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Summary Background Scabies is a common parasitic skin condition that causes considerable morbidity globally. Clinical and epidemiological research for scabies has been limited by a lack of standardization of diagnostic methods. Objectives To develop consensus criteria for the diagnosis of common scabies that could be implemented in a variety of settings. Methods Consensus diagnostic criteria were developed through a Delphi study with international experts. Detailed recommendations were collected from the expert panel to define the criteria features and guide their implementation. These comments were then combined with a comprehensive review of the available literature and the opinion of an expanded group of international experts to develop detailed, evidence‐based definitions and diagnostic methods. Results The 2020 International Alliance for the Control of Scabies (IACS) Consensus Criteria for the Diagnosis of Scabies include three levels of diagnostic certainty and eight subcategories. Confirmed scabies (level A) requires direct visualization of the mite or its products. Clinical scabies (level B) and suspected scabies (level C) rely on clinical assessment of signs and symptoms. Evidence‐based, consensus methods for microscopy, visualization and clinical symptoms and signs were developed, along with a media library. Conclusions The 2020 IACS Criteria represent a pragmatic yet robust set of diagnostic features and methods. The criteria may be implemented in a range of research, public health and clinical settings by selecting the appropriate diagnostic levels and subcategories. These criteria may provide greater consistency and standardization for scabies diagnosis. Validation studies, development of training materials and development of survey methods are now required. What is already known about this topic? The diagnosis of scabies is limited by the lack of accurate, objective tests. Microscopy of skin scrapings can confirm the diagnosis, but it is insensitive, invasive and often impractical.Diagnosis usually relies on clinical assessment, although visualization using dermoscopy is becoming increasingly common.These diagnostic methods have not been standardized, hampering the interpretation of findings from clinical research and epidemiological surveys, and the development of scabies control strategies. What does this study add? International consensus diagnostic criteria for common scabies were developed through a Delphi study with global experts.The 2020 International Alliance for the Control of Scabies (IACS) Criteria categorize diagnosis at three levels of diagnostic certainty (confirmed, clinical and suspected scabies) and eight subcategories, and can be adapted to a range of research and public health settings.Detailed definitions and figures are included to aid training and implementation. The 2020 IACS Criteria may facilitate the standardization of scabies diagnosis., What is already known about this topic? The diagnosis of scabies is limited by the lack of accurate, objective tests. Microscopy of skin scrapings can confirm the diagnosis, but it is insensitive, invasive and often impractical.Diagnosis usually relies on clinical assessment, although visualization using dermoscopy is becoming increasingly common.These diagnostic methods have not been standardized, hampering the interpretation of findings from clinical research and epidemiological surveys, and the development of scabies control strategies. What does this study add? International consensus diagnostic criteria for common scabies were developed through a Delphi study with global experts.The 2020 International Alliance for the Control of Scabies (IACS) Criteria categorize diagnosis at three levels of diagnostic certainty (confirmed, clinical and suspected scabies) and eight subcategories, and can be adapted to a range of research and public health settings.Detailed definitions and figures are included to aid training and implementation. The 2020 IACS Criteria may facilitate the standardization of scabies diagnosis.

Introduction La lepre est une des premieres causes de neuropathies dans le monde. Son evolution peut etre marquee par des complications immunologiques appelees reactions lepreuses. La reaction de type 1 ou reaction de reversion (RR) est responsable d’une infiltration rapide et douloureuse des lesions cutanees et de nevrites potentiellement severes et irreversibles. La reaction de type 2 ou erytheme noueux lepreux (ENL), est une reaction a complexes immuns caracterisee par des nodules inflammatoires douloureux associes a des signes generaux. La prise en charge therapeutique des reactions lepreuses repose avant tout sur la corticotherapie generale prolongee, source de morbidite importante. La thalidomide, alternative therapeutique efficace dans l’ENL, est d’utilisation limitee par sa toxicite et sa tolerance mediocre. Au cours de la RR, des immunosuppresseurs conventionnels comme la ciclosporine ou l’azathioprine ont ete utilises mais les donnees d’efficacite et de tolerance sont parcellaires dans cette indication, et leur disponibilite reduite dans les pays d’endemie. Dans la litterature, une vingtaine de cas d’efficacite du MTX ont ete rapportes. L’objectif de l’etude vise a analyser l’efficacite et la tolerance du methotrexate (MTX) au cours des reactions lepreuses ainsi que l’epargne cortisonique. Materiel et methodes Il s’agit d’une etude retrospective multicentrique incluant l’ensemble des patients suivis pour une lepre et ayant recu du MTX dans le cadre d’une reaction lepreuse de type 1 et 2 depuis 2016. Resultats Un total de 13 patients ont ete inclus, 5 femmes et 8 hommes. Les reactions etaient : ENL (n = 10) et RR (n = 9). La dose mediane de MTX etait de 20 mg par semaine avec une duree mediane de traitement de 14 mois. Au cours du traitement, 9/13 patients n’ont pas eu de recidive reactionnelle sous MTX. Parmi les 4 patients ayant recidive, on notait 3 RR et 2 ENL. La dose de prednisone etait reduite de 86 % en moyenne lors de l’arret du MTX. Un sevrage en corticoides etait obtenu chez 5 des 11 patients sous CTC. La tolerance du MTX etait correcte. Un patient a presente une cytolyse grade II. Parmi les 8 patients ayant arrete le MTX (3 pour conception, 1 pour cytolyse, 1 pour nausees, 2 pour inefficacite, 1 pour COVID-19) 6 ont recidive dans un delai median de 8 mois apres l’arret du MTX (3–13). Discussion Il s’agit de la plus grande cohorte rapportant l’interet du MTX pour limiter les recidives reactionnelles au cours de la lepre et permettre une epargne cortisonique. Le MTX semble etre une alternative de choix dans le traitement des reactions lepreuses corticodependantes avec un profil de tolerance favorable. L’efficacite suspensive plaide en faveur d’une utilisation prolongee pour limiter la frequence des rechutes a l’arret. La disponibilite et le cout reduit du MTX permettent d’envisager une utilisation dans les pays d’endemie.

Introduction Les patients ayant une maladie bulleuse auto-immune (MBAI) etant a risque d’infection (âge, traitement corticoide et/ou immunosuppresseur), nous avons evalue le risque de la COVID-19 et de ses formes severes chez les patients ayant une MBAI. Materiel et methodes Cette etude retrospective multicentrique (49 services de dermatologie) a inclus tous les cas connus de COVID survenus entre janvier et juin 2020 en France metropolitaine. Les cas ont ete classes en certains (PCR + ), probables (PCR− ou non faite, TDM pulmonaire evocateur) ou possibles (PCR et TDM negatifs ou non faits mais signes cliniques et/ou cas contacts). L’incidence cumulee des cas de COVID a ete calculee a partir des cas certains et hospitalises de patients MBAI suivis dans chaque service, puis comparee a celle dans la population generale sur la meme periode (donnees Sante Publique France) apres standardisation indirecte sur l’âge et la region. L’incidence et le pronostic ont ete analyses pour l’ensemble des MBAI et pour le sous-groupe ayant recu du rituximab (RTX) dans les 9 derniers mois. Resultats Incidence : 59 cas de COVID-19 ont ete recenses (âge : 73,1 ± 16,2 ans) parmi 5180 patients suivis pour une MBAI : 29 (49 %) correspondaient a des cas certains, 8 (14 %) probables et 22 (37 %) possibles. Les MBAI etaient une PB (n = 21, 36 %), une P muqueuse (PM) (PC/EBA, n = 19, 32 %), un pemphigus (n = 18, 31 %) et 1 P gestationnelle (n = 1, 2 %). Le ratio d’incidence standardise (RIS) etait de 0,42 [IC95 % : 0,20–0,80] p = 0,005 pour les PB, 1,02 [0,37–2,26], p = 0,91 pour les pemphigus et de 1,18 [0,55–2,23], p = 0,62 pour les PM. Parmi les 516 patients ayant recu du RTX, on comptait 22 cas possibles probables ou certains d’infection COVID correspondant a un RI = 5,37 [3,15–8,96], parmi lesquels 13 cas probables ou certains (RI = 4,90 [2,43–9,40]) par rapport aux patients n’ayant pas recu de RTX, et un RI de formes certaines et hospitalisees de 3,62 [1,29–8,85]. Pronostic 30 cas (51 %) ont ete hospitalises pour COVID et 15 (25 %) sont decedes (RR = 1,63 [0,83–2,55] p = 0,13 par rapport a la population generale ajustee a l’âge et a la region. Un patient MBAI avait 3,4 [2,2–5,1] fois plus de risque de deceder sur la periode epidemique s’il contractait la COVID que s’il ne la contractait pas. L’âge moyen des patients ayant une forme severe (hospitalisation ou deces) de COVID etait plus eleve que celui de ceux ayant une forme non severe (77,9 ± 11,2 vs 65,0 ± 19,3, p = 0,006). Les RR de forme severe des PM/pemphigus avec COVID probable ou certaine traites par RTX (âge moyen 68,8 ± 14,9) etaient respectivement de 0,77 [0,45–1,33] p = 0,33 et de 0,51 [0,08–2,56] p = 0,40 par rapport aux PM/pemphigus avec COVID non traites par RTX (âge moyen 76,7 ± 9,1). Discussion La COVID entraine une forte surmortalite chez les patients MBAI. L’incidence semble particulierement elevee parmi les patients ayant recu du RTX, sans que l’on puisse conclure a une plus grande severite de la COVID-19 chez ces patients.

International audience; No abstract available

Introduction Nous decrivons une serie de dermatoses developpees a l’occasion du confinement (mars–avril 2020) lors de la premiere vague de l’epidemie COVID-19. Materiel et methodes Cas no 1 : homme de 59 ans, isolement social, exogenose. Ulcerations diffuses du siege, du scrotum et de la verge, hemorragiques, douloureuses. Contexte de station au sol prolongee et maceration. Carences vitaminiques multiples (B9, zinc, fer, vitamine C, PP, D). Propos incoherents. Decouverte d’une encephalopathie de Gayet–Wernicke associee a un syndrome de Korsakoff. Cas no 2 : femme de 78 ans, isolement social, denutrition, probable maltraitance domestique (mari). Impotence fonctionnelle totale depuis plusieurs mois. Adressee pour une volumineuse escarre sacree. Decouverte de fractures deplacees des deux cols femoraux, non consolidees, anciennes. Cas no 3 : femme de 62 ans, isolement social, denutrition severe. Majoration de sa consommation alcoolique (livraison a domicile). Prurit, bulles tendues sur l’ensemble du corps et ulcerations etendues, hemorragiques. Atteinte du visage et des muqueuses. Carences en vitamine PP, C, B9. Diagnostic retenu : pemphigoide bulleuse dans une forme « historique » sur terrain denutri, avec retard de prise en charge. Cas no 4 : femme de 48 ans, anorexique, isolement social. Majoration de la consommation d’alcool lors du confinement et « peur de faire ses courses ». Erytheme bien limite œdemateux du dos des pieds, du decollete et des avant-bras, douloureux, d’evolution peripherique bulleuse. Carences en vitamines PP, B1, B6, C. Nous retenons le diagnostic d’erytheme pellagroide. Regression sous renutrition. Discussion A cote des manifestations cutanees correlees a la maladie COVID-19 (urticaire, exantheme maculopapuleux, eruption vesiculeuse…), nous souhaitions attirer l’attention sur d’autres manifestations dermatologiques indirectement liees a la pandemie. Le premier confinement a notamment ete marque par une augmentation de la consommation d’alcool en population generale, surtout en cas de consommation reguliere prealable et de trouble psychiatrique. A cela s’ajoutait la peur de faire ses courses, modifiant les habitudes alimentaires et favorisant le comportement de « binge-eating » (ou en l’occurrence « drinking »). L’exogenose et la denutrition ont ete a l’origine des dermatoses carentielles des patients no 1 et 4. L’isolement social a restreint le champ des interactions, induisant un huis-clos mortifere pouvant mener a des situations de maltraitance (patiente no 2). L’ensemble de ces cas illustre les dommages collateraux de la pandemie COVID-19. L’isolement social et le retard de soins ont joue un role majeur, soit dans la survenue de la dermatose elle-meme (dermatoses carentielles), soit dans son evolution pejorative (pemphigoide bulleuse avec retard de prise en charge), aboutissant a des presentations cliniques « historiques ».

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert’s response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

International audience

Human T-cell leukemia virus type 1 (HTLV-1) is highly endemic in areas of central Africa; mother-to-child transmission and sexual transmission are considered to be the predominant routes. To determine the prevalence and subtypes of HTLV-1/2 in pregnant women in Gabon, we conducted an epidemiological survey in the five main cities of the country. In 907 samples, the HTLV-1 seroprevalence was 2.1%, which is lower than that previously reported. Only one case of HTLV-2 infection was found. The HTLV-1 seroprevalence increased with age and differed between regions ( P ≤ 0.05), with the highest prevalence (5%) in the southeastern region. A wide range of HTLV-1 proviral loads was observed among the infected women. The level of the proviral load was correlated with a high HTLV-1 antibody titer ( P ≤ 0.02). Sequencing of HTLV-1 env and long terminal repeat fragments showed that all but one strain belonged to the central African subtype B; the outlier was of cosmopolitan subtype A. The new strains of subtype B exhibited wide genetic diversity, but there was no evidence of clustering of specific genomes within geographical regions of the country. Some strains were closely related to simian T-cell leukemia virus type 1 strains of great apes, suggesting that in these areas some HTLV-1 strains could arise from relatively recent interspecies transmission. The sole HTLV-2 strain belonged to subtype B. In this study we showed that the prevalence of HTLV-1 in the southeast is one of the highest in the world for pregnant women.

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. Methods In Bamako, 132 patients with pyoderma, diagnosed and graded as “severe” on clinical grounds, were randomly assigned to an oral treatment by either amoxicillin (50 mg/kg per day) or erythromycin; infections of the follicular appendage were excluded. Both drugs were associated with the topical application of povidone iodine. The patients were evaluated openly at the seventh day of treatment for cure or marked improvement of the clinical features, indicating successful treatment. Results Three patients were lost to follow-up. Treatment was successful in 57 of 64 patients treated with amoxicillin vs. 58 of 65 patients treated with erythromycin (P = 0.00). Conclusions Amoxicillin was as efficacious as erythromycin in the treatment of severe pyoderma in Mali. Owing to its efficacy, added to high availability and low cost, this compound should be considered a first-line treatment of this disorder in this country, and perhaps in other countries where this condition presents in a similar way.

International audience; BACKGROUND: Kaposi sarcoma (KS) is a complex tumor of uncertain clonality. Studying the viral clonality of the human herpesvirus 8 (HHV-8) in KS to determine clonality of the tumors, a strategy that has been used previously with Epstein-Barr virus and its associated tumors, may elucidate whether multicentric (disseminated) KS lesions correspond to metastatic lesions or to expansions of independent clones. METHODS: A series of 139 KS biopsies (from skin, lymph node, or tonsil) was obtained from 98 patients, with 59 biopsies from 18 patients with disseminated multicentric KS skin lesions. The degree of spindle cell infiltration in biopsies was established by direct observation of hematoxylin-eosin-stained sections, and HHV-8 viral load was quantified by real-time polymerase chain reaction. To determine cellular clonality, the size heterogeneity of the HHV-8-fused terminal repeat (TR) region was determined by probing of electrophoresed restricted genomic DNA from KS biopsies for the HHV-8 TR sequence. RESULTS: HHV-8 clonality analysis was performed on the 62 samples for which sufficient DNA was obtained. Most samples corresponded to histologically nodular lesions with high spindle cell infiltration and high viral load. A clonal HHV-8 pattern was determined for 59 samples; 11 were found to be monoclonal and 48 to be oligoclonal. The informative samples that were from disseminated KS skin lesions (n = 26, from six patients) were either monoclonal or oligoclonal, and the size of HHV-8 episomes varied between these samples. CONCLUSION: Although some tumor KS lesions were monoclonal expansions of HHV-8-infected spindle cells, most advanced lesions were oligoclonal proliferations. Furthermore, individual KS disseminated tumor skin lesions were found to represent distinct expansions of HHV-8-infected spindle cells. Thus, our results suggest that KS lesions, especially in patients with advanced skin tumors, are reactive proliferations rather than true malignancies with metastatic dissemination.

In this review we present a synthesis of the current knowledge of leprosy based on the epidemiological studies and the latest data obtained in basic research and the strategies undertaken to fight out this pathology. The significant progress in the genomic study of the leprosy bacillus, and in understanding the basic mechanisms governing the individual susceptibility to the disease, together with the stagnation in the incidence of the new cases observed for ten years, represent focus of interest. If the efficiency of the recommended treatments is actually confirmed by a low relapse rate, however the drying up of new cases, which could be expected by reducing the infectiousness of the treated cases, is nonetheless slow in coming. Recent studies support the effectiveness of prophylaxis based on a single dose of rifampicin and/or a BCG vaccination of patient contacts. This could allow an increased reduction of the incidence of the disease. However, no official position validates such strategies. Because of an ambiguity in the expression of the objectives for managing the disease, i.e. « elimination of a disease considered as a public health problem », which should not to be confused with « eradication of the disease », which, in fact, has no relevance today, demobilization in fighting against leprosy is to be feared.

Objective We conducted a comprehensive, systematic review of the global childhood population prevalence of impetigo and the broader condition pyoderma. Methods PubMed was systematically searched for impetigo or pyoderma studies published between January 1 1970 and September 30 2014. Two independent reviewers extracted data from each relevant article on the prevalence of impetigo. Findings Sixty-six articles relating to 89 studies met our inclusion criteria. Based on population surveillance, 82 studies included data on 145,028 children assessed for pyoderma or impetigo. Median childhood prevalence was 12·3% (IQR 4·2-19·4%). Fifty-eight (65%) studies were from low or low-middle income countries, where median childhood prevalences were 8·4% (IQR 4·2-16·1%) and 14·5% (IQR 8·3-20·9%), respectively. However, the highest burden was seen in underprivileged children from marginalised communities of high-income countries; median prevalence 19·4%, (IQR 3·9-43·3%). Conclusion Based on data from studies published since 2000 from low and low-middle income countries, we estimate the global population of children suffering from impetigo at any one time to be in excess of 162 million, predominantly in tropical, resource-poor contexts. Impetigo is an under-recognised disease and in conjunction with scabies, comprises a major childhood dermatological condition with potential lifelong consequences if untreated.

Joint Bone Spine - In Press.Proof corrected by the author Available online since samedi 19 juillet 2014

Hepatitis B virus (HBV) surface antigen (HBsAg) was found in 9.2% of 1,186 pregnant women from Gabon, of whom 10.1% had the HBe antigen and 89.9% had anti-HBe antibodies. Antibodies to the hepatitis delta virus (HDV) were found in 15.6% of the HBsAg-positive women. The HBV strains were of the A3 and E genotypes. The HDV strains belonged to HDV clades 1 and 8. These results provide clear evidence that HDV clade 8 is indigenous to Africa.

La Presse Medicale - In Press.Proof corrected by the author Available online since mercredi 10 juin 2015

Proliferating trichilemmal cyst is considered as a rare tumor that originates in the outer root sheath of hair follicle. Metastatic potential has not been yet fully established. Moreover, histological analysis does not allow precise malignancy prediction. Proliferating trichilemmal cyst glucose metabolism behavior was never previously described. Herein, we report the case of a 62-year-old patient with a left shoulder proliferating trichilemmal cyst showing an intense uptake of ¹⁸F-FDG on PET/CT examination. ¹⁸F-FDG PET/CT could be proposed to optimize diagnostic strategy of patients with proliferating trichilemmal cysts.

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. Methods We retrospectively collected all cases of skin diseases diagnosed during consultations provided at the Institut Marchoux in Bamako, the only center specializing in dermatology in Mali, during the year 1993. Results A total of 10,575 new outpatients were seen with 10,889 skin diseases. The main skin diseases registered were as follows: infectious dermatoses (41% of all diagnoses, including scabies (16.6%), superficial mycoses (13.6%), and primary pyoderma (5.6%)), dermatitis (20.4%), papular urticaria (4.4%), acne (4.2%), pityriasis alba (3.6%), keratoderma (3.6%), and urticaria (3%). Typical tropical infectious diseases accounted for only 1% of all diagnoses. Conclusions It appears that certain skin diseases (mainly scabies and pyoderma) are an important health problem for the population of the Bamako area. Public health policies should be implemented in order to manage this problem rationally.

Background Using skin-lightening compounds for a cosmetic purpose that are normally restricted to medical use or forbidden has become a world-wide practice. Complications are numerous. Immigrant communities often import their practice from their original country. Methods A review of the literature on the subject of complications of cosmetic skin-bleaching, with special focus on data concerning immigrants originating from highly endemic countries, was conducted. Results Complications of cosmetic skin-bleaching are common, involving mainly the skin although some general complications are also reported with a growing incidence. Conclusion The high frequency of this practice, added to the frequency of various complications, suggests it might be considered as a genuine public health problem currently.

Pemphigus has been largely studied in developed countries (North America and Europe) and in Brazil. In these geographical settings, pemphigus presents two very different epidemiological and clinical patterns. Little is known about pemphigus in other regions of the world, particularly in Africa. We report here a study of 30 cases of pemphigus observed in Bamako, Mali. Our data suggest that pemphigus in this area presents a distinctive pattern. Our cases of pemphigus were diagnosed on the basis of clinical, histological and direct immunofluorescence studies. We estimated the annual incidence in the Bamako region to be 0.29 cases per 100,000 inhabitants. There was no endemic focus in Mali. The disease was observed mainly in women (24 of 30; 80%), especially those older than 40 years (mean age, 46.7 years), and in the Fulani ethnic group (10 of 30; 33%). Our study group was composed of 25 cases of pemphigus foliaceus (PF) (83%), four cases of pemphigus vulgaris and one case of pemphigus vegetans. Pustules with hypopyon were observed in 11 patients (37%). A diffuse verrucous change in the skin was noted in four cases of erythrodermic PF. In 16 patients with PF, localized verrucous lesions mimicking seborrhoeic keratoses were observed when oral corticosteroid treatment was decreased. Histopathological examination demonstrated eosinophilic spongiosis in 50% of patients. These data suggest that pemphigus in Mali differs from the two main known patterns of the disease: the North American/European one, and the Brazilian pattern, with which it shares the predominance of superficial forms but otherwise differs in many features.

In order to estimate the importance as a public health problem of skin diseases, we investigated the prevalence and severity of skin diseases in a representative sample of children in Mali. 1817 children were randomly selected in 30 clusters by probability-proportional-to-size sampling in Koulikoro region. The mean prevalence (+/- 2 SD) of skin diseases was 34 +/- 4%. The most frequent dermatoses were pyoderma (12.3 +/- 1.6%), tinea capitis (9.5 +/- 2.5%), pediculosis capitis (4.7 +/- 1.4%), scabies (4.3 +/- 1.5%), and molluscum contagiosum (3.6 +/- 1%). The most troublesome dermatoses were scabies and severe pyoderma. Pyoderma was the only dermatosis associated with poor individual or household hygiene. Public health services were little used by the population for skin diseases, probably because of the lack of an adequate response by the services and the high cost of treatment. The high prevalence and the severity of many of the lesions, and the discomfort caused, make pyoderma and scabies a significant public health problem in Mali.

Hypertrophic scars and keloids result from abnormal wound healing in predisposed individuals. They occur within months of cutaneous trauma (surgical wounds, piercing, lacerations) or inflammation (acne, folliculitis, vaccination site). They have rarely been reported after chickenpox. Herein we report a dramatic case in a 4-year-old black girl and discuss the issues related to the management of hypertrophic scars and keloids in this peculiar situation.

Objective To compare the effectiveness of oral ivermectin (IV) and two different modalities of topical benzyl benzoate (BB) for treating scabies in a community setting. Methods The trial included patients aged 5-65 years with scabies who attended the dermatology department at the Institut d'Hygiene Sociale in Dakar, Senegal. The randomized, open trial considered three treatments: a single application of 12.5% BB over 24 hours (BB1. group), two applications of BB, each over 24 hours (BB2 group), and oral IV, 150-200 mu g/kg (IV group). The primary endpoint was the disappearance of skin lesions and itching at day 14. If necessary, treatment was repeated and patients were evaluated until cured. Results were analysed on an intention-to-treat basis. A pre-planned intermediate analysis was carried out after the BB1, BB2 and IV groups had recruited 68, 48 and 65 patients, respectively. Findings At day 14, 33 patients (68.8%) in the BB2 group were cured versus 37 (54.4%) in the BB1 group and 16 (24.6%) in the IV group (P < 10(-6)). Bacterial superinfection occurred more often in the IV group than in the BB1 and BB2 groups combined (28% versus 7.8%, respectively; P = 0.006). At day 28, 46 patients (95.8%) in the BB2 group were cured versus 52 (76.5%) in the BB1 group and 28 (43.1%) in the IV group (P < 10(-5)). These clear findings prompted early study cessation. Conclusion Topical BB was clearly more effective than oral IV for treating scabies in a Senegalese community.

L’HTLV-1 (human T cell leukemia/lymphoma virus type 1) est le premier des retrovirus a avoir ete identifie chez l’homme. Il fut isole aux Etats-Unis en 1980 a partir de cellules lymphoides T du sang peripherique d’un patient atteint d’un « mycosis fongoide atypique », dont on admet aujourd’hui qu’il s’agissait d’un cas de leucemie/lymphome T de l’adulte (ATL, pour « adult T-cell leukemia/lymphoma ») 1. Outre cette pathologie tumorale de pronostic defavorable, ce retrovirus humain exogene est associe a une neuromyelopathie chronique invalidante, la paraparesie spastique tropicale ou myelopathie associee a l’HTLV-1 (TSP/HAM, pour « tropical spastic paraparesis/HTLV-1-associated myelopathy ») 2, ainsi qu’a des maladies inflammatoires diverses interessant l’oeil, la peau, ou le muscle. Dans ce chapitre, apres avoir rappele les principales caracteristiques epidemiologiques et virologiques de l’HTLV-1, nous insisterons sur la riche expression dermatologique qui caracterise plusieurs des maladies liees a ce virus, au premier rang desquelles l’ATL et l’entite connue sous le nom d’infective dermatitis.

Les particularites medicales de sujets ayant une peau fortement pigmentee, dite noire, sont de doux ordres1: d’une part, la pigmentation, primaire preexistante ou secondaire a un processus pathologique, peut etre a ’origine de modifications de ’aspect de certaines lesions elementaires par rapport a ce qui est abserve sur peau peu pigmentee dite blanche; il en resulte des particularites semiologiques, plus ou moins marquees, cependant meconnues par certains praticiens du fait de la description largement preponderante dans la litterature medicale (pour ne pas dire exclusive dans de nombreux ouvrages) de la semiologie sur peau blanche. D’autre part, certaines affections, a expression cutanee plus ou moins importante, apparaissent statistiquement plus frequentes, ou plus rares, ou bien se caracterisent par une plus (ou moins) grande severite, ou par des particularites d’un autre ordre, chez les sujets ayant une peau intensement pigmentee par rapport a ceux ayant la peau claire, que cela soit une consequence directe de la pigmentation cutanee (c’est le cas par exemple pour les pathologies induites par la lumiere, qui sont beaucoup plus rares sur peau dite noire), ou du a des facteurs d’autre nature, constitutionnels ou acquis, sans que souvent il soit possible de faire la part de ces differentes eventualites; nous trouvons commode, a la suite d’autres auteurs2, de regrouper ce type de particularites sous ’intitule ethnique, terme dont ’imprecision, soulignee a juste titre, permet du moins de ne pas prejuger des roles physiopathologiques sous-jacents respectifs de facteurs genetiques, environnementaux, comportementaux, ou socio-economiques.

Revue du rhumatisme - In Press.Proof corrected by the author Available online since mercredi 9 juillet 2014

In Africa where there are limited laboratory resources for human immunodeficiency virus (HIV) testing the presence of seborrheic dermatitis--common in early stages of infection--may have potential as a clinical marker for HIV. To assess the predictive value of this skin disease a prospective study was conducted at the Institut Marchoux in Bamako Mali in 1992-94. The 305 study participants whose HIV status was unknown at study entry were grouped by dermatologic condition; in 21 cases two or more dermatoses were present. 159 of these patients were found to be HIV-positive. The HIV rates by condition were as follows: seborrheic dermatitis (28/58 patients or 48%) psoriasis (10/48 patients 21%) widespread dermatophytosis (11/33 patients 33%) molluscum contagiosum (8/17 patients 47%) herpes zoster (64/81 patients 79%) Kaposis sarcoma (31/31 patients 100%) prurigo (27/59 patients 46%) and associations of several dermatoses (19/21 patients 90%). The proportions of seropositive patients with two or more clinical signs of acquired immunodeficiency syndrome (AIDS) were 18% 10% 9% 75% 27% 74% and 52% respectively. Thus Kaposis sarcoma prurigo and molluscum contagiosum were the dermatologic conditions most frequently associated with clinical indicators of a poor prognosis. Seborrheic dermatitis on the other hand has a high prevalence in HIV-infected persons but a relatively early occurrence in HIV natural history (evidenced by its low association with full-blown AIDS) making it a useful indicator of HIV infection in African populations.