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Mycetoma refers to a chronic subcutaneous granulomatous infection found predominantly in India, South America, and Africa. It is characterized by subcutaneous nodules, draining sinuses, and grains. It usually involves the feet and may result in disfigurement. Although mycetoma can be clinically diagnosed, effective therapy requires etiological characterization of the causative organism by pathology and culture. Where the causative agents are bacterial, mycetoma is subclassified as actinomycetoma; and where the organisms are fungal, it is termed eumycetoma. This chapter focuses on eumycetoma, which is difficult to treat and requires a combined approach for the best results. A combination of debulking surgery and antifungals is used, with azoles as first-line (itraconazole) followed by allylamines until clinical cure is obtained. In resistant cases, second-line azoles (posaconazole and voriconazole) or a combination of azoles and allylamines are used. Greater awareness and health worker education is necessary to diagnose and treat eumycetoma early and effectively. This, together with community awareness, is imperative to preventing chronic and disfiguring eumycetoma.

Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis that may present with limited to severe disease, posing a therapeutic challenge. A 7-year-old African female who presented with extensive PG showed a remarkable response to corticosteroid wrap monotherapy.

A 31-year-old HIV-seropositive woman from Durban, KwaZulu-Natal, South Africa, presented with a 3-month history of widespread umbilicated and ulcerated skin papules, plaques, and nodules. The skin lesions were biopsied and sent for histology and fungal culture; the cultured isolate was referred for molecular identification. Histology, fungal culture, and molecular testing confirmed that the dimorphic fungal pathogen Emergomyces africanus had caused a disseminated mycosis.

BACKGROUND Mucocutaneous diseases (MCD) have been commonly described among human immunodeficiency virus (HIV) infected patients before the combined antiretroviral therapy (cART) era. There is limited data on the frequency and type of MCD in the cART era in African children and adolescents. This study aimed to describe the prevalence and spectrum of MCD in South African children and adolescents seropositive for HIV on cART. METHODS A cross-sectional study of 310 participants aged 0-19 years attending a public sector ART clinic at King Edward VIII Hospital, Durban, South Africa, was conducted. Demographic, clinical, and laboratory information was obtained from the participants and hospital records. Participants were examined. Data were collated and analyzed with SPSS version 23. RESULTS MCD were observed in 77.4% of HIV-infected children. The prevalence was higher among males and adolescents above 16 years old (83.9%). Infectious skin disorders (44.7%) were less common than noninfectious dermatoses (55.3%). More common disorders encountered included generalized pruritus (32.6%), fungal infections (20.9%), and inflammatory (20.4%) and pigmentary (20.4%) skin disorders. Tinea capitis and pedis were the most prevalent fungal infections, while oral candidiasis (0.2%) was the least. Inflammatory skin disorders and dyschromia appeared to be more common than in the pre-cART era. CONCLUSIONS While MCD are still common in HIV-infected children and adolescents in the cART era, the pattern and types of disorders have changed to a predominance of non-infectious dermatoses.

Background: Dermatological diseases are amongst the commonest reasons for consultation at primary care level. Yet, dermatology teaching in medical and nursing curricula is inconsistent and often insufficient to enable medical and nursing professionals to manage these conditions effectively. Methods: We tested the knowledge of 100 doctors and 195 nurses who attended dermatology training sessions held in three health districts in the province of KwaZulu-Natal (KZN), South Africa, by using a quasi-experimental uncontrolled before-and-after study design. At the start of the session, participants were exposed to 15 slides representing common dermatological conditions; this was followed by a test. The participants then attended a series of short lectures followed by the same test. Pre- and post-intervention test scores were compared, and the results were analysed by professional status, health district and type of facility. Results: The mean (standard deviation [SD]) pre-intervention test score was 40.6% (20.5%). Doctors scored significantly higher than nurses (p

Skin manifestations are common in HIV infected patients with a prevalence rate ranging from 36% to 52% in children and 41% to 94% in adults. At least 30% present with skin conditions as a manifestation of their underlying HIV and 90% manifest with skin conditions during the course of HIV. In addition, therapy with antiretroviral therapy is responsible for drug reactions and immune reconstitution syndrome which most commonly presents with skin lesions. Common dermatoses are more severe and recalcitrant to therapy in HIV infected patients; however, there may be skin conditions that are specific and occur only in the context of HIV infection. Thus, early recognition of skin lesions can prompt investigation and early management of HIV infection as well as recognition of failure and resistance to antiretroviral therapy.

Werner syndrome (WS) is a rare autosomal recessive disorder characterized by a constellation of adult onset phenotypes consistent with an acceleration of intrinsic biological aging. It is caused by pathogenic variants in the WRN gene, which encodes a multifunctional nuclear protein with exonuclease and helicase activities. WRN protein is thought to be involved in optimization of various aspects of DNA metabolism, including DNA repair, recombination, replication, and transcription. In this update, we summarize a total of 83 different WRN mutations, including eight previously unpublished mutations identified by the International Registry of Werner Syndrome (Seattle, WA) and the Japanese Werner Consortium (Chiba, Japan), as well as 75 mutations already reported in the literature. The Seattle International Registry recruits patients from all over the world to investigate genetic causes of a wide variety of progeroid syndromes in order to contribute to the knowledge of basic mechanisms of human aging. Given the unusually high prevalence of WS patients and heterozygous carriers in Japan, the major goal of the Japanese Consortium is to develop effective therapies and to establish management guidelines for WS patients in Japan and elsewhere. This review will also discuss potential translational approaches to this disorder, including those currently under investigation.

Background. Atopic dermatitis (AD) is a chronic, pruritic condition with significant morbidity and some variation in clinical characteristics across different populations. Objectives. To describe the characteristics and management of AD in a paediatric cohort. Methods. A cross-sectional, descriptive study of paediatric AD patients attending the skin clinic at the King Edward VIII Hospital in Durban, South Africa, is described. Results. The observed prevalence of AD was 60.1%. A preponderance of male patients (55.6%) was seen across the cohort. An onset of AD by 1 year of age was reported in more than half (53.5%) of the patients. Slightly more than a third of the patients presented with severe disease, as determined by affected body surface area (≥50%). The head, neck and limbs were the most involved areas. Eczema herpeticum was the most common co-existing dermatosis (2.4%). Bleach baths (2%), wet wrap therapy (3.6%) and systemic immunosuppressants (4.8%) were used in the management of recalcitrant cases. Conclusion. The observed prevalence of AD is one of the highest documented among paediatric skin diseases in hospital-based studies in Africa. Predominance in children of preschool age, onset of disease by the age of 5 years, co-existing eczema herpeticum and recalcitrant disease requiring systemic immunosuppressants are consistent with trends in patients from European or Asian descent, while the level of severe disease and head and neck involvement are more consistent with reports from Africa. Further studies in a local context are needed to better understand the disease and its presentation in different populations.

Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe life-threatening mucocutaneous reactions. There is an ongoing controversy regarding the use of systemic corticosteroids and intravenous immunoglobulin (IVIG) in SJS/TEN and their utility in HIV-infected patients. Objectives: The objective was to assess the outcome of a combination of intensive supportive care with oral corticosteroids in SJS and a combination of systemic steroids and IVIG for 3 consecutive days in HIV-infected patients with TEN. In addition, we assessed management in a general dermatology ward without implementing wound debridement. Methods: This was a retrospective cohort study of 36 HIV-infected adults with SJS/TEN admitted to a tertiary dermatology unit between 1st January 2010 and 31st July 2011. Standard-of-care protocols included identification and elimination of the possible causative drug, meticulous wound care without debridement, initiation of oral prednisone (1 mg/kg/day) on admission for 3 consecutive days, and the addition of IVIG (1 g/kg/day) for 3 consecutive days to those with TEN. Results: Of the 36 patients in the study, 32 were female. Nevirapine was the commonest drug implicated. A diagnosis of tuberculosis did not increase the case fatality rate. Complications included infections, anaemia, drug-induced hepatitis, ocular involvement, renal impairment, deep vein thrombosis, respiratory distress, Leucopenia, gastritis and hypernatremia. The overall survival rate was 97%. Conclusion: HIV-infected SJS and TEN patients were treated in a tertiary dermatology ward with a treatment plan of skin care, and a combination of systemic corticosteroids and IVIG respectively had a survival rate of 97%.

In South Africa(S.A), a country of about 50.6 million inhabitants, approximately 85% of the population is dependent on the public health sector. A total of 220 dermatologists practise in South Africa, with a ratio of 1 dermatologist: 216 000 people and most practising in the private urban areas. The importance and the need to quantify the burden of disease led us to describe prospectively the epidemiology of skin conditions in five public referral hospitals in the second most populous province of South Africa (S.A), KwaZulu Natal (KZN). This article is protected by copyright. All rights reserved.