[Spectacular regrowth of decalvating pelade treated with triamcinolone intramuscularly and topical hair follicle stimulator]

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.

Kerion celsi due to Microsporum audouinii: a severe form in an immunocompetent girl

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.

[Cutaneous tuberculosis affecting the buttock in an immunocompetent adult patient]

La tuberculose est une maladie endémique au Sénégal. Les formes cutanées sont rares et se caractérisent par leur polymorphisme clinique. Elles représentent 2% des localisations extra pulmonaires de la tuberculose. Nous rapportons l'observation d'une gomme tuberculeuse de la fesse révélant une localisation pulmonaire active chez un adulte immunocompétent. Un homme âgé de 47 ans fut admis pour une tuméfaction douloureuse de la fesse droite évoluant depuis quatre ans. L'examen physique notait un placard induré et polyfistulisé fait de nodules confluents avec une émission de pus jaunâtre, siégeant à la face inférointerne de la fesse droite, associé à des adénopathies inguinales bilatérales d'allure inflammatoire. Une tuberculose cutanée était retenue devant l'histologie qui montrait un granulome tuberculoïde et la recherche de BAAR dans le liquide de tubage gastrique qui était positif. La tomodensitométrie thoraco-abdominopelvienne avait montré de multiples micronodules pulmonaires acinaires basals bilatéraux. Les sérologies VIH et VHB étaient négatives. Une guérison était obtenue six mois après un traitement antituberculeux. La tuberculose cutanée se caractérise par son polymorphisme clinique en zone d'endémie. Elle doit aussi être cherchée devant tout placard d’abcès du périnée.

A pain in the rear

Tuberculosis is an endemic disease in Senegal. Cutaneous forms are rare and are characterized by their clinical polymorphism. They account for 2% of the extrapulmonary locations of tuberculosis [1, 2]. We report an observation of a tuberculous gumma of the buttock that led to the discovery of an active pulmonary localization in an immunocompetent adult. A 47-year-old man was admitted for a painful swelling of the right buttock that had been developing for four years. The physical examination noted an indurated, multinodular, and polyfistulized plaque, with confluent yellowish pus emission, on the inferomedial face of the right buttock, associated with bilateral inguinal lymphadenopathy. Cutaneous tuberculosis was found in the histology, which showed TB granuloma, and the gastric tube fluid was positive for acid-fast bacilli. Thoracoabdominopelvic CT showed multiple basal acinar micronodules in both lungs. Serology was negative for both HIV and HBV. All signs of tuberculosis disappeared after six months of treatment. In endemic zones, cutaneous tuberculosis is characterized by its clinical polymorphism. It must also be looked for in any perineal abscess. Early management greatly improves the prognosis.

Validation of the Patient-Oriented SCORing for Atopic Dermatitis tool for black skin

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 < 0.0001). Correlation coefficients for SCORAD and PO‐SCORAD subscale scores were also good, except for symptom intensity criteria.

Conclusion

Altogether, these data indicate that PO‐SCORAD for black skin correlates well with SCORAD and is therefore a valuable tool, which requires no specific level of education, for use by black skin patients with AD.

[Epidemiological and anatomoclinical features of scalp tumors in black Africans]

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.

Apport des signes cutanés sur le diagnostic précoce d'une maladie périodique: à propos d'un cas

Les auteurs rapportent l'observation d'une maladie périodique diagnostiquée à l'aide de placards érysipélatoïdes récidivants et persistants sous antibiothérapie. L'interrogatoire, les tests génétiques et l'évolution favorable sous colchicine ont permis d'asseoir le diagnostic.

Non-tubercular caseous adenopathy in Senegal

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.

[Multifocal histoplasmosis due to Histoplasma capsulatum var. duboisii in a 22 year-old Senegalese patient without proven immunodepression]

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.

[Endemic Kaposi's sarcoma in Dakar: 29 cases]

INTRODUCTION

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.

PATIENTS AND METHODS

A 7-years retrospective study, including all patients with endemic Kaposi's disease diagnosis was carried out.

RESULTS

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.

CONCLUSION

Endemic Kaposi's disease is more frequent in elderly people with a higher frequency of extracutaneous involvement and florid forms.