Pellagra defines systemic disease as resulting from a marked cellular deficiency of niacin. It is characterized by 4 “D’s”: diarrhea, dermatitis, dementia, and death. Diagnosis of pellagra is difficult in the absence of the skin lesions, and is often facilitated by the presence of characteristic ones. The dermatitis begins as an erythema. Acute pellagra resembles sunburn in its first stages, but tanning occurs more slowly than typically in sunburn. Exacerbation follows re-exposure to sunlight. In this work we review the findings of this once mysterious disorder, one that still challenges clinicians world-wide.

Pellagra: dermatitis, dementia, and diarrhea.

Niacin has recently been demonstrated to lower blood pressure in hypertensive patients and to reduce cardiovascular events when combined with a statin. As a consequence, niacin has been elevated from being of historical interest as the treatment for pellagra, to being a compound with possible relevance to contemporary therapeutics. In spite of this, niacin deficiency leading to pellagra continues to be a health problem in some countries. Characterized by an exposed-site hyperpigmented dermatitis, pellagra is generally accepted to have been the first photosensitivity syndrome described. At its worst, pellagra manifests as one of the most striking examples of systemic photosensitivity. This is the only photosensitivity syndrome where death is included as a cardinal clinical feature (the often quoted four 'Ds': dermatitis, diarrhoea, dementia and death). However, the pathogenetic mechanism for the photosensitivity caused by niacin deficiency has yet to be determined. This review seeks to update the classification and phenotypic characterization of the various forms of niacin-deficient photosensitivity. Previous speculation about possible mechanisms for the pathogenesis of photosensitivity due to niacin deficiency is reviewed in the context of advances in the understanding of the photochemical basis of photosensitivity reactions. The review concludes by highlighting research required to advance the understanding of this photosensitivity syndrome.

Pellagra: a review with emphasis on photosensitivity.

Morgenstern V, Zutavern A, Cyrys J, et al. Am J Respir Crit Care Med . 2008;177(12):1331–1337

PURPOSE OF THE STUDY. To assess the relationship between exposure to traffic-related air pollutants and allergic disease outcomes in a prospective birth cohort during the first 6 years of life.

METHODS. A birth cohort of 3061 children in the Munich, Germany, metropolitan …

Atopic Diseases, Allergic Sensitization, and Exposure to Traffic-Related Air Pollution in Children

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare severe cutaneous drug reactions. No large scale epidemiological data are available for this disorder in India. Aims: To carry out a systematic review of the published evidence of the drug-induced SJS and TEN in Indian population. Methods: Publications from 1995 to 2011 describing SJS and TEN in Indian population were searched in PubMed, MEDLINE, EMBASE and UK PUBMED Central electronic databases. Data were collected for the causative drugs and other clinical characteristics of SJS and TEN from the selected studies.Results: From 225 references, 10 references were included as per selection criteria. The major causative drugs were antimicrobials (37.27%), anti-epileptics (35.73%) and non-steroidal anti-inflammatory drugs (15.93%). Carbamazepine (18.25%), phenytoin (13.37%), fluoroquinolones (8.48%) and paracetamol (6.17%) were most commonly implicated drugs. Regional differences were observed for fluoroquinolones, sulfa drugs and carbamazepine. Total 62.96% of patients showed systemic complications. Most common complications were ocular (40.29%) and septicemia (17.65%). Higher mortality was observed for TEN as compared to SJS (odd ratio-7.19; 95% confidence interval (CI) 1.62-31.92; p = 0.0023). Observed mortality is higher than expected as per SCORTEN score 3. Duration of hospital stay was significantly higher in TEN (20.6 days; 95% CI 14.4-26.8) as compared to SJS (9.7 days; 95% CI 5.8-13.6; p = 0.020). Cost of management was significantly higher in TEN (Rs. 7910; 95% CI 5672-10147; p < 0.0001) as compared to SJS (Rs 2460; 95% CI 1762-3158). No statistical data were described for steroid use in the studies included. Conclusion: Carbamazepine, phenytoin, fluoroquinolones and paracetamol were the major causative drugs. TEN is showing higher mortality, morbidity and economic burden than SJS.

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A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population.

Cutaneous drug reactions are the most common type of adverse drug reaction. These reactions, ranging from simple pruritic eruptions to potentially life-threatening events, are a significant cause of iatrogenic morbidity and mortality. Stevens-Johnson syndrome (SJS) is a serious and potentially life-threatening cutaneous drug reaction. Although progress has been made in the management of SJS through early detection, prompt hospitalization, and immediate cessation of offending agents, the prevalence of permanent disabilities associated with SJS remains unchanged. Nevertheless, despite being a problem that is global in scope, government and health care agencies worldwide have yet to find a consensus on either diagnostic criteria or therapy for this disorder. Here, we provide the internist and emergency room physician with a brief review the SJS literature and summarize the latest recommended interventions with the hope of improving early recognition of this disease and prevention of permanent sequelae and mortality that frequently complicate SJS.

Stevens‐Johnson syndrome: Pathogenesis, diagnosis, and management

Adherence to antiretroviral therapy (ART) is beneficial in reducing the risk of emergence of HIV resistant strains. Adherence to ART among Persons Living with HIV/AIDS (PLWHA) is influenced by several factors related to the patient, the medication, and health facilities. In Togo, previous studies on adherence to ART have reported good adherence to ART during the first year of follow-up. However these may hide many disparities dues to cultural specificities which may differ across geographic areas of the country. We sought to determine the level of adherence to ART and document the associated factors among PLWHA at the regional hospital of Sokode, Togo. This was an analytical cross-sectional study conducted from May to July 2013 at the regional hospital of Sokode among 291 PLWHA who had been on ART for at least three months before the study. A total of 291 PLWHA on ART were enrolled in the study. The mean age (±SD) was 37.3 ± 9.3 years and the sex ratio (Male/Female) was 0.4. Among them, 195 (67.0%) were living with their partners and 210 (72.2%) had formal education. Two-thirds (194/291; 66.7%) of the PLWHA interviewed lived in urban areas. The global adherence to ART was 78.4%; the factors associated with ART adherence were: level of education (aOR = 3.54; p = 0.027), alcohol consumption (aOR = 0.43; p = 0.033), ART perception (aOR = 2.90; p = 0.026) and HIV status disclosure to sexual partner (aOR = 7.19; p ≤ 0.001). Although the level of adherence to ART in this study was higher than those reported in some studies in Sub-Saharan Africa, it remains sub-optimal and needs improvement. This may therefore hinder the implementation of efficient interventions related to access to ART services.

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Predictors of adherence to antiretroviral therapy among people living with HIV and AIDS at the regional hospital of Sokodé, Togo

This was a cross-sectional study performed on a sample of women over 15 years of age and resident in the city of Lomé. The sample was based on a rational selection from different neighborhoods and departments of the city of Lomé, covering all socio-professional categories of the female population. A pre-set and pre-tested questionnaire was used. In the first part of the study, direct contact was made with the women to collect sociodemographic data (age, socio-professional activity, marital status and educational level) and the names of the cosmetic products used. In the second part, after identifying the users of skin-bleaching cosmetic products, we performed a dermatologic examination on these women to investigate any potential cutaneous complications arising from this practice. The findings were analyzed using the E PI -I NFO program, version 5.01b (1992; Epicentre, Paris). The χ 2 test and Fisher’s exact test were used for the statistical analysis with a 5% significance threshold.

Cosmetic use of skin-bleaching products and associated complications

Aim To define the epidemiologic and clinical profile and course of the disease in African Kaposi's sarcoma (KS) and acquired immunodeficiency syndrome (AIDS)-associated KS in Togo. Methods This was a retrospective study performed on the medical records of patients seen at the Department of Dermatology, University Hospital of Lome, Togo from January 1994 to December 2004. The medical records of all patients with KS, who had undergone human immunodeficiency virus (HIV) serology, were included in the study. Results Ninety-three files on 98 patients with KS, who had undergone HIV serology, were included in the study. The annual incidence during the study period was 8.5. HIV serology was positive in 73 patients (78.5%) and negative in 20 patients (21.5%). The mean age of the patients with AIDS-associated KS was 33.8 ± 8.2 years, and 49.5 ± 15.8 years for African KS. The male to female ratio for AIDS-associated KS was 1.4, and 9 for African KS. The mortality rate at 2 years for African KS was 5%, and 45% for AIDS-associated KS. Conclusion The low level of access to antiretroviral drugs in HIV-infected patients explains the morbidity and mortality from AIDS-associated KS in Togo.

Kaposi's sarcoma in a hospital setting in Lomé (Togo): a study of 93 cases.

Objective. The aim of the study is to investigate the possible associations between the blood groups ABO and Rhesus systems and the presence of keloids in patients with black skin. Method. This case-control study was conducted between September 2007 and August 2011 comparing dermatologic outpatients with keloids to matched controls recruited in preanesthetic consultation at Tokoin Teaching Hospital of Lome (Togo). Results. The distribution of different ABO blood groups and Rhesus blood groups in both groups (cases versus controls) was not significantly different. This distribution of different blood groups was superimposed on the general population of blood donors at the National Blood Transfusion Center of Lome. Univariate analysis between each blood group and the presence of keloid does not yield any statistically significant association between blood groups and presence of keloids in the subjects. Conclusion. The study shows no significant association between blood groups and the presence of keloids in our patients. Further investigation needs to be conducted to elucidate this hypothesis further by conducting multicenter studies of several ethnic groups.

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Is There an Association between Keloids and Blood Groups

Objective This study aims at describing the clinical characteristics of patients with acne using skin bleaching (SB) products.



Patients and methods  This is a prospective study conducted over 8 months in three dermatology departments and one private clinic. All patients examined for acne were included in the study.



Results  The study included 119 patients examined for acne from March to October 2010. Among them 48 (40.7%) did SB. Hydroquinone was the first product used for SB (26 of 48), followed by topical corticosteroids (17 of 48). The elementary lesions were papules (99.2%), comedos (36.1%), pustules (63.9%), pigmentation (26.1%), scars (21%), and nodules (20.2%). The extent of acne on the face was observed in all patients (100%). The lesions were extensive among 43.7% of the patients. The extent of acne lesions was not statistically associated with SB. Other body areas concerned were the chest (20.2%), back, and shoulders (41.2%). The relative risk of having lesions on the back and/or shoulders when the patient practiced SB was 2.71 (CI: 1.08–6.84), which is significant.



Conclusion  The study suggests that the back and shoulders can be the main areas for acne lesions associated with the practice of SB. The influence of different types of product is unclear.

Koussake Kombaté

Papers

Predictors of adherence to antiretroviral therapy among people living with HIV and AIDS at the regional hospital of Sokodé, Togo

Cosmetic use of skin-bleaching products and associated complications

Kaposi's sarcoma in a hospital setting in Lomé (Togo): a study of 93 cases.

Is There an Association between Keloids and Blood Groups

Acne and skin bleaching in Lomé, Togo