[Place of theses and dissertations in the scientific publications of dermato-venereology teachers of the University of Lome (Togo)]. / Place des thèses et mémoires dans les publications scientifiques des enseignants de dermato-vénéréologie de l'université de Lomé (Togo): Ce travail a fait l'objet d'une communication orale lors des 5e journées dermatologiques de Ouagadougou (Burkina Faso) en octobre 2017.

The aim of this study was to situate the place of theses and dissertations (senior healthcare technicians, D.E.S or master) in the scientific publications of dermato-venerology teachers at the University of Lomé (Togo). We listed the theses and dissertations on dermato-venerology between 1990 and 2016, in three institutions of the University of Lomé and consulted databases (Medline, Inist, registers of the service) to search for publications by teachers during this period. A total of 41 theses and 50 dissertations were completed, on infectious dermatoses and STI/HIV (46.1%), immunoallergic dermatoses (11.0%) and tumour dermatoses (8.8%). Of these 91 works, 56 (including 28 theses) were published in indexed (21 theses and 26 dissertations) or non-indexed (7 theses and 2 dissertations) journals. These 56 publications represented 27.7% of the 202 publications made by the dermato-venerology teachers at the University of Lomé during this period. Of the 28 published theses, the MD student was the first author in one case (3,6%) This work shows that theses and dissertations in dermato-venerology represent almost one third of the publications in this discipline in Togo.

Reasons for inpatient admissions to the dermatology department in Lomé, Togo : Trends between 1992 to 2005 and 2005 to 2016.

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.

Chronic leg ulcers in hospitalized patients in Lomé, Togo: 125 cases.

The aim of this study was to document the profile and causes of chronic leg ulcers (CLU) in patients hospitalized in Lomé, Togo. This retrospective study reviewed records from the dermatology departments (CHU Sylvanus Olympio and Campus, and the dermatology center of Gbossimé) from 2000 to 2017 and from the general surgery department of CHU Sylvanus Olympio from 2013 to 2017 to identify cases. In all, 125 cases of CLU were identified during the study period. The patients' mean age was 56.6 years and the sex ratio (M/F) was 0.89. The average time from CLU onset to consultation was 10.9 weeks (range : 7 weeks to 4 years). They were mainly associated with a history of diabetes (32 cases), arterial hypertension (16 cases), varicose veins (14 cases), and malnutrition (14 cases). The main causes were : ulcers of infectious origin in 49.6% of cases (including 38 with phagedenic ulcers), ulcers of vascular origin in 36% (including 21 cases with a venous ulcer) and diabetic ulcers in 8.8% of cases. The ulcer was unilateral in 122 patients (67 on the right and 55 on the left) and bilateral in 3 patients. The locations were the foot in 56 cases, the leg in 37 cases, and leg and foot in 32 cases. In addition to dressings, surgical debridement was performed in 23 patients, followed by skin autografts for 16. Amputation was performed for 31 patients. Sixteen (12.8%) of the 125 patients died. Our study observed a high rate of phagedenic ulcers among CLU in Togo. It also pointed to a problem explaining the very high mortality rate: delayed consultation by patients who arrive only after the onset of complications.

[Factors associated with the severity of acute ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis in sub-Saharan Africa]. / Facteurs de risque associés à la sévérité de l'atteinte oculaire au stade aigu du syndrome de Stevens-Johnson et de la nécrolyse épidermique toxique en Afrique subsaharienne.

AIM: The purpose of this study was to identify risk factors associated with the severity of acute ocular involvement in Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) in sub-Saharan Africa. PATIENTS AND METHOD: A retrospective study was carried out at the dermatology department in collaboration with the ophthalmology department for SJS/TEN patients between January 2000 and December 2016 in Lomé (Togo). The severity of acute ocular involvement was evaluated using the Power classification, and the drug eruption score was assessed using de Bastuji-Garin classification. RESULTS: A total of 107 cases of SJS/TEN (84 cases of SJS, 20 cases of TEN and 3 cases of overlap syndrome) were analyzed. There were 71 women and 36 men, with an average age of 32.3±12.5 years (range: 5 to 75 years). Sulfonamides (37.4%) were the most commonly used drugs followed by nevirapine (22.4%). HIV serology was positive in 46 (58.2%) of the 79 patients tested. A total of 54 (50.5%) patients had acute ocular involvement, which was mild in 29.9% of patients, moderate in 13.1% and severe in 7.5%. In multivariate analysis, exposure to sulfadoxine was the sole factor associated with moderate or severe acute ocular involvement in SJS/TEN (adjusted odds ratio=3.3; 95% CI=[1.1; 10.2]). CONCLUSION: Exposure to sulfadoxine was identified in our study as a risk factor associated with the severity of acute ocular involvement in SJS/TEN. Multicenter studies should be conducted in sub-Saharan Africa to confirm this associated risk factor.

HIV prevalence and behavioral studies among female sex workers in Togo in 2015.

The purpose of this study is to determine the seroprevalence of HIVamong female sex workers (FSWs) and to document the behavior in this target population four years after the last study and possibly readjust these interventions. We conducted from March 27 to April 4, 2015 a crosssectional study of 1197 FSWs. Behavior data were collected by interviewer-administered questionnaires. The FSWs were then subjected to blood tests to measure the prevalence of HIV. The average age of respondents FSWs was 28 years and 20% had their first sexual intercourse before 15 years old. Overall, 48% of the FSWs received between 1 and 7 customers per working day. The majority of FSWs (90%) had consistently used condoms during their last week of work. HIV seroprevalence was 11.7% for FSWs. HIV prevalence was higher in FSWs living in Lomé, the capital city, (13.4%) than those living in the Kara region, in the North of the country (2%), P < 0.0001. The results of this study show the positive behavioral change in FSWs with a stabilization of HIV prevalence in this group after four years.

[Risk factors and allergic manifestations associated with atopic dermatitis in Lomé (Togo): a multicenter study of 476 children aged 0-15 years]. / Facteurs de risque et manifestations allergiques associés à la dermatite atopique à Lomé (Togo) : étude multicentrique portant sur 476 enfants de 0 à 15 ans.

OBJECTIVE: The aim of this study was to determine the prevalence and document the risk factors and allergic reactions associated with atopic dermatitis (AD) in children in Lomé. METHOD: This cross-sectional multicenter study took place from March to June 2013 in four health facilities in Lomé. It applied the criteria of the United Kingdom Working Party (UKWP). RESULTS: We included 476 children aged 0-15 years who came for a vaccination or pediatric consultation; 31.3% were diagnosed with AD. The mean age of the children with AD was 33.91 ± 37 months, and the sex ratio (M/F) 0.96. In the univariate analysis, several risk factors and allergic reactions were significantly associated with AD including weaning, asthma, allergic conjunctivitis, allergic rhinitis, food allergy, alopecia, seborrheic dermatitis in infants, and prurigo. In the multivariate analysis, AD was associated with prurigo (aOR = 15.59, 95% CI = 7.54 to 32.21), allergic rhinitis (aOR = 7.51, 95% CI = 4.31 to 13.10), and food allergy (aOR = 5.32 95% CI = 1.20 to 23.48) were associated with AD. CONCLUSION: AD is common in children in Lomé. Prurigo, allergic rhinitis and food allergy are allergic manifestations associated with it. These results deserve confirmation by a prospective study over a longer period.

[Risk factors associated with leg erysipelas (cellulitis) in sub-Saharan Africa: A multicentre case-control study]. / Facteurs de risque associés à l'érysipèle de jambe en Afrique subsaharienne: étude multicentrique cas-témoins.

BACKGROUND: Acute bacterial cellulitis of the leg (erysipelas) is a common problem involving considerable morbidity in dermatology practice in Africa. Previous studies conducted in Europe and North Africa have highlighted lymphoedema and toe-web intertrigo as independent factors associated with leg erysipelas. The aim of this case-control study was to identify risk factors associated with leg erysipelas in sub-Saharan Africa, within a different socio-economic and culture context. PATIENTS AND METHODS: We conducted a prospective case-control study in hospital dermatology departments in 8 sub-Saharan African countries over a 12-month period (October 2013 to September 2014). Each case of acute leg cellulitis was matched with 2 controls for age (±5 years) and sex. We analysed the general and local factors. RESULTS: During the study period, 364 cases (223 female, 141 male) were matched with 728 controls. The mean age was 42.15±15.15 years for patients and 42.11±36 years for controls. Multivariate analysis showed the following to be independent risk factors associated with leg erysipelas in our study: obesity (odds ratio [OR]=2.82 ; 95% confidence interval: 2.11-3.76), lymphoedema (OR=3.87, 95%CI: 2.17-6.89), voluntary cosmetic depigmentation (OR=4.29, 95%CI: 2.35-7.83), neglected traumatic wound (OR=37.2, 95%CI: 24.9-57.72) and toe-web intertrigo (OR=37.86, 95%CI: 22.27-64.5). CONCLUSION: The results of this study confirms the major role of local risk factors (toe-web intertrigo, lymphoedema) previously identified in other geographical settings. However, the originality of our study consists of the identification of voluntary cosmetic depigmentation as a risk factor for leg erysipelas in sub-Saharan Africa.

[HIV infection and mortality in the dermatology department in Lomé, Togo]. / Mortalité en dermatologie à Lomé (Togo) : le poids de l'infection à VIH.

OBJECTIVE: The aim of this study was to document the causes of death in the dermatology department in Lome´ and the role of HIV infection in those deaths. PATIENTS AND METHOD: This retrospective study examined the records of all patients admitted to this department from 1992 through 2012. RESULTS: During the study period, 52 (13.5%) of the 386 patients hospitalized in the Sylvanus Olympio University Hospital dermatology department died in the hospital. Their mean age was 37.7 ± 12.8 years (range: 18 to 68 years) and half (26 patients/52) were female. Kaposi's sarcoma (54.1%) was the most lethal skin disease, followed by cutaneous drug reactions (12.5%) and herpes zoster virus infection (11.1%). Of the 52 patients who died, HIV serology was positive in 28 of the 33 (84.8%) patients tested. The most lethal diseases, including Kaposi's sarcoma, Stevens-Johnson syndrome (toxic epidermic necrolysis), and chicken pox/shingles skin diseases were those in which HIV seroprevalence was highest. CONCLUSION: This study shows that HIV infection plays an important role in mortality in the dermatology department at Lome´, probably through the immunosuppression it induces.

[AIDS related Kaposi sarcoma: 103 cases in dermatology in Lomé (Togo)]. / Maladie de Kaposi associée au VIH : 103 observations en dermatologie à Lomé (Togo).

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.

[Profile of Buruli ulcer treated at the National Reference Centre of Togo: a study of 119 cases]. / Profil de l'ulcère de Buruli pris en charge au Centre national de référence du Togo: étude de 119 cas.

The purpose of this study was to describe the epidemiological, clinical, therapeutic profile and the outcome of Buruli ulcer (BU) in the National Reference Center for Buruli ulcer treatment (NRCBUT) in Togo. It was a retrospective and descriptive study of records of patients treated for BU in the NRCBUT between June 2007 and December 2010. During the study period, 119 patients (56.3% males) were treated in the NRCBUT for BU. The median age of patients was 14 years. The proportion of children (< 15 years) was 56.3%. On admission, 85 patients were at ulcer stage and 34 patients at the pre-ulcer stage. BU wounds were mainly located on lower limbs (50.4%), followed by upper limbs (32.6%) and trunk (13.3%). The location of the wounds on the lower limbs were more frequent in patients older than 15 years (P < 0.001), while those on the upper limbs (P = 0.002) and trunk (P = 0.03) were more frequent in patients aged less than 15 years. All patients had received medical treatment which was based on rifampicin-streptomycin combination for eight weeks. This treatment was coupled to surgery in 30 cases. The outcome was punctuated by complications in 7 patients, limb amputation in 3 patients, and sequels in 10 patients. This study confirmed that the BU is the prerogative of young subjects and the exposed areas in the skin facilitates transmission. Apart from these classic features, some unique aspects including the age-dependent distribution are related to the pathogenesis of this disease.

[Syndromic management of sexually transmitted infections in health care facilities in Togo: cases reported, 2005-2009]. / Prise en charge syndromique des infections sexuellement transmissibles dans les structures de soins au Togo : étude des cas notifiés de 2005 à 2009.

OBJECTIVE: The aim of this study was to evaluate trends in sexually transmitted infections (STI) in Togo. METHOD: This retrospective descriptive study included all STI cases reported from 2005 through 2009. RESULTS: During the study period, 241,561 STI cases were recorded in the six health regions of Togo, for an annual frequency of 48,312 cases. The mean age of patients was 27.4 ± 12.6 years, and those aged from 20 to 30 years accounted for 55.4% of all cases. The sex ratio (male/female) was 0.3. The most common STI syndrome was vaginal discharge (57.2%), followed by pelvic inflammatory disease (24%), urethral discharge (12.1%), and genital ulcer disease (5%). During the study period, the proportion of cases involving urethral discharge increased significantly, rising from 4.2‰ in 2005 to 4.5‰ in 2009 (p = 0.02), while the proportion involving genital ulcer disease remained stable (1.6‰ in 2005 and 2009). The proportion of cases involving vaginal discharge and pelvic inflammatory disease decreased significantly. CONCLUSION: Overall, this study shows that the number of STI cases reported by health facilities in Togo was stable from 2005 to 2009. Continued epidemiological surveillance is important to document STI trends as part of the HIV control program.

[Basidiobolomycosis: a review]. / Basidiobolomycose: revue générale.

This general review of the biomedical literature indexed on Medline (PubMed) and Pascal (INIST) over the past 40 years (1970-2010), supplemented by some unindexed studies, found 89 articles published about basidiobolomycosis. These case reports (n = 67) and series (n = 22) described 172 cases of basidiobolomycosis (84 in Asia, 47 in tropical Africa, 25 in North America, 12 in South America, two in Europe and two in Australia). Patients younger than 15 tears accounted for 70%, and the sex-ratio (M/F) was 2.1. Clinically, basidiobolomycosis results in firm subcutaneous plaques, sharply circumscribed, generally cold and painless, becoming hot and painful during flares. It can cause invasive disease of the gastrointestinal tract or lungs and can even be disseminated throughout the body. The main treatments are potassium iodide, trimethoprim-sulfamethoxazole, and the azole derivatives. The latter are very effective and well tolerated, unlike the former, which present a risk of recurrence or severe side effects.

[Fixed drug eruption in dermatology setting in Lomé (Togo): a retrospective study of 321 cases]. / Érythème pigmenté fixe en pratique dermatologique à Lomé (Togo): étude rétrospective de 321 cas.

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.

[Early guttate leukoderma in Darier's disease in a patient with black skin]. / Leucodermie en gouttes précoce au cours de la maladie de Darier chez un sujet à peau noire.

BACKGROUND: The clinical manifestations of Darier's disease are polymorphic and diverse. Guttate leukoderma has been described in around twenty patients with genetically pigmented skin. We report a case of widespread guttate leukoderma several years before the classic signs of Darier's disease in a patient with black skin. CASE REPORT: A 19-year-old woman consulted for characteristic signs of Darier's disease evolving for the previous four years. Examination revealed perifollicular, non-confluent hypopigmented macules and papules in small drop size (1-5mm in diameter) scattered on the trunk, limbs and the jaw and chin. These hypopigmented lesions had been present since the age of six years. Histology of the keratotic papules confirmed the diagnosis of Darier's disease. Histological inspection of a hypopigmented lesion showed hyperkeratosis, acantholysis and a considerable reduction of epidermal melanin pigment. DISCUSSION: Our observation suggests that a guttate leukoderma could be an early sign, readily accessible to dermatologists, in the diagnosis of Darier's disease in black-skinned patients.

Causes of mortality associated with HIV/AIDS in health-care facilities in Togo: a six-month prospective study.

In order to determine the rate and the different causes of mortality associated with HIV/AIDS in health-care facilities we conducted a prospective study between 1 April and 30 September 2010 in the six health regions of Togo. We rationalized the choice of the healthcare facilities in order to cover the entire national territory. During the study period, 24,054 patients were hospitalized. HIV serology was positive in 1065 (18.2%) of the 5865 tested patients. Of the 24,054 patients, we recorded 2551 deaths (10.6%), including 309 HIV-infected patients (5.2%). The mortality rate associated with HIV/AIDS was 1.3% of the total number of inpatients and 5.3% of the number of patients tested for HIV. The mortality rate among HIV-infected patients was 29%. The causes of death in patients infected with HIV/AIDS were mainly anaemia and cerebral toxoplasmosis. This study shows that mortality associated with HIV/AIDS in health-care facilities in Togo remains relatively high.