Cutaneous manifestation of HIV/AIDS: Part 2

The insidious damage to the immune system by the human immunodeficiency virus results in increasing susceptibility to opportunistic viral infections. These can be localised, widespread, confined to the skin, or systemic. They can cause mild though disfiguring lesions such as molluscum contagiosum (MCV), or lead to life-threatening infections such as human papillomavirus (HPV-induced squamous cell carcinoma. Southern African Journal of HIV Medicine Vol. 6 (1) 2005: pp. 12-1

Teledermatology by Videoconference : Experience of a Pilot Project

Background: There is a shortage of medical specialists within the provincial departments of health in South Africa. Telemedicine is a potential way of providing specialist services, at a distance, to rural areas. This study assesses patient and staff satisfaction and issues, technological and operational, associated with the establishment of a videoconference-based teledermatology service. Methods: An ISDN-based videoconference link was established between Port Shepstone Hospital and the Nelson R Mandela School of Medicine in Durban. Patients with a dermatological problem that would have necessitated transfer to the academic hospital for diagnosis and/or management were entered into a prospective study which evaluated the ability to make a diagnosis and prescribe a management plan by videoconference and the patients\' and doctors\' satisfaction with the consultations. Results: A total of 69 patients were seen during 12 videoconferenced consultation sessions. Seventeen patients (24.6%) were subsequently referred to the academic hospital: nine patients were sent because a definitive diagnosis could not be made; and eight patients were transferred for specialist management based on the diagnosis made. The patients\' and referring doctors\' satisfaction with the consultation was 80.3% and 82.1% respectively, while the dermatologist was satisfied 67.6% of the time. The dermatologist was dissatisfied with ten (14.7%) of the consultations and this was related to difficulties in making a definitive diagnosis. The referring doctors found 59 (85.9%) of the consultations to be of educational value. No problems were noted in diagnosing lesions in dark-skinned patients. Conclusion: Videoconferenced teledermatology between district hospitals and regional hospitals is possible and can improve services to rural areas. Further studies on widespread implementation and sustainability are warranted. South African Family Practice Vol. 50 (3) 2008: pp. 70-70

Primary cutaneous malignancies in the Northern Cape Province of South Africa: A retrospective histopathological review

Background. Excessive sun exposure and a high prevalence of HIV increase skin cancer risk in South Africa (SA).Objective. To describe the nature and extent of skin cancers presenting in the public and private health sectors of the Northern Cape Province of SA.Methods. A retrospective analysis of histologically confirmed new primary cutaneous malignancies from 1 January 2008 to 31 December 2012 was conducted using public and private health sector databases. Types, quantity and distribution of common invasive malignancies by population group, age, gender, anatomical site and health sector were explored. One-year cumulative incidence was calculated and logistic regression models were used to analyse incidence and melanoma thickness trends.Results. A total of 4 270 biopsies (13 cutaneous malignancies) were identified. The commonest was squamous cell carcinoma (SCC), followed by basal cell carcinoma, Kaposi’s sarcoma (KS), cutaneous malignant melanoma (CMM) and basosquamous carcinoma, in descending order. The odds of a white male developing SCC increased by 8% each year (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.01 - 1.15; p=0.022), while the odds of a black male developing SCC and KS decreased by 9% (OR 0.91, 95% CI 0.84 - 0.99; p=0.033) and 18% (OR 0.82, 95% CI 0.70 - 0.97; p=0.022), respectively, each year. SCC and CMM were diagnosed at more advanced stages in the public than in the private healthcare sector. CMM is being detected earlier, as indicated by low-stage depth increasing by 72% annually (OR 1.72, 95% CI 1.04 - 3.01; p=0.042).Conclusions. Results suggest that reported skin cancer patterns are changing. There is a need for further research and equitable appropriation of financial resources and effort towards developing primary skin cancer prevention initiatives in SA

Updates in the understanding and treatments of skin & hair disorders in women of color

AbstractSkin of color comprises a diverse and expanding population of individuals. In particular, women of color represent an increasing subset of patients who frequently seek dermatologic care. Acne, melasma, and alopecia are among the most common skin disorders seen in this patient population. Understanding the differences in the basic science of skin and hair is imperative in addressing their unique needs. Despite the paucity of conclusive data on racial and ethnic differences in skin of color, certain biologic differences do exist, which affect the disease presentations of several cutaneous disorders in pigmented skin. While the overall pathogenesis and treatments for acne in women of color are similar to Caucasian men and women, individuals with darker skin types present more frequently with dyschromias from acne, which can be difficult to manage. Melasma is an acquired pigmentary disorder seen commonly in women with darker skin types and is strongly associated with ultraviolet (UV) radiation, genetic factors, and hormonal influences. Lastly, certain hair care practices and hairstyles are unique among women of African descent, which may contribute to specific types of hair loss seen in this population, such as traction alopecia, trichorrhexis nodosa and central centrifugal cicatricial alopecia (CCCA)

Acne in South African black adults: A retrospective study in the private sector

Background. Acne vulgaris is the most common skin disorder affecting teenagers and young adults, and is becoming increasingly common in middle-aged women. It affects all skin types and ethnic groups, but dark-skinned individuals are burdened by post-inflammatory hyperpigmentation (PIH) as a sequela. PIH causes distress in acne patients even after the inflammatory lesions have resolved.Objective. To describe the characteristics of acne in black South African adults in the private health sector in Durban, KwaZulu-Natal Province.Methods. A retrospective study of records of patients attending two large private dermatology clinics in central Durban, mainly catering for black patients, was performed. Data were collected for the period January - December 2014. Records with acne as a diagnosis were retrieved and analysed with regard to age, demographics, type and severity of acne, therapy, HIV status and outcomes.Results. Of a total of ~3 000 charts available for the 12-month period, 242 had acne as a diagnosis and were retrieved and analysed. Of these patients, 204 (84.3%) were female and the remainder were male. The mean age was 28.5 years (under-18s were excluded from the study). Inflammatory acne was the most frequently encountered form (58.6%). Fifteen patients (6.2%) were on topical treatment only, and 226 (93.4%) were on topical plus systemic treatment. PIH was the most common sequela (81.0% of patients).Conclusions. The majority of the patients were young females with inflammatory acne, and PIH was the most common sequela. Early and vigorous treatment of acne may minimise its complications, including those seen mainly in black patients.

Primary cutaneous malignancies in the Northern Cape Province of South Africa: A retrospective histopathological review

Background. Excessive sun exposure and a high prevalence of HIV increase skin cancer risk in South Africa (SA).Objective. To describe the nature and extent of skin cancers presenting in the public and private health sectors of the Northern Cape Province of SA.Methods. A retrospective analysis of histologically confirmed new primary cutaneous malignancies from 1 January 2008 to 31 December 2012 was conducted using public and private health sector databases. Types, quantity and distribution of common invasive malignancies by population group, age, gender, anatomical site and health sector were explored. One-year cumulative incidence was calculated and logistic regression models were used to analyse incidence and melanoma thickness trends.Results. A total of 4 270 biopsies (13 cutaneous malignancies) were identified. The commonest was squamous cell carcinoma (SCC), followed by basal cell carcinoma, Kaposi’s sarcoma (KS), cutaneous malignant melanoma (CMM) and basosquamous carcinoma, in descending order. The odds of a white male developing SCC increased by 8% each year (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.01 - 1.15; p=0.022), while the odds of a black male developing SCC and KS decreased by 9% (OR 0.91, 95% CI 0.84 - 0.99; p=0.033) and 18% (OR 0.82, 95% CI 0.70 - 0.97; p=0.022), respectively, each year. SCC and CMM were diagnosed at more advanced stages in the public than in the private healthcare sector. CMM is being detected earlier, as indicated by low-stage depth increasing by 72% annually (OR 1.72, 95% CI 1.04 - 3.01; p=0.042).Conclusions. Results suggest that reported skin cancer patterns are changing. There is a need for further research and equitable appropriation of financial resources and effort towards developing primary skin cancer prevention initiatives in SA

“We just don’t have the resources” : supervisor perspectives on introducing workplace-based assessments into medical specialist training in South Africa

DATA AVAILABILITY : The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.BACKGROUND : South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context. METHODS : This paper reports on the qualitative data generated from a mixed methods study that employed a parallel convergent design, utilising a self-administered online questionnaire to collect data from participants. Data was analysed thematically and inductively. RESULTS : The themes that emerged were: Structural readiness for WBA; staff capacity to implement WBA; quality assurance; and the social dynamics of WBA. CONCLUSIONS : Participants demonstrated impressive levels of insight into their respective working environments, producing an extensive list of barriers and enablers. Despite significant structural and social barriers, this cohort perceives the impending implementation of WBA to be a positive development in registrar training in South Africa. We make recommendations for future research, and to the medical specialist educational leaders in SA.The Department of Higher Education and Training, Republic of SA, via the University Capacity Development Grant.https://bmcmededuc.biomedcentral.comam2024School of Health Systems and Public Health (SHSPH)SDG-04:Quality Educatio

Genome-wide association study in frontal fibrosing alopecia identifies four susceptibility loci including HLA-B*07:02

Frontal fibrosing alopecia (FFA) is a recently described inflammatory and scarring type of hair loss affecting almost exclusively women. Despite a dramatic recent increase in incidence the aetiopathogenesis of FFA remains unknown. We undertake genome-wide association studies in females from a UK cohort, comprising 844 cases and 3,760 controls, a Spanish cohort of 172 cases and 385 controls, and perform statistical meta-analysis. We observe genome-wide significant association with FFA at four genomic loci: 2p22.2, 6p21.1, 8q24.22 and 15q2.1. Within the 6p21.1 locus, fine-mapping indicates that the association is driven by the HLA-B*07:02 allele. At 2p22.1, we implicate a putative causal missense variant in CYP1B1, encoding the homonymous xenobiotic- and hormone-processing enzyme. Transcriptomic analysis of affected scalp tissue highlights overrepresentation of transcripts encoding components of innate and adaptive immune response pathways. These findings provide insight into disease pathogenesis and characterise FFA as a genetically predisposed immuno-inflammatory disorder driven by HLA-B*07:02