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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.

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.

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.

Although the foot remains the main localization of mycetomas, extrapodal attacks, which are rarely studied, are also possible and occur either initially or following an extension. The objectives were to describe the epidemiological, clinical and etiological features of extrapodal mycetomas in Senegal.Cross-sectional and retrospective study with multicentric enrollment in four reference department, two of which are in dermatology and two in orthopedics and traumatology. We included the files of patients with extrapodal mycetoma followed from January 2000 to December 2020. The data were analysed with SPSS software. Any p less than or equal to 0.05 was statistically significant.We collected 82 cases representing 39% of mycetoma cases (n = 210). The average age was 41.9. The sex ratio was 3.1. Professionally, most patients were active farmers in 51% of cases (n = 33), pastoralists and housewives in 9 % (n = 6) respectively. The mean duration of evolution was 7.5 years. Exclusively extrapodal topographies were noted in 84% of cases (n = 69). Foot and extrapodal locations were concomitant in 16% of cases (n = 13). Mycetoma foci were distributed as follows: 59 in the trunk, 47 in the lower limbs, 9 in the upper limbs, 1 in the scalp and 1 in the neck. The etiology was actinomycotic in 46% of cases (n = 38), fungal in 38% (n = 31). It was not specified in 16% of cases (n = 13). Bone involvement occurs after 5 years (p = 0.001) unrelated to the etiology (p = 0.6).Extrapodal mycetomas are secondary to direct inoculation. However, extension to bone is exclusively due to diagnostic delay. Periodic consultations in endemic areas combined with training of resident health personnel are necessary for early diagnosis in order to improve the prognosis.

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.

Introduction La gale est une maladie tropicale negligee (MTN) qui touche entre 150 a 200 millions de personnes au monde. Nos objectifs etaient d’evaluer l’impact de la gale sur la qualite de vie (QDV) et d’evaluer le retentissement psychologique, social, professionnel et scolaire de la gale chez des patients consultant dans des services de dermatologie a Dakar. Materiel et methodes Il s’agit d’une etude longitudinale multicentrique prospective qui a ete menee du 18 aout au 19 decembre 2020, aux services de Dermatologie-Venereologie de l’Institut d’Hygiene Sociale, du Centre Hospitalier National Aristide Le Dantec, et du Centre Hospitalier National d’Enfant Albert Royer. Le diagnostic de gale etait retnu sur les criteres de l’IACS (International Alliance for the Control of Scabies) 2020. Les questionnaires Dermatology Life Quality Index (DLQI) et Child Dermatology Life Quality Index (CDLQI) etaient utilises. La saisie et l’analyse des donnees etaient effectuees grâce aux logiciels “IBM SPSS Statistics” version 26. Les tests du Khi 2 ou de Fischer etaient utilises dans leurs conditions d’applicabilite(p Resultats Nous avons inclus 104 patients atteints de gale âges de 2 mois a 80 ans (60 adultes et 26 enfants). Le sex-ratio etait de 0,8. Les troubles du sommeil etaient presents chez 81,3 % des patients. Le score moyen du CDLQI etait de 7,8 ± 3,49 (7–15). Le score moyen du DLQI etait de 8,1 ± 4,75 (6 et 16). Plus de la moitie des adultes avaient un effet modere a important sur la QDV. Le retentissement psychologique concernait aussi bien les enfants que les adultes (sentiments de tristesse chez 84,6 % des enfants et de gene et d’embarras chez 70 % des adultes). Chez les enfants, le retentissement concernait aussi la qualite du sommeil (80,8 %), et les activites de loisirs (53,8 %). Les femmes avaient un retentissement plus important que les hommes sur les relations sociales (60,5 % vs 18,2 %), les habitudes vestimentaires (57,9 % vs 18,2 %) et les activites quotidiennes (57,9 % vs 36,4 %) et de loisirs (52,6 % vs 45,5 %). Le retentissement sur les activites scolaires et professionnelles concernait plus les hommes que les femmes (54,5 % vs 29 %). Des liens statistiquement significatifs ont ete trouves entre la severite du score DLQI et le revenu mensuel moyen (p = 0,03), les troubles du sommeil (p = 0,002) et la depigmentation cosmetique volontaire (p = 0,04). La presence de consultations prealables etait significativement associee a la severite des scores CDLQI et DLQI (p = 0,04). Discussion Les troubles du sommeil etaient presents chez la grande majorite des patients. Le score moyen du CDLQI montrait que la moitie des patients avaient un effet modere a important sur la QDV. Plus des 2/3 des adultes avaient un score moyen du DLQI qui correspondait a un effet modere a important sur la QDV.

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.

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.

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.

Use of medicinal plants is common and widespread throughout Africa, including in Senegal. Because efficacy has been demonstrated, public policies have been instituted that have allowed plant-based therapies to have an important role in general primary care. However, little is known about the cutaneous safety of many plant-based therapies. In this 6-month prospective study all cases of dermatitis induced or aggravated by exclusive use of medicinal plants were evaluated via skin allergy testing. The results were classified and compared with the available literature. Forty-three cases of plant-therapy-associated cutaneous reactions were identified, including worsening of existing conditions (56%), recurrence of a previously resolved condition (16%) and new dermatitis arising spontaneously (28%). In the cases where the condition was new, generalized exfoliative dermatitis occurred in 42% of cases with an average time of onset of 9 days. Specific plants were identified in 65% of cases and included 18 varieties. The frequency and severity of plant-induced cutaneous reactions should be the basis for the creation of a phytovigilance programme and re-evaluation of how traditional medicine is used in the general population. When irritation occurs, identification of the responsible plant and allergy testing should be the first steps towards relieving symptoms.

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 La dermatite seborrheique (DS) est une dermatose chronique et recidivante. En Afrique, les etudes sur la DS sont tres rares. L’objectif de notre etude etait de determiner le profil epidemio-clinique et les facteurs associes a la DS chez les adultes a Dakar. Materiel et methodes Il s’agissait d’une etude transversale a visee analytique avec un recueil prospectif des donnees. Elle etait effectuee du 1er avril au 30 septembre 2018 dans les services de dermatologie des hopitaux IHS et Aristide Le Dantec, et a la consultation dermatologique de l’hopital FANN. Etait inclus, les patients âges d’au moins 18 ans. Le diagnostic etait clinique. Les variables etaient analyses grâce au logiciel Epi-info 7. Resultats Nous avions collige 111 patients, soit une frequence hospitaliere de 1,61 %. L’âge moyen etait de 33 ans et le sex-ratio de 0,2. Les celibataires representaient 54 % et les maries 42 % des cas. Les patients etaient eleves ou etudiants dans 32 % des cas, femmes au foyer dans 28 %. Il existait un stress dans 40,54 % des cas, une maladie de systeme dans 23,42 % et une atopie dans 21,62 %. La depigmentation volontaire etait notee chez 10,7 % des patientes. Le prurit etait absent chez 53 %. Des squames etaient trouvees dans 88 % (n = 98) des cas. La topographie au cuir chevelu etait trouvee dans 83,78 % des cas et elle etait isolee dans 52 %. La localisation faciale etait notee dans 47 %, et elle etait isolee dans 15 %. Une acne etait notee dans 14,4 %. La serologie VIH etait negative chez 97 % (n = 108) des patients qui l’avaient effectuee. Il existait une relation statistiquement significative entre la localisation au cuir chevelu et des facteurs comme le stress (p = 0,034), le genre feminin (p = 0,023), le statut de marie (p = 0,021) et l’existence d’une maladie de systeme (p = 0,048). La localisation faciale etait liee au genre masculin (p = 0,0204). Conclusion La DS est relativement frequente chez l’adulte, en dermatologie, a Dakar. Elle survient essentiellement chez la femme. Les facteurs associes a cette dermatose seraient l’etat psychosocial, l’atopie et les maladies de systeme.

Introduction:In Africa, an increase in the incidence of lupus erythematosus has been noted in recent years. Very few studies have been conducted on epidemiological and clinical aspects of this disease in sub-Saharan Africa. The purpose of this study was to report the epidemiological, clinical and evolutionary aspects of lupus disease in an African Black population. Materials and methods: This was a retrospective cross-sectional study including all cases of lupus seen in two departments of Dermatology in Dakar from 1999 to 2015. Results: Three hundred and forty cases were recorded, corresponding to a hospital frequency of 0.05%. The average age was 33 years. The sex ratio was 0.17. The various manifestations were: dermatological (89.4%), rheumatological (33.2%), cardiac (5.8%), renal (12%), respiratory (5.6%), neuropsychiatric (4.7%), digestive (2.6%), hematological (70%) and immunological (56.2%). Lupus was associated with antiphospholipid antibody syndrome (35%), dermatomyositis (26.3%), rheumatoid arthritis (17.5%) and scleroderma (21%). Patients were treated with corticosteroids (92%), immunosuppressive (12%) and synthetic antimalarial drugs (88.2%). A remission was noted in 80%. The complications were an infection (20.5%) and the occurrence of squamous cell carcinoma (0.8%). Death occurred in 2.6%. Conclusion: Lupus erythematosus is a frequent condition in our regions and represents the first connective tissue disease in our department. Systemic lupus erythematosus is by far the most frequent form, followed by chronic lupus, while subacute lupus seems very rare. The disease is often severe with frequent visceral involvements. The prognosis is still poor in our regions due to the delayed diagnosis with frequent renal involvement and frequent infectious complications.

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.

Le syndrome de Stevens-Johnson (SSJ) et le syndrome de Lyell (SL), ou necro-epidermolyse toxique, representent des reactions cutanees d’hypersensibilite rares, habituellement d’origine medicamenteuse, potentiellement mortelles.L’objectif de cette etude etait de decrire les aspects epidemiologiques, etiologiques, cliniques et therapeutiques du spectre SSJ-SL au Senegal.Les dossiers de patients atteints de SSJ, de SL et du syndrome de chevauchement (SC), hospitalises dans le Service de Dermatologie du CHU Aristide Le Dantec de Dakar, entre janvier 2001 et decembre 2006, ont ete etudies. Les dossiers de 72 patients (32 hommes et 40 femmes), âges de 6 a 78 ans, ont ete colliges. L’etiologie etait medicamenteuse dans 68,1 % des cas; les antibiotiques representaient 34,3 % des medicaments incrimines.Dans 89,5 % des cas, les premieres manifestations etaient apparues entre 1 et 15 jours apres la prise medicamenteuse et, dans 62 % des cas, les manifestations buccales etaient predominantes. Au total, les lesions buccales sont observees dans 93,1 % des cas; il s’agit le plus souvent d’ulcerations touchant surtout la demi-muqueuse labiale (respectivement dans 97 % et 61,2 % de ces cas).Les atteintes buccales au cours du spectre SSJ-SL etaient frequentes et severes. Leur caractere souvent inaugural devrait permettre un diagnostic precoce de la maladie.

Although Behçet's disease is well-documented in Eastern populations, epidemiologic data in Sub-Saharan African population is scarce. The aim of this study was to define the epidemiologic and therapeutic aspects as well as clinical course of Behçet's disease in African black population.The study included 50 patients with Behçet's disease. The average age was 32 (18-67) years. A total of 31 patients were men and 19 were women. Two patients had a positive family history of Behçet's disease. The oral and genital aphthous lesions were present in 100% of patients. The pathergy test was positive in 16 patients (32%). Following skin conditions were observed: pseudofolliculitis in 15 patients (30%), acneiform papules in 6 patients (12%), erythema nodosum in 4 patients (8%) and leg ulcers in one patient. Ocular involvement was reported in 22 patients (44%) and joint involvement in 20 patients (40%). Neurological abnormalities were noted in 12 patients (24%). Gastrointestinal involvement with wide and deep ulcerations in the ileocecal region was observed in a patient. As treatment, a combination of oral corticosteroids and colchicine was used in 97% of our patients. Thalidomide was introduced in 3 patients and anticoagulation treatment in 19 patients. Clinical improvement was noted in 25 patients (50%), recurrence in 14 patients (28%) and 3 patients were lost to follow (6%).The Behçet's disease is not uncommon in black skin and generally affects young adults. Severe aphthous ulcers of the oral cavity and genital area are the most consistent finding.

Background and aim The use of skin bleaching products for cosmetic purposes is a frequent practice (25-96%) in women from sub-Saharan Africa. The dermatologic complications associated with this practice have been comprehensively reported. The aim of this work was to study the epidemiologic, clinical, and cosmetic aspects of these complications in order to produce better therapeutic guidelines for their management. Methods This was a prospective, descriptive study performed over a 6-month period. All women aged between 15 and 50 years, who consulted a dermatologist (Le Dantec Hospital or Institute of Social Hygiene), experienced a complication associated with artificial depigmentation, and agreed to take part in the study, were included. The data were input and analyzed using Epi info version 6.0. Results Eighty-six female patients were included, with a mean age of 29.34 years (range, 16-49 years). The breakdown by level of education was as follows: primary (48.8%), secondary (18.3%), and higher (8.5%) education. Twenty-two per cent of our population had not attended school. The mean monthly cost of skin bleaching products was 6.22 euros. The initial skin tone before using skin bleaching products was black in 41.5% of patients, light in 32.9%, and intermediate in 25.6%. The mean duration of exposure was 6.7 ± 5 years (range, 1-30 years). The breakdown by skin bleaching products showed that topical corticosteroids were the most frequently used (78%), followed by hydroquinone (56%), products based on vegetable extracts (31.7%), caustic products (8.5%), and, finally, products of unknown composition (41.4%).Two components or more were frequently combined (86.5%). The aesthetic complications of artificial depigmentation were the reason for consulting a dermatologist in 10 patients (12%). Nineteen types of aesthetic complication were reported in our sample. Hyperpigmentation of the joints was the most frequently found complication (85.4%), followed by striae atrophicae (72%) and skin atrophy (59.8%). The number of aesthetic complications found in the patients varied from one to nine. Patients frequently presented (71.9%) with other complications associated with artificial depigmentation. Conclusions Aesthetic complications associated with artificial depigmentation are common, but rarely the reason for consulting a dermatologist. In the absence of suitable therapeutic agents, prevention, based on informing women of the damaging effects of artificial depigmentation, is the only way forward.

Background Acne, a chronic inflammatory dermatosis of the pilosebaceous follicle, is very widespread worldwide, affecting 75-80% of adolescents, with an impact on their quality of life. The etiologic factors are not always the same, and the treatments proposed are not always well tolerated in black individuals. Aims To determine how acne affects the black population in Dakar, Senegal, and to assess the results of and tolerance to treatment. Methods This was a prospective study conducted on a sample of patients who attended consultations for acne in our dermatology department between December 2002 and March 2003, and who agreed to take part in the study (informed consent was obtained). An anonymous questionnaire was used as a support. Results Ninety-three patients were included in the study, with a hospital frequency of 5.3% and an average age of onset of acne of 25.58 years. In 75% of cases, the acne sufferers were young women, 76.3% of whom were single. Acne was of the superficial inflammatory type in 76.3%, retentional in 67.7%, and nodulocystic in 12.9% (Some patients who have acne vulgaris may have pustules, papules and nodules or cystic lesions so the percentages add up to 100). Signs of hyperandrogeny were observed in 19.1%, with hirsutism in 93.8%. Artificial depigmentation was noted in 38.7%. Stress was found in 89.2% and a depressive state in 3.4%. Solar exposure aggravated the lesions in 52.7%. In terms of therapy, only 1.1% received oral retinoids. An improvement was noted in 67.2%, and resistance was observed in 7.3%. Discussion In Dakar, Senegal, patients with acne consult later than elsewhere. The majority of cases are women, contrary to certain other studies. The inflammatory forms predominate in adult women. The most frequent location is on the face. An evolution to pigmentary disorders is found in 67.7%. Predisposing factors include the use of depigmenting cosmetic products and sun exposure. Local treatment, such as benzoyl peroxide and topical retinoids, which promote melanoderma in black skin, is widely used. The exorbitant cost of oral retinoids considerably limits their use in Senegal. Conclusion Acne, an adolescent pathology, is increasingly being observed in adults using depigmenting cosmetics. The multiple clinical forms are dominated by inflammatory acne. The many relapses and cost of treatment have a detrimental effect on the quality of life of patients.

The aim of our study was to determine the epidemiological and clinical aspects of vitiligo in the largest dermatology department of Senegal. A cross-sectional and descriptive study in a period of 5 months was performed covering all the vitiligo cases. Fifty patients were identified (26 women and 24 men). The mean age was 26.5 years. A family history of vitiligo was found in 11 cases and a psychoaffective disturbance in 6 cases. The clinical forms distinguished were generalized vitiligo ( 𝑛 = 3 3 ), localized vitiligo ( 𝑛 = 1 6 ), vitiligo universalis ( 𝑛 = 4 ), and segmental vitiligo ( 𝑛 = 1 ). The Koebner phenomenon was found in 7 cases. Associated diseases were atopic dermatitis ( 𝑛 = 2 ), contact dermatitis ( 𝑛 = 1 ), diabetes ( 𝑛 = 1 ), and Graves' disease ( 𝑛 = 1 ). The disgraceful character of Vitiligo was the predominance of generalized forms and the elective localization in sun-exposed areas. The family character, the psychoaffective disturbances, the Koebner phenomenon increased by the lifestyle and the itching dermatosis were the aggravating factors.

Occupational dermatitis, mainly allergic contact dermatitis and skin irritations are increasing because of new allergens and diversity of the industrial procedures. In Senegal occupational contact dermatitis are currently observed and they are not declared at our social security institution. The aim of our trial was to determinate the frequency of occupational allergic contact dermatitis, the allergens responsible and the exposed occupations. We included in a one year lasting prospective trial, all patients with occupational contact dermatitis confirmed by positive cutaneous allergological tests. Among 201 cases of contact dermatitis, 27 (12,91%) were included and predominant occupational sectors were building, mechanics, health, cleaning and trade. Main responsible allergens were dichromate of potassium (7), N-isopropyl N-phenylparaphenylenediamine (3), fragrance mix (3), thiuram mix (3), colophane (3), formaldehyde (2), nickel sulphate (2), Chalk (2). Building sector was the most frequent source because of high use of dichromate of potassium in cement and formaldehyde in painting-glue. In mechanics, N-isopropyl N-phenylparaphenylenediamine is present in rubbers and fragrance mix in oils. Occupational dermatitis in health workers are due to presence of thiuram mix in the gloves, and dichromate of potassium found in antiseptics. To decrease the incidence of occupational contact dermatitis in our country, we have to promote prevention among workers by using individual protective outfits and increasing workers medical survey and information about risks and means of prevention.

The koranic schools are in poor socio-economical conditions in Dakar and skin diseases are common in these conditions. The goal of our descriptive study was to determine the prevalence of skin diseases occurring in these situations. One hundred five boys from four koranic schools of Dakar were examined. Eighty percent of the examined boys were with unless one skin disease. Tinea capitis (42.66%), scabiosis (13.33%), pyoderma (15.33%), plantar keratodermia (100%) were the skin diseases. In 34.52% these skin disease were associated and antecedents of skin infections diseases were reported in 89.5% of boys. Atopic dermatitis was in 2.38% cases, keloid in 1.19%. The other frequent diseases were abdominal parasitosis (71.42%), umbilical hernia (6.66%). All skin diseases were improved only in 50% of cases after two months of treatment. Tinea capitis was cured in 4 months after treatment. The high prevalence and the chronicity of the skin disease were due to poor socio-economical conditions.

Background Dermatosis papulosa nigra (DPN) is a benign epithelial tumour, common in the black population. It is a special topographic form of ethnic seborrheic keratosis, which is more common in the white population. Its benign character has meant that very few studies have been performed. In Senegal, no investigation has been carried out to date. Aim To determine the epidemiologic and semiological characteristics of DPN, and the aesthetic results of DPN exeresis. Methods A prospective study was carried out over a period of 6 months (November 2005 to April 2006) at the Dermatology Department, Le Dantec CHU, Dakar, Senegal.The diagnosis of DPN was clinical. If desired, exeresis of the lesions by fine-needle or fine-scissor electrosurgery was carried out, and the results were evaluated over a period of 6 weeks. Results Thirty patients were evaluated: 21 women and nine men. The average age was 39.8 years (range, 25-70 years). A family predisposition was found in 93.3% of cases. The average age of onset of the lesions was 22 years, with a progressive increase in size and number. The lesions appeared initially on the face and then spread to all photoexposed areas. The lesions were profuse, numbering between 50 and 100 in 66.6% of cases, and coalesced to form plaques in 26.6%. In other cases, the lesions were papular, pediculate, or wide-based brown to deep black in colour, and with a keratotic appearance. Eight of the 21 women practiced artificial depigmentation and presented with profuse lesions. Aesthetic problems were found in 60% of patients. When performed, exeresis was satisfactory without scarring in 60% of cases at day 45. Hypochromic scars persisted in four patients who practiced artificial depigmentation and in one who had been treated with carbon dioxide snow. Conclusion This study on 30 cases of DPN is the first in Senegal. The classic female predominance, family predisposition, and photodistribution of the lesions were found. The lesions were profuse, with a background of artificial depigmentation. This suggests that the sun may be an etiopathogenic factor. Aesthetic problems are an indication for ablation of the lesions using a method that minimises the risk of scarring. Artificial depigmentation may cause delayed healing and dyschromic scars, as may the application of carbon dioxide snow.