A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa).

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert's response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

[Giant verrucous nevus in a 15-year old girl: about a case]. / Nævus verruqueux géant chez une adolescente de 15 ans: à propos d'un cas.

Verrucous nevus is a benign tumor showing a linear pattern on Blaschko lines. It is caused by mosaic mutations of the receptor FGFR3 gene. It manifests as an aesthetic disfigurement, but individuals even experience functional complications due to itchiness. Lesions may be localized or extended (giant). In our context, the scarcity of specialized centers in dermatology is a cause of diagnostic delay inducing the patient to undertake unsuitable therapies responsible for infectious or degenerative complications. We report the case of a 15-year old girl with a history of keratotic papules showing a linear pattern along the neck, the right upper limb, the flank since childhood. Histological examination confirmed the diagnosis of verrucous nevus.

[Neonatal lupus in an infant of a mother followed up for dermatomyositis: medical images]. / Lupus néonatal chez un enfant dont la mère est suivie pour une dermatomyosite.

Neonatal lupus is rare. It is due to the transmission of maternal autoantibodies across the placenta during pregnancy. We here report the case of a 2-month old female infant treated for erythematous macular cutaneous lesions on the face and the trunk. Her mother was followed up for dermatomyositis diagnosed on the basis of clinical lesions, muscle weakness and elevation in muscle enzyme levels. However she had not underwent antinuclear antibody test (ANA). Clinical examination showed atrophic erythematous lesions distributed like butterfly wings on both sides of the nasal pyramid, satellite lesions on the front, with red hair. The remainder of the physical examination was unremarkable. Laboratory tests were not performed because infant's parents also refused the biopsy. These lesions suggested seborrheic dermatitis, rosacea or atopic dermatitis. However, rosacea is very rare in infants and usually affects fair-skinned people. In seborrheic dermatitis, lesions are not atrophic. The age of onset of atopic dermatitis is usually 3 months. Lesions regressed in 15 days under dermocorticoid therapy.

[Epidemio-clinical profile of dermatoses in children receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali)]. / Profil épidémio-clinique des dermatoses chez les enfants vus en consultation dermatologique dans le service de dermatologie du centre national d'appui à la lutte contre la maladie à Bamako (Mali).

INTRODUCTION: Skin diseases are a major public health problem in developing countries. In common practice, children represent the most affected segment of the population. This study aims to describe the epidemiological and clinical aspects of skin diseases in children aged 0-15 years receiving dermatological consultation in the Department of Dermatology at the National Center for Disease Control in Bamako (Mali). METHODS: We conducted a cross-sectional study in the Department of Dermatology and Venereology at the National Center for Disease Control from 1 January 2009 to 31 December 2009.Out of a total of 16339 patients who had undergone a dermatological consultation 5149 children were included in the study. RESULTS: Dermatitis-frequency in hospital attending children was 31.51%. We enrolled 2838 boys (55,10%) and 2311 girls (44.90%), with a sex-ratio of 1,22. Patient age ranged from 03 days to 15 years with an average age of 8 ± 5.7 years. Infectious dermatoses accounted for 55.10% of all dermatoses, immuno-allergic dermatoses (32.5%), inflammatory dermatoses (11.85%). CONCLUSION: Our study highlights the severity of infectious and immuno-allergic pathologies and the necessity to promote simple preventive measures such as hygiene, buying a clipper for each child.

Pruritus in dermatological hospital in Bamako, Mali.

Pruritus is a symptom frequently encountered in dermatology consultations. For practitioners working in a tropical environment, particularly in Africa, the diagnosis of pruritus remains a constant problem. The aim of this study was to describe the epidemioclinical aspects and the etiologies of pruritus encountered at the dermatological hospital in Bamako. We conducted a prospective survey on a cohort of patients attending the Department of Dermatology at the Centre National d'Appui (CNAM-Ex Institut Marchoux) in the Fight against Disease over a 1-year period (June 1, 2009-May 31, 2010). Consequently, the study included every patient, whatever their age and gender, that agreed to take part in the survey and whose main reason for attending for a consultation was "pruritus." The clinical and biological data were entered and analyzed using Epi Info software, version 6.04 fr. A total of 232 patients (163 women, 69 men) attended because of pruritus out of 1761 overall patients (i.e., a prevalence of 13.17%). The mean age of the patients was 33 ± 19 years. Dermatological causes represented 95% of the etiologies. This work allowed us to observe the systemic causes of pruritus in the dermatological environment in Mali and greater likelihood of black women to attend because of pruritus.