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A 5-year-old boy was referred because of urticarial flares with angioedema. Antihistamines and systemic steroids were not useful to prevent flares. At examination, at distance of a flare, chronic red-brownish plaques were found on the legs, trunk, and back, resembling granuloma annulare. The skin biopsy showed epithelioid and giant-cell granulomas, elastophagia, and "flames figures" surrounded with many eosinophils. A diagnosis of disseminated granuloma annulare-like variant of Wells' syndrome as described earlier by Caputo was made. A treatment with dapsone was initiated and enabled to stop flares. Wells' syndrome is a rare clinicopathologic entity with a chronic benign course and often misleading clinical presentation. Our case illustrates the clinical polymorphism and benefit of dapsone therapy. [ABSTRACT FROM AUTHOR]

Objective. The usual preferential site of BU is in the limbs. In our experience, we noticed atypical and often misleading sites which pose serious issues for the diagnosis and often for the treatment. Methods. This is a retrospective study conducted over a period of ten years of BU treatment at the Department of Dermatology of the University Teaching Hospital of Treichville (Abidjan, Côte d’Ivoire). We included in this study all BU cases with atypical site diagnosed clinically and confirmed either by the histology, by smear, or by PCR. Results. Epidemiologically, the age of patients ranged from 3 to 72 years with a median age of 14.2 years. Children aged less than 15 years were affected in almost 80% of case. The clinical table was dominated by ulcerated forms in 82.1% of cases. The unusual topography mostly observed was that of the torso (thorax, back, and abdomen) in 76.8% of cases. Conclusion. BU is an endemic disease in Côte d’Ivoire where it constitutes a serious public health issue. Several years following its first cases, BU still is little known. This dermatosis may present atypical misleading clinical aspects which must be ignored.

Condylomas are rare skin disorders in children. The giant form of Buschke-Löwenstein tumor is exceptional; its presence therefore raises the problem of identifying the route of contamination and ruling out a possible sexual abuse. In the actual report two cases of giant condylomas were described. The frst case in an 8-year-old boy was attributable to a familial sexual abuse. The second case in a 3-year-old girl was attributable to an innocent familial contagion. [ABSTRACT FROM AUTHOR]

Aims: To determine the epidemiological profile of newborn dermatitis and to describe the different clinical aspects of the observed neonatal dermatitis., Procedure: The study took place at the University Hospital of Cocody (Abidjan). The study was cross-sectional, descriptive and analytical, carried out on the basis of prospective recruitment. The study included newborns who were seen in outpatient or inpatient settings by 4 april 2018 to 23 August 2018 and in whom the pediatrician had observed cutaneous and/or mucosal lesions. The diagnosis was made with the collaboration of a dermatologist., Results: During the study period, 116 newborns were identified. The age of the patients seen in pediatrics with dermatitis varied from 1 to 28 days, with a mean of 16.86 ± 8.4 days. The median age was 19 days. The most representative age range (32.8%) was 24-28 days. The sex ratio (M/F) was 1. In almost 2/3 of the cases, the children were born at term, 29.3% were premature and 5.2% were born after term. In almost 2/3 of the cases (63.8%), the newborns had a birth weight of more than 2500 g. Only 3.4% of newborns seen in pediatric consultations were referred for a dermatitis. The age of the lesions at the time of consultation varied from 1 to 26 days, with a mean of 06.19 days ± 5.13. In more than half (53.5%) of the cases, the lesions had evolved for less than 5 days. Transient dermatitis was more frequent (51.7%), followed by infectious dermatitis (32.8%). Transient dermatitis of the newborn was dominated by sweaty miliaria (40%). Infectious dermatitis were mainly represented by mycotic (68.4%) and bacterial (31.9%) infections. Bacterial dermatitis were composed of neonatal impetigo (83.3%) and folliculitis (16.7%). In almost half of the cases (46.1%) the mycotic dermatitis were represented by candidosis intertrigo and in 38.5% of the cases there was oral candidiasis. The other neonatal dermatitis observed were dominated by diaper rash (64.3%) (Photo 2) and congenital nevi (21.5%). More than half (57.1%) of the cases of toxic erythema neonatorum occurred between days 6 and 10 of life. Nearly half (41.6%) of the cases of sudoral miliaria occurred between birth and day 5 of life. More than half (57.1%) of the cases of sebaceous hyperplasia occurred before the 5th day of life. All cases of neonatal scaling and mongoloid spots were already present between birth and day 5 of life. The mean age of patients with transient dermatitis was 14.31 days compared with 19.41 days for those with the other dermatitis. The difference in age was statistically significant (p < 0.05). The transient dermatitis predominated in male neonates while the other dermatitis predominated in females, however the difference observed at the level of sex was not statistically significant (p > 0.05)., Conclusion: The diagnosis of neonatal dermatitis is not always obvious, especially on black skin where few publications have been published., (Le comité de rédaction se réserve le droit de renvoyer aux auteurs avant toute soumission à l'avis des lecteurs les manuscrits qui ne seraient pas conformes à ces modalités de présentation. En outre il leur conseille de conserver un exemplaire du manuscrit, des figures et des tableaux.)

Background: Most umbilical tumors are diagnosed as benign tumors, umbilical metastases of abdominal and pelvic tumors, or Sister Marie Joseph nodule. Herein, we report a case of cutaneous umbilical endometriosis mistaken for a keloid., Patients and Methods: A young black woman aged 26 consulted for a painful umbilical tumefaction. She had noted the appearance of a nodule of the umbilicus 10 months ago with bleeding during her menstrual periods. Skin examination revealed a firm and painful umbilical nodule 2.5cm in diameter. She was treated with corticosteroid injections for one month for umbilical keloid. Given that the symptoms recurred regularly at the time of menstruation, we suspected umbilical endometriosis. This diagnosis was finally confirmed by histopathological examination and hormone therapy was instituted on gynecological advice before scheduled surgical excision., Conclusion: In a setting of an umbilical tumor simulating a keloid associated with cyclical symptoms in a black woman, the diagnosis of umbilical endometriosis should not be overlooked by the dermatologist., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: Buruli ulcer is an infection caused by Mycobacterium ulcerans occurring in tropical areas. In West Africa, it is an emerging threat mainly affecting children aged under 15years. This chronic disease is complicated by dystrophic scars in which squamous cell carcinoma can occur in the long term., Patients and Methods: This is a retrospective study of squamous cell carcinomas in Buruli ulcer scars seen at the Treichville University Hospital (Abidjan, Ivory Coast) over a five-year period., Results: During the study period, 8cases were observed and concerned young adults presenting Buruli ulcer in their childhood. Tumours were restricted to the limbs, with loco-regional invasion. Treatment was primarily surgical. Four of the patients died., Discussion: The risk of recurrence of cancer in these scars remains poorly evaluated, highlighting the importance of long-term monitoring strategies for human patients in order to ensure rapid identification of any changes in Buruli ulcer scars., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Fixed drug eruption (FDE) is a specific skin reaction and the only exclusively medicinal dermatosis. Among the drugs usually responsible are the antituberculous antibiotics including rifampicin and, less often, isoniazid and pyrazinamide. FDE after taking ethambutol is rarely described., Case Report: A 32-year old HIV negative patient presented a FDE localized to the internal surface of the lips and the interdigital folds during the 4th month of antituberculous treatment comprising rifampicin, isoniazid and ethambutol. The diagnosis was supported by the characteristic appearances of the lesions of FDE and their early reappearance in the same areas after accidental reintroduction of antituberculous triple therapy including ethambutol. Double-agent therapy with rifamicin and isoniazid was tolerated well., Conclusion: Discovery of FDE requires a rigorous search for the responsible medicine. During antituberculous treatment, the practitioner has to bear in mind the potential role of ethambutol, which is possibly potentiated by rifampicin., (Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Severe cutaneous drug reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life threatening in adults. They seem to be less common in children. The purpose of this study was to describe the epidemiological, clinical and etiological profile of these drug reactions in African child. It was about a retrospective study carried on for 10 years at the Dermatology center of University Hospital of Treichville, Abidjan (Cote d'Ivoire).Were included all children aged 0-15 years hospitalized for severe cutaneous drug reaction. They represented 14.1% (27 cases) with an estimated hospital rate of 0.01%. The sex ratio (M/F) was 1.2. The mean age was 10.3 years. 19 children were suffering from SJS (63%) and 9 children (33.3%) from TEN. Sulfonamides were the most commonly used drugs with sulfadoxin-pyrimethamin (25.9%), used for malariae, and cotrimoxazole (22.2%). Self-medication was practiced by 70.4% of parents. The average time to onset of lesions from drug intake was 8.2 days. Only one child was HIV infected. Three children affected by TEN (11.1%) died.

Necrotizing fasciitis is a severe soft tissue infection caused by flesh-eating bacteria. It usually occurs on the lower limbs. The purpose of this report is to describe a case involving Streptococcus pyogenes on the breast of a 22-year-old African woman with HIV.

Histoplasmosis is a subcutaneous mycosis caused by dimorphic fungus which is to be found in two types: the capsulatum and duboisii types. The capsulatum type has had an increasing incidence with the HIV-AIDS epidemics but it is not demonstrated that the duboisii one has had the same upward incidence. Signs in children and immunocompetent patient are rarely described during this disease. The diagnosis is often late in the child as it looks like Molluscum contagiosum lesions. We report a case of skin histoplasmosis of duboisii type non associated with HIV infection in a child. Diagnosis has been confirmed by a histopathological test of a nodule biopsy. Medical treatment was successfully based on itraconazol.

Pyoderma gangrenosum is an uncommon chronic ulcerative dermatosis with unknown aetiology and with a pathology which is still obscure. In 15-45% of cases, it is related to intestinal chronic inflammatory disease (MICI), to a systemic disease that it can sometimes reveals or to an immunodeficiency This disease starts whether with a pustule, a bubble or a nodule which leads during its evolvement to a superficial ulceration with clear edges. Its diagnosis is easy and is mainly clinical. It is a disease which is localized preferably in lower limbs. Treatment is mainly based on oral route corticotherapy. We report a case of gangrenosum pyoderma localized on the penis in a 43-year-old HIV infected patient. It is an uncommon localization, misleading and delicate. We have treated successfully this patient by oral corticotherapy combined with local antiseptic treatments for 6 months.

Context: Cheloid scars are common in black African. Treatment is not adequately codified and chronicity of these cheloid scars is responsible for frequent recurrences., Objective: To assess treatment of cheloid scars for their codification., Material and Methods: This study has been conducted in the dermatology unit. It is a therapeutic and prognostic study over one year. All the patients bearing cheloid scars and who agree to take part in this study were included., Results: Average age was 28 without any sex predominance. The most used treatment was the combination of surgery and corticoid injections in 66% of cases. We had achieved a rate of 94.5% of good results when combining injections, surgery and pressotherapy., Conclusion: Therapeutic method combining injection of corticoid to surgery and to other therapeutic means provide good outcomes. It should be done in accordance with the clinical features of the cheloid scar.

Infection due to Mycobacterium ulcerans or Buruli ulcer usually occurs on the limbs (70%) or trunk (20%). Involvement of the head and neck region is less frequent but can lead to serious sequels. The purpose of this report is to describe 8 patients including 7 children who were treated for Buruli ulcers on the head in the dermatology department of the University Hospital Center in Abidjan, Cote d'Ivoire. Eye lesions and visual impairment were the most frequent sequels.

Histoplasmosis is a deep mycosis whose capsulatum variety is recognized as being an AIDS-defining infection. However AIDS associated with Histoplasma capsulatum var. duboisii is rarely reported. We report a case of cutaneous duboisii histoplasmosis associated with AIDS which has been mistaken for molluscum contagiosum for many months. The diagnosis has been confirmed by means of a biopsy of a nodule followed by an anatomo-pathological examination. The medical treatment was successfully based on combination Triomune (stavudine + lamividine + nevirapine) and itraconazole.

Mycobacterium ulcerans infection (Mu) is an emerging public health problem. The cumulative number of cases in Ivory Coast was 10,382 in 1997. One of the key points of the Yamoussoukro "global initiative" in December 1997 involved detection and treatment of cases at the early-disease stage. The threefold purpose of this transversal study was to determine the frequency of nodular-stage Mu infection, to describe the features of the nodules, and to identify nodular features suitable for early screening use. Of the 93 nodules removed, 58.1% were due to Mu, indicating that the prevalence of nodular-stage Mu in Zoukougbeu, Ivory Coast was 9 per 1000 inhabitants. All Mu nodules were recent, caused pruritus, and displayed oedematous edges. The mean duration of disease was 23 months. In endemic areas, Mu infection should be suspected for any lesion that is of recent onset (< 5 year), shows visible elevation, has a diameter of 3 cm or more, or is mobile under the skin. Cold nodules that are adherent to the superficial skin layer and located on the limbs or firm cold nodules should also be considered as suspect. Excision of cold nodules caused by Mu is recommended. The wound heals within 4 weeks and no recurrences have been reported after 6-month follow-up.

Genital ulcers are common manifestations of infectious disease. The incidence of genital ulcers featuring a chronic course has increased since the beginning of the AIDS epidemic. The purpose of this 18-month cross-sectional study was to determine the main infectious causes of chronic genital ulcers (CGU) and their correlation with HIV infection. A total of 29 patients with CGU defined as an ulcer showing no sign of healing after more than one month were studied. Mean age ranged from 24 to 54 years. The male-to-female sex ratio was 1:5. The etiology was herpes in 19 cases (65.5 p. 100), chancroid in 6 cases (20.6 p. 100), streptococcal infection in 2 cases (6.8 p. 100), Pseudomonas aeruginosa infection in 1 case (3.4 p. 100) and cutaneous amibiasis in 1 case (3.4 p. 100). Twenty-two patients (75.8 p. 100) presented HIV infection including 16 with HIV1 and 6 with HIV1 and HIV2. All patients with herpes were HIV-positive. Eighteen of these patients were in stage C3 of HIV infection. Genital herpes was the main etiology of UGC in patients with HIV infection (p < 0.001). Conversely chancroid was the main etiology in patients without HIV infection (p < 0.05). This finding suggests that herpetic CGU is highly suggestive of AIDS whereas chancroid CGU is not. Although syphilis is widespread in Africa, it was not a cause of CGU in this study. Search for herpes simplex virus or Haemophilus ducreyi in patients with CGU is an important criteria for presumptive diagnosis of AIDS in Africa.

The incidence of cutaneous atypical mycobacterial infections is increasing. Their clinical presentation is variable. The atypical mycobacteria are difficult to culture and thus diagnosis can be difficult to establish. PCR (Polymerase Chain Reaction) and mycolic acid analysis have recently been used for mycobacterial species identification, but are not routinely used. Risk factors for cutaneous atypical mycobacterial infection include (1) immunodepression due to HIV infection, lymphoma, leukemia or immunosuppressive therapy. Immunodepression is responsible for the emergence of cutaneous infections by a large variety of atypical mycobacterial species, particularly in industrialized countries. (2) The natural environment is directly responsible for the emergence of cutaneous infections but a small number of atypical mycobacterial species including M. marinum in Europe and North America, and M. ulcerans in the tropics. (3) The medical environment when sterilization is inadequate is also not uncommonly responsible. Clinical features are rarely specific for mycobacterial species, and thus analysis of factors relevant to treatment is more important than species classification. We describe environmental forms (Buruli ulcer caused by M. ulcerans is endemic in the tropics, and swimming pool granuloma which is the aquatic form of M. marinum infection), opportunist forms caused by various species in immunodepressed hosts and iatrogenic and accidental forms mostly due to M. fortiutum and M. chelonei. We review the literature and update the clinical characteristics and risk factors for these diseases.