A. Kane

Aesthetic problems associated with the cosmetic use of bleaching products

Background and aim  The use of skin bleaching products for cosmetic purposes is a frequent practice (25–96%) in women from sub‐Saharan Africa. The dermatologic complications associated with this practice have been comprehensively reported. The aim of this work was to study the epidemiologic, clinical, and cosmetic aspects of these complications in order to produce better therapeutic guidelines for their management.

Epidemiologic, clinical, and therapeutic features of acne in Dakar, Senegal.

Background  Acne, a chronic inflammatory dermatosis of the pilosebaceous follicle, is very widespread worldwide, affecting 75–80% of adolescents, with an impact on their quality of life. The etiologic factors are not always the same, and the treatments proposed are not always well tolerated in black individuals.

Mycétomes diagnostiqués au Sénégal de 2008 à 2010

INTRODUCTION Mycetomas are inflammatory pseudotumours of subcutaneous and possibly osseous soft fabrics, generally polyfistulas with chronic mode of evolution. PATIENTS AND METHODS This study was carried out at the laboratory of parasitology and mycology of Le Dantec hospital in Dakar, Senegal, including 113 patients, from june 2008 to july 2010. RESULTS Patients were from different regions in Senegal and in neighborhood countries, referred to the laboratory for mycetoma diagnosis. Among the 250 patients referred, 113 were positives after direct observation and culture corresponding to 45.2% index of infestation. The age range varies between 13 to 73years with an average age of 33.9years. The age bracket ranging between 20-39years is more infected (27.34%), followed by 40-59years (25.2%), 60years and more (4.5%), 30-39years (16.64%), 13-19years (7.2%). The infection sex rate were, male: 79.6% and female: 20.4%. Infection prevalence profession dependant was found mainly in farmers and breeders with respectively: 48.7%, and 42.5%. The foot infestation is most represented with 72.5%, then leg (12.3%), knee (7.1%), scalp (2.7%), hand (1.8%). The other localizations are found with less than 1%: back, thigh, chest and ganglion inguinal. According to mycetoma agents, fungy are represented than mycetomas actinomycosic with respectively 70% and 30%. The species found were: Madurella mycetomatis (53.1%), Actinomadura pelletieri (23%), Leptosphaeria senegalensis (9.7%), Streptomyces somaliensis (2.6%), Actinomadura madurae (2,6%), Pseudallescheria boydii (1.8%), Nocardia spp. (1.8%), Scedosporium apiospermum (0.9%), Fusarium solani (0.9%). We found agents of dermatophytes: Microsporum langeronii (1.8%), and Trichophyton mentagrophytes (0.9%). CONCLUSION This study confirms that mycetomas are endemic affections in Senegal, where it still remain a real cause of disability among population leaving in rural area.

Premiers cas de carcinomes épidermoïdes sur terrain de dépigmentation artificielle

INTRODUCTION We report two cases of squamous cell carcinoma (SCC) in two black women (phenotype VI) using bleaching compounds for cosmetic purposes over a period of 15 years. CASE REPORTS Two women (aged 45 and 47 years) with a long history of cosmetic use of bleaching compounds consulted at a dermatology unit for skin tumours. A diagnosis of SCC was confirmed by histological examination of tumour biopsies. One patient was HIV-positive. Surgical treatment was performed in both cases: simple postoperative complications were seen in one patient but the other died at home following recurrence of carcinoma in the year following diagnosis. DISCUSSION To our knowledge, theses two cases represent the first description of SCC occurring after prolonged cosmetic use of bleaching compounds. Carcinoma occurred in both cases in skin exposed to sun. In our patients, the mechanism of carcinogenesis may have involved melanin destruction, solar exposure and corticosteroid-induced immunosuppression. A direct carcinogenic effect of hydroquinone or other unidentified compounds is another possibility; the carcinogenicity of hydroquinone is well established in rodents. While these observations do not provide formal proof of any implication of depigmentation products in SCC, they emphasize the need for monitoring of dark-skinned women using skin lighteners.

Dermatosis papulosa nigra in Dakar, Senegal

Background  Dermatosis papulosa nigra (DPN) is a benign epithelial tumour, common in the black population. It is a special topographic form of ethnic seborrheic keratosis, which is more common in the white population. Its benign character has meant that very few studies have been performed. In Senegal, no investigation has been carried out to date.

Behçet's disease in black skin. A retrospective study of 50 cases in Dakar.

INTRODUCTION Although Behçets disease is well-documented in Eastern populations, epidemiologic data in Sub-Saharan African population is scarce. The aim of this study was to define the epidemiologic and therapeutic aspects as well as clinical course of Behçets disease in African black population. RESULTS The study included 50 patients with Behçets disease. The average age was 32 (18-67) years. A total of 31 patients were men and 19 were women. Two patients had a positive family history of Behçets disease. The oral and genital aphthous lesions were present in 100% of patients. The pathergy test was positive in 16 patients (32%). Following skin conditions were observed: pseudofolliculitis in 15 patients (30%), acneiform papules in 6 patients (12%), erythema nodosum in 4 patients (8%) and leg ulcers in one patient. Ocular involvement was reported in 22 patients (44%) and joint involvement in 20 patients (40%). Neurological abnormalities were noted in 12 patients (24%). Gastrointestinal involvement with wide and deep ulcerations in the ileocecal region was observed in a patient. As treatment, a combination of oral corticosteroids and colchicine was used in 97% of our patients. Thalidomide was introduced in 3 patients and anticoagulation treatment in 19 patients. Clinical improvement was noted in 25 patients (50%), recurrence in 14 patients (28%) and 3 patients were lost to follow (6%). CONCLUSION The Behçets disease is not uncommon in black skin and generally affects young adults. Severe aphthous ulcers of the oral cavity and genital area are the most consistent finding.

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.

Tinea in Senegal: an epidemiologic study

The tineas are frequent in poor countries, especially in the tropics, where they are promoted by the hot climate and by promiscuity. One characteristic of the disease is alopecia, which can be distressing for patients and their relations and adversely affect their quality of life. In the majority of cases it is children who are affected. However, tinea is increasingly reported in adults, promoted by many factors. The aim of our study was to explore the epidemiologic profile of tinea in Senegal.

Alopecia in Senegalese women.

Fifty female patients aged between 14 and 45 years were included in the study. This represents 7.6% of the 654 women aged 14 years and above who consulted a dermatologist during the period of the study. The course of the alopecia was progressive in 92% of cases. The pattern of alopecia was diffuse in 86% of cases and localized in 14%. Alopecia was partial in 78% of cases. Associated signs comprised scaling in 14 cases, pruritus in two cases, folliculitis in three cases (Fig. 1), anemia in one case and pregnancy in one case. There were 11 cases of tinea capitis and four cases of alopecia areata. The hair was tightly braided on a regular basis in 100% of cases, synthetic hair extensions were used in 90% of cases (Fig. 2), and in 70% of cases hair was pulled back into a chignon. Hair straightening using a “cold” method was practised by 78% of patients: on a regular monthly basis in 38% of cases, every 2 months in 45% of cases, and every 3 months in 17% of cases. Thirty-seven per cent of patients used brushing techniques, hot curling irons, dryers and steam hoods. All patients used various types of cosmetic products regularly and simultaneously (gels or hair sprays, oil baths, lotions and creams). Figure 1 Folliculitis decalvans secondary to chemical straightening Blackwell Publishing, Ltd. Oxford, UK IJD nternational Jour al of Dermatology 0011-9059Science, 2005 44 Original article

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.