Skin diseases in Bamako (Mali)

Background Skin diseases have only recently been considered as a possible public health problem in developing countries. Data supporting this matter are scarce. The aim of this study is to report the experience of a specialized dermatologic center in Bamako (Mali) in order to complete two previous studies conducted in the Bamako area: a prevalence study in the general population and a study in nonspecialized health centers of Bamako. It is our intention to provide a comprehensive picture of the problem of skin diseases in an African developing country. Methods We retrospectively collected all cases of skin diseases diagnosed during consultations provided at the Institut Marchoux in Bamako, the only center specializing in dermatology in Mali, during the year 1993. Results A total of 10,575 new outpatients were seen with 10,889 skin diseases. The main skin diseases registered were as follows: infectious dermatoses (41% of all diagnoses, including scabies (16.6%), superficial mycoses (13.6%), and primary pyoderma (5.6%)), dermatitis (20.4%), papular urticaria (4.4%), acne (4.2%), pityriasis alba (3.6%), keratoderma (3.6%), and urticaria (3%). Typical tropical infectious diseases accounted for only 1% of all diagnoses. Conclusions It appears that certain skin diseases (mainly scabies and pyoderma) are an important health problem for the population of the Bamako area. Public health policies should be implemented in order to manage this problem rationally.     

HIV and other sexually transmitted diseases at a rural hospital in Zimbabwe.

OBJECTIVE--To define the epidemiological characteristics of STD patients attending an outpatient clinic in rural Zimbabwe, to examine the aetiologic agents causing infection and to determine their relationship with HIV infection. SUBJECTS--319 men and 146 women, making a sample of about 7% all patients attending an STD clinic during the 3 month study period. Microbiological data were collected from 104 men and 72 women selected randomly from these. Pregnant women were excluded and patients who had received antibiotics within the previous 14 days were excluded from the microbiology sub-sample. SETTING--An outpatient STD clinic at a District Hospital on a major truck route about 300 km north of the capital, Harare. METHODS--All new patients attending the clinic during a 3 month period were enrolled for clinical and epidemiological investigations using a standard procedure. Specimens for microbiological investigation were taken from every second patient seen on the first three days of each week. RESULTS--The typical patient was male (m:f ratio 2.2) aged 20-29 years (68% patients), not married (56% men) and in paid employment (66% men vs. 27% for the district). In men the most common presenting feature was genital ulceration, while in women, discharges were more common. Genital warts were noted frequently in both sexes. In the sub-sample examined microbiologically, H ducreyi was isolated from 46% ulcers clinically diagnosed as chancroid, and motile spirochaetes were detected in 25% painless ulcers. Neither of these were detected in ulcers in women, but HSV antigen was found as frequently in ulcers from men (19%) as from women (17%). In patients with genital discharges, gonococcal infection occurred in 64% men and 17% women, while T vaginalis was isolated from 39% women and only 8% men. Over 60% gonococcal isolates were PPNG, and 18% showed in vitro resistance to tetracycline. Yeasts, mainly C albicans were isolated from 42% women with a discharge and 25% women with ulcers. In men the presence of yeasts was associated with superficial ulceration and itchiness of the glans. Positive HIV-1 serology was found in 64% patients. There was no statistical association with current genital ulcers, though there was an association with previous STD episodes and particularly with serological evidence of syphilis. Apart from yeasts, there was no association between positive HIV-1 serology and the presence of pathogens in the genital tract. CONCLUSIONS--The high prevalence of HIV-1 antibodies in STD patients in Karoi suggests integration of STD and AIDS control programmes to be a necessity. Since paid employment was a common feature of both STD clinic attendance and HIV-1 seropositivity, these programmes may be effectively directed through the work place.     

Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use

BACKGROUND: Hand decontamination is crucial to control nosocomial infections. The utility of hand decontamination is related not only to its antimicrobial effectiveness, but also to its acceptability by hospital staff. OBJECTIVES: We aimed to assess skin tolerance and antimicrobial effects of two widely accepted hand hygiene measures under in-use conditions. METHODS: Fifty-two nurses were randomly assigned for an 8-day period to either an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand samples were obtained both before and after a hand hygiene procedure, and skin tolerance was assessed using clinical scores and measurement of transepidermal water loss. RESULTS: Self-assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcoholic disinfectant (P = 0.004 and P = 0.01, respectively). The alcohol-based rinse was significantly more effective than liquid soap in removing transient contaminant micro-organisms (P = 0.016). Twenty of 50 hand washes with non-antiseptic soap apparently resulted in bacterial contamination of the hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0.003), and with the degree of skin damage (P = 0.005) in the antiseptic group. CONCLUSIONS: In everyday hospital practice, alcohol-based disinfectant is more effective and better tolerated than non-antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the number and the quality of hand hygiene procedures.     

Skin diseases in children in rural Kenya: long-term results of a dermatology project within the primary health care system

BACKGROUND: Following an epidemiological study on skin diseases in 5780 pupils from 13 schools in rural western Kenya in 1993, a dermatology project within the primary health care system was established in 1994 by the German non-government organization (NGO) 'Doctors in Aid of Children with Skin Diseases in Africa'. Within this project trained community health workers carried out regular visits to schools and nurseries and treated children with hydrocortisone acetate 1% cream for dermatitis, gentian violet 1% solution for bacterial skin infections, Whitfield's ointment for dermatophytoses and benzylbenzoate emulsion 25% for scabies. OBJECTIVES: To assess the impact of this intervention. METHODS: In 1999, after a 5-year period, 4961 pupils from the same 13 schools were re-examined and the prevalence rates were compared. RESULTS: Non-infective dermatitis had a prevalence of 1.7% in 1993 as well as in 1999; among the communicable diseases bacterial infections declined from 12.7% to 11.3% (not significant), fungal infections rose from 10.1% to 13.9% (P < 0.05) and arthropod infections (mainly scabies) remained at similar levels of 8.3% in 1993 and 8.0% in 1999. A distinctive reduction could only be found for tropical ulcers (0.1% in 1999 compared with 1.2% in 1993). CONCLUSIONS: The prevalence of dermatoses in children in rural Africa does not only depend on treatment schemes within the primary health care system, but on the socio-economic conditions available.     

Nordic Occupational Skin Questionnaire (NOSQ-2002): a new tool for surveying occupational skin diseases and exposure

Occupational skin diseases are among the most frequent work-related diseases in industrialized countries. Good occupational skin disease statistics exist in few countries. Questionnaire studies are needed to get more data on the epidemiology of occupational skin diseases. The Nordic Occupational Skin Questionnaire Group has developed a new questionnaire tool - Nordic Occupational Skin Questionnaire (NOSQ-2002) - for surveys on work-related skin disease and exposures to environmental factors. The 2 NOSQ-2002 questionnaires have been compiled by using existing questionnaires and experience. NOSQ-2002/SHORT is a ready-to-use 4-page questionnaire for screening and monitoring occupational skin diseases, e.g. in a population or workplace. All the questions in the short questionnaire (NOSQ-2002/SHORT) are included in the long version, NOSQ-2002/LONG, which contains a pool of questions to be chosen according to research needs and tailored to specific populations. The NOSQ-2002 report includes, in addition to the questionnaires, a comprehensive manual for researchers on planning and conducting a questionnaire survey on hand eczema and relevant exposures. NOSQ-2002 questionnaires have been compiled in English and translated into Danish, Swedish, Finnish and Icelandic. The use of NOSQ-2002 will benefit research on occupational skin diseases by providing more standardized data, which can be compared between studies and countries.     

Skin diseases in displaced populations: a review of contributing factors,challenges, and approaches to care

There are 70.8 million persons displaced worldwide due to war, persecution, and violence. Eighty percent of displaced persons reside in low- and middle-income countries with limited healthcare resources. Cutaneous diseases are commonly reported among displaced persons owing to numerous interrelated factors such as inadequate housing, overcrowding, food insecurity, environmental exposures, violence including torture, and breakdown of healthcare infrastructure. Diagnosis and management of these conditions, as well as an understanding of the context in which they present, is crucial to providing dermatologic care for displaced populations worldwide. Herein, we define displaced populations and, within this context, review the epidemiology of skin diseases, discuss pertinent skin conditions, examine challenges to care provision, and present approaches for improving dermatologic care. Inflammatory and communicable infectious disorders are the most common skin diseases seen in displaced populations. Other relevant conditions include skin manifestations of heat injuries, cold injuries, immersion foot syndromes, macronutrient and micronutrient deficiencies, torture, and sexual and gender-based violence. Provision of dermatologic care to displaced populations is hampered by limited diagnostic and therapeutic resources and specialist expertise. Medical screening for cutaneous disorders, context-relevant dermatology training, and telemedicine are potential tools to improve diagnosis and management of skin diseases in displaced populations.     

糠秕孢子菌与相关皮肤病

糠秕孢子菌 (ＭｉｃｒｏｓｐｏｒｕｍＦｕｒｆｕｒ)最初由Ｒｏｂｉｎ 185 3年命名 ,1989年Ｂｉａｌｌｏｎ新设马拉色菌属 (Ｍａｌａｓｓｅｚｉａ) ,随将之改名为糠秕马拉色菌 (ＭａｌａｓｓｅｚｉａＦｕｒｆｕｒ)。Ｍ .ｆｕｒｆｕｒ直径 2ｎｍ～ 4ｎｍ ,长 10ｎｍ～ 40ｎｍ ,棍棒状或呈微弯曲似“Ｓ”形 ,同时可看到直径 3ｎｍ～ 8ｎｍ球形 ,厚壁 ,多成群存在的孢子 ,间或出芽。也有只见菌丝或只见孢子。糠秕孢子菌属正常皮肤寄生菌 ,可以从几乎所有成人的体表分离出来〔1〕。一般在青春期前后和新生儿期生长繁殖活跃〔2〕,与这些阶段皮脂腺…     

High-affinity binding and lack of growth-promoting activity of 12(S)-hydroxyeicosatetraenoic acid (12(S)-HETE) in a human epidermal cell line

The arachidonic acid metabolite 12-hydroxyeicosatetraenoic acid (12-HETE) is assumed to play an important role in skin physiology and pathophysiology. Specifically, it has recently been discussed as a growth promoting agent in keratinocytes. Our aim was to find out whether epidermal cells possess specific receptors for 12-HETE which would mediate the effects of this eicosanoid in skin, including the putative growth stimulating activity. We could identify specific binding sites for 12(S)-HETE on the human epidermal cell line SCL-II. The analysis of binding data revealed a single class of binding sites with a Kd of 2,6 nM and a Bmax of 216,000 sites per cell. The binding was saturable, readily reversible, and specific for 12(S)-HETE with lower affinities for other monoHETE. We failed to detect any significant proliferative activity of 12(S)-HETE in the same epidermal cell line, although we applied three independent methods for evaluation of cell growth and used a concentration of 12(S)-HETE which should enable an optimal receptor occupancy. Thus, epidermal cells possess high-affinity 12(S)-HETE binding sites which are likely to be involved in the effects of this eicosanoid in epidermis. However, biologic effects other than direct growth stimulation seem to be transduced by 12(S)-HETE receptors in epidermal cells which need further investigation.     

Sexually transmitted diseases in Riyadh, Saudi Arabia: a study of patients attending a teaching hospital clinic

Of 716 men attending consecutively a dermatovenereological clinic in Riyadh, Saudi Arabia, over a period of a year 70·1% had non-specific genital infection, a figure which is four times that for gonorrhoea and 13 times that for syphilis. Most of the patients were single men aged between 20 and 29 years and had acquired their infections abroad. Although Riyadh is a cosmopolitan city with a large foreign population 79% of the infections occurred in local inhabitants.