O. Faye

Prevalence and factors associated with hidradenitis suppurativa: Results from two case-control studies

BACKGROUND Conflicting opinions have been reported regarding the epidemiology of hidradenitis suppurativa. OBJECTIVE We sought to evaluate the prevalence of hidradenitis suppurativa and to identify associated factors. METHODOLOGY Prevalence was evaluated using a representative sample of the French population (n=10,000). Associated risk factors were assessed using two case-control studies, one population-based with 67 self-reported patients and 200 control subjects, and the other clinic-based with 302 medically assessed patients and 906 control subjects. RESULTS The prevalence was 1% of the French population. Multivariate analyses showed a strong association with current smoking in self-reported (odds ratio=4.16, 95% confidence interval [2.99-8.69]) and in medically assessed (odds ratio=12.55 [8.58-18.38]) populations. Association with body mass index was significant in medically assessed patients (odds ratio=1.12 [1.08-1.15]) for each increase of 1 U of BMI. LIMITATIONS A causal relationship could not be established with such a cross-sectional study. CONCLUSION Hidradenitis suppurativa is a common disease, frequently associated with smoking and being overweight.

Combination Therapy with Clindamycin and Rifampicin for Hidradenitis Suppurativa: A Series of 116 Consecutive Patients

Background: Antibiotics are frequently used to treat hidradenitis suppurativa (HS); however, few data on their efficacy are available. Objective: To evaluate the efficacy of a combination of systemic clindamycin (300 mg twice daily) and rifampicin (600 mg daily) in the treatment of patients with severe HS. Methods: Patients (n = 116) who received this combination were studied retrospectively. The main outcome measure was the severity of the disease, assessed by the Sartorius score, before and after 10 weeks of treatment. Results: The Sartorius score dramatically improved at the end of treatment (median = 29, interquartile range = 14.5, vs. median = 14.5, interquartile range = 11; p < 0.001), as did other parameters of severity as well as the quality of life score. Eight patients (6.9%) stopped the treatment because of side effects. Conclusion: The combination of clindamycin and rifampicin is effective in the treatment of severe HS.

Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity

BACKGROUND Factors associated with the severity of hidradenitis suppurativa (HS) are not known. OBJECTIVE We sought to identify factors associated with the severity of HS. METHODOLOGY The severity of disease in a series of 302 consecutive patients with HS was assessed using the Sartorius score. RESULTS Atypical locations were more common in men than in women (47.1% vs 14.8%; P < .001). Men also had more severe disease (median Sartorius score: 20.5 vs 16.5; P = .02). Increased body mass index (P < .001), atypical locations (P = .002), a personal history of severe acne (P = .04), and absence of a family history of HS (P = .06) were associated with an increased Sartorius score. The Sartorius score was highly correlated with the intensity and duration of pain and suppuration (all P values < .001). LIMITATIONS The referral center base of the study may have biased recruitment. CONCLUSION Our data showed a significant association between the severity of HS and several clinical and behavioral factors. Prospective studies are needed to confirm the prognostic role of these factors.

Skin diseases in Bamako (Mali)

Background Skin diseases have only recently been considered as a possible public health problem in developing countries. Data supporting this matter are scarce. The aim of this study is to report the experience of a specialized dermatologic center in Bamako (Mali) in order to complete two previous studies conducted in the Bamako area: a prevalence study in the general population and a study in nonspecialized health centers of Bamako. It is our intention to provide a comprehensive picture of the problem of skin diseases in an African developing country.

Lymphœdème compliquant une hidradénite suppurée : trois observations

Resume Introduction Nous rapportons les observations de deux femmes et un homme âges de 36 a 52 ans souffrant d’hidradenite suppuree depuis de nombreuses annees, compliquee d’un lymphœdeme sus-pubien. Observations L’aspect clinique etait celui d’une tumefaction en ballon de rugby, retombant en besace sur les organes genitaux dans un cas, a consistance ferme voire dure. Il n’y avait pas d’atteinte ganglionnaire ou de blocage des voies lymphatiques abdominales. Une exerese chirurgicale large des lesions suivie secondairement de greffe a entraine la guerison chez un malade. L’examen de la piece operatoire revelait des lymphangiectasies et de la fibrose. Discussion La survenue de lymphœdeme est due au blocage et/ou a la destruction des voies lymphatiques secondaire a l’inflammation et a la suppuration chronique. Une fois la maladie presente, aucun traitement medical n’est efficace.

Side effects of depigmenting products in Bamako, Mali

There can be no doubt that, generally speaking, having beautiful, radiant skin is by no means a matter of minor concern for women in Mali, as for those in other countries. They therefore use all available means to enhance their skin: foundation, other types of make-up and, increasingly, skin-bleaching products. The use of skin-bleaching products has become a fashionable practice in recent years in our African villages, involving mainly women but sometimes both sexes. Termed “caco” in Mali and “xeesal” in Senegal, the users of these products have been increasing in number: prevalences of 25% in Bamako 1 and 59% in Togo 2 have been reported. The financial impact of the practice is by no means negligible, and cutaneous complications are very frequent. 3 However, the risk of any specific complication occurring is not the same for all the complications which are likely to occur. Risks vary from one individual to another and are also connected with the type of product used. The aim of this study was to quantify the risk of cutaneous complications occurring in connection with the cosmetic use of skin-bleaching products.

Oral amoxicillin vs. oral erythromycin in the treatment of pyoderma in Bamako, Mali: an open randomized trial.

Background  Pyoderma (bacterial superficial skin infection) is an extremely common disorder in tropical developing countries. In these settings, Streptococcus pyogenes is considered to be the main etiological agent. Apart from epidemics of poststreptococcal glomerulonephritis where mass treatment with intramuscular benzathine‐penicillin is recommended, no recommendation exists for the treatment of pyoderma in this setting. The aim of this study was to evaluate the efficacy of oral amoxicillin in the treatment of pyoderma in Mali, by comparison with oral erythromycin.

Hair Care and Hair Styles in Women in Bamako, Mali

In contrast to Caucasian hair, which is fine and silky, black African hair has a dry and frizzy consistency. In both sexes, the natural hairstyle formed by the hair is used in various contexts as a means of self-expression, in particular to express female beauty. 1 Dry and frizzy hair does not easily lend itself to different methods of hair styling. Nevertheless, our hair salons produce hair styles that are impressive in aesthetic terms but which are poorly documented. 2 Hair care may also be sought for scalp problems such as pruritus, dandruff and alopecia. The types of hair care and styles available, as well as the side effects of the techniques employed, are poorly understood in Bamako. The aim of this study was to acquire a better understanding of the hair care and hair styling carried out in salons and hairdressing centers, as well as the side effects of these procedures observed in women in Bamako.

Prevalence of Cutaneous Leishmaniasis in Districts of High and Low Endemicity in Mali.

Historically the western sahelian dry regions of Mali are known to be highly endemic for cutaneous leishmaniasis (CL) caused by Leishmania major, while cases are rarely reported from the Southern savanna forest of the country. Here, we report baseline prevalence of CL infection in 3 ecologically distinct districts of Mali (dry sahelian, north savanna and southern savanna forest areas). We screened 195 to 250 subjects from 50 to 60 randomly selected households in each of the 6 villages (four from the western sahelian district of Diema in Kayes region, one from the central district of Kolokani and one from the southern savanna district of Kolodieba, region of Sikasso). The screening consisted of: 1] A Leishmanin Skin Test (LST) for detection of exposure to Leishmania parasites; 2] clinical examination of suspected lesions, followed by validation with PCR and 3] finger prick blood sample to determine antibody levels to sand fly saliva. LST positivity was higher in the western district of Diema (49.9%) than in Kolokani (24.9%) and was much lower in Kolondieba (2.6%). LST positivity increased with age rising from 13.8% to 88% in Diema for age groups 2–5 years and 41–65 years, respectively. All eight PCR-confirmed L. major CL cases were diagnosed in subjects below 18 years of age and all were residents of the district of Diema. Exposure to sand fly bites, measured by anti-saliva antibody titers, was comparable in individuals living in all three districts. However, antibody titers were significantly higher in LST positive individuals (P<0.0001). In conclusion, CL transmission remains active in the western region of Mali where lesions were mainly prevalent among children under 18 years old. LST positivity correlated to higher levels of antibodies to sand fly salivary proteins, suggesting their potential as a risk marker for CL acquisition in Mali.

A cross-sectional study of the filarial and Leishmania co-endemicity in two ecologically distinct settings in Mali

BackgroundFilariasis and leishmaniasis are two neglected tropical diseases in Mali. Due to distribution and associated clinical features, both diseases are of concern to public health. The goal of this study was to determine the prevalence of co-infection with filarial (Wuchereria bancrofti and Mansonella perstans) and Leishmania major parasites in two ecologically distinct areas of Mali, the Kolokani district (villages of Tieneguebougou and Bougoudiana) in North Sudan Savanna area, and the district of Kolondieba (village of Boundioba) in the South Sudan Savanna area.MethodsThe prevalence of co-infection (filarial and Leishmania) was measured based on (i) Mansonella perstans microfilaremia count and/or filariasis immunochromatographic test (ICT) for Wuchereria bancrofti-specific circulating antigen, and (ii) the prevalence of delayed type hypersensitivity (DTH) responses to Leishmania measured by leishmanin skin test (LST).ResultsIn this study, a total of 930 volunteers between the age of 18 and 65 were included from the two endemic areas of Kolokani and Kolondieba. In general, in both areas, filarial infection was more prevalent than Leishmania infection with an overall prevalence of 15.27% (142/930) including 8.7% (81/930) for Mansonella perstans and 8% (74/930) for Wuchereria bancrofti-specific circulating antigen. The prevalence of Leishmania major infection was 7.7% (72/930) and was significantly higher in Tieneguebougou and Bougoudiana (15.05%; 64/425) than in Boundioba (2.04%; 8/505) (χ2 = 58.66, P < 0.0001). Among the filarial infected population, nearly 10% (14/142) were also positive for Leishmania with an overall prevalence of co-infection of 1.50% (14/930) varying from 2.82% (12/425) in Tieneguebougou and Bougoudiana to 0.39% (2/505) in Boundioba (P = 0.0048).ConclusionThis study established the existence of co-endemicity of filarial and Leishmania infections in specific regions of Mali. Since both filarial and Leishmania infections are vector-borne with mosquitoes and sand flies as respective vectors, an integrated vector control approach should be considered in co-endemic areas. The effect of potential interaction between filarial and Leishmania parasites on the disease outcomes may be further studied.