Gennaro Franco

Epidemiology of Skin Disorders in Ethiopian Children and Adolescents: An Analysis of Records from the Italian Dermatological Centre, Mekelle, Tigray, Ethiopia, 2005 to 2009

Abstract:  Skin disorders are an important problem in children living in developing countries, but only a few epidemiologic investigations on pediatric dermatoses are available in the literature. Our study is an analysis of the range and frequency of skin diseases presenting to the Italian Dermatological Center in a pediatric Ethiopian population. A retrospective analysis was performed on 17,967 medical records of children aged 0 to 18 years attending the Italian Dermatological Centre in Mekele (Ethiopia) from January 2005 to December 2009. Infections and infestations accounted for 47% of the disorders seen; fungal infections were the most common (44.1%), followed by bacterial and parasitic diseases. Dermatitis constituted the second most common diagnostic category (24.7%) of the disorders seen, and contact dermatitis was the most common diagnosis (48.8%). Pigmentary disorders and disorders of skin appendages were more common in girls, whereas fungal and parasitic infections were more common in boys. Bacterial and parasitic infections were more common in children younger than 1 year old, fungal infections in those aged 1 to 5.9, and disorders of skin appendages and pigmentary disorders in those aged 15 to 18. These findings demonstrate that most of the disorders seen could be easily managed in clinical practice with appropriate skill development. It is crucial to ensure that training of medical students and pediatricians focuses on accurate recognition, diagnosis, and management of these common skin diseases and that families, teachers, health workers, and nurses be educated about the most common signs of prevalent skin diseases to help facilitate appropriate care.

Skin diseases highlighting essential global public health priorities.

Which are the essential global public health activities that should be carried out in order to attain the largest impact on poverty reduction and health improvement in the world? Since its foundation in 2001 the Human Mobile Population Committee (HMPC) has continued to devote its efforts to finding answers to this question, with a particular focus on the skin diseases of the Human Mobile Population (HMP) and other groups of disadvantaged people.

Autochthonous Creeping Eruption in an Italian Child

The international medical literature is more and more frequently reporting cases of so-called tropical diseases in Western regions amongst persons who have not come from other countries and who have never traveled abroad.[1-5] One of the most frequent cases is that of creeping eruption[6] caused by the larvae of nematodes that do not have humans as their normal and final host, such as Ancylostoma brasiliensis, A. caninum, Gnathostoma spinigerium, Uncinata stenocephala, and Bunostomum phlebotomum.[7,8] Occasionally, human ancylostomes (A. duodenale and Necator ameriFig. 2. Complete cure after treatment with albendazole. canus), in the course of their penetration through the skin, may also give rise to a similar syndrome of short duration. skin condition had continued to progress. Various blood tests and This condition usually arises from contact with soil contaminaexamination of the feces for parasites did not reveal any abnormalted by animal feces. The larvae penetrate the skin through the hair ity. It was not possible to perform a skin biopsy because the follicles and the eccrine glands but remain in the cutaneous tissue parents’ consent for this was not obtained. where they eventually die, being unable to complete the cycle of On the basis of the characteristic clinical aspect of the skin development as in their normal hosts. This disease therefore eruption, and in view of the normal results of laboratory tests, a affects areas of the body that are normally more exposed, such as diagnosis of creeping eruption was made. The differential diagthe plantar regions and the fingers, and much less frequently other areas.[8] nosis of larva currens or strongyloidiasis (Strongyloides stercoralis), which also shows an elective tropism for the perianal area, was A 3-year-old boy of Italian nationality in a good general state of excluded because of the negative results of parasitologic examinahealth came to our attention soon after spending a few days at the tion of the feces and the absence of eosinophilia and gastrointesticoast near Rome. He had rapidly developed, in the course of 1 nal symptoms such as abdominal pain and diarrhea. week, linear erythemato-edematous serpiginous lesions that were intensely itchy, localized to his buttocks and the perianal region, The patient was treated with a single oral 400-mg dose of radially disposed around the anal orifice, and partly impetiginized albendazole (in 4% suspension), which resulted in complete reso(figure 1). History-taking did not reveal any period of holiday or lution of all cutaneous signs and symptoms (figure 2) within 15 stay anywhere abroad. The child had already been given topical days. On subsequent follow-up examinations after 30 and 45 days, corticosteroid treatment at a non-specialist medical center, but the no relapse was noted.

Juxta-clavicular beaded lines

We present a case series of 63 patients diagnosed with juxta‐clavicular beaded lines. This condition is more frequent in dark‐skinned people and corresponds to an anatomical variant of simple sebaceous hyperplasia. In view of the strong reactivity of the melanocytes in dark‐skinned people, and of the possible hypochromic results, no treatment is advised.

Female Genital Mutilation and Risk for Transmission of STIs

Female genital mutilation (FGM) is a traditional cultural practice, but also a form of violence against girls, which affects their lives as adult women. FGM comprises a wide range of procedures: the excision of the prepuce; the partial or total excision of the clitoris (clitoridectomy) and labia; or the stitching and narrowing of the vaginal orifice (infibulation). The number of girls and women who have been subjected to FGM is estimated at around 137 million worldwide and 3 million girls per year are considered at risk. Most of the females who have undergone mutilation live in 28 African countries.

Clinical features of acne vulgaris in 444 patients with ethnic skin

Dear Editor, The demographics of Europe reflect a constantly changing mixture of people of various ethnic groups, in particular Italy represents one of the European countries with high numbers of migrant people. This phenomenon has had a significant impact on the practice of medicine, mainly dermatology. The observation of people with ethnic skin in our outpatients’ department is increasing daily. Acne vulgaris is the most frequent dermatosis encountered in the general population and in ethnic groups. Acne represents the most common motivation leading patients to the dermatologist in the black population in the USA, accounting for 28% of the dermatoses seen in black individuals. This percentage reaches 14% and 30% in the UK and France, respectively. Acne vulgaris is also the most common dermatological disease in the Latino population and the second most common dermatological disease in Asiatic individuals. In recent years, the published work has begun to acknowledge ethnicity, and patients’ skin color has been considered a key factor in acne management. We have observed 444 cases of acne vulgaris among patients with ethnic skin between 1 January 2005 and 31 December 2008. We classified patients according to the area of origin and the Fitzpatrick skin phototype, because we consider the classification on the basis of race to be out-of-date. In addition, this classification allows us to identify patients coming from the same geographic area, but that can have different skin colors. For example, people coming from North Africa have a lighter skin color compared to those coming from sub-Saharan Africa. In fact, skin color is determined by the amount and type of melanin, and variation in skin color is largely due to genetics. As a general

Skin cancer risk assessment in dark skinned immigrants: the role of social determinants and ethnicity

ABSTRACT Objectives: Dark-skinned people have a lower incidence rate of skin cancer, in particular melanoma, which is detected at more advanced stages leading to poorer prognoses and long-term outcomes compared to whites. The gap in survival is due to some difficulty in melanoma detection, lack of attention from doctors and awareness by patients. This study aims to assess skin cancer risk awareness in dark-skinned immigrants and to determine the influence of socioeconomic factors and ethnic origin on behaviors. Design: This is a cross-sectional health facility based study carried out in a 12-month period. A semi-structured questionnaire to assess skin cancer risk awareness and a dermatological examination was offered to dark-skinned immigrants consecutively attending the dermatology department of the National Institute for Health, Migration and Poverty in Rome. Results: 147 dark-skinned immigrants were enrolled, of which 54.4% were males, coming from Africa (53.1%). They were mainly young, aged 18–34 (56.5%). The level of education and length of stay in Italy was significantly related to the awareness about skin cancer: people with a high educational level (OR: 8.1 95% CI: 3.2–23.4) or immigrated more than 4 years before the interview (OR: 2.1 95% CI: 1.0–4.4) have a greater knowledge about skin cancer. Conclusions: Education level is the strongest predictive factor of skin cancer awareness, whereas cultural behaviours and personal experience of sunburns are the main factors determining sunlight avoidance. Health promotion programs targeting immigrants must consider cultural differences related to ethnicity and country of origin, and adopt a transcultural approach.