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Background: Dermatological manifestations are frequent and often constitute a circumstance of HIV discovery in 70% of cases [1]. They are observed in 83% of patients with AIDS and at an early stage in 75% [2,3,4,5]. The objective of this study was to describe the epidemiological, clinical, therapeutic, and evolutionary aspects of skin manifestations during HIV infection in children. Materials and Methods: We conducted a cross-sectional, multicentric, descriptive study over a period of ten years in two dermatology departments and one pediatric department in Dakar, Senegal. We included all HIV-seropositive children aged 0–15 years with mucosal cutaneous manifestations. A dermatologist and a specialist in the medical care of HIV performed the diagnosis of cutaneous manifestations. Data entry and analysis were performed with the SPSS software, version 9.05. Results: We collected 206 cases of cutaneous manifestations in 454 children followed for HIV infection. The hospital frequency was 45.3%. The children were male in 115 cases (55.83%) and female in 91 cases (44.17%), giving a sex ratio of 1.26. The mean age of the patients was sixty months, with extremes of one month to fourteen years. A mycotic dermatosis origin was noted in 47.37%, ringworm in 22.37%, dermatophytosis in 8.58%, oral candidiasis in 6.58%, seborrheic dermatitis in 6.58%, and perleche in 3.29%. Bacterial skin diseases were represented by furunculosis in 1.97%, and impetigo in 7.24%. Viral dermatoses included molluscum contagiosum in 10.53%, shingles in 9.21%, warts in 9.87%, and chickenpox in 3.95%. As for parasitic dermatoses, scabies was noted in 8.55, followed by larva migrans in 0.66% and cutaneous leishmaniosis in 0.66%. Immuno-allergic dermatoses accounted for 25% and included prurigo in 94.3%, atopic dermatitis in 1.90%, and fixed pigmented erythema in 1.90%. Conclusion: Cutaneous manifestations are a common discovery during HIV infection in children. They are marked by a predominance of infectious dermatoses in sub-Saharan Africa. Key words: skin diseases; HIV; children; Dakar

Background: Previous studies in Africa have shown severity of toxidermia with a risk of mortality and mucosal synechia. Our objective was to study the epidemiological, clinical, etiological and evolutionary aspects of toxidermia in Dakar. Methods: A cross-sectional retrospective study was conducted at the Department of Dermatology of the Hospital Le Dantec from January 2001 to December 2015. She identified all of the toxidermia cases of hospitalization in this department. The diagnosis was based on the French criteria for drug accountability. Results: Two hundred cases of toxidermia were recorded. The hospital frequency was 9.2%. The sex ratio was 0.61. The average age was 33 years. Clinical forms of bullous toxidermia were Stevens Johnson/Lyell in 54% (n = 108), erythema multiforme in 3% (n = 6), and fixed pigmented erythema in 2% (n = 4). Mucosal involvement was noted in 56.5% (n = 113). Visceral involvement was noted in 15% (n = 30) with respiratory involvement in 24 cases of SSJ/NET and 6 cases of DRESS. The drugs identified were antibiotics in 38,7% (n = 53), analgesics in 15,3% (n = 21), anti-comitials in 13,1% (n = 18), antiretrovirals in 11,7% (n= 16), antituberculosis drugs in 9,5%% (n = 13) and medicinal plants in 11,7% (n = 16). The outcome was favorable in 62.5% (n = 125). Death was noted in 12%. Conclusion: Toxidemia in Dakar are characterized by predominance in severe clinical forms in young adults and mortality was related to infectious and hydro electrolyte complications.

Subcutaneous or furunculoid myiasis is an ectoparasitosis caused by the cutaneous or subcutaneous carriage of larvae of various diptera. The causal agent is most often Cordylobia Anthropophaga in tropical areas. We report an observation of multiple subcutaneous myiasis in an infant. The toddler was 2 months old, with no previous history of myiasis and was up to date with vaccinations. He was treated for furunculoid lesions evolving for 5 days. The dermatological examination revealed three inflammatory nodules centred by a whitish orifice without fluid discharge, located on the thorax, the back and the buttocks. The rest of the clinical examination was unremarkable. A maggot was extracted by bi-digital compression of a nodule in the thorax. The diagnosis of furunculoid myiasis was set. The treatment consisted of manual extraction of the maggots and local care. The evolution was favourable after two weeks, labelled by a complete healing of the lesions. Our case is particular because of the occurrence of subcutaneous myiasis in an infant and its misleading clinical presentation simulating multiple furuncles.

Mycetoma is a rare and neglected tropical disease among children. Extrapodal forms, in particular the buttock, are serious because they expose to visceral extension. We are reporting an observation remarkable for its clinical tumor presentation in a child. An 11-year-old boy was admitted at to the dermatology department for a buttock tumor that has been evolving for 2 years. Physical examination showed a multinodular, polyfistulized, and inflammatory tumor emitting red granules located in the buttocks. Mycological examination isolated Actinomadure pelletieri that confirms the diagnosis of actinomicotic mycetoma. The evolution, after a two-year follow-up, was positive under antibiotic therapy combining cotrimoxazol, clavulanic acid amoxicillin and streptomycin. Our observation is specific by the occurrence of a pseudotumoral actinomycotic buttock mycetoma in a child, the diagnostic delay and the favorable evolution without recurrence after a follow-up of 24-month.

Background SCORing for Atopic Dermatitis (SCORAD) is a tool developed by the European Task Force on Atopic Dermatitis (AD) which is used by physicians to assess AD severity during consultations with their patients. Patient‐Oriented SCORAD (PO‐SCORAD) is a self‐assessment tool for use by patients which has been validated in a study performed in European countries. However, there is currently no adapted tool for evaluating AD severity in black skin. Objective To evaluate the performance of the version of the PO‐SCORAD specifically adapted for black skin patients (children and adults) with AD. Methods In this multicenter, cross‐sectional and non‐interventional study, children and adults with AD were recruited during regular consultations. This international study was performed in seven sub‐Saharan countries (Benin, Burkina Faso, Cameroon, Ivory Coast, Gabon, Mali and Senegal). During the consultation, AD severity was assessed by the physician using SCORAD score and by the patients or parents using PO‐SCORAD. Results One hundred and thirteen patients were included, 72 children and 41 adults, mainly females (61.6%). SCORAD assessed by physicians and PO‐SCORAD assessed by patients/parents were well correlated (r = 0.66, P

Introduction: Multiple autoimmune syndrome is rarely described in the African literature. We report 25 cases. Patients and Method: A Retrospective, descriptive study was carried out in the Rheumatology Department of Aristide Le Dantec University Hospital in Dakar from 2013 to September 2019. Patients with at least 3 distinct autoimmune diseases were included. Results: Twenty-five cases of multiple autoimmune syndrome were collected in 23 women and 2 men, with a mean age of 42.4 years (extremes: 24 and 67 years). The mode of discovery of the disease was a connective tissue disease in 19 cases (76%) and an organ-specific autoimmune disease in 6 cases. According to Humbert and Dupond’s classification, 18 patients (72%) had both type 2 and type 3 criteria. An isolated type 2 was noted in 5 cases (20%) and an isolated type 3 in 1 case (4%). One case (4%) was unclassifiable. The evolution under treatment was marked by remission in 84% of cases. Conclusion: Multiple autoimmune syndromes account for 5.66% of the autoimmune diseases in our study. They predominate in young women with a mean age of 42.4 years. Not all entities were classifiable by the Humbert and Dupond’s classification. The evolution under treatment was marked by remission in 84% of cases.

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.

We here report the case of a 42-year-old female patient presenting with alopecia areata that had progressed over the past month. The anamnesis revealed no psychoaffective irritative stimulus or atopy. Clinical examination was normal. The patient weighed 65kg with a BMI of 22kg/m2. Haemoglobin level was 12.5g/dL. Fasting blood glucose was 1.01g/L, TSHus and T4L were normal; 0.23 pmol/L and 13.32 pmol/L, respectively. Anti-nuclear and Anti-electroconvulsive Therapy (ECT) antibodies were negative. The diagnosis of isolated alopecia areata was retained. The patient was treated with intramuscular injections of 80mg of triamcinolone every ten days for 4 sessions (total dose of 320mg). Hair loss treatment topical spray was applied (12 sprays a day). Patients's outcome was marked by a spectacular regrowth of hair assessed at day 30 and day 60.

A 9-year-old girl presented a large inflammatory cup-shaped scalp lesion with alopecia surrounded by pustules, dander, and suppuration associated with an occipital inflammatory lymphadenopathy for 1 month. Wood’s light exam was positive as well as KOH mount showing ectothrix type hair involvement. Hair and pus culture on Sabouraud dextrose agar (SDA) added with chloramphenicol and supplemented with cycloheximide isolated a dermatophyte species identified as Microsporum audouinii according to the colonies features. Species identification was confirmed by matrix-assisted laser desorption-ionization–time of flight mass spectrometry (MALDI–TOF MS) and the patient was treated for kerion celsi with terbinafine tablets 125 mg per day associated with a ketoconazole-based shampoo. The evolution was favorable, with hair regrowth after 2 months.

We here report the case of a 42-year-old female patient presenting with alopecia areata that had progressed over the past month. The anamnesis revealed no psychoaffective irritative stimulus or atopy. Clinical examination was normal. The patient weighed 65kg with a BMI of 22kg/m2. Haemoglobin level was 12.5g/dL. Fasting blood glucose was 1.01g/L, TSHus and T4L were normal; 0.23 pmol/L and 13.32 pmol/L, respectively. Anti-nuclear and Anti-electroconvulsive Therapy (ECT) antibodies were negative. The diagnosis of isolated alopecia areata was retained. The patient was treated with intramuscular injections of 80mg of triamcinolone every ten days for 4 sessions (total dose of 320mg). Hair loss treatment topical spray was applied (12 sprays a day). Patients's outcome was marked by a spectacular regrowth of hair assessed at day 30 and day 60.

Introduction L’importance des manifestations dermatologiques dans le diagnostic des deficits immunitaires primitifs a ete deja rapportee par certaines etudes mais exceptionnellement en Afrique subsaharienne. Le but de cette etude est de decrire les manifestations dermatologiques au cours des deficits immunitaires primitifs sur peau noire. Materiel et methodes Il s’agit d’une etude de cohorte ouverte portant sur des enfants presentant des manifestations dermatologiques suspectes de deficit immunitaire primitif a l’hopital d’Enfant Albert Royer de Dakar. Le diagnostic de deficit immunitaire primitif est basee sur la classification phenotypique de l’union internationale des societes d’immunologistes. Resultats Vingt huit patients ont ete suivi dont 18 filles et 10 garcons. L’âge moyen etait de 7 ans (extreme = 4 mois et 18 ans). L’âge de debut des symptomes etait inferieur a 3 ans dans 17 cas, entre 3 et 10 ans dans 6 cas, superieur a 10 ans dans 5 cas. La medecine traditionnelle etait le premier recours therapeutique dans 26 cas. Les manifestations dermatologiques etaient : condylomes ano-genitaux (n = 9) ; maladie de Kaposi (n = 2), epidermodysplasie verruciforme (n = 2), varicelle maligne (n = 1), molluscum contagiosum tumoral dissemine (n = 1) ; Candidose bucco-oesophagienne (n = 1) ; mycetome fongique cervico-facial (n = 1) ; becegite disseminee (n = 1) ; tuberculose scrofuloderme (n = 1) ; lupus aigu (n = 3) ; vitiligo extensif (n = 1) ; syndrome PAA ou Pyoderma-Acne-Arthrite (n = 1) ; erythrodermie (n = 1) ; acrodermatite enteropathique (n = 2) ; lymphome cutane (n = 1). Les manifestations extradermatologiques etaient : sepsis (n = 4) ; arthrite (n = 4) ; diarrhee (n = 3) ; pneumopathie infectieuse (n = 2) ; pericardite (n = 1) ; calcifications cardiaques (n = 1) ; crises convulsives (n = 1), thyroidite auto-immune (n = 1) ; alteration de l’etat general (n = 7). Cinq cas ont beneficie d’exploration pour le typage immunologique du deficit. Cette exploration a revele : 1 deficit d’expression de la classe CMHII, 1 syndrome d’hyper Ig E, 1 deficit primitif en complement C2 et 2 deficits congenitaux en zinc. Apres 3 ans de suivi regulier de la cohorte, nous avons eu 4 perdus de vue, 3 deces dont 2 par sepsis et 1 par metastase de neoplasie, 1 cas d’aggravation de molluscum contagiosum tumoral et 7 cas de recidive de condylome. Discussion Ces resultats montrent le deficit d’exploration des deficits immunitaires primitifs dans notre contexte d’exercice et la diversite des manifestations dermatologiques revelatrices. Cependant, tous les cas qui beneficie d’un typage immunologique ont ete confirme, suggerant une tres grande sensibilite des manifestations dermatologiques pour le diagnostic des deficits immunitaires primitifs. Ce constat devra etre confirme par d’autres etudes.

The pyoderma gangrenosum (PG) is a chronic ulcerative neutrophilic dermatosis rare in children. It is often associated with chronic inflammatory bowel disease, some systemic diseases and leukemias. We report six cases in children. We collected six cases, the average age was 10 years (4-15 years), the sex ratio was 0.16 (5 boys and 1 girl). The ulcerated clinical form of PG was noted in all children. The topography was in the lower limbs in five cases and in the cephalic extremity in three cases. The mean duration of evolution was 2 years (15 days-7 years). PG was associated with ulcerative colitis in one case. Oral corticosteroids were administered in all cases at a dose of 0.5 to 1 mg/kg. The complete healing of the cutaneous lesions was obtained. Two children were lost to sight. Our study reports a male predominance of PG in children with ulcerative clinical form of the limb and association with ulcerative colitis. Corticosteroids appear to be efficient, but may be limited by their complications.

Resume Introduction Les etiologies des intertrigos chez l’adulte sont multiples et variees. L’objectif de notre travail etait d’etudier les aspects epidemiologiques, cliniques, evolutifs et facteurs de risque des intertrigos chez les adultes. Methodologie Nous avons mene une etude prospective d’une duree de 7 mois dans deux services de dermatologie de Dakar. Ont ete inclus apres consentement tous les adultes presentant un intertrigo consultant durant cette periode. Resultats Nous avons recense 103 patients atteints d’intertrigo, soit une prevalence hospitaliere de 2,54 %. Le sex-ratio etait de 0, 63 et l’âge moyen de 41,9 ans. Les habitudes et modes de vie etaient une depigmentation artificielle dans 26 cas, une activite sportive pratiquee dans 22 cas, le port de vetements synthetiques et le tabagisme respectivement dans 20 cas et dans 22 cas. Des complications infectieuses etaient notees dans 9 cas (8,7 %). Elles etaient de type bacterienne (3,88 %) et virale (1,94 %). Une erythrodermie seche etait notee dans 3 cas (2,9 %). Les etiologies etaient dominees par les mycoses dans 48,5 %, les manifestations immuno-allergiques dans 34,9 %, la maladie de Verneuil et le psoriasis inverse dans chacun 2,9 %. Les femmes representaient 58 % des patients ayant une dermatophytie et 63 % des cas de candidoses. La depigmentation artificielle etait notee dans 35 % des cas de dermatophytie et 45 % des cas de candidoses. Conclusion Les intertrigos chez les adultes sont dominees par les etiologies infectieuses en particulier les mycoses et suivies des affections immuno-allergiques. Il existe des professions a risque et des terrains.

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.

Resume Introduction Au Senegal, les leishmanioses cutanees sont souvent dues a l’espece Leishmania major . L’immunodepression liee a l’infection par le virus de l’immunodeficience humaine (VIH) contribuerait a l’emergence de la leishmaniose chez l’homme et faciliterait l’infection de la peau par des especes a tropisme visceral. Nous rapportons la premiere observation senegalaise de leishmaniose cutanee opportuniste a Leishmania infantum sur un terrain d’infection par le VIH. Observation Un garcon de 5 ans avait depuis deux mois des ulcerations crouteuses du cuir chevelu et de l’avant-bras gauche, ainsi que des adenopathies cervicales et axillaires. L’examen parasitologique des lesions du cuir chevelu, du bras et des liquides de cytoponction ganglionnaire et medullaire mettait en evidence a l’examen direct des formes amastigotes de leishmanies. La technique d’amplification genomique pratiquee sur les substrats cutane, ganglionnaire et medullaire identifiait L. infantum comme l’espece responsable. La serologie retrovirale de l’enfant etait positive pour le VIH1. Le traitement antiretroviral combine a celui de la leishmaniose permettait d’obtenir une amelioration clinique. Discussion La co-infection leishmaniose cutanee a L. infantum et VIH constitue une association complexe de par ses enjeux therapeutiques. Les modalites evolutives, cliniques et biologiques de la co-infection dependent de la restauration de l’immunite ainsi que de l’efficacite, de la tolerance et de la disponibilite des medicaments anti-leishmaniens.

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.

Introduction: The aim of this study was to evaluate the frequency and clinico-anatomical features of facial skin cancers in an African Black population.

Introduction La pseudo-folliculite de la barbe (PFB) est une dermatose inflammatoire chronique, favorisee par le rasage, particulierement frequente chez les hommes de phototype VI, avec un important prejudice esthetique et professionnel. Malgre sa frequence, il existe tres peu d’etudes qui lui soit consacrees, a travers le monde et particulierement en Afrique sub-Saharienne. Notre objectif etait de determiner les aspects epidemiologiques et cliniques, ainsi que les facteurs de risque associes a la survenue de la PFB. Materiel et methodes Il s’agissait d’une etude prospective, longitudinale et descriptive a visee analytique, portant sur 655 eleves policiers, de phototype VI, consentants, de l’ecole nationale de police de Dakar. Le diagnostic de PFB etait clinique. L’exploitation des donnees a ete realisee a l’aide du logiciel Epi-info version 6.0 avec un test de Chi2 au seuil de significativite de 5 % et un odd-ratio > 2. Resultats Sur les 655 eleves policiers, 254 presentaient une PFB, soit une prevalence de 38,8 %. Il s’agissait de 242 hommes et 12 femmes (sex-ratio de 20,2), d’âge moyen de 26,80 ans (± 2,59) avec des extremes allant de 22 a 36 ans. L’âge de debut de la PFB se situait en majorite entre 18 et 20 ans (39,8 %) avec un âge moyen de debut de 22,2 ans (± 3,6). Les manifestations cliniques etaient le plus souvent a type de papulo-pustules (60,2 %). Des signes de penetration trans-epidermique etaient observes chez 27,9 % des patients. Le prurit etait present chez 66,1 % des cas. Les lesions se localisaient le plus souvent au niveau de la region sous-mandibulaire (69,8 %), la region mandibulaire (49,6 %) et la face anterieure du cou (44 %). Des complications etaient notees chez 90,1 % des cas a type d’hyperpigmentation post-inflammatoire (87 %) et de lesions cheloidiennes (3,1 %) et un retentissement psychologique chez 91 % des cas. L’existence de cas familiaux de PFB (p Discussion Il s’agit de la premiere etude realisee en Afrique sur la PFB. Elle revele une frequence elevee de la PFB chez les noirs africains. Une anomalie genetique revelee par le rasage doit etre evoquee dans la survenue de la PFB. D’autres etudes sur le plan genetique et immuno-histochimique seraient souhaitables.

The authors report the case of a 22-year-old man referred seven months after the onset of papulo-nodular skin lesions, lymphadenopathy, splenomegaly and hepatomegaly. Mycologic and histologic examination of skin lesions enabled the diagnosis of African histoplasmosis, by Histoplasma capsulatum var duboisii. The lymph nodes were caseous. The culture in Lowenstein-Jensen medium was negative.

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.

There is a lack of data on endemic Kaposi's sarcoma in sub-Saharan Africa. The goal of this study was to clarify its epidemiological, clinical and therapeutic aspects in that region.A 7-years retrospective study, including all patients with endemic Kaposi's disease diagnosis was carried out.We identified 29 cases of endemic Kaposi's representing 1.2% of total hospitalizations and an incidence of 4.4. The mean age and the sex ratio were 63.2 years 2.22 respectively. The average delayed time to seek for medical care was 6.75 months. Cutaneous manifestations were dominated by angiomatous papulonodular lesions in 15 cases (51.72%) ulcerated lesions in 8 cases (27.58%), lymphedema in 5 cases (17.24%), a sarcomatous degeneration in 2 cases and verrucous papules in one case. Mucosal involvement was observed in 7 cases (24.13%). The extracutaneous lesions were noted in 18 cases, with 6 cases of bone, 5 cases of lymph nodes, 5 cases of gastrointestinal and 2 cases of lung involvement. The outcome was favorable for single-agent chemotherapy with bleomycin in more than half of the cases. Recurrences were observed in 2 patients, 2 cases were died and 7 cases never came back.Endemic Kaposi's disease is more frequent in elderly people with a higher frequency of extracutaneous involvement and florid forms.En Afrique sub-saharienne il existe peu de données concernant la maladie de kaposi endémique. L'objectif de ce travail, était de préciser ses aspects épidémiologiques, cliniques et thérapeutiques.Une étude rétrospective d'une durée de 7 ans, recensant tous les malades présentant une maladie de kaposi endémique.Nous avions recensé 29 cas de maladie de kaposi endémique représentant 1,2% des hospitalisés soit une fréquence annuelle de 4,14 cas par an. La moyenne d'âge était de 63,2 ans et le sex-ratio de 2,22. Le délai moyen de consultation était de 6.75 mois. Les manifestations cutanées étaient dominées par les lésions papulo-nodulaires angiomateuses dans 15 cas (51,72%), de lésions ulcérées dans 8 cas (27,58 %), d'un lymphœdème dans 5 cas (17,24%), une dégénérescence sarcomateuse sans 2 cas et des papules verruqueuses dans un cas. Les localisations muqueuses étaient notées dans 7 cas (24,13%). Les atteintes extracutanées notées dans 18 cas, étaient osseuses dans 6 cas, ganglionnaires dans 5 cas, digestives dans 5 cas et pulmonaires dans 2 cas. L'évolution était favorable sous monochimiothérapie à la bléomycine dans plus de la moitié des cas. Les récidives étaient observées chez 2 malades, des perdus de vus dans 7cas et 2 cas de décès.La maladie de kaposi endémique prédomine chez les personnes âgées avec une fréquence élevée des atteintes extracutanées et des formes florides.

Our aims were to study the epidemiological, clinical, and parasitological aspects of cutaneous leishmaniasis in the dermatology department of the Aristide Le Dantec hospital. This retrospective study reviewed records of cases treated over a 4-year period (from April 2010 through April 2014) at the HALD Dermatology department. The study included all patients with cutaneous leishmaniasis during the study period. The diagnostic criteria were clinical, parasitological, and histological. The study included 38 patients, corresponding to 9.5 cases per year. Patients' average age was 25 years (4-65 years) and the sex ratio was 1.6. The mean time from symptom outset to consultation was 3.2 months. The disease was located in limbs in 23 cases (63.8%), the face in 6 cases (16.6%), and disseminated in 9 (19.6%). The clinical presentation was ulcerated and crusted in 17 patients (44.7%), sporotrichoid in 13 (28.9%), pseudo-lepromatous in 4 (10.5%), and lupoid in 3 cases (7.9 %). It included warts, mucosa, and tropical sores (Aleppo boils) in all cases. We observed 3 cases associated with HIV; one had a pseudo-lepromatous presentation and resulted from immune restoration syndrome, while two patients had clinical forms of associations: ulcerative and crusted lesions associated with mucosal leishmaniasis in a 55-year-old patient, and cutaneous ulcerative, lupoid, and crusted multifocal (cutaneous, medullary, and lymph nodes) lesions in a 4-year-old infected with Leishmania infantum. Crusted ulcerative cutaneous leishmaniasis is the predominant form of cutaneous leishmaniasis. Infection with HIV can be an important factor in clinical and parasitological atypia.

International audience; Buruli ulcer is a necrotizing skin disease caused by Mycobacterium ulcerans and is usually associated with tropical climates and exposure to slow-moving or stagnant water. We report a case of Buruli ulcer that may have originated in an urban semiarid area of Senegal.

Resume Les mycetomes sont des pseudotumeurs inflammatoires de la peau, des tissus sous-cutanes et eventuellement des os, d’evolution chronique. Nous rapportons l’observation d’une cultivatrice de 40 ans, originaire du Nord du Senegal qui presentait une tumeur ulcero-bourgeonnante laissant soudre des grains rouges, siegeant au niveau dorsolombaire. L’aspect clinique des lesions faisait evoquer en premier une tumeur maligne des parties molles. La confirmation du mycetome reposait sur l’histopathologie cutanee et la mise en evidence d’Actinomadura pelletieri a la culture. La tomodensitometrie dorsolombaire ne montrait pas de signes de compression medullaire. L’evolution etait favorable sous triple therapie associant cotrimoxazole, amoxicilline-acide clavulanique et streptomycine pendant 12 mois.

Introduction Les IST constituent des cofacteurs de l’infection a VIH. Leur prise en charge adequate permet de reduire le risque de transmission du VIH. L’objectif de notre etude etait de determiner la frequence hospitaliere des signes ou syndromes d’IST chez les personnes infectees par le VIH et de decrire les aspects therapeutiques. Materiel et methodes Il s’agissait d’une etude transversale descriptive, avec un recueil retrospectif et prospectif des donnees, menee sur une periode de 5 ans (du 1er janvier 2009 au 31 decembre 2013) dans 4 sites de suivi de PVVIH a Dakar. Les signes cliniques a l’examen initial des patients et les premieres examens bacterio-virologiques etaient pris en compte dans notre etude. Les donnees etaient recueillies sur Excel et analysees grâce au logiciel IBM SPSS Statistics 20. Resultats Nous avons recense 703 personnes infectees par le VIH dont 96 avec des signes d’IST, soit une frequence hospitaliere de 13,65 %. Le sex-ratio etait de 0,46 et l’âge moyen de 40 ans ± 11 ans avec des extremes de 16 et 73 ans. Il existait des antecedents d’IST dans 5,4 % (n = 38) des cas. Les ulcerations genitales etaient trouvees dans 52 % (n = 50) des cas, les leucorrhees dans 59 % (n = 57), les condylomes dans 19,8 % (n = 19) et les douleurs pelviennes chroniques dans 43 % (n = 42). Aucun cas d’ecoulement uretral n’a ete trouve. Ces manifestations etaient associees dans 60,4 % des cas (n = 58). Le prelevement vaginal, effectue dans 31,5 % (n = 18), isolait un germe dans 61 % (n = 11). Les germes responsables d’IST trouves etaient les suivantes : Chlamydia trachomatis (n = 5), Mycoplasma genitalium (n = 4), Trichomonas vaginalis (n = 1). La serologie syphilitique, effectuee chez 387 patients, etait positive chez 2,5 % (n = 10). Une positivite de l’Ag HBs etait notee chez 7,53 % (n = 33) des 438 patients chez lesquels cet examen etait effectue. Les recommandations nationales sur la prise en charge syndromique d’une ulceration genitale, des leucorrhees et des douleurs pelviennes etaient respectivement adoptees dans 4 % (n = 2), 6,9 % (n = 3) et aucun cas. Une guerison, apres traitement syndromique, etait notee dans 81,1 % (n = 73). Conclusion La frequence des signes d’IST est elevee chez les personnes infectees par le VIH. Malgre le faible taux de recherche microbiologique, les recommandations nationales sur la prise en charge syndromique des IST sont rarement respectees.

Introduction: Studies on erythroderma in adults are rare. The aim of this study is to specify the epidemiological and etiological characteristics of acquired erythroderma in adults in Dakar.Patients and Methodology: This was a retrospective study based on the records of patients aged over 16 years admitted for erythroderma in the Department of Dermatology of Dakar University Hospital over a period of 10 years.Results and Discussion: We collected 180 cases of adult’s erythroderma corresponding to a hospital prevalence of 18 cases /year. Erythroderma represented 0.2% of all medical visits and 4.22% of admissions in our department. The mean age of patients was 45 years with a sex-ratio of 1:54. Erythroderma was in the majority, secondary to a complication of preexisting dermatoses, with eczema leading the list. The main factors leading to the exacerbation resulting in erythroderma were HIV infection and the intake of an inappropriate drug, mostly traditional plants.Conclusion: Erythroderma is a particularly frequent condition in our regions, where it is mostly caused by the exacerbation of prexisting dermatoses, often due to unsuitable treatments, such as medicinal plants.

We report a case of a 28-year-old man with xanthomas over the extensors of the limbs, cataract, chronic diarrhea and various neurological disabilities. There was also an ichthyosis, which predominate over the lower limbs. Chest CTscan showed bilateral apical opacities with cystic images in the culmen. Brain MRI revealed bilateral and symmetric T2 and FLAIR hyper-signals sequences in the region of dentate nucleus and adjacent cerebellar and periventricular white matter. We have reported the first case of CTX in Senegal, which is remarkable by an acquired ichthyosis and excavated lung lesions simulating a tuberculosis.

Introduction: The nevirapine is the most widely accused drug in toxidermias in patients living with HIV. It is responsible for toxic epidermal necrolysis called Lyell syndrome or Stevens Johnson syndrome, severe during pregnancy. We report five cases in pregnant women who are HIV-positive. Case reports: Five pregnant women aged 35 years on average with a mean gestational age of 29.6 weeks of amenorrhea were HIV1-positive.The mean CD4 count was 416/mm3. They had severe toxidermia such as Lyell syndrome or Stevens Johnson syndrome. These toxidermias appeared on average 26 days after taking antiretroviral triple therapy including nevirapine as part of the prevention of mother-to-child transmission of HIV (PMTCT). The outcome was favorable after discontinuation of antiretrovirals. Nevirapine was substituted with lopinavir/ritonavir. Newborns had received antiretroviral prophylaxis and were not infected with HIV. Conclusion: The nevirapine toxidermia is common during antiretroviral therapy. These toxidermia are severe during pregnancy related to maternal and fetal vital risks. The replacement of nevirapine with an anti-protease is a therapeutic alternative in our resource-limited countries.

Introduction: The aim of this study was to determine the epidemiological and drug etiology of the toxic epidermal necrosis (TEN) or Lyell’s syndrome in our Department.Patients and Methodology: Medical records of all admitted patients for TEN over an eleven-year period were analysed retrospectively.Findings: We collected 251 cases of drug-induced skin reactions, representing 0.3% of medical visits and 0.7% of admissions. On average, 5 patients suffering from TEN were hospitalized every year. They mostly consisted of young women with a mean age of 35 ± 19.71 years and a sex-ratio of 0.5. About half of patients have been evacuated by road from the various provinces of the country, sometimes over 500 km away. The culprit drug was prescribed by a nurse of an infirmary in 35% of the cases. A self-medication with a drug bought in the street or in a pharmacy was found in 24 patients (40%). There was poly-medication in 17 patients (28%). The inducing drugs were mostly sulphonamides, neuroleptics, paracetamol, allopurinol and NSAI. An oral phytotherapy (Momordica charantia and Guiera senegalensis) induced the TEN in 2 patients. Death occurred in 18 patients (30%).Discussion: Lyell syndrome is still frequent in sub-Saharan Africa where its prevalence even seems to be increased. Its incidence is probably favorised by self-medication especially with street medicines, unregulated access to drugs, inappropriate prescriptions, the circulation of counterfeit medicines, as well as the high prevalence of HIV. The remoteness of patients from dermatological department and the lack of sanitary evacuation systems explain its still poor prognosis in our regions.

The occurrence of Pyoderma gangrenosum (PG) during pregnancy or postpartum has rarely been reported. These forms can also occur on a recent scar facilitated by the pathergy phenomenon. A 25-year-old woman showed an abruptly worsening of a post-caesarean wound that evolved rapidly into a painful, purulent, extensive ulcer with breakdown of sutures, along with fever and leukocytosis despite antibiotic therapy. The diagnosis of postoperative PG was evoked on the unusual course of the surgical wound, the existence of old cribriform scars on the legs, the clinical appearance of the ulceration around the surgical incision and confirmed by histology, as well as the favourable outcome under systemic corticosteroid. This case raises once again the issue of the possible relationship between pregnancy and PG. In our case, pregnancy could have triggered the PG, and the Caesarean section facilitated its clinical expression by the pathergy phenomenon. Thus, pregnancy could be in the same way as chronic inflammatory diseases, such as arthritis, inflammatory bowel disease and haematological disorders, a triggering or exacerbating factor of PG.

Introduction Les metastases cutanees des adenocarcinomes rectaux sont rares et se traduisent le plus souvent sous forme de nodules sous-cutanes de siege abdominal. Les localisations perineales ont ete tres exceptionnellement observees. Nous rapportons l’observation de metastases perineales revelatrices d’un adenocarcinome rectal, particulieres par leur presentation a type de maladie de Crohn cutanee. Observation Un homme âge de 47 ans, aux antecedents de constipation chronique, etait hospitalise pour des lesions ulcerees et papulo-nodulaires de la region ano-perineale evoluant depuis 1 mois. L’examen clinique montrait des ulcerations en coup de couteau, un lymphoedeme scrotal et des nodules fermes non inflammatoires de la region perineale et des poly adenopathies inguinales d’allure tumorale. Le toucher rectal notait une induration des parois du canal anal. L’examen histopathologique d’un nodule cutane etait en faveur d’un adenocarcinome papillaire. La coloscopie montrait une tumeur du canal anal. L’examen anatomopathologique de la biopsie de la tumeur rectale montrait un adenocarcinome moyennement differencie. Le scanner thoraco-abdomino-pelvien objectivait des adenopathies inguinales bilaterales et de multiples nodules pulmonaires. Une chimiotherapie palliative selon le protocole (Xeloda + Oxaliplatine) etait proposee. L’evolution etait fatale 2 semaines apres la premiere cure de chimiotherapie. Conclusion Les metastases perineales d’adenocarcinomes rectaux peuvent etre la presentation initiale de ces tumeurs. En plus, la presentation clinique peut simuler a tout point de vue une maladie de Crohn cutanee.

Introduction L’ichtyose hereditaire est une genodermatose rare dont l’incidence est estimee a 13,4 cas/millions d’habitants. En Afrique subsaharienne son incidence est peu connue et elle pose des problemes psycho-sociaux majeurs a l’origine de stigmatisation. L’objectif de notre travail etait d’etudier les aspects epidemiologiques, cliniques et evolutifs de l’ichtyose a Dakar. Materiel et methodes Une etude retrospective allant du 1 er janvier 2004 au 1 er janvier 2014 etait effectuee au service de Dermatologie de l’hopital Aristide Le Dantec. Tous les malades hospitalises ou suivis en ambulatoire pour une ichtyose hereditaire etaient inclus. Le diagnostic d’ichtyose etait retenu sur l’aspect clinique des le-sions, les donnees de l’interrogatoire, le mode de survenue et la notion de consanguinite. Resultats Nous avons colliges 38 cas d’ichtyoses hereditaires soit une frequence hospitaliere de 0,12%. L’âge moyen etait de 7 ans [3jours-26ans]. Le sex-ratio etait de 0,58.Une consanguinite parentale etait notee dans tous les cas. Une origine geographique en milieu rural defavorise etait notee chez 30 cas. Le delai moyen de consultation etait de 7 ans. Les formes cliniques observees etaient l’erythrodermie ichtyosiforme congenitale seche dans 18cas, l’ichtyose lamellaire dans 10cas, l’ichtyose vulgaire dans 6cas et les bebes collodions dans 4cas. L’evolution etait favorable sous emollients et keratolytiques avec un delai de suivi de 6mois. Conclusion Notre etude montre une rarete de l’ichtyose a Dakar avec une nette predominance feminine. Le retard de consultation etait lie a l’origine geographique rurale qui temoigne de l’inaccessibilite a des soins specialises. L’erythrodermie ichtyosiforme congenitale seche etait la forme clinique la plus frequente. Les ressources limitees des malades pourraient expliquer le nombre eleve de perdu de vue et l’inaccessibilite des retinoides oraux dans la prise en charge therapeutique.

Introduction L’histoplasmose africaine est une mycose profonde le plus souvent cutanee, osseuse et ganglionnaire posant souvent des problemes therapeutiques. Nous en rapportons un cas multifocal avec atteinte cutanee et survenant sur chez un garcon de 22 ans sans immunodepression prouvee. Observations SS âge de 22 ans, originaire du Senegal oriental, etait refere, apres 7 mois d’evolution de lesions papulo-nodulaires sous cutanees asymptomatiques, disseminees. A l’admission en juillet 2014, l’etat general etait conserve. On notait des lesions cutanees polymorphes faites de nodules sous cutanes dissemines atteignant le cuir chevelu, de papulo-nodules ombiliques et de nodules bourgeonnants, charnus siegeant au visage et a la face anterieure du thorax. Il existait des adenopathies sous mandibulaires, axillaires, inguinales non inflammatoires et une splenomegalie type III selon Hackett. Les examens des appareils pleuro-pulmonaire et locomoteurs etaient normaux. La mycologie des lesions cutanees et ganglionnaires avait mise en evidence des levures d’Histoplasma capsulatum var duboisii. Le liquide ganglionnaire etait caseeux avec absence de BAAR a la culture. Les serologies VIH1, 2 et HTLV etaient negatives. Une amelioration partielle etait notee sous d’Itraconazole 400 mg/jour suivie d’une aggravation secondaire des lesions cutanees. Certaines devenaient tumorales ulcero bourgeonnantes avec envahissement osseux. Le patient rehospitalise en Fevrier 2015, un traitement par Amphotericine B a raison de 0,5mg/kg/j puis 1mg/kg/j par voie intraveineuse fut entrepris mais de facon irreguliere suite a un epuisement financier. Le patient est decede dans un tableau de septicemie.

Introduction Les facteurs etiopathogeniques du lichen plan sont infectieux, psychologiques et auto-immuns. Une association a un diabete a ete recemment rapportee. L’objectif de notre etude etait de determiner les caracteristiques epidemio-cliniques et les facteurs associes du lichen plan a Dakar. Materiel et methodes Il s’agit d’une etude multicentrique et prospective, effectuee du 07 mars au 07 septembre 2016. L’histopathologie n’etait effectuee que pour les formes atypiques. Tous les patients ayant consulte pour un lichen plan etaient inclus. Les patients avec notion de prise medicamenteuse avant l’eruption etaient exclus. La recherche d’anticorps anti-HVC etait systematique lorsqu’existaient des atteintes muqueuses. Les donnees etaient analysees par SPSS IBM 20. Resultats L’âge moyen etait de 38 ans (4 ans, 77 ans) ; le genre feminin representait 84,6 % (n = 66) des cas. Les patients âges de 20 a 59 ans constituaient 75,6 % des cas. Ils etaient maries dans 61,5 % des cas. Une obesite ou un surpoids etait note dans 41 %. Un conflit conjugal ou relationnel etait present dans 25,6 %. Des antecedents de lichen plan etaient rapportes dans 24,4 % (n = 19) des cas, et un cas similaire dans la famille etait trouve dans 14 %. Un prurit etait present dans 96,2 %. Les localisations etaient : cutanees (97,4 %), muqueuses (15,4 %) et phaneriennes (5,1 %). L’atteinte muqueuse n’etait isolee que dans un cas, et il n’y avait pas d’atteinte ungueale. Les lesions etaient profuses dans 56,4 % des cas. Les formes cliniques etaient : typiques (52,6 %), erythemato-squameuses (17 %), verruqueuses (14,5 %), pigmentogenes (14,5 %) et blaschkolineaire (1 cas). L’histopathologie avait confirme le lichen dans 91,4 %. La glycemie etait elevee dans un cas, parmi les 71 patients chez qui elle a ete realisee. La recherche de l’Ag HBs etait effectuee dans 84,6 % des cas, et etait positive dans 3,03 %. Les anticorps anti-HVC et anti-HIV etaient negatifs respectivement chez 24 et 30 des patients qui les avaient effectues. Conclusion Le lichen plan atteint principalement la jeune femme adulte mariee. Une obesite ou un surpoids sont souvent associes. Le seul facteur associe trouve est un conflit psychoaffectif. Les serologies HIV et des hepatites virales B et C ne doivent etre systematiquement effectuees. L’association a un diabete n’est pas confirmee.

Introduction les necroses digitales posent en regle les difficultes de leur diagnostic etiologique. Peu d’etudes ont ete realisees dans nos regions. L’objectif de notre etude etait de determiner les aspects etiologiques et evolutifs des necroses digitales. Patients et methodes Il s’agissait d’une etude retrospective d’une duree de 7 ans (janvier 2008 a mai 2014). Le diagnostic reposait sur la clinique, l’histologie, l’immunologie et l’imagerie. Resultats Nous avions collige 17 dossiers de patients dont 6 hommes et 11 femmes soit un sex-ratio de 0,35. L’âge moyen etait de 41,5 (extremes de 24 et 71 ans). Les necroses interessaient les membres superieurs dans 6 cas et les membres inferieurs dans 4 cas. L’atteinte touchait a la fois les membres superieurs et inferieurs dans 7 cas. Les signes cliniques associes etaient domines par le syndrome de raynaud et les polyarthralgies inflammatoires. A la biologie, le syndrome inflammatoire etait quasi-constant. Le bilan immunologique realise chez 15 patients etait contributif au diagnostic dans 13 cas. L’echo-doppler arteriel de 10 patients objectivait un epaississement parietal dans 4 cas, une thrombose dans 3 cas. L’histologie etait realisee chez deux patients. Les diagnostics etaient les suivant : sclerodermie (n : 5), SAPL (n : 3), syndrome de chevauchement (lupus, sclerodermie dans le premier cas ; lupus sclerodermie et syndrome de Sjogren dans le deuxieme cas) (n : 2), vascularites systemiques (n : 6) : a ANCA (n : 1) ; secondaires (n : 3) et indeterminees (n : 2), Leo-Buerger (n : 1), Le traitement medical etait instaure chez tous les patients. Un traitement chirurgical etait effectue chez 14 patients. Des complications immediates ont ete retrouvees chez 2 patients. Un cas de deces etait note et une recidive necrose ischemique dans 2 cas. Conclusion Dans notre serie les etiologies etaient dominees par les maladies auto-immunes systemiques. Le retard diagnostique et therapeutique pourrait mettre en jeu le pronostic vital d’ou l’interet d’une prise en charge medico-chirurgicale rapide.