F. Ly

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.

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.

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.

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.

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.

The characteristics of severe forms of psoriasis on pigmented skins: A retrospective study of 102 cases in Dakar, Senagal

Background: Severe forms of psoriasis can be life-threatening for patients. Our objective was to determine the epidemiological, clinical, therapeutic aspects and outcome of severe forms of psoriasis. Methodology: A 18 years retrospective study conducted in the department of Dermatology at Le Dantec hospital listed all the severe forms of psoriasis. Results: We have collected 102 cases of severe forms. The sex ratio was 1.55 and the average age of 47 years. The family histories of psoriasis were reported in 5 patients. Arterial hypertension was noted in 10 patients, diabetes in 4 patients and obesity in 6 patients. Smoking and alcoholism were found respectively in 10 cases and 7 cases. The average duration of the lesions was 2 years. Phytotherapy was reported in 62 patients (62%). Pruritus was present in 86 patients (84%). The clinical forms of psoriasis were: erythroderma in 76 cases (74.5%), psoriatic arthritis in 14 cases (13.7%) and a pustular form in 12 cases (11%). HIV serology was positive in 12 patients. All patients had received a treatment with topical corticosteroids and emollients. Methotrexate was initiated in 57 patients and retinoids in 27 cases. The outcome was favorable in 67 patients (65%). We recorded 6 deaths (6%). Conclusion: The large use of oral phytotherapy medicines and inappropriate treatment precipitated or speeded up the occurrence of severe forms of psoriasis among our patients.

Diaper dermatitis among the infant in Dakar: Study of 205 cases

Background: Diaper dermatitis in infant is a common reason for dermatological consultation. The aim of this study was to describe the epidemiological, clinical, etiological and evolutionary aspects of diaper dermatitis in infant. Materials and Methods: A cross-sectional descriptive study was conducted in three dermatology departments in Dakar. All infants [1-30 months] who are followed from October 1, 2015 to April 30, 2016 for diaper dermatitis was included. Results: We collected 205 cases, a hospital frequency of 22.18%. The sex ratio was 1.02 and the mean age was 8.49 months. Diaper dermatitis was inflammatory in 67%, irritative in 18%, infectious in 12% and associated with general disease in 3%. Dermatitis was seborrheic in 51.7%, mycotic in 14.6% and associated with: acrodermatitis enteropathic in 4 cases and granuloma gluteale infantum in one case. Baby diapers were used in 93.7% by moms with a change of less than 6 times a day in 84.9%. The clinical outcome was favorable in 56.1%. Conclusion: Diaper dermatitis in infant is a common infant dermatosis in Dakar. The multiple causes necessitate a rigorous diagnostic approach. Severity is related to association with general diseases.

Stevens Johnson Syndrome and Toxic Epidermal Necrolysis Induced by Nevirapine among HIV-Infected Pregnant Women: Five Cases

Introduction: The nevirapine is the most widely accused drug in toxidermias in patients living with HIV. It is responsible for toxic epidermal necrolysis called Lyell syndrome or Stevens Johnson syndrome, severe during pregnancy. We report five cases in pregnant women who are HIV-positive. Case reports: Five pregnant women aged 35 years on average with a mean gestational age of 29.6 weeks of amenorrhea were HIV1-positive.The mean CD4 count was 416/mm3. They had severe toxidermia such as Lyell syndrome or Stevens Johnson syndrome. These toxidermias appeared on average 26 days after taking antiretroviral triple therapy including nevirapine as part of the prevention of mother-to-child transmission of HIV (PMTCT). The outcome was favorable after discontinuation of antiretrovirals. Nevirapine was substituted with lopinavir/ritonavir. Newborns had received antiretroviral prophylaxis and were not infected with HIV. Conclusion: The nevirapine toxidermia is common during antiretroviral therapy. These toxidermia are severe during pregnancy related to maternal and fetal vital risks. The replacement of nevirapine with an anti-protease is a therapeutic alternative in our resource-limited countries.

F15 : Lupus vorax : à propos d’une observation

La tuberculose cutanee represente 2% des localisations extrapulmonaires de la tuberculose. Le lupus tuberculeux est la forme cutanee la plus frequente, mais sa forme ulcero-vegetante ou vorax est rarement decrite. Nous rapportons un cas de lupus tuberculeux dans sa forme ulcero-vegetante sur une lesion de lupus discoide. Un patient de 42 ans suivi pour lupus erythemateux chronique, et perdu de vue pendant 7 ans, avait consulte pour une tumeur du visage dans un contexte febrile. L’examen dermatologique montrait une tumeur ulcero-bourgeonnante, douloureuse, a fond necrotique, saignant au contact reposant sur un placard de lupus discoide, et prenant toute la levre superieure. Des lesions similaires etaient notees a la face interne des joues. L’examen des autres appareils retrouvait des adenopathies cervicales de grande taille dont une etait fistulisee, un syndrome de condensation pulmonaire bilaterale et une dysphonie. Devant les signes cutaneomuqueux, une degenerescence en carcinome epidermoide d’une lesion discoide, un lymphome NK /T et un lupus tuberculeux dans sa forme ulcero-vegetante ont ete evoques. Le geneXpert, effectue sur les crachats, etait positif et l’histopathologie cutanee avait mis en evidence un granulome tuberculoide sans necrose caseeuse. Ainsi, nous avions retenu le diagnostic d’une tuberculose multifocale avec atteinte cutanee de type vorax. A 5 mois d’une qua- dritherapie antituberculeuse, l’evolution a ete marquee par une cicatrisation des lesions cutaneo-muqueuses et une regression des signes ganglio-pulmonaires. Notre observation est particuliere du fait qu’elle est rarement decrite en Afrique subsahariennne. La presentation clinique fait d’abord evoquer une degenerescence carcinomateuse d’une lesion de lupus discoide. Cependant les localisations a distance de la tuberculose ainsi que l’histopathologie nous ont permis de conforter notre diagnostic.