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Background The pathogenesis of lichen planus (LP) is mostly autoimmune, while psychological and infectious factors are recognized to trigger or aggravate the disease. An association with diabetes is reported. Our objective was to determine the epidemio-clinical characteristics of LP and its associated factors. Methods This multicentric, prospective study was conducted over a 6-month period. The histopathology was only performed for atypical forms. Patients with a notion of drug intake before the rash were excluded. Anti-hepatitis C Virus (HCV) antibodies screening was systematical in case of mucosal damage. The data were analyzed using the SPSS IBM 20 software. Results The average age was 38 years. Women represented 84.6% (n = 66) of the studied population. The patients were married in 61.5%. Obesity or overweight status was noted in 41%. A marital or relational conflict was found in 25.6%. History of LP was reported in 24.4% (n = 19). Pruritus was found in 96.2%. The locations were as follows: skin (97.4%), mucous membranes (15.4%), and hair and nails (5.1%). Lesions were diffuse in 56.4%. The clinical forms were as follows: typical (52.6%), erythematosquamous (17%), warty (14.5%), pigmented (14.5%), and blaschkolinear (one case). Histopathology confirmed the diagnosis of LP in 91.4%. Blood sugar level was high in one case. Hepatitis B surface antigen (HBsAg) was positive in 3.03%. Anti-HIV and anti-HCV antibodies were negative. Conclusion Lichen planus is a relatively rare disease in sub-Saharan Africa and is seen more in adults. The clinical manifestations are polymorphic, but the mucosal damage is rarely isolated.

Introduction Au Sénégal, les études portant sur les tumeurs du cuir chevelu sont quasi inexistantes. Notre objectif était de déterminer le profil épidémiologique et anatomo-clinique des tumeurs du cuir chevelu en dermatologie. Méthodes Il s'agit d'une étude prospective, descriptive et analytique, réalisée sur une période de 16 mois (01 mars 2014 au 30 juin 2015), effectuée aux deux services de dermatologie de Dakar. La confirmation diagnostique était histopathologique. Résultats Nous avions colligé 36 patients dont 14 cas de tumeurs malignes et 22 cas de tumeurs bénignes. Le sex ratio était de 1:1, et l'âge moyen de 51 ans pour les premières et 39 ans pour les dernières. La fréquence hospitalière était de 0,18%. Le délai moyen de consultation était de 14 mois pour les tumeurs malignes et 52 mois pour les formes bénignes. Dans 11 cas de tumeurs malignes, le traitement traditionnel était le premier recours. Les tumeurs malignes étaient: carcinome épidermoïde (n=8), carcinome basocellulaire (n=3), lymphome, hidradénocarcinome et dermatofibrosarcome de Darier Ferrand (un cas chacun). Les tumeurs bénignes étaient: botriomycome (n=5), kyste trichilemmal, hamartome sébacé, cylindrome et lipome (2 cas chacun), et chéloide, syringocystadénome papillifère, schwannome, neurofibrome et nævus (un cas chacun). La malignité de la tumeur était associée à l'aspect ulcéro-bourgeonnant (p=0.003), au diamètre >4cm (p=0.05), à la douleur (p=0.009) et au saignement (p=0.006). Conclusion Les tumeurs du cuir chevelu, sur peau noire, sont dominées par les formes bénignes. Le carcinome épidermoïde est la tumeur maligne prédominante.

Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.Les études africaines sur le neuro-Behçet (NB) sont majoritairement maghrébines, mais l'Afrique noire n'est pas en reste. L'objectif de l'étude était de décrire les particularités diagnostiques et thérapeutiques du NB dans une série sénégalaise colligée à Dakar. Il s'agit d'une étude rétrospective à visée descriptive menée à la clinique de neurologie du centre hospitalier universitaire de Fann de Dakar, au Sénégal. Tous les patients répondant aux critères diagnostiques de NB ont été inclus. Seize patients ont été colligés, 14 hommes et deux femmes avec un âge moyen de 40 ans [18–71]. Les principaux signes neurologiques étaient un déficit moteur (13 cas), des céphalées (10 cas) et un trouble du langage (4 cas). Les signes extraneurologiques étaient dermatologiques (14 cas), oculaires (2 cas) et articulaires (2 cas) à type de gonarthrite unilatérale aseptique. Une fièvre était présente chez neuf patients. L'atteinte neurologique était majoritairement parenchymateuse isolée (8 cas) ou mixte (6 cas). Les principales formes cliniques de NB étaient la rhombencéphalite (8 cas) et la névrite optique rétrobulbaire (4 cas). Sept patients avaient un angio-Behçet cérébral à type de thromboses veineuses cérébrales (3 cas), d'infarctus cérébraux (2 cas) et d'hématomes intracérébraux (2 cas). Sous prednisone (16 cas) et azathioprine (3 cas), l'évolution clinique à court terme était majoritairement favorable (14 cas) avec un score de Rankin modifié de 2 au moment de l'exeat. Le NB est une maladie de l'homme adulte sous-diagnostiquée en Afrique noire. Des études ultérieures multicentriques nationales et sous-régionales sont souhaitables.

Mycetoma remains endemic in the tropical and subtropical regions of the “mycetoma belt” including Senegal. It affects more commonly young men in the age group of 20 to 40 years. The foot represents the most commonly affected site. The most common extra-podal localizations are leg, knee, buttocks, hand and arm. We report an exceptional case of cervical fungal mycetoma that occurred in a 13-year-old Senegalese child. He consulted for a cervico-submandibular tumefaction with multiple sinuses and black grains discharge evolving since 6 years, associated to laryngeal dyspnoea. Mycological examination with culture isolated Madurella mycetomatis. Cervical CT Scan showed bone and soft tissue invasion. Terbinafine alone was administered. During the evolution, tracheotomy was performed following the aggravation of the laryngeal disorders. Death from severe sepsis occurred after 8 months of evolution. The particularities of our case are the occurrence of fungal mycetoma in a child, the cervical localization and the difficulties of therapeutic management largely due to the diagnostic delay.

to assess : the frequency of emergencies among patients admitted to dermatology departments in Dakar, their most common causes, mortality rate, and the most frequent dermatoses. This one-year prospective study took place in the two reference departments for the treatment of dermatological diseases in Dakar. We have included all patients with a dermatological emergency, regardless of age and gender, as determined by the doctor receiving the patient. The data were entered in Excel and analyzed with R software, version 3.1.2. the study included 189 patients, 40 % of all dermatology department admissions. The sex ratio was 0.89 (M/F) and the average age 49 years. The mean time from arrival to treatment was 30 minutes. Absolute emergencies accounted for 45.4 % of these emergencies, and relative emergencies 54.6 %. Absolute emergencies were dominated by severe drug eruptions (17 %) and relative emergencies by infectious dermatoses (38 %). Emergency measures were carried out in all cases, associated with etiological treatment. The mortality rate was 7 % (n=14), and 5 (36 %) of these deaths were due to severe drug eruptions. Infectious dermatoses and severe drug eruptions are the most frequent emergencies. The high mortality rate, related mostly to drug eruptions, indicates the need for early management and an adequate technical platform.

To determine the epidemiological and etiological profile of tinea capitis in adults in Dakar (Senegal).A 9-month prospective, multicenter, descriptive and analytic study. Patients included were aged over 18 years. Mycological tests were used to confirm the diagnosis.121 patients were included with a mean age of 36.1 years and a hospitalisation frequency of 0.8%. The age range of 64.4% of patients was between19 and 38 years. 51% of patients were housewives. A low socioeconomic level was found in 72.8% of cases. In 3.3% of patients, the disease began in childhood. 31.4% of patients had already consulted a traditional healer. Similar familial cases were noted in 60.3% of patients. Contact with a sheep was noted in 32.2% of cases, deliberate skin lightening in 64% of women, hair salon attendance in 46.7% of women, and immunosuppression in 17.3% of patients, while itching was present in 95.5%. Dermatologic examination showed scaled plaques and a diffuse form, with 92.6% and 64% (n=75) respectively. Wood's light examination was positive in 40.2% of patients. A positive culture test was found in 71%. The most frequently encountered species were: T. soudanense (65%), M. audouinii (21%), T. rubrum (4.7%), M. gypseum (3.5%), T. violaceum (2.3%), T. verrucosum (2.3%) and M. canis (1 case). The clinical course was favorable under treatment with griseofulvin or terbinafine.Tinea capitis in adults mainly affects young women. The diffuse form is the most common. The most frequently encountered species was T. soudanense.

Lupus vulgaris is a common presentation of cutaneous tuberculosis (TB), but its ulcerative or vegetating form also called vorax is rare.We report a case of lupus vulgaris in its vorax form, which occurred in a patient with discoid lupus erythematous. A 42-year-old patient monitored for chronic lupus erythematosus consulted again for a facial tumor and fever. Physical examination revealed painful ulcerative and crusted lesions on an old discoid lupus lesion and covered the entire upper lip. Similar lesions were noted on cheeks. Moreover, there were cervical lymphadenopathy, a bilateral pulmonary condensation syndrome, and dysphonia. Cutaneous histopathology had revealed a tuberculoid granuloma without caseating, and nucleic acid amplification tests (GeneXpert®) performed on sputum were positive. Thus, the diagnosis of multifocal TB with skin involvement of vorax type was confirmed. The outcome was favorable following TB treatment. Our observation is distinctive as it is a granulomatosis and ulcerative form of lupus vulgaris, which occurred on a discoid lupus erythematous lesion. This is a rare form of lupus vulgaris. This scarcity can be explained by diagnostic difficulties as there are numerous differential diagnoses and histopathology is not often helpful.

The etiologies of intertrigo in adults are numerous and different. The objective of our work was to study the epidemiological, clinical and the risk factors of intertrigo in adults.We conducted a prospective study for a period of seven months in two Dermatology Units in Dakar (Senegal). All adults patient with intertrigo seen during this period who gave consent were included.One hundred and three patients with intertrigo were diagnosed with a hospital prevalence of 2.54%. The sex -ratio was 0.63 and the average age was 41. The study of habits and lifestyles of the patients found a history of intensive skin lightening, sport, wearing synthetic clothes and smoking in 26, 22, 20 and 22 cases, respectively. Infectious complications mainly bacterial (3.88%) and viral (1.94%) were reported in nine cases (8.7%). A dry erythroderma was noted in 3 cases (2.9%). It was found that the intertigo was commonly caused by fungal infections with a prevalence of 48.5% followed by immuno-allergic reactions with a prevalence of 34.9%, suppurative hidradenitis and inverse psoriasis with the same prevalence of 2.9%. Fifty-eight percent of cases with tinea and 63% of cases with candidiasis were women. Thirty-five percent of tinea cases and 45% of candidiasis cases were found to have a history of intensive skin lightening.The cause of intertrigo in adults are mainly infectious, particularly fungi, infections and immuno-allergic diseases. There are predisposing factors and some professions are more at risk.

The authors report a case of multifocal African histoplasmosis with polymorphic skin involvement occuring in a patient without proven immunosuppression. He was a young 22-year-old patient from eastern Senegal - but born in Ouganda - who presented with polymorphic skin lesions: ombilicated papulo-nodules, gums and ulcerative and budding lesions. He showed lymphadenopathies without clinical inflammation and with a cheesy appearance of the biopsy but without tuberculosis and also hepatosplenic and bone involvement. Mycological samples of the skin and lymph nodes biopsies revealed yeasts of Histoplasma capsulatum var. duboisii with a positive culture on Sabouraud medium. HIV serology, HTLV1et 2, the serum proteins electrophoresis were unremarkable. Treatment with amphotericin B was irregular because of its inaccessibility in the national territory and its cost. The patient died of sepsis together with the aggravation of his disease.

In Senegal, reported cases of cutaneous leishmaniasis are often due to Leishmania major. Immunosuppression related to HIV infection contributes to the emergence of leishmaniasis in humans and to cutaneous localization of viscerotropic species. We report the first observed case in Senegal of opportunistic cutaneous leishmaniasis due to Leishmania infantum associated with HIV.A 5-year-old boy presented crusted ulcerative lesions of the scalp and left forearm, together with axillary and cervical lymphadenopathy present for two months. Direct parasitological examination of the scalp and arm lesions, coupled with liquid aspiration of lymph nodes and bone marrow, enabled identification of amastigote forms of Leishmania. Polymerase chain reaction performed on skin, lymph node and bone marrow biopsy samples allowed identification of L. infantum. The child was positive for HIV1. Treatment of HIV infection and leishmaniasis resulted in clinical improvement.Co-infection with cutaneous leishmaniasis due to L. infantum and HIV is a complex combination in terms of the related therapeutic issues. The clinical and laboratory outcomes depend on restoration of immunity and on the efficacy, safety and availability of anti-leishmaniasis drugs.

Epilepsy is a public health problem in Senegal and Africa because of its severity and its social importance. It occurs at any age sparing no sex. It can influence sexual life and reciprocally. Our aims were to study the effects of antiepileptic drugs on the sexual lives of women with epilepsy, the influence of these drugs on pregnancy and breastfeeding.We conducted a prospective study from 1st March to 31st August 2011 in the neurological department of the Fann-Dakar teaching hospital Senegal. Only women with epilepsy were included.We collected 120 patients aged 16-64years with a mean age of 30.58years, 45% married, 44.16% were uneducated preponderant. All patients were taking antiepileptic drugs, 89.16% was alone. Fifty-five percent of our patients had epilepsy for at least 6years; 45.83% had generalized epilepsy; 44.17% of partial seizures. In our cohort, 64.16% were under phenobarbital, 69.16% had good adherence. As side effects of drugs, 90% had sexual problems. Seventy-five percent enjoyed an active sex life. A decrease in the number of sex per week for the disease [31/55=56.66%] was noted. In addition, 51.17% were using contraception, including 38.7% of oral kind and 64.86% had noticed an increase in seizure frequency during their pregnancies. Of the 74 women who had contracted a pregnancy, 41.89% had premature infants, 16.21% have made abortions and 61.17% had psychosocial life affected.People with epilepsy often experience sexual problems that may be caused by epilepsy, antiepileptic and/or reactions of the partner and the other facing the diagnosis of epilepsy.

Congenital hypomagnesemia is a rare disease, with an impact on cognitive and neurological development. We report on three familial cases of congenital hypomagnesemia, two boys and one girl who belong to the same consanguineous family. They all presented neonatal seizures and a psychomotor developmental delay. Cerebral computed tomography showed cerebral atrophy and calcifications in one case and magnetic resonance imaging found predominant cerebellar atrophy in the two other cases. All three patients also had hypocalcemia, hyperphosphoremia, and hypomagnesemia. The parathyroid hormone blood level was low in two cases and normal in the third. One 7-month old patient died. The others received a supplementation of calcium and magnesium, which normalized calcemia, phosphatemia but not magnesemia, which remained low despite high doses. They have both developed cognitive and behavioral impairments.

Cryptococcal meningitis is much less common in children than adults. The purpose of this report is to describe 3 cases of cryptococcal meningitis observed in children admitted to the Neurology Department of the Fann University Hospital Center in Dakar, Senegal between July 2003 and November 2008. There were 2 girls whose ages were 8 and 15 years and one 9-year-old boy. All 3 patients presented acute or chronic meningoencephalitis. Diagnosis was based on direct microscopic examination of India ink preparations of cerebrospinal fluid (CSF) showing Cryptococcus neoformans at direct exam. Two patients were immunocompromised including one presenting severe protein-caloric malnutrition and one infected by HIV-1. The third patient was immunocompetent. All 3 patients were treated by intravenous Fluconazole. The immunocompetent boy died after 1 month of hospitalization due to cardiovascular and respiratory insufficiency. Both girls survived with severe neurosensory sequels. Cryptococcal meningitis that is relatively frequent in adulthood may be underestimated in children and should be tested for in any children presenting meningoencephalitis of undetermined cause.

Senegal, like many African countries is facing the so-called demographic and epidemiological transition leading to the development of neurological diseases. These diseases dominated by stroke and status epilepticus are public health priorities with a high prevalence, high lethality and high cost of care. These diseases are managed at the department of neurology, Fann Teaching Hospital, Dakar-Senegal (the only one) with a 65 beds capacity. Unfortunately, access care to the clinic is lately associated with human and material resource scarcity. To improve the management of patients at the clinic, it is important to increase resources (human and material), sensitize the population on early access to health services and prevention of risk factors.

A central nervous system infection due to Morganella morganii is uncommon. We report a case diagnosed at the neurological department of Fann teaching hospital in Dakar, Senegal. A 12-year-old boy was hospitalized for acute meningoencephalitis. The CT scan was normal and the study of cerebrospinal fluid (CSF) revealed cytological and biochemical abnormalities and M. morganii. HIV and syphilitic serologies were negative and blood CD4 lymphocyte count showed 354 per mm(3). The treatment with cefotaxime associated with gentamicin for 6 weeks was successful. The outcome of infection depends on many factors such as the onset and quality of treatment, the virulence of the germ and the status of immune system.

Describe the epidemiology of stroke among patients hospitalized at the Clinic of Neurology , Fann University, Dakar-Senegal.Retrospectively, sociodemographic, medical history and clinical data were collected for patients hospitalized for stroke from January 1st 2001 to November 1st 2003 and to whom a Computed Tomography scan of the brain was done.The population of study (314 patients) had a mean age of 61.3 years (+/-13.8) and was composed of 56.1% of women. The mean time of admission was 8.4 days (+/-23.5). The leading risk factors of stroke were hypertension, history of stroke and diabetes. Ischemic stroke represented 60.2%. The occurrence of stroke was associated with coma and hypertension. The letality rate was 24.8%.It is necessary to develop and implement health education program against risk factors for the population to reduce stroke morbidity and mortality.

The fast of Ramadan submits body to transient metabolic modifications; and decrease of glycaemia can be one of results. Physical exercise modifies rate of plasmatic hormones responsible for its regulation. The purpose of this study is to appreciate the influence of the fast on this biologic parameter in sportsmen and sedentaries. Thirty (30) healthy subjects (15 sportsmen of stamina and 15 sedentaries), with 25 years of average age were recruited. They have all a comparable diet. We excluded subjects having practised a physical exercise the day of the test. Capillary glycaemia was measured after weighed and physical exam, in 2 periods: in second Ramadan's fortnight, 15 minutes before food intake, two (2) months after Ramadan at least 4 hours at distance of the last meal. Comparisons were remitted in the test of Student, significant for p value lower than 0.05. During Ramadan, the glycaemia of the sportsmen at rest, is at one exception always superior or equal to that of the sedentaries. However, there is non significant difference as much during the fast as in normal food intake. Respective averages are 4.6 mmol/l, 0.15 and 4.5 mmol/l, 0.01 during Ramadan. They cross then in 4.8 mmol/l, 0.2 and 4.8 mmol/l, 0.4 in normal food intake. Landmark, the comparison of the averages from period to the other one in every group shows a significant difference only for the sedentaries. The return to normal food intake was expressed by an important gain in weight for all subjects. The fast of Ramadan has no notorious influence on sportsman's glycaemia contrary to that of sedentary. In other words, the sportsman administers better his stocks of glucose. Previous works however strongly advised against sports practice during Ramadan and more particularly the competitions, because, exercises of strong intensity can induce dehydration.

In this case report, the authors studied the difficulties to set up the diagnosis of hysteria in the Briquet's Syndrome. The description presented here is about an eleven years old girl patient without any particular family background and who, after her tonsils have been out against her will, presented a hysteria in the form of Briquet's Syndrome. All the explorations showed no abnormalities. It is the questioning, and the analysis of facts from informations by the patient and her family which allowed to conclude the diagnosis of hysteria. She received a chemotherapy, associated with a psychotherapy and a family guidance. The course was favourable after two months. The authors compare these findings with some data of the literature and underline the diagnostic and therapeutic difficulties they faced. How physicians should approach such form of hysteria to set up the diagnosis is to proceed by elimination because the disease can simulate all sorts of medical or psychiatrical affections.

This study deals with some psycopathological features of naawtal. Naawtal is a Wolof word designating a social practice based on black magic that consists in ostracizing someone to prevent him from competing for a common goal or approaching a loved one. This traditional practice leads to involuntary migration from one place to another in the country. The survival of this practice in the socio-economic context of modern Senegal and indeed its extension to social classes not previously involved, reflects individual suffering, collective malaise, and ongoing social adjustments. Analysis of the practice of naawtal not only distinguishes motives, author, means of casting the spell (involving birds and wind), and the way to break the spell but also underlies the essential place of sexual identity with the notion of greater female vulnerability. To illustrate this article, the case of a woman persecuted by auditory hallucinations is analyzed in the light of the syndrome of mental and motor automatism characteristic of the diagnosis of chronic hallucinatory psychosis. The basic notion of internal exile and drifting contained in this traditional representation of mental illness is called on to explain the psychopathologic features. The authors emphasize the value of the reference to naawtal in the therapeutic relationship in helping to achieve acceptance of psychiatry in Africa.

The authors describe by turns their experience about indigenous medicine in Senegal, in New-Caledonia and in Nepal. They show that these indigenous medicines have common fundamental characteristics, although these various cultures are not linked together by their history. They compare these ways of thinking with occidental scientific medicine, and with the way of thinking of psychoanalysis.

Formerly known as a dreadful calamity for industrialized countries, drug abuse now seems to have spread all over the world. In Senegal, it has been very difficult to gather reliable statistics on its extensiveness. To better define the problem in Senegal, UNESCO has launched an epidemiological study on young people drug abuse and alcoholism in schools and elsewhere. The authors analyse the results of this study and draw the following conclusions: all types of drug use are linked to religious practice, drug use by young people is due to curiosity or their ignorance of drug drawbacks and their lack of education, school, family, religious education and social repression play an important role in the fight against drug use.

Where the government cannot meet wide-ranging health needs of the population and when people are given the opportunity to manage their own affairs and to be involved in decision-making, they can become very efficient. This was demonstrated by an experiment in a senegalese town (450 000 inh.) between 1975 and 1981. A strategy for priority health care with the active participation of the local community was developed to provide a network of acceptable and accessible health services. This was with government support. --The government provides the basic structure of its health services to which the community contributes. It provides the medical staff, technical guidance and logistic support and helps the community volunteers to develop sound accounting procedures. --The community contributes financial and human resources to improve the coverage of the health units. Based on a self-financing system controlled by a health committee per each health unit, communities are in decision making concerning the utilization and management of the community's resources. Procedures to control the community's financial contribution are especially well detailed in the paper. In view of this successful experiment, the minister of public health with the agreement of the government, has recommended that community participation in financing health care services be extended to all regions of the country.

This study emphasizes the role of the socio-cultural status and consequently of psychologic factors in sexual impotence of the black African in Senegal: --role of age, related to the perception of a dual status; --role of the ethnic group giving or not preeminence to sex; --rank in the brotherhood which may raise a conflict with ancestor; --matrimonial situation having significance of an acceptance of the cultural code about sex; --somatizations expressing the sexual potentialities; --non structured neurosis as expression of psychic and sexual inhibition; --religious behaviour with opportunities of conflicts with the religious authorities.