P. Niamba

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.

Stevens–Johnson syndrome and toxic epidermal necrolysis in sub‐Saharan Africa: a multicentric study in four countries

The purpose of this study was to document the clinical profile, etiologies, and outcomes of Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in hospitals in four sub‐Saharan African countries.

Low prevalence of detectable HIV plasma viremia in patients treated with antiretroviral therapy in Burkina Faso and Mali.

Background:Sub-Saharan Africa has seen dramatic increases in the numbers of people treated with antiretroviral therapy (ART). Although standard ART regimens are now universally applied, viral load measurement is not currently part of standard monitoring protocols in sub-Saharan Africa. Methods:We describe the prevalence of inadequate virological response (IVR) to ART (viral load ≥ 500 copies/mL) and identify factors associated with this outcome in 606 HIV-positive patients treated for at least 6 months. Recruitment took place in 7 hospitals and community-based sites in Bamako and Ouagadougou, and information was collected using medical charts and interviews. Results:The overall prevalence of IVR in treatment-naive patients was 12.3% and 24.4% for pretreated patients. There were no differences in rates of IVR according to ART delivery sites and time on treatment. Patients living farther away [odds ratio (OR) = 2.48; 95% confidence interval (CI) 1.40 to 4.39], those on protease inhibitor or nucleoside reverse transcriptase inhibitor regimens (OR = 3.23; 95% CI 1.79 to 5.82) and those reporting treatment interruptions (OR = 2.36; 95% CI 1.35 to 4.15), had increased odds of IVR. Immune suppression (OR = 3.32, 95% CI 1.94 to 5.70) and poor self-rated health (OR = 2.00; 95% CI 1.17 to 3.41) were also associated with IVR. Conclusions:Sufficient expertise and dedication exist in public hospital and community-based programs to achieve rates of treatment success comparable to better-resourced settings.

Diffuse cutaneous leishmaniasis in an HIV-positive patient in western Africa

A 36‐year‐old HIV1‐positive woman presented with a 6‐month history of a progressive papular and nodular eruption of the face and subsequent extensive spread to the rest of the skin. The diagnosis of diffuse cutaneous leishmaniasis was established by direct examination and skin biopsy. This atypical form had a dramatic improvement after a 21‐day treatment with meglumine antimoniate. This clinical form may be confused with other endemic diseases in western Africa, especially leprosy.

Use of cutaneous depigmenting products by women in two towns in Burkina Faso: epidemiologic data, motivations, products and side effects

The use by women of cosmetic products to modify skin color in order to “improve” their appearance and to increase their powers of seduction probably dates from the dawn of time. The products used have varied through time and from place to place, and often according to current ideas of beauty. Black women have been using depigmenting cosmetic products for over a quarter of a century. 1 Their use of these products is clearly increasing worldwide. 1–4 In Burkina Faso, data on this practice exist for the town of Ouagadougou, but no study has previously been carried out in Bobo-Dioulasso, the second city of the country. In this town the practice seems more prevalent. 1,2 The purpose of this study was to evaluate and re-evaluate the situations in Bobo-Dioulasso and Ouagadougou, respectively, and specifically to determine the current prevalence of this practice, to identify the products used, to investigate the motivations of the women using the products, and finally to describe dermatologic complications.

Inadequate adherence to antiretroviral treatment and prevention in hospital and community sites in Burkina Faso and Mali: a study by the ATARAO group

Our objective was to determine the prevalence and identify the factors that influence antiretroviral therapy (ART) adherence among patients in Bamako and Ouagadougou. A cross-sectional study was conducted among 94 men and 176 women receiving ART. Data were collected through questionnaires and chart reviews. Logistic regressions were performed to isolate determinants of adherence. Overall, 58% of the patients were adherent, but there were differences in the levels of adherence according to country and treatment site. Sociodemographic factors were not associated with adherence. However, social characteristics such as having children, in Ouagadougou, or being a housewife and not planning to have a child in the next year, in Bamako were associated with adherence. Time on ART was negatively associated with adherence in both countries with decline occurring later in Bamako. Levels of adherence are inadequate particularly among more experienced patients. Further adherence research and monitoring using longitudinal designs are warranted to assess the extent to which adherence is declining with time on treatment.

Leishmaniose cutanée à Leishmania major avec atteinte de la moelle osseuse chez un malade infecté par le VIH au Burkina Faso

BACKGROUND Leishmaniasis covers three well-individualized clinical variants, each due to individual species found in different geographic areas. Herein we report the first case of cutaneous leishmaniasis due to Leishmania major involving bone marrow in an AIDS patient in Burkina Faso. CASE REPORT A 38-year-old HIV-positive man presented with generalized, copper-coloured, painless, infiltrated, itching, papulonodular lesions present over the previous 10 months. Skin biopsy confirmed the diagnosis of diffuse cutaneous leishmaniasis. The bone-marrow smear showed numerous leishmania. The culture was positive and L. major was identified. The patient was being treated with antiretroviral medication and a pentavalent antimonial compound. The disease progression consisted of attacks and remissions separated by an average of three weeks. DISCUSSION L. major is the Leishmania species identified in Burkina Faso. It is responsible for typical cutaneous leishmaniasis but particular clinical forms have been described in immunodeficient patients, especially with diffuse cutaneous involvement. The spread of L. major infection to bone marrow could represent a public health problem in our country, where the HIV epidemic is still not under control, and particular vigilance is thus called for.

Disseminated histoplasmosis caused by Histoplasma capsulatum var. duboisii in a non-HIV patient in Burkina Faso: Case report

Histoplasmosis is a fungal infection due to Histoplasma capsulatum. The African form of this mycosis, caused by Histoplasma capsulatum var. duboisii, remains rare. We report a case of disseminated African histoplasmosis with skin, lymph nodes, bones and viscera localizations. The 22-year-old patient was HIV-seronegative and was considered immunocompetent. The presence of Histoplasma capsulatum var duboisii in ulcerations and a nodule pus aspiration was confirmed by direct microscopic examination and by culture. The medical treatment was based on fluconazole. Even though a regression of the symptoms was observed, the patient died. In disseminated African histoplasmosis, an early laboratory diagnosis must be carried out for accurate treatment.

Alopecia in consultations in the dermatology department at Burkina Faso: epidemiologic, clinical, and etiologic aspects

Background  Hair loss, or alopecia, in a man or woman can have major psychologic repercussions.

Management of congenital nevi at a dermatologic surgical paediatric outpatient clinic: consequences of an audit survey 1990-1997.

Background: Since 1987 we have run a Dermatologic Surgical Paediatric Outpatient Clinic (DSPOC) within the Children’s Hospital in Bordeaux. Objective: We analyse the consequences of an audit survey concerning the management of patients with congenital nevi (CN) seen at this clinic. Methods: We reviewed the cases of 192 children examined and photographed at the DSPOC during the period January 1990–December 1997. Patients were contacted for a reassessment of their status. The management options chosen at the DSPOC were reviewed as well as the satisfaction of the patients or parents of young children. Results: Of 192 children prerecruited, 56 girls and 52 boys could be included in the survey. They were mostly European whites and 67% were <6 months of age at the first DSPOC visit. 65/108 (61%) had been operated following the first DSPOC visit. The mean follow-up based on the 1997–1998 survey was 33 months (8 months to 10 years). The size of the nevus, independently of location, influenced decision for early surgery. Another important factor was the estimated disfigurement risk (15% of decisions) mostly related to CN of the face. There was a significant risk of pigmentary recurrence around the scar in children operated before the age of 2, but long-term follow-up indicated a spontaneously regressive course. Conclusions: Nevus recurrence in cases operated early suggests a time-dependent phenomenon in nevogenesis. Early counselling is important. Early surgery seems associated with a better scar quality. Explanations concerning risks and outcome are best given with the cooperation of a surgeon and a dermatologist.