Kaposi Sarcoma in Afghanistan: A Case Series from a Tertiary Referral Center.

Kaposi sarcoma is a vascular endothelial neoplasm caused by human herpesvirus 8. Although it is a well-studied disease, little is known about the specific characteristics or epidemiology of Kaposi sarcoma in Afghanistan. The data consist primarily of anecdotal reports and epidemiological studies extrapolated from neighboring countries. In this case series, we summarize existing data about Kaposi sarcoma in Afghanistan and present seven histologically confirmed cases with associated clinical features to shed light on the characteristics of Kaposi sarcoma in this unique geographic setting.

Chronic abdominal pain and diarrhea.

Pigmented macules on the patient's oral mucosa provided an important clue to the diagnosis.

Cutaneous myiasis in an elderly woman in Somaliland.

BACKGROUND: Cutaneous myiasis is a self-limited skin infestation by developing fly larvae, with three clinical subtypes: furuncular, migratory, and wound myiasis. Furuncular myiasis is endemic throughout much of Africa; however, few reports are from the Horn of Africa. CLINICAL PRESENTATION: An 85-year-old woman in Somaliland presented with a 12-day history of multiple painful and pruritic nodules on the temple, arm, chest, breast, flank, and legs. The posterior of a larva was visible within several lesions. One larva was extracted from an arm nodule and identified as Cordylobia anthropophaga (tumbu fly) by morphologic examination. The patient was instructed to occlude the other nodules with petroleum jelly and return in 3 days. Instead, she visited a traditional healer who extracted the remaining larvae. CONCLUSIONS: We present a case of furuncular cutaneous myiasis due to Cordylobia anthropophaga. Treatment options for this infestation include occlusion with petroleum jelly to cause larvae to exit, surgical extraction, and oral ivermectin. Occlusion may not be acceptable for some patients. Extraction may cause significant inflammatory response if the larva is damaged during the process. To our knowledge, this is the first published report of myiasis in Somaliland, although it is probably underreported. Myiasis is a common dermatosis associated with travel to endemic areas. Furuncular myiasis can easily be misdiagnosed as furunculosis or cellulitis. Dermatologists must be familiar with the clinical features and management of this dermatosis.

Skin lightening practices, beliefs, and self-reported adverse effects among female health science students in Borama, Somaliland: A cross-sectional survey.

BACKGROUND: Skin-lightening (SL) products are common, especially in Africa. Adverse effects from these products represent a public health concern. Use of these products in Somaliland is unknown. OBJECTIVE: This study aimed to determine the prevalence of use of SL products among female health science students, beliefs about these products and practices, and adverse effects experienced. METHODS: This was a cross-sectional survey of a convenience sample of female health science students at Amoud University in Borama, Somaliland. RESULTS: Of the 400 students who were invited to participate, 265 completed the survey (response rate: 66%). Mean participant age was 21.1 years (standard deviation: 2.0 years). The majority of students were single (91.2%) with a Fitzpatrick skin type of 3 or darker (94.2%). Past or present use of SL products was reported by 25.6% of participants, and 52.2% admitted to current use. Compared with non-users, more SL product users agreed that lighter skin color gives a woman more confidence, helps a woman have better job opportunities, and increases chances of getting married. They also agreed that advertisements on television for SL products influence a women's preference for a lighter skin tone (p < .05). More than 60% of participants were unsure what active ingredients were in their SL products. Only 9% denied any undesirable adverse effects, and the remainder reported an array of local and systemic adverse effects. The vast majority realize that SL products may cause undesirable local (92%) and systemic (89%) adverse effects. LIMITATIONS: Generalizability is limited because a nonrandomized convenience sample from one university was studied. Response bias also may have skewed results. CONCLUSION: Use of SL products among female health science students in Somaliland is common, and causes cutaneous and systemic adverse reactions. Use appears influenced by beliefs about the benefits of lighter skin color. Education is needed on the proper use of these products, how to avoid harmful products, and how to prevent complications.

Teledermatology and teledermatopathology as educational tools for international dermatology: a virtual grand rounds pilot curriculum.

BACKGROUND: Teledermatology may improve dermatologic care access in underserved areas and expand the clinical experience of dermatologists-in-training. The potential for teledermatology to supplement global health curricula in dermatology residency education has not been explored. METHODS: An international virtual grand rounds (VGR) curriculum was created based on teledermatology cases from Kabul, Afghanistan. The learning objectives included understanding the diagnosis and management of skin diseases in unfamiliar resource-limited settings and highlighting socioeconomic, cross-cultural, and ethical issues. A 17-item, Likert scale questionnaire was used to assess the effectiveness of the curriculum, including specific Accreditation Council for Graduate Medical Education (ACGME) competencies, as well as interest in global health and teledermatology. RESULTS: The survey was completed by 85 of 118 VGR attendees (72% response rate). Most respondents considered the curriculum valuable to their education (mean 4.5 on a 5-point Likert scale; standard deviation, 0.5), learned more about diagnosis and treatment of skin diseases in international settings (4.5; 0.6) and in the US (4.1; 0.8), and learned more about socioeconomic, cultural, and ethical issues in skin health (4.6; 0.5). The majority also reported being more interested in global dermatology (4.1; 0.8) and would recommend VGR to a colleague (4.5; 0.6). CONCLUSION: This pilot curriculum provided an innovative platform to enhance undergraduate and graduate medical education in international dermatology. International teledermatology education may be used to address multiple ACGME core competencies and increase resident awareness of sociocultural determinants of skin health.

Propranolol for infantile hemangiomas in developing countries.

BACKGROUND: Propranolol is the treatment of choicefor complicated infantile hemangiomas (IH). However,in some locations, propranolol has not yet becomestandard of care. To our knowledge, until 2014,propranolol had not been used in Afghanistan totreat IH. OBJECTIVES: To raise further awareness thatpropranolol is the treatment of choice for complicatedIH, suggest a propranolol induction, maintenance,and taper protocol, show an example of therapeuticsuccess in a resource-limited country, and discusspotential challenges. METHODS: At an academicteaching hospital in Kabul, Afghanistan, we conducteda retrospective chart review of patients treated withpropranolol for IH from 2014-2015. RESULTS: Seventeenpatients were treated using a modified protocol basedon consensus recommendations. Average age was 6.3months (range 2.5 to 18 months). Thirteen patientshad focal IH and four had large segmental facial IH.Three patients were lost to follow-up. The remaining14 had good response and very few complications,including one patient co-managed by utilizing storeand-forward teledermatology. CONCLUSIONS: Patientsin resource-limited countries can be managedsuccessfully using a modified version of a propranololinduction, maintenance, and taper protocol. Indeveloping countries where dermatologists arescarce, we suggest IH may be co-managed withprimary care physicians via teledermatology.

The social acceptability of handheld umbrellas for sun protection.

PURPOSE: Little is known about handheld umbrella (HU) use for sun protection in the United States. We sought to determine whether women consider the HU a socially acceptable form of sun protection and whether viewing pictures of famous women carrying umbrellas is influential. METHODS: This is a cross-sectional survey study of 382 women. Participants viewed a collage of famous women carrying umbrellas to assess effect on social acceptability. RESULTS: Twelve percent had used a HU for sun protection. Participants were more likely to use an umbrella after viewing the collage (P<0.001). The majority would consider umbrella use if recommended by a dermatologist. Independent predictors of social acceptability were age, had not lived in another country, sun protective clothing use and no sunscreen use, while skin color, ethnicity and education were not. Mean rating of social acceptability was an intermediate score of 5.41 (1=not acceptable, 10=totally acceptable) and increased to 5.88 postcollage (P<0.001). CONCLUSION: Social acceptability of HUs was moderate. Popular media may play a role in whether women view HUs as a socially acceptable form of sun protection. Dermatologists may consider recommending HUs as an adjunct but not replacement for other methods of sun protection.