[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.

Stevens-Johnson and Lyell syndromes in children in a hospital setting in Lomé, Togo, from 2000 to 2015.

OBJECTIVE: The aim of this study was to document the profile of children with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, also called Lyell syndrome) in hospital settings in Lomé, Togo. METHOD: This descriptive retrospective study examined the records of children aged 0 to 15, seen and/or hospitalized in the dermatology department of CHU-SO Lomé and diagnosed with SJS/TEN between 2000 and 2015. RESULTS: Records were identified for 14 children with these diagnoses during the study period. Their average age was 10.9 ± 3.9 years. The average time between taking the apparently causal medication and the onset of symptoms was 10.5 days (range: 4 to 21 days). SJS accounted for 64.3% of the cases. Six children with SJS and one with TEN had ocular involvement. Antibacterial sulfonamides were the main drug involved for 43% of children, followed by anticonvulsants for 14/3%. CONCLUSION: Our results show that SJS/TEN is rare but serious in children. The antibacterial sulfonamides used for the treatment of malaria and anticonvulsants are their most frequent cause.

[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.

[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.

[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.