Pigmentary Disorders in Black Skin from Pathophysiology to Treatment

Pigmentary disorders are frequent and more visible in patients with darker phototypes (Fitzpatrick’s IV–VI). They also have an important psychological impact and are the cause of inappropriate cosmetic practices. Pigmentary disorders comprise a wide range of pathologies, and the pathophysiological mechanisms have evolved considerably in recent years. Pigment disorders vary in their clinical presentation from achromia to hyperpigmentation to hypopigmentation. Inflammatory dermatoses, such as acne, are often complicated by postinflammatory hyperpigmentation; psoriasis and lichen planus are accompanied by dyschromia. Some skin diseases, such as mycosis fungoides, have atypical presentations in the form of hypopigmented plaques. All these dyschromias have an important impact on the quality of life and are responsible for practices such as voluntary cosmetic depigmentation with products like dermocorticoids, hydroquinone and mercury salts, and various depigmenting products. This practice is at the origin of pigmentary disorders, such as exogenous ochronosis, lichen-like and lupus-like dermatoses, and periorbital hyperpigmentation. Therapeutic management is difficult and relies on chemical (peeling), physical (laser), and medicinal means (tranexamic acid); hence, the interest is in prevention through early diagnosis and the avoidance of favorable factors

A framework for scabies control.

Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals

La dépigmentation cosmétique à Dakar (Sénégal) : facteurs socio-économiques et motivations individuelles

The cosmetic use of bleaching products in Dakar, Senegal: socio-economic factors and claimed motivations In order to evaluate the reasons for the cosmetic use of skin bleaching products, a questionnaire was proposed to a sample of 368 women presenting at a dermatological centre in Dakar. According to the collected data, bleaching products appear to be more frequently used among women from Dakar, aged from 20 to 40 years, married or having a boy- friend, with an educational level equivalent to primary school, a job implying contacts with customers, and among women having access to certain consumption goods (TV, phone, car). According to their statements, the main motivations of women using bleaching products are the following: be fashionable, be pretty, imitate close friends, practice self- medication. Female friends of bleaching products users are said to often compliment and prompt them, contrarily to family members who generally criticize strongly the practice; the husbands present an intermediary position. These data suggest that bleaching products' s use works like a fashion phenomenon, with both identification to a group (mainly, female friends) and a claim to certain values, especially urbanity, modernity, adult femininity, power of seduction, and access to a certain social level. A wish of emancipation toward classical patterns of women seems present. There is a significant ambivalence of bleaching products users concerning their cosmetic practices. According to thèse data, the usual explanations for the cosmetic use of bleaching products, i. e. a negative perception of black skin making reference to racial typology, are not confirmed. In order to understand the current use of bleaching products, it is essential to adopt a historical perspective, especially with regard to local perceptions of skin colour differences, as to local strategies of seduction.Résumé. Afin d'identifier les déterminants de la pratique de dépigmentation cosmétique, une enquête par questionnaire a été effectuée auprès d'un échantillon de trois cent soixante-huit femmes fréquentant un centre de santé spécialisé en dermatologie à Dakar. Selon les données recueillies, la dépigmentation cosmétique apparaît plus fréquente chez les Dakaroises âgées de vingt à quarante ans, chez les femmes mariées ou faisant état d'un compagnon, chez les femmes ayant un niveau de scolarisation primaire, une activité professionnelle comportant un contact avec une clientèle, et chez celles qui disposent de certains biens de consommation (télévision, téléphone, automobile). Les principales motivations des utilisatrices sont le suivi de la mode, le désir d'être belle, l'imitation de personnes de l'entourage et l'automédication. Les amies des utilisatrices apparaissent comme étant souvent à l'origine de compliments et d'incitations directes, contrairement à la famille en général, très critique, le conjoint ayant une position intermédiaire. L'analyse de ces données suggère que la dépigmentation cosmétique fonctionne souvent comme un phénomène de mode, avec identification à un groupe (rôle prépondérant des amitiés féminines) et revendication implicite de certaines valeurs : urbanité, modernité, féminité adulte, pouvoir de séduction et accès à un certain niveau social ; un désir d'émancipation par rapport aux modèles féminins classiques semble perceptible. L'adhésion des utilisatrices de ces produits à leur pratique apparaît souvent ambivalente. Ces données ne confirment pas les hypothèses explicatives classiques voyant dans la dépigmentation cosmétique l'expression d'un complexe lié à une perception dévalorisante de la peau noire par référence à une typologie raciale occidentale. Il convient de resituer la dépigmentation cosmétique dans une perspective historique locale de modes de perception des différentes tonalités de couleur de peau, ainsi que de stratégies de séduction.La despigmentación cosmética en Dakar (Sénégal) : factures socio-económicos y motivaciones individuales Afin de identificar los déterminantes de la práctica de despigmentación cosmética, se realizó una encuesta por cuestionario en Dakar con una muestra de 368 mujeres que frecuentan un centro sanitario especializado en dermatología. Según los datos recogidos, la despigmentación cosmética es más frecuente en las mujeres originarias de Dakar, que tienen entre 20 y 40 años, en las mujeres que están casadas o en pareja, con un nivel de escuela primaria, con una actividad profesional que implica un contacto con una clientela y en las mujeres que disponen de ciertos bienes de consumo (televisión, teléfono, automóvil). Las principales motivaciones declaradas por las utili/adoras son : el seguir la moda, el deseo de ser bellas, la imitación de personas del entorno y la auto-medicación. Las amigas son las que generalmente halagan e incitan directamente a las utilizadoras a esta práctica, contrariamente a la familia, que es en general muy crítica. El cónyugue está en una posición intermedia. El análisis de estos datos sugiere que la despigmentación cosmética actúa frecuentemente como un fenómeno de moda, con identificación a un grupo (papel prépondérante de las amistades femeninas) y como revindicación implícita de ciertos valores : urbanidad, modernidad, feminidad adulta y poder de seducción, ascensión a un cierto nivel social ; el deseo de emancipación con respecto a los modelos femeninos clásicos es perceptible. La ambivalencia de la adhesión de las utilizadoras de estos productos a la práctica de la despigmentación cosmética es bastante clara. Los datos obtenidos en esta encuesta no confirman las hipótesis explicativas clásicas, que ven en la despigmentación cosmética, la expresión de un complejo en relación a una percepción desvalorizada de la piel negra con respecto a una tipología racial occidental. Nos parece importante resituar a la despigmentación cosmética en una pespectiva histórica local de los modos de percepción de las diferentes tonalidades del color de la piel, así como también de las estrategias de seducción.Mahé Antoine, Ly Fatimata, Gounongbé Ari. La dépigmentation cosmétique à Dakar (Sénégal) : facteurs socio-économiques et motivations individuelles. In: Sciences sociales et santé. Volume 22, n°2, 2004. pp. 5-33

Ivermectin versus benzyl benzoate applied once or twice to treat human scabies in Dakar, Senegal: a randomized controlled trial

Objective To compare the effectiveness of oral ivermectin (IV) and two different modalities of topical benzyl benzoate (BB) for treating scabies in a community setting. Methods The trial included patients aged 5-65 years with scabies who attended the dermatology department at the Institut d'Hygiene Sociale in Dakar, Senegal. The randomized, open trial considered three treatments: a single application of 12.5% BB over 24 hours (BB1. group), two applications of BB, each over 24 hours (BB2 group), and oral IV, 150-200 mu g/kg (IV group). The primary endpoint was the disappearance of skin lesions and itching at day 14. If necessary, treatment was repeated and patients were evaluated until cured. Results were analysed on an intention-to-treat basis. A pre-planned intermediate analysis was carried out after the BB1, BB2 and IV groups had recruited 68, 48 and 65 patients, respectively. Findings At day 14, 33 patients (68.8%) in the BB2 group were cured versus 37 (54.4%) in the BB1 group and 16 (24.6%) in the IV group (P < 10(-6)). Bacterial superinfection occurred more often in the IV group than in the BB1 and BB2 groups combined (28% versus 7.8%, respectively; P = 0.006). At day 28, 46 patients (95.8%) in the BB2 group were cured versus 52 (76.5%) in the BB1 group and 28 (43.1%) in the IV group (P < 10(-5)). These clear findings prompted early study cessation. Conclusion Topical BB was clearly more effective than oral IV for treating scabies in a Senegalese community

Fungal mycetoma and pregnancy: An association with costly and difficult management, about a case.

Mycetomas are endemic diseases in tropical and sub-tropical countries of Africa, Asia and America, mainly affecting rural populations living below the poverty line. We report a particular case of a mycetoma associated with pregnancy whose evolution was good, but at the cost of significant financial expenses. This was a 39-year-old woman who developed a fungal mycetoma due to Madurella mycetomatis from the ingunocrural region. The patient had to develop several previous pregnancies on this site of mycetoma, the outcome of which was favorable. The last pregnancy was accompanied by an aggravation of the mycetoma in the form of polyfistulized inflammatory swelling of the right inguino-crural region emitting black grains. Magnetic Resonance Imaging (MRI) of the region showed invasion of the adductor muscles at the level of the root of the thigh on its antero-internal side with no sign of pelvic extension or underlying bone lesion. The patient was treated by surgery associated with antifungal treatment. The evolution was favorable for pregnancy and mycetoma

Les dermites du siège chez le nourrisson à Dakar: Etude de 205 cas [Diaper dermatitis among the infant in Dakar: Study of 205 cases]

Background: Diaper dermatitis in infant is a common reason for dermatological consultation. The aim of this study was to describe the epidemiological, clinical, etiological and evolutionary aspects of diaper dermatitis in infant. Materials and Methods: A cross-sectional descriptive study was conducted in three dermatology departments in Dakar. All infants [1-30 months] who are followed from October 1, 2015 to April 30, 2016 for diaper dermatitis was included. Results: We collected 205 cases, a hospital frequency of 22.18%. The sex ratio was 1.02 and the mean age was 8.49 months. Diaper dermatitis was inflammatory in 67%, irritative in 18%, infectious in 12% and associated with general disease in 3%. Dermatitis was seborrheic in 51.7%, mycotic in 14.6% and associated with: acrodermatitis enteropathic in 4 cases and granuloma gluteale infantum in one case. Baby diapers were used in 93.7% by moms with a change of less than 6 times a day in 84.9%. The clinical outcome was favorable in 56.1%. Conclusion: Diaper dermatitis in infant is a common infant dermatosis in Dakar. The multiple causes necessitate a rigorous diagnostic approach. Severity is related to association with general diseases. RÉSUMÉ Introduction: Les dermites du siège du nourrisson est un motif fréquent de consultation dermatologique. L’objectif de notre étude était de décrire les aspects épidémiologiques, cliniques, étiologiques et évolutifs des dermites du siège du nourrisson. Matériels et Méthodes: Une étude descriptive a été menée dans trois services de dermatologie à Dakar. Tous les nourrissons [1-30 mois] suivis du 1er Octobre 2015 au 30 Avril 2016 pour une dermite du siège étaient inclus. Résultats: Nous avons colligé 205 cas, soit une fréquence hospitalière de 22,18%. Le sex- ratio était de 1,02 et l’âge moyen de 8,49 mois. Les dermites du siège étaient inflammatoire dans 67%, irritative dans 18%, infectieuse dans 12% et associée à une maladie générale dans 3%. La dermite était séborrhéique dans 51,7%, mycosique dans 14,6% et associée à : une acrodermatite entéropathique dans 4cas et un granulome glutéal dans un cas. Les couches étaient utilisées dans 93,7% par les mamans avec un changement de moins de 6 fois par jour dans 84,9%. L’évolution clinique était favorable dans 56,1%. Conclusion: Les dermites du siège du nourrisson sont des dermatoses fréquentes chez le nourrisson à Dakar. Les causes multiples rendent nécessaire une démarche diagnostique rigoureuse. La gravité est liée à l’association avec des maladies générales

Antiphospholipid Antibodies and Systemic Scleroderma

Objective: Antiphospholipid antibodies (APLs) could be associated with an increased risk of vascular pathologies in systemic scleroderma. The aim of our study was to search for APLs in patients affected by systemic scleroderma and to evaluate their involvement in the clinical manifestations of this disease. Materials and Methods: We conducted a cross-sectional descriptive study, from January 2009 until August 2010, with patients received at the Department of Dermatology (Dakar, Senegal). Blood samples were taken at the hematology laboratory and were analyzed for the presence of APLs. Results: Forty patients were recruited. Various types of either isolated or associated APLs were found in 23 patients, i.e. 57.5% of the study population. The most frequently encountered antibody was IgG anti-β2 GPI (37.5% of the patients), followed by anticardiolipins (17.5%) and lupus anticoagulants (5%). No statistically significant association of positive antiphospholipid-related tests to any of the scleroderma complications could be demonstrated. Conclusion: A high proportion of patients showing association of systemic scleroderma and APLs suggests the presence of a morbid correlation between these 2 pathologies. It would be useful to follow a cohort of patients affected by systemic scleroderma in order to monitor vascular complications following confirmation of the presence of antiphospholipid syndrome