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INTRODUCTION Skin cancer is the main cause of death in persons with albinism (PWA) in Africa. Education would minimize sun damage. OBJECTIVE To evaluate the efficacy and acceptance of a photoprotection educative and sunscreen (Umozi Max) package designed for PWA in reducing sunburns and skin cancer. PATIENTS AND METHODS A multicenter, noncontrolled, before-and-after, interventional study was conducted in PWA > 12 years of age, from February to May, 2019, in Malawi. During the baseline and the follow-up visits (at 8 and 15 weeks), subjects received an educational program designed to PWA and use of Umozi Max. At every visit, photoprotection behavior and knowledge were checked and cutaneous lesions were recorded. Univariate and bivariate analysis were performed. RESULTS A total of 210 PWA were analyzed, 50% males, with a mean age of 24.5 (SD 11.29) years. The percentage of people using sun protective clothing increased from 80% to 100% and sunscreen from 81.9% to 99.5%. People avoiding the midday sun increased by 38.9% (P

Background:\ud Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment.\ud \ud Objective:\ud We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG.\ud \ud Methods:\ud This was a retrospective cohort study of UK secondary care patients with a clinical diagnosis of PG that was suitable for topical treatment (recruited between July 2009 and June 2012). Participants received topical therapy after normal clinical practice (primarily topical corticosteroids [classes I-III] and tacrolimus 0.03% or 0.1%). The primary outcome was speed of healing at 6 weeks. Secondary outcomes included the following: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality of life; treatment failure; and recurrence.\ud \ud Results:\ud Sixty-six patients (22-85 years of age) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28 of 66 (43.8%) ulcers healed by 6 months. The median time to healing was 145 days (95% confidence interval, 96 days to ∞). Initial ulcer size was a significant predictor of time to healing (hazard ratio, 0.94 [95% confidence interval, 0.88-1.00); P = .043). Four patients (15%) had a recurrence.\ud \ud Limitations:\ud Our study did not include a randomized comparator.\ud \ud Conclusion:\ud Topical therapy is potentially an effective first-line treatment for PG that avoids the possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone.

Vulval Crohn's disease [VCD] is a challenging condition that can occur without gastrointestinal Crohn's disease [GCD]. We reviewed the clinical features and effects of therapy in a cohort of 22 patients with VCD to determine whether the presence of GCD affected the clinical presentation and treatment response. Of these, 64% had GCD and 65% of these presented with GCD prior to VCD. Fissuring, ulceration, and scarring were more common in those with VCD alone. Potent and ultra-potent topical steroids showed benefit in most patients. There was no clear evidence of sustained remission with metronidazole. Azathioprine was the most commonly used oral immunosuppressive agent, with an efficacy of 57%. Patients with both VCD and GCD had a better clinical response compared with those with VCD alone [70% and 25%, respectively]. Infliximab and adalimumab were effective in 56% and 71% of patients, respectively. Excision of redundant tissue was helpful in four patients. The absence of GCD may delay the diagnosis in women who present with vulval symptoms alone. The more active clinical features in those with VCD alone may represent a more aggressive condition, or the severity of the cutaneous disease may have been reduced by immunosuppression taken for GCD. Several patients obtained sustained remission in their GCD with anti-tumor necrosis factor alpha [anti-TNFα] agents while the VCD remained active.

Purpose Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous disorder that frequently involves the ocular surface. This study aims to investigate the natural history and resolution of acute ocular involvement in patients with TEN admitted to the intensive care unit (ICU). Methods Case notes of patients admitted to ICU with TEN at a tertiary referral centre in a 9-year period were retrospectively reviewed. Patients’ characteristics, severity of ocular involvement, SCORTEN systemic severity score and treatment were correlated with resolution of ocular involvement and time to resolution. Results Nine out of 10 (90%) patients had ocular involvement with 4 graded as mild, 2 as moderate and 3 as severe. All had bilateral ocular disease. The median length of hospital stay was 28 days and the median time to resolution of ocular involvement was 19 days. Four out of 9 (44%) patients still had active ocular disease at the time of discharge. Only older age (p=0.032) and a milder grade of ocular disease (p=0.001) were significantly associated with resolution of ocular disease. In a multivariable Cox-regression model, only a milder grade of ocular disease remained independently associated with time to resolution of ocular disease (p=0.006). Conclusions Grading of acute ocular disease severity does not reflect systemic disease severity and is significantly associated with resolution and time to resolution of ocular involvement in TEN. The high rate of ocular involvement in patients with TEN and relatively large proportion of patients with active disease on discharge reiterates the need for constant ophthalmological monitoring of these patients.

Breast cancer diagnosed during pregnancy is a relatively uncommon event. This challenging situation presents clinicians with difficult decisions, often requiring a multidisciplinary approach at a time of heightened anxiety for the patient and their family. This paper describes the case of a young woman with metastatic breast cancer diagnosed in early pregnancy, and outlines how this complex clinical situation was managed.

Background Early detection of several skin-related neglected tropical diseases (skin NTDs)–including leprosy, Buruli ulcer, yaws, and scabies- may be achieved through school surveys, but such an approach has seldom been tested systematically on a large scale in endemic countries. Additionally, a better understanding of the spectrum of skin diseases and the at-risk populations to be encountered during such surveys is necessary to facilitate the process. Methods We performed a school skin survey for selected NTDs and the spectrum of skin diseases, among primary schoolchildren aged 5 to 15 in Côte d’Ivoire, West Africa. This 2-phase survey took place in 49 schools from 16 villages in the Adzopé health district from November 2015 to January 2016. The first phase involved a rapid visual examination of the skin by local community healthcare workers (village nurses) to identify any skin abnormality. In a second phase, a specialized medical team including dermatologists performed a total skin examination of all screened students with any skin lesion and provided treatment where necessary. Results Of a total of 13,019 children, 3,504 screened positive for skin lesions and were listed for the next stage examination. The medical team examined 1,138 of these children. The overall prevalence of skin diseases was 25.6% (95% CI: 24.3–26.9%). The predominant diagnoses were fungal infections (n = 858, prevalence: 22.3%), followed by inflammatory skin diseases (n = 265, prevalence: 6.9%). Skin diseases were more common in boys and in children living along the main road with heavy traffic. One case of multi-bacillary type leprosy was detected early, along with 36 cases of scabies. Our survey was met with very good community acceptance. Conclusion We carried out the first large-scale integrated, two-phase pediatric multi-skin NTD survey in rural Côte d’Ivoire, effectively reaching a large population. We found a high prevalence of skin diseases in children, but only limited number of skin NTDs. With the lessons learned, we plan to expand the project to a wider area to further explore its potential to better integrate skin NTD screening in the public health agenda., Author summary Integration of neglected tropical diseases (NTDs) into the public health agenda has been a priority in global health for the last decade. A common feature shared by several NTDs is skin involvement. Conditions within this group of NTDs have now been classified as skin NTDs to promote wider NTD integration. Several skin NTDs including leprosy, Buruli ulcer, yaws, and scabies are co-endemic in Côte d’Ivoire, West Africa. As children are vulnerable to these diseases, we carried out the first large-scale integrated, multi-skin NTD school survey in a rural district of this country. Our strategy of involving community healthcare workers and dermatologists effectively reached a large population. However, the detection of skin NTDs may have been limited because of the low schooling and attendance rate. We found a high prevalence of skin diseases among schoolchildren (26%), possibly due to poor socio-economic status and air pollution, which requires more attention. This high prevalence of skin diseases posed a challenge for our project as the need for medications and those with dermatological skills exceeded our capacity to reach our initial target population. Our study provides important lessons that will aid the framing of future school skin surveys in sub-Saharan Africa.

OBJECTIVE To develop and test a robust clinical staging system for podoconiosis, a geochemical disease in individuals exposed to red clay soil. METHODS We adapted the Dreyer system for staging filarial lymphoedema and tested it in four re-iterative field tests conducted in an area of high-podoconiosis prevalence in Southern Ethiopia. The system has five stages according to proximal spread of disease and presence of dermal nodules, ridges and bands. We measured the 1-week repeatability and the inter-observer agreement of the final staging system. RESULTS The five-stage system is readily understood by community workers with little health training. Kappa for 1-week repeatability was 0.88 (95% CI 0.80-0.96), for agreement between health professionals was 0.71 (95% CI 0.60-0.82), while that between health professionals and community podoconiosis agents without formal health training averaged 0.64 (95% CI 0.52-0.78). CONCLUSIONS This simple staging system with good inter-observer agreement and repeatability can assist in the management and further study of podoconiosis.

In the 21st century, despite increased globalization through international travel for business, medical volunteerism, pleasure, and immigration/refugees into the United States, there is little published in the dermatology literature regarding the cutaneous manifestations of helminth infections. Approximately 17% of travelers seek medical care because of cutaneous disorders, many related to infectious etiologies. This review will focus on the cutaneous manifestations of helminth infections and is divided into 2 parts: part I focuses on nematode infections, and part II focuses on trematode and cestode infections. This review highlights the clinical manifestations, transmission, diagnosis, and treatment of helminth infections. Nematodes are roundworms that cause diseases with cutaneous manifestations, such as cutaneous larval migrans, onchocerciasis, filariasis, gnathostomiasis, loiasis, dracunculiasis, strongyloidiasis, ascariasis, streptocerciasis, dirofilariasis, and trichinosis. Tremadotes, also known as flukes, cause schistosomiasis, paragonimiasis, and fascioliasis. Cestodes (tapeworms) are flat, hermaphroditic parasites that cause diseases such as sparganosis, cysticercosis, and echinococcus.

Molluscum contagiosum is a common viral infection of the skin that frequently affects children. Lesions take between 6 and 18 months to resolve spontaneously and are a source of great embarrassment to both caretakers and children, often affecting attendance at school and limiting social activity. Treatment options to date have been poorly tolerated by children but recent studies have suggested that potassium hydroxide may be beneficial. This double-blind, randomized, placebo-controlled study compared 10% potassium hydroxide with placebo (normal saline). Twenty patients, aged 2 to 12 years, were recruited. Parents applied a solution twice daily to lesional skin until signs of inflammation appeared. Children were examined by the same observer on days 0, 15, 30, 60, and 90. Seventy percent of children receiving topical potassium hydroxide cleared, compared with 20% in the placebo group. Further dosing studies are required to identify whether weaker concentrations of potassium hydroxide are as efficacious, with less irritancy.

Background Skin diseases represent one of the most frequent causes of morbidity in developing countries; however, little is known about the dermatologic needs of the population. The prevalence of skin disease in two different rural communities in southwestern Ethiopia was determined using descriptive epidemiologic techniques. Methods A household survey, designed to ascertain demographic information and dermatologic needs, was given to all households in both communities (827). The point prevalence of skin diseases was determined after examination by dermatologists of 768 self-selected individuals (40% of individuals were invited to attend dermatologic examination, either those self-reporting skin disease or identified as positive cases during the household survey); an individual survey form was given to all of these patients. Results Although 47% (S/UO) and 59% (Kishe) of the households in the two communities reported skin symptoms, the true dermatologic needs of these settlements were far greater than the expressed values, as examination by dermatologists of randomly selected households revealed that 67% of householders not reporting dermatoses had significant skin disease. During the point prevalence study, the commonest complaints were parasitic (scabies, pediculosis, and onchocerciasis) infestations (46% of diagnoses), followed by bacterial and fungal infections (33%); other conditions included endemic nonfilarial elephantiasis. Overcrowding was the main risk factor for infection. Thirty-two per cent (S/UO) and 39% (Kishe) of examined individuals had received previous treatments, which were ineffective in 74% and 63% respectively. Conclusions Subsistence farmers spend a high proportion of their limited cash income on ineffective treatment. Simple schemes of management for the most common dermatoses, which local health workers could be trained to recognize and manage, could do much to redress the burden of skin disease in this population.

It is always assumed that the prevalence of skin diseases in developing countries is very high, and that infestations and skin infections are highly endemic in poor rural communities; however, very few epidemiologic reports verify these assumptions. As part of a continuing study of dermatologic needs in southwestern Ethiopia, and to estimate the prevalence of treatable skin disease in children, a school survey was undertaken in Shebe. In October 1992, 112 children were examined by a team of dermatologists and their conditions were recorded. Twenty-two children (19.6%) were considered healthy and 90 (80.4%) had one or more skin diseases. A total of 140 conditions were identified and considered treatable in 98% of children. Infestations were the most prevalent skin pathology, 81.2%, followed by fungal infections, 13.4%.

Tinea capitis should be considered in all adults with a patchy inflammatory scalp disorder Tinea capitis (scalp ringworm) is uncommon after puberty. When it occurs in adults the clinical features may be atypical and this may delay the diagnosis.1 Unless the possibility of dermatophyte infection is considered, unnecessary investigations may be performed and inappropriate treatment prescribed, as illustrated in the four cases described below. ### Case 1 A 45 year old Afro-Caribbean woman had had an itchy pustular eruption of the scalp with associated hair loss for several months. Her general practitioner had treated it unsuccessfully with neomycin and gramicidin ointment and oral flucloxacillin and metronidazole. During this period the woman underwent lymph node aspiration and chest radiography because she had an enlarged but painless cervical lymph node. Cytological examination showed a mixed population of lymphocytes, indicating reactive changes; in addition, the surgical house officer observed that the woman had “quite a nasty rash on her scalp.” At the time of her referral to the dermatology clinic she had circumscribed areas of hair loss over the crown, with peripheral inflammation, pustules, and scaling (fig 1). Culture of bacterial swabs had negative results and a presumptive diagnosis …