevalence of Koposi's sarcoma and seborrheic dermitits was surprising given the advanced stage of immunodepression in our patients. The most frequent mucocutaneous manifestations of HIV infection in Benin are infectious disease and prurigo.

[Gangrene with pyocyanic infection and osteitis in a patient presenting endemic Kaposi's sarcoma: case report from Benin]. / Gangrène à pyocyanique et ostéite sur maladie de kaposi endémique: une observation au Bénin.

Infectious complications involving chronic skin ulcers have been well document but superinfection of ulcerated Kaposi's sarcoma nodules by multiresistant germs has rarely been reported. The purpose of this report is to describe a case in a 57-year-old HIV-negative black African man. Kaposi's sarcoma nodules appeared suddenly and spread rapidly on the right leg with pain and fever. Onset was associated with a laboratory-documented inflammatory syndrome and two metatarsal bone defects. Amputation of the leg was required due to the presence of multiresistant germs: Pseudomonas aeruginosa, multiresistant Staphylococus aureus and Candida albicans. Occurrence of bone lesions beneath superinfected Kaposi's sarcoma nodules poses a challenge for differential diagnosis of the underlying cause, i.e. either Kaposi's sarcoma or infectious osteitis. Since etiologic diagnosis of bone defects requires facilities that are rarely available in an African hospital, surgical treatment is the only alternative if antimicrobial therapy fails.

[Risk factors and allergic manifestations associated with atopic dermatitis in Lomé (Togo): a multicenter study of 476 children aged 0-15 years]. / Facteurs de risque et manifestations allergiques associés à la dermatite atopique à Lomé (Togo) : étude multicentrique portant sur 476 enfants de 0 à 15 ans.

OBJECTIVE: The aim of this study was to determine the prevalence and document the risk factors and allergic reactions associated with atopic dermatitis (AD) in children in Lomé. METHOD: This cross-sectional multicenter study took place from March to June 2013 in four health facilities in Lomé. It applied the criteria of the United Kingdom Working Party (UKWP). RESULTS: We included 476 children aged 0-15 years who came for a vaccination or pediatric consultation; 31.3% were diagnosed with AD. The mean age of the children with AD was 33.91 ± 37 months, and the sex ratio (M/F) 0.96. In the univariate analysis, several risk factors and allergic reactions were significantly associated with AD including weaning, asthma, allergic conjunctivitis, allergic rhinitis, food allergy, alopecia, seborrheic dermatitis in infants, and prurigo. In the multivariate analysis, AD was associated with prurigo (aOR = 15.59, 95% CI = 7.54 to 32.21), allergic rhinitis (aOR = 7.51, 95% CI = 4.31 to 13.10), and food allergy (aOR = 5.32 95% CI = 1.20 to 23.48) were associated with AD. CONCLUSION: AD is common in children in Lomé. Prurigo, allergic rhinitis and food allergy are allergic manifestations associated with it. These results deserve confirmation by a prospective study over a longer period.

[Herpes Zoster, predictive element of human immunodeficiency virus infection (HIV). Epidemio-clinical study in Cotonou (Benin)]. / Le zona, élément prédictif de l'infection à virus de l'immuno-déficience humaine (VIH). Etude épidémio-clinique à Cotonou (Bénin).

An epidemio-clinical study of Herpes Zoster in 39 healthy patients of Benin has permitted to the authors to evaluate the positive predictive value of Herpes Zoster for HIV infection on West Africa; and to compare it with results of central Africa. The mean age of patients is 34.74 years. The positive predictive value of Herpes Zoster for HIV infection is 41.02%. It is increased by the cranial site of Herpes Zoster.

[Buschke-Loewenstein tumor. Apropos of 2 cases in Cotonou, Benin]. / Tumeur de Buschke-Loewenstein. A propos de deux cas vus à Cotonou, Bénin.

About two cases of Buschke-Loewenstein tumor--one of the penis in man infected with HIV and another of perianal area-, the authors insist on the relative frequency of Buschke-Loewenstein tumor in non-circumcised and homosexual groups. They emphasize the continuous precancerous spectrum of Buschke-Loewenstein tumor.

[Ectodermal dysplasia. Apropos of 6 familial cases in negroid children]. / Dysplasie ectodermique. A propos de 6 cas familiaux chez des enfants de race noire.

Six cases of ectodermic dysplasia were observed in children of a black family. The different forms include dental abnormalities and a particular pilar dysplasia in black subjects. Ectodermic dysplasia is transmitted recessively on the X chromosome.

[Mibelli porokeratosis in 2 brothers]. / Porokératose de Mibelli chez deux frères.

INTRODUCTION: Mibelli's porokeratosis is uncommon in black persons. We report two brothers who had two different clinical presentations. CASE REPORT: The brothers were seen at the ages of 16 and 19 years. Both had Mibelli's porokeratosis, one with a papulo-verruciform presentation located on the scrotum, the anus, the gluteal area and the back of the hand, and the other with a superficial disseminated eruption involving the face and the forearm. DISCUSSION: The incidence of Mibelli's porokeratosis in the black population at Cotonou is approximately 0.3 per 10.000. The presence of the disease in two uterine brothers confirms the monogenic and familial nature of Mibelli's porokeratosis. Dominant transmission cannot be easily demonstrated when the parents of the patients are phenotypically healthy.

[Cutaneous-pulmonary sarcoidosis. Diagnostic difficulties in the Black African milieu]. / Sarcoïdose cutanéo-pulmonaire. Difficultés diagnostiques en milieu Noir Africain.

About a case of pulmonary and dermatologic manifestations of sarcoidosis, in a Black African patient, the authors emphasize the clinical polymorphism of sarcoidosis. They insist on the diagnostic criteria of sarcoidosis which are not at all specific of the disease but necessitate a compatible interpretation; particularly in Black Africa where leprosy, tuberculosis and many others granulomatous diseases are endemic.

[Contact eczema and allergens: an analysis of the preliminary results of patch tests in the Dermatology Service of the National Hospital and University Center in Cotonou]. / Eczema de contact et allergenes: analyse des resultats preliminaires des tests epicutanes du Service de Dermatologie du Centre National Hospitalier et Universitaire (CNHU) de Cotonou.

About a preliminary study of patch-test in 39 cases of contact dermatitis with allergens of international Contact Dermatitis Research (ICDRG), the authors noted 27 (69.2%) positive patch-tests. Men are frequently exposed to formaldehyde and dichromate potassium. Women are more exposed to fragrance-mix and formaldehyde. Hand workers have the uppermost percentage of positive patch-test (90.9%). The authors observed also 16 cases of contact polysensitivity for at least two allergens.

[Zoon's balanitis in circumcised and HIV infected man, at Cotonou (Benin)]. / Balanite de Zoon chez un homme circoncis et infecté par le VIH, à Cotonou (Bénin).

Balanitis of Zoon (BZ) characterized by an important plasma cell infiltration occurs exclusively in uncircumcised men aged between 40-80 years. We report here a case of BZ in an HIV infected patient who was circumcised since birth. A 43-year old man consulted in 2009 for itchy and not painful glans erosion evolving for one year. He is HIV1 infected and has been under didanosine, lamiduvine and nelfinavir for three years. Under this treatment, his CD4 count increased from 26 cells/mm(3) in 2007 to 206 cells/mm(3) at the time of the consultation. We noted after examination clean burgeoning erosion, red in places, pink in other places, with fuzzy boundary, sitting on the glans and extending into the preputial sulcus. Histopathology showed infiltration by sheets of plasma cells with perivascular topography in the dermis. The bacterial cultures and syphilis serology were negative. We noted a good outcome after four weeks of application of 3% oxytetracycline ointment. This observation suggests that the BZ can occur on a HIV infected patient whether he was circumcised or not. Thus, it appears fair to think of BZ faced with a chronic erosion of the glans in HIV infected patient.

[Profile of immune and allergic dermatoses among children at the outpatient dermatology clinic in Cotonou (Benin)]. / Profil des dermatoses immunoallergiques chez les enfants dans le service de dermatologie du CNHU-C (Bénin).

OBJECTIVE: The aim of this work was to study the profile of immune and allergic dermatoses (IAD) in children consulting at the outpatient dermatology clinic at the National University Hospital in Cotonou (Benin). METHOD: This retrospective descriptive study examined records of children consulting with this diagnosis over a 10-year period. RESULTS: IAD (902 cases, 37%) were the most common pediatric dermatosis, followed by infectious dermatosis (24%). The sex ratio of children was 0.78. The age groups most strongly affected were those aged 1-30 months (25.39%) and 150-180 months (19.73%). The main IAD were: eczema (47.9%) and prurigo simplex (40.7%). Other IADs included lichen planus (5.1%), toxicoderma (3.8%), urticaria (1.5%), and erythrodermic eczema (1%). The incidence of eczema increased from 13.5% in 2000 to 21.5% in 2009, an increase of 62.2% over 10 years. CONCLUSION: IADs are common at the Cotonou hospital clinic and are dominated by eczema, the incidence of which has increased significantly over time.

[Epidemiological and clinical characteristics of anogenital dermatoses in the department of dermatology-venereology in Cotonou, Benin]. / Profil épidémioclinique des dermatoses anogénitales dans un service de dermatologie à Cotonou (Bénin).

OBJECTIVE: The aim of this study was to document the epidemiological and clinical characteristics of anogenital dermatoses (AGDs) in Cotonou, Benin. METHOD: This retrospective, descriptive study, conducted in the Department of Dermatology-Venereology at the National University Hospital of Cotonou, examined medical records of admissions and outpatient consultations for the 5-year period 2005-2009 and included the records of all patients with a clinical diagnosis of AGD. RESULTS: The prevalence of AGD in our series was 2.6% and the prevalence of sexually transmitted AGDs (STIs) was 1.3%. The sex ratio (M:F) was 2.5, and the patients' average age was 31.1 years. AGDs were classified as infectious (77%), inflammatory (12.6%), non-infectious tumors (3.7%), physiological (2.1%), psychodermatoses (2.1%), non-infectious ulcers (1.6%), and dyschromia (1%). STIs accounted for 44% of the AGDs: condyloma (65.5%), genital herpes (19%), urethritis (8.3%), and chancroids (4.8%). The primary sites in men were the foreskin, the groin, the scrotum, and the glans, and in women, the labia majora, the groin, the labia minora, and the anal cleft. CONCLUSION: AGDs were relatively rare in hospital consultations in Cotonou. They were mainly infectious (viral or fungal), and nearly half were STIs.

Prevalence of xerosis, eczema, and hair and nail abnormalities in PLWHA in Cotonou, Benin.

BACKGROUND: The objective of this investigation was to study the prevalence of xerosis, eczema, and hair and nail abnormalities in PLWHA in Cotonou. PATIENTS AND METHODS: A retrospective study was performed on the records of PLWHA in Cotonou. All PLWHA with xerosis, eczema, or abnormal appendages were included. RESULTS: Forty-seven patients had xerosis or eczema. Their mean age was 38 years; the sex ratio 0.51 and the mean CD4 count 89 cells/mm(3). Twenty-three patients had xerosis, which affected the whole body (n = 20), lower limb (n = 2), limbs and trunk (n = 1), without gender difference. Twenty-four patients had eczema of which eight had both eczema and xerosis. Forty-two patients had abnormalities of the hair or nails. Their sex ratio was 0.80 and the mean CD4 count 110 cells/mm(3) . Nineteen patients had abnormalities of the hair and scalp: straight hair (n = 16), squamous lesions (n = 2), and folliculitis abscess (n = 1) with a male predominance. Twenty-three patients had nail dermatophytosis (n = 15), candidiasis (n = 7), and ingrowing nails (n = 1). These conditions affected more often women (74%) than men (26%). CONCLUSION: The prevalence of eczema and xerosis is low in our patients. Onychomycosis was the most frequent nail abnormality.

[Drug eruptions in children in Cotonou, Benin]. / Toxidermies Chez Les Enfants A Cotonou, Benin.

INTRODUCTION: The aim of this study was to investigate the epidemiological aspects of drug eruptions in children in hospital area in Cotonou. PATIENTS AND METHOD: A retrospective study was carried out in the Department of Dermatology of Cotonou (Benin) from 1998 to 2009. All cases of drug eruption occurred, during the study period, in children under 16 years old were selected for the study. The diagnosis of the drug eruption was based on clinical findings. The Identification of culprit drugs was based on the criteria as defined by the French Group of Pharmaco-vigilance. RESULTS: From 1998 to 2009, 232 cases of drug eruption were diagnosed in the Department of Dermatology. Of this, 35 cases occurred in children under 16 years old. The patient mean age was 6.6 years with a sex ratio of 0.94. 4 patients were HIV positive. The culprit drug was identified in 21 patients (60%): sulfonamides 52.38% (11/21 cases), penicillin 9.52% (2 cases), vaccine 9.52% (2 cases), acetaminophen 9.52% (2 cases), acetyl salicylic acid 4.76% (n = 1), quinine 4.76% (n = 1), phenobarbital 4.76% (n = 1) and ceftriaxone 4.76% (n = 1). The main clinical patterns were: fixed drug eruption 45.71% (16/35), maculopapular rash 17.14% (n = 6), Stevens-Johnson syndrome 17.14% (n=6), and urticaria 8.57% (n = 3), 1 case of toxic epidermal necrolysis was seen and one patient died. CONCLUSION: Skin reactions caused by drug intake are a rare disorder among children and fixed drug eruption is the main clinical presentation of the disease in Cotonou (Benin).