The aim of this study was to report the frequency of and reasons for dermatology admissions in Lomé (Togo) between 2005 and 2016. This retrospective study examined records from August 2005 to December 2016 from the dermatology departments of the two teaching hospitals in Lomé, Togo. During the study period, 454 (1.1%) of the 40,231 new patients who consulted in dermatology were hospitalized, with a total of 460 separate admissions (mean dermatology hospitalizations per year: 42). Patients' mean age was 43±17.6 years and the sex ratios (M/F) was 0.6. The main reasons for hospitalization were Stevens-Johnson syndrome (SJS), also known as erythema multiforme majus, and toxic epidermal necrolysis (TEN) (28.9%), followed by bullous erysipelas (21.4%), connective tissue disease (10.3%), and Kaposi sarcoma-associated herpes virus (9%). The average length of stay in hospital was 15±13.7 days. The diagnosis that accounted for the longest mean length of stay was deep fungal infections (63.5 days) (P<0.0001). We recorded 39 deaths, for a death rate of 8.6%. Death rates were highest for deep fungal infections (37.5%) and SJS/TEN (12.2%). Our study confirmed the low rate of inpatient admissions in dermatology and revealed a change in the reasons for hospitalization and a decrease in mortality in dermatology in Lomé, compared with the previous 13 years. This decrease in mortality may be attributed to the improvement of hospital care provided to patients but also by the generalization of antiretroviral treatment in Togo that began more than 10 years ago.

OBJECTIVE:The aim of this work was to study the prevalence of skin diseases among inmates in Lomé (Togo) and its relation to their HIV status.PATIENTS AND METHODS:This cross-sectional descriptive study took place from November 14 to December 5, 2011, in the civil prison of Lomé and included prisoners who agreed to have an HIV screening test.RESULTS:In all, 194 prisoners, all men (median age: 29 years), were examined during the study period. The group aged younger than 30 years accounted for 51% of the population. Overall, 166 (85.6%) of the 194 prisoners examined had cutaneous lesions; 153 reported that these had developed after their imprisonment. HIV serology was positive in 21 (10.8%) of the 194 prisoners tested. The most common cutaneous diseases were pruritus (n = 62), fungal infections (n = 45), boils (n = 26), eczema (n = 21), and scabies (n = 20). The frequency of skin disorders did not differ significantly between HIV-infected prisoners and those who were not infected (p>0.05).CONCLUSION:This study shows a potential for high prevalence of HIV infection and an existing high prevalence of infectious dermatosis among these prisoners. It is essential to reduce the overpopulation and crowding in prisons to decrease the prevalence of these skin disorders.

Background. - Oral propranolol produces dramatic results in severe infantile haemangioma. We report a case of rapid and significant regression of an infantile haemangioma in infant treated topically with 2% propranolol ointment.Patients and methods. - A female infant aged 11 weeks was seen as an outpatient for two infantile haemangiomas on the front of the left knee and the vulva. After parental consent was given, the child was treated with a topical preparation of 2% propranolol ointment prepared by the pharmacy. Regression was rapid and on the 45th day, lesion size had been reduced by an estimated 75%. No adverse effects were observed.Discussion. - Topical propranolol appears to be effective and safe for the treatment of superficial haemangiomas. Clinical trials are required to determine the optimal dosage and pharmaceutical form, method of use and treatment duration. (C) 2013 Elsevier Masson SAS. All rights reserved.

OBJECTIVE The purpose of this study was to describe the epidemiological and clinical profile and the treatment and natural history of AIDS-related Kaposi sarcoma in 3 major dermatology departments in Lomé (Togo). PATIENTS AND METHOD This retrospective, descriptive study was based on the records of patients with AIDS-related Kaposi sarcoma from January 2005 through October 2011. RESULTS During the study period, 157 patients were treated in the dermatology departments for Kaposi sarcoma. HIV serology was positive for 103 (89.6%) of the 115 patients tested. Seventy-nine patients were known to be HIV-positive before the consultation, while Kaposi sarcoma was the circumstance of discovery of the HIV infection for 24. The average age of the 103 patients was 36.7±14.9 years and the sex-ratio (M/F) was 1.1. The main locations of the lesions were the lower limbs (n = 76), mucosa (n = 53), trunk (n = 38) and upper limbs (n = 17). The average CD4-cell count was 226±168 cells/mm(3). The main antiretroviral protocol used was stavudine/lamivudine/nevirapine (70 cases). Besides the antiretroviral treatment, chemotherapy was prescribed, with vinblastine for 17 patients, bleomycin for 5, and doxorubicin for one. For financial reasons, 80 other patients did not receive chemotherapy and were lost to follow-up after an average duration of 3 months. At 5 months, the rate of complete remission was 21.1%, partial remission 21.1%, and failure 57.8%. Side effects were dominated by hematologic and nervous complications. CONCLUSION Our study highlighted a high prevalence of AIDS-related Kaposi sarcoma in dermatology departments in Lomé, with a tendency to gender equality. It also shows the difficulties of access to chemotherapy for most patients and the poor efficacy of chemotherapy.

The aim of this study was to determine the frequency and list of drugs responsible for fixed drug eruption (FDE) in Lomé (Togo). A descriptive retrospective study of patients with FDE treated from January 2006 to November 2011 in dermatology service at the teaching hospital of Lomé (Togo) was conducted. During the study period, 321 cases of FDE were reported among 472 cases of toxidermia observed. Mean age of the patients was 31.27 ± 14.01 years and sex-ratio (M/F) was 1.01. One hundred thirty-three (41.4%) of 321 patients had a previous FDE, against 58.6% who were in their first attack. The most common form was the hyperpigmented form (247 cases/321). The main locations of the lesions were the trunk (N = 127) followed by the lower limbs (N = 85), the upper limbs (N = 81) and external genital organs (N = 53). A drug was incriminated in 163 (50.8%) of the 321 patients, in whom 109 patients took their drug by self-medication. Antibacterial sulfonamides were the first drug involved (70.5%), followed by nonsteroidal anti-inflammatory drugs (9.8%), antimalarial drugs (7.4%) and antibiotics (3.7%). All patients received a banned drug. In addition, 111 patients were treated with antihistamines, 69 with corticosteroids, and 58 with topical antiseptics. During follow-up, 42 of 321 patients have been seen; all had a favorable outcome. Our study confirms the frequency of FDE and the role of antibacterial sulfonamides as the cause of FDE in Africa and documents the effects of self-medication in toxidermia in Togo.

The purpose of this retrospective study was to obtain data on the epidemiology, clinical features, and outcome of bacterial dermohypodermitis (BDH) observed in a hospital setting hospital in Lomé, Togo. Cases of BDH treated in dermatology and internal medicine of the Lomé university hospital center from January 1999 to December 2009 were reviewed. A total of 104 patients were hospitalized for BDH during the study period. Mean patient age was 42.9 +/- 16.1 years and sex ratio (M/F) was 0.89. Infection by HIV was detected in 10 of 37 patients in whom serology was performed. The site of erysipelas was located on the legs and feet in 93 cases (89.4%), entire lower limb in 4 (3.9%), upper limbs in 4 (3.9%), thighs in 2 (1.9%), and buttock in 1 (0.9%). The main local and systemic risk factors were existence of an entry site in 89 cases, use of depigmenting drugs in 11, HIV infection in 10, previous history of erysipelas in 9 cases, and lymphoedema in 8. First-line treatment used penicillin G in 90 cases. Seven patients presented necrotizing fasciitis. Necrotizing fasciitis was associated with HIV infection in 2 cases, use of non-steroidal anti-inflammatory drugs (NSAID) in 2, and use of depigmenting drugs in one. Two deaths were recorded in the necrotizing fasciitis group including one HIV-infected patient. Recurrence was observed in 8 patients and secondary complications such as lower limb elephantiasis occurred in 7 patients.

OBJECTIVES:The aim of this study was to describe features of self-medication for skin conditions observed at public dermatology centres in Lome, Togo.METHODS:This cross-sectional study was conducted from July 1 to September 30, 2008 in 3 public dermatology centres in Lome-Commune. All patients consulting at the study centres for the first time were recruited, interviewed and examined.RESULTS:Of 600 patients enlisted in the study, 264 (44%) had practiced self-medication. There were more women than men (sex ratio: 0.8). In most cases, products used for self-medication were recommended by a friend and/or relative (72%). Most products were obtained from either pharmacies (42.4%) or street vendors (37.9%). The average cost of self-medication was 520 FCFA (0.79 euros). Products applied by the topical route were the most common (72%) and most patients reported dissatisfaction with results (67.8%).CONCLUSION:This study demonstrates that self-medication is widely practiced for dermatologic conditions in Lome and provides insight into the circumstances, reasons and sources of self-medication.

Le zinc est un oligoélément essentiel pour le bon fonctionnement de l’organisme, sa carence est responsable d’un ensemble de manifestations surtout dermatologiques. L’étiologie peut être héréditaire (acrodermatite entéropathique) ou acquise (pseudo-acrodermatite entéropathique).Étude rétrospective incluant les cas de carence en zinc colligés en consultation de dermatologie pédiatrique au CHU Med VI de Marrakech.Il s’agit de huit cas pédiatriques, ayant intéressé sept filles et un seul garçon, un nourrisson était sous allaitement maternel exclusif, une fille avait deux sœurs qui avaient la même symptomatologie, une patiente était suivie pour une entéropathie exsudative, une pour l’allergie aux protéines de lait de vache et deux filles pour maladie cœliaque. Ces patients consultaient pour une symptomatologie faite essentiellement d’une dermite de siège résistante aux traitements symptomatiques, des lésions érythémato-vésiculeuses et squameuses, parfois érosives, périorificielles et acrales. Le diagnostic positif a été posé par le dosage de la zincémie avec diminution des phosphatases alcalines. Un traitement par le sulfate de zinc était institué, l’évolution était favorable.Mis à part, l’acrodermatite entéropathique, autant d’étiologies acquises peuvent donner une carence en zinc et réaliser un tableau d’acrodematite-like ou pseudo-acrodermatite entéropathique. La confirmation du diagnostic repose sur le dosage de la zincémie ou sur le test diagnostique par la supplémentation en zinc même avec une zincémie normale. Le traitement par le zinc permet en général la résolution de la symptomatologie.Zinc is an essential trace element for the functioning of the body, its deficiency is responsible for different dermatological manifestations. The etiology may be hereditary (acrodermatitis enteropathica) or acquired (pseudo-acrodermatitis enteropathica).Retrospective study of cases of zinc deficiency collected in pediatric dermatology consultation University Hospital Med VI in Marrakech.These eight pediatric cases concerned seven girls and one boy. The cases followed were: an infant exclusively breastfed, a girl who had two sisters with the same symptoms, a patient followed for exudative enteropathy, one case of allergy to cow's milk protein and two cases of celiac disease. These patients consulted for symptoms essentially made of a resistant diaper rash to symptomatic treatment, vesicular and erythematous scaly lesions, sometimes erosive, peri-orificial with the extension to extremities and trunk (two cases). The diagnosis was made by assay of plasma zinc, it was decreased in all cases, with a decrease in alkaline phosphatase in 4 cases. Treatment with zinc sulfate was instituted and the result was the healing of lesions in 7 cases.Except the acrodermatitis enteropathica, many acquired etiologies can give a zinc deficiency and simulate an acrodermatitis enteropathica “pseudo-acrodermatitis enteropathica”. The decrease in the alkaline phosphate levels point out this deficiency and indicate the need for zinc supplementation. The confirmation of the diagnosis is based on the dosage of the plasma zinc or the diagnostic test by zinc supplementation. The treatment generally helps to make the symptoms disappear.

OBJECTIVES:The purpose of this study was to document epidemiological features, outcomes, and aetiologies of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in a teaching hospital in Lomé, Togo.METHOD:A retrospective study of patients with SJS/TEN treated from January 2002 to April 2009 in a teaching hospital in Lomé was conducted.RESULTS:During the study period, 89 patients were treated for SJS/TEN, i.e., SJS in 76 cases, TEN in 9, and overlapping SJS/TEN in 4. Mean age was 30.3 +/- 13.4 years and sex ratio (M/F) was 0.7. Serological testing for HIV was carried out in 75 patients and was positive in 41 (54.6%) including 36 patients with SJS, 3 with TEN and 2 with overlapping SJS/TEN. A total of 9 patients died including 4 with SJS, 4 with TEN and one with overlapping SJS/TEN. Six of the patients who died were HIV-infected. Complications included blindness in 3 cases, moderate dry eye syndrome in 1, vaginal synechiae in 2, synechiae of labial commeasures in 1, and hypertrophic scars in 1. Antibacterial sulphonamides (50.6%) were the most commonly implicated drugs followed by nevirapine (23.6%), non-steroidal anti-inflammatory drugs (5.6%), and anti-epileptic medications (3.4%).DISCUSSION:Our results also document the high frequency of nevirapine as a new SJS/TEN cause unrelated to antibacterial sulphonamides. With increasing access to HIV medication in sub-Saharan Africa countries, practitioners should take these data into account for patient monitoring.

Basidiobolomycosis is a deep mycosis which preferentially affects rural young people in tropical countries. We report a case of basidiobolomycosis successfully treated with ketoconazole. It was a 9-year-old boy of rural origin in whom the diagnosis of basidiobolomycosis was suspected due to a deep skin infiltration involving the chest and neck. Histology revealed hypodermic granulomatous inflammation with predominantly macrophage and eosinophils. The child was treated successfully with ketoconazole in eight weeks. Treatment of basidiobolomycosis is based on azole derivatives which are particularly effective. Histopathology is very important in the diagnosis of this affection, especially in tropical countries where it may simulate Mycobacterium ulcerans infection.

OBJECTIVES:The aim of this retrospective study was to determine the relative frequency and trends of skin cancers in Togo.METHOD:The records of patients with primitive skin cancers diagnosed in the pathology laboratory of Lomé teaching hospital from 1994 to 2005 were reviewed.RESULTS:During the study period, 223 cases of skin cancers were recorded. The overall mean patient age and male-to-female ratio were 42 +/- 17 years and 1.56 respectively. The most common forms of skin cancers observed were Kaposi's sarcoma in 103 cases (46.2%), skin carcinoma in 75 cases (33.6%), melanoma in 23 cases (10.3%), and dermatofibrosarcoma protuberans in 16 cases (7.2%). In the Kaposi's syndrome group, the average age and male-to-female ratio were 39 +/- 15 years and 2.68 respectively and the main location was the lower limbs (77.9%). In the cutaneous carcinoma group, 64 cases involved squamous cell carcinoma with an average age and male-to-female ratio of 48 +/- 17 years and 1.29 respectively. In 18 cases squamous cell carcinoma developed on chronic leg ulcer. In the melanoma group, the average age and male-to-female ratio were 55 +/- 16 years and 0.64 respectively and the main location was the distal extremities. In the dermatofibrosarcoma protuberans group, the average age and male-to-female ratio were 45 +/- 20 years and 0.78 respectively. The other types of skin cancers observed were mycosis fongoides in 4 cases (1.8%) and Paget's disease in 2.CONCLUSION:This study showed that Kaposi's sarcoma was the most frequent skin cancer in Togo in conjunction with the current HIV infection epidemic. Findings also indicated that the incidence of other types of skin cancers was relatively stable.

To assess the prevalence and risk factors for diabetic retinopathy (DR) in people with young onset type 1 (T1DM-Y) and type 2 diabetes (T2DM-Y).T1DM-Y(n = 150) and T2DM-Y(n = 150) participants, age between 10 and 25 years at diagnosis, had a complete clinical evaluation, biochemical assessment, and four field digital retinal colour photography. The Early Treatment Diabetic Retinopathy Study grading system was used to grade DR. Proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) were considered as sight threatening DR.The prevalence of any DR was 53.3% [95% CI 45.3–61.3] in T1DM-Y (duration of diabetes: 12.4 ±7.4years) and 52.7% [44.7–60.7] in T2DM-Y (11.8 ± 8.3 years). The age and gender adjusted prevalence of DR, DME and PDR was 62.5%, 10% and 7.3% in T1DM-Y, whereas it was 65.8%,12.7% and 9.3% in T2DM-Y respectively. In multivariable logistic regression, diabetes duration [Odds ratio (OR) 1.99 per 5 years; CI 1.42–2.79], waist circumference [1.28 per 5 cm;1.05–1.56] and microalbuminuria [2.39 per 50 μg;1.07–5.31] were associated with DR in T1DM-Y, and diabetes duration [2.21 per 5 years; 1.61–3.02], diastolic blood pressure [1.54 per 5 mmHg;1.18–2.02], Glycated hemoglobin [1.37 per %;1.07–1.75] and lower stimulated C-peptide [1.54 per 0.5 pmol/ml;1.15–2.05;] were associated with DR in T2DM-Y.Over half of the people with young-onset diabetes, regardless of type, have retinopathy within 10–12 years of diabetes duration, emphasizing the need for regular eye screening and aggressive control of glucose and blood pressure to prevent DR.