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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.

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.

Endodontic infections are characterized by their microbial polymorphism with the presence of pathogenic agents such as bacteria. The aim of this study was to investigate the presence of yeast in the root canals of teeth with pulp necrotic with or without apical periodontitis and to study the sensibility of these at disinfection at sodium hypochlorite to 2.5 %.Root canal samples, taken with paper points before and after disinfection with sodium hypochlorite dosed at 2.5 % on 50 single rooted teeth in 38 patients, were seeded in petri dishes containing Sabouraud Chloramphenicol (SC) (Conda Laboratories, Madrid). These stains were incubated in an incubator at 37°C for 48hours. The presence of yeast was confirmed by white colonies on the entire circumference of the tip paper. The identification of species was done by macroscopic and microscopic examinations associated with Blastese test.The yeast colonies were isolated from 7 teeth (14 %) out of 50. All positive samples were from teeth with an open necrotic pulp (P0.001). The only species found was Candida albicans. Immediate disinfection with sodium hypochlorite at 2.5 % did not show a complete elimination of yeasts.The results of this study show that the canal of necrotic teeth with or without apical periodontitis may shelter yeasts even after immediate disinfection with sodium hypochlorite 2.5 %.

Mycetomas are localized chronic inflammatory infectious diseases involving subcutaneous tissues, skin and bones. We report a case of mycetoma in a 40-year-old farmer from the north of Senegal. The clinical appearance of the lesions suggested primarily the diagnosis of a soft tissue malignant tumor. Mycetoma diagnosis was confirmed by histopathologic evidences and growth of Actinomadura pelletieri in cultured samples. The evolution was good under a triple antibiotic therapy combining cotrimoxazole, amoxicillin-clavulanic acid and streptomycin for 12 months.

Because of the widespread repartition of allergens, allergic contact dermatitis is the most common inflammatory skin disease. It's the best model of dilated hypersensibility mediated by T lymphocytes cells. Atopic dermatitis and irritative dermatitis are to be distinguished to contact dermatitis. The aetiological diagnosis is the most important step of management of patients with that disease because it's the best way to avoid recurrences. The identification of cause is based on aetiological interrogatory and epicutaneous tests with 23 allergens completed with personnel products and specialised tests. Contact dermatitis can be classified according to results of aetiological management. In occupational contact dermatitis, contact dermatitis due to drugs, to metals, cosmetics, clothes and accessory and proteins. Management of patients with contact dermatitis is based on individual eviction, protection, cosmetovigilance, declaration of occupational dermatosis and allergovigilance.

Our aim was to report the cutaneous features of antiphospholipid antibodies syndrome in Dermatology in Dakar.Our study was retrospective from January 2000 to December 2001. All patients were diagnosed according to the criteria of the international consensus statement in 1999 on the antiphospholipid antibodies.Eleven cases (all female) were collected with a median age of 28 years. A systemic lupus was associated in 7 cases, a scleroderma in 1 case and mix connectivity in 1 case. The dermatological manifestations found in all patients were necrosis of the extremities (4 cases), purpuric lesions (4), cutaneous ulcers (3), acrocyanosis (2), livedo (1) and subungual splinter hemorrhage (1). The obstetrical incidents were noted in 82% of cases; there were precocious and repeated abortions (in 5 cases), foetal loss (in 4 patients), precocious delivery (in 2 cases), lateness of growth in uterus (in 1 case). It was an arterial thrombosis in 2 cases. The mean level of anticardiolipin antibodies was 60 UGPL and a dissociation of the syphilitic serology was present in 9 patients. A severe thrombopenia in 1 case was observed. The evolution was favorable in 7 patients. In other cases, we noted foetal loss in 2 cases and distal necrosis relapse in 2 cases.Cutaneous manifestations are diverse. They can be lupus involvements or microcirculatory thrombosis and they make the diagnostic easy.

Sarcoidosis cases had been rarely reported in Senegal in spite of the high frequency of sarcoidosis in black people. The purpose of this work was to determine the epidemiological, clinical and evaluative profile of sarcoidosis in Dakar.We performed a multicentric retrospective trial in order to characterise sarcoidosis cases in Senegal from 1968 to 2004.Twenty cases (21 females and 9 men) were observed. The average age was 40 years. Duration before first medical attention was up to one year in 20 cases. Ten patients received an anti tuberculosis treatment before sarcoidosis diagnosis. Sarcoidosis was a systemic disease in 76% of cases and only cutaneous in 24%. Cutaneous lesions were found in 66,66% of cases. Presenting features were cutaneous (46%), general (30%), rheumatoid, (16,6%), Lofgren syndrome (3 cases). The cutaneous lesions were specific in 94% of cases as small nodules (50%), placards (20%), great nodules (15%) and scars sarcoidosis (10%). Extra cutaneous involvement were pulmonary (73,33%), lymphadenopathy (66,66%), and rheumatoid (20%). Pulmonary tuberculosis was associated in 4 cases.Our data confirmed rarity of sarcoidosis in Senegal opposite to the high reported frequency in other black population in developed country. Clinical features were polymorph and the systemic forms predominant. Tuberculosis may be rule out in order to avoid miss diagnosis.

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.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.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.

Mycetoma is a pathological process during which eumycetomic (fungal) or actinomycotic causative agents from exogenous source produce grains. Medical treatment is available for actinomycetomas and surgery is still the main treatment for eumycetoma. We report 90 cases of actinomycetoma occuring in male adult patients coming mainly from central Senegal. Patients living far from health structures consult after a long evolution period for tumors and pains which prevent them from carrying out their activities. The three etiological agents in our patients were Actinomadura pelletieri (60 cases), Actinomadura madurae (25 cases) and Streptomyces somaliensis (5 cases). The three clinical features are inflammatory forms (75 cases) mainly due to Actinomadura pelletieri, tumoral forms (13 cases) and cystic forms (2 cases). Lesions are localized on the foot in 50% of cases and in other part of the body for the other half. Bone damage was observed in 55% of cases. 83% of the patients were cured after a one-year treatment of sulfametoxazole adminstered orally. Two patients died of visceral involvement.

Vibrio vulnificus is a Gram-negative halophilic pathogen for man that can cause septicemia in patients with chronic liver disease. In healthy subjects, infections are generally local or regional. We report two cases of necrotizing dermo-hypodermitis due to Vibrio vulnificus.The first patient was a 21-year-old fisherman who developed extensive necrotizing dermo-hypodermitis 24 hours after a penetrating scratch with a fish bone. The second patient was also a fisherman. This 35-year-old man developed a massive area of necrotic tissue on the left leg, also 48 hours after a penetrating fish bone scratch. Both patients exhibited neutrophil hyperleukocytosis and thrombocytopenia. Bacteriological study of the pus and damaged tissue identified Vibrio vulnificus. Blood cultures were negative. Liver tests and liver ultrasound were normal. The course was favorable in both cases with antibiotic treatment and excision of the necrotic tissue.For these two cases of Vibrio vulnificus necrotizing dermo-hypodermitis, the diagnosis was based on epidemiological, clinical and bacteriological arguments. Neither of these patients had liver disease, explaining the limited locoregional nature of the infection. The severity of the skin necrosis and its rapid course are related to the toxins produced by V. vulnificus. Curative medical and surgical care is generally effective in cases without septicemia and prognosis is good. Education of exposed subjects, fishermen and patients with chronic liver disease, should be helpful for prevention.