Dermatovenorology

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Magnitude of Topical Corticosteroid Side Effects among Vitiligo Patients of Alert Hospital, Addis Ababa, Ethiopia.
(Addis Abeba University, 2021-05) Tadesse, Mikiyas; Dr. Woldeyes, Miheretu (MD, Assistant professor of dermatovenerology; Photodermatologist); Dr.Beshir, Amel(MD, Assistant professor of dermatovenerology)
Introduction: The global prevalence of vitiligo lies within the range of 0.1% – 2%. It is the most common disorder of pigmentation. It causes mild to severe psychological disturbance in more than a third of affected individuals. Additionally, public attitude towards vitiligo is negative in significant proportions of study subjects in countries like Ethiopia, adding to the psycho-social trauma. Topical corticosteroids are the mainstay of treatment in most government facilities of Ethiopia. Despite the relentless use of topical corticosteroids in general, and in Ethiopia in particular, studies giving exact account of the prevalence and types of side-effects are very few. Objective: The major objective of this study is to determine the magnitude of topical corticosteroid side effects among vitiligo patients of ALERT Hospital, Addis Ababa, Ethiopia. This study will also try to look into the differences in the incidence of adverse effects based on age, sex and site of application. This study will further try to identify the intermittent application pattern of topical corticosteroids least associated with adverse effects. Methodology: Institution-based, descriptive, cross-sectional study was conducted from May- August 2021. A total of 130 vitiligo patient who came to ALERT hospital for follow-up were included in the study. Face-to-face structured interview and observation was used for data collection. Data was entered using Epi-Info software version 7.1.4.0., and was cleaned, exported to and analyzed using SPSS version 21. Tables, Frequencies, proportion and Graphs along with measures of central tendency and dispersion were used to present the data as needed. Results: In relation to the local side effects observed, 85 (65.4%) of the study subjects had no local side effect. Of the rest (45 patients), 27 (20.8%) had only 1 local side effect and 18 (13.8%) had 2 local side effects. The most frequent local side effect was telangiectasia (recorded in 30 patients), followed by Epidermal atrophy (seen in 21 patients). The highest proportion of local side effect per treatment site was observed over the flexural areas in which 5 (45.4%) of the 11 treatments in this region resulted in local side effects. This region was followed by breast and neck, 44.4% and 34.4% of sites affected respectively. There was no statistically significant difference based on sex or age in relation to the magnitude of local side-effects. Conclusion: High incidence of local side effects was implicated in our study. The pattern of side effects is however similar to available studies with few exceptions. Neck is witnessed to be one of the side effect prone areas. Systemic side effects were negligible in our study.
Magnitude, Cause & Mortality of Ten, Ten-SJS & SJS in ALERT Hospital from May 2015 to May 2020G.C Addis Ababa, Ethiopia
(Addis Abeba University, 2021-08) Getachew, Fikirte; Dr.Girma, Selamawit (MD ,Dermatologist, assistant professor); Dr.Assefa, Seble (MD, Dermatologist, Assistant professor); Dr.G/Hiwot, Wintana(MD, Dermatologist, Assistant professor)
Background: Epidermal necrolysis (EN) is rare with the overall incidence of 1 to 6 case per million person-years and 0.4 to 1.2 cases per million person-years, for SJS &TEN respectively. The mortality rate associated with EN varying from 10% for SJS to almost 50% for TEN. Increasing age, significant comorbidity, and greater extent of skin detachment correlate with poor prognosis. Method: A retrospective study was conducted on EN patients visited ALERT hospital in the time frame mentioned above. The data was collected by reviewing the chart of patients with a clinical diagnosis of SJS, SJS-TEN&TEN between may2015-may2020. The collected data was analyzed. RESULT: 50 patients with a diagnosis of SJS,SJS/TEN over lap & TEN were admitted during the study period.68% of the patients diagnosed with SJS, SJS-TEN & TEN are females. The most common affected age group is between 25-50 years of age. TEN, SJS/TEN & SJS was most frequently attributed to antibiotics .ciprofloxaciline being the leading causative agent. HIv infection is the most common comorbidity associated. Mortality rate of 14% for SJS/TEN & 2.5% for the TEN groups was found& Anemia was the most common complication seen. Conclusion: Women and persons aged 25–50 years were the most affected groups within our study population, and drugs, especially ciprofloxaciline was the causative agent in 16% of the cases.
Pattern of Autoimmune Bullous Disorders Based on Histopathological Diagnosis, in ALERT Hospital, Addis Ababa, Ethiopia 2021: An Eight Years (2014-2021) Retrospective Study
(Addis Abeba University, 2021-08) Tadesse, Yohannes; Melaku, Aklilu (MD, Assistant Professor of Dermatopathology); Ayele, Adane (MD, Assistant Professor of Dermatopathology); Mulubirhan, Edom(MD, Assistant Professor of Dermatopathology)
Background: Autoimmune bullous diseases are a group of rare, acquired disorders causing blistering of the skin and/or mucous membranes characterized by overlapping features, resistance to treatment, and run a chronic course associated with signiﬁcant morbidity and mortality. The incidence of autoimmune bullous diseases among the general population is reported as 14.5/million/year. Therapy of bullous diseases consists of suppressing the immune system, controlling inflammation and improving healing of erosions. Majority of autoimmune bullous diseases are chronic diseases that can cause physical and emotional distress which is exacerbated by the need to often have lifelong treatment with immunosuppressive therapies that have potentially severe adverse effects. To the knowledge of the investigator, there is no study conducted regarding the prevalence of auto immune bullous diseases in Ethiopia. Objective: Assess the pattern of autoimmune bullous diseases based on histopathological diagnosis in ALERT/AHRI hospital from 2014-2021 Methods: A retrospective cross sectional study was conducted at ALERT/AHRI. Histopathologic reports of all patients from January, 2014- June, 2021 were reviewed and cases with autoimmune conditions were selected. Obtained data were coded and entered using EpiData version 4.6.0.2, and it was cleaned and analyzed using SPSS. Descriptive analysis of basic participant’s characteristics and disease pattern of autoimmune disease was conducted. Result: From the 13,563 patients sent for biopsy analysis, 134 patients were sent for histopathology confirmatory test for AIBD in the study period, 86 study participants who full fill the operational definition were enrolled and analyzed. Among these 37.2% of them were male and the rest 62.8% were female, with a mean age of 40.9 year, the minimum age of disease onset being 7 month of age and the maximum age of disease onset was 82 years old. The most frequent AIBD was Bullous pemhigoid with 34.8% (n=30), followed by pemphigus foliaceous and pemphigus vulgaris each being 24.4% (n=21). Conclusion and recommendations: This study found bullous pemphigoid is the most prevalent in the assessed institution site. The overall mean age of the patients being 40.9 years, with a minimum age of 7 month and maximum of 82 years. Moreover, AIBD was seen in higher predominance in female patients, it is recommended for researchers to conduct a prospective study including other hospitals with a clinical correlation plus a qualitative study to assess how to improve the quality of life for such patients. Moreover, it is recommended to use a confirmatory diagnosis of AIBD i.e. immunofluorescence study for further researches.
Correlation of the Clinical Diagnosis of Cutaneous Leshmaniasis with Skin SLT Smear Histology and Culture at Dermatology Clinic, ALERT Center from May 2018 to May 2020 G.C Addis Ababa, Ethiopia.
(Addis Abeba University, 2021-09) Azene, Netsanet; Shibeshi, Dagnachew(MD,Dermatoenerologist,Allergologist,PhD); Mohammed, Fewzia(MD, Dermatoenerologist,Assistant professor); Mulatu, Eliyas (MD, Dermatoenerologist,Assistant professor)
Background: Leishmaniasis is a complex of diseases caused by the protozoa Leishmania and transmitted by the bite of infected phlebotomine sandfies. clinical diagnosis of CL may be possible in endemic areas.since the treatment is potentially toxic laboratory confirmation is mandatory. Objective:To asses correlation of clinical diagnosis of cutaneous leishmaniasis with positive laboratory tests used for the identification of leishmania parasite (skin slit smear ,culture and histopathology)among clinically diagnosed cases at dermatology clinic ,ALERT center from May 2018 to May 2020 G.C Addis Ababa, Ethiopia. Methodology: retrospective review of medical records of patients diagnosed with cutaneous leishmanias in ALERT Hospital, AA, Ethiopia from May 2018 to May 2020 was performed . Patient medical records retrieved and analyzed using SPSS Version 24. The results will be submitted to ALERT hospital, AAU College of Health Sciences, Department of Dermatovenerology, School of Public Health and FMOH. Results: Total of 215 were clinically diagnosed as cutaneous leishmaniasis by the dermatologist and dermatology residents. Out of 215, 158 (73.5%) patients were slit-skin-smear (SSS) positive,culture was done for 57 patents ,25 /215(11.6%) and histopathology done for 32/215(14.9% ), from these LD body seen in 4/32(12.5%) and in 25/32(78.13%) suggestive histology result and in 3/32(9.34%) diagnosis of other diseases was made. Conclusion: In our study , slit-skin-smear (SSS) positivity was 73%(158/215), culture positivity was 43.84%(25/57) and histopathology positivity was 90.6% (29/32). From total of 215 clinically suspected case 208 cases was diagnosed with one of the investigation modality SSS,culture or histopathology.Therefore clinical suspected cases by the clinician became 96.7% (208/215) positive. Recommendation: In limited resources setting and clinical accuracy of 96.7 %, clinical diagnosis by a dermatologist showed significantly comparable positive result with the laboratory investigation
Knowledge of and Attitude towards Leprosy among non Leprosy Patients Visiting ALERT Hospital from May 2021 to August 2021 G.C Addis Ababa, Ethiopia.
(Addis Abeba University, 2021-09) Keweti, Hawi; Dr. Tesfaye, Messay(MD ,Dermatovenerologist, Pediatric dermatologist, Ass professor); Dr.Teferi, Genet(MD, Dermatovenerologist, Ass professor )
Background: leprosy is a chronic infectious disease caused by Mycobacterium leprae, that predominantly affects the skin and peripheral nerves, resulting in neuropathy and associated long-term consequences, including deformities and disabilities. The disease is associated with stigma, especially when deformities are present. Objective: To assess the level of knowledge and attitude towards leprosy among non leprosy patients visiting ALERT Hospital from May 2021 to August 2021 G.C. Method: A cross sectional study was conducted among patients who visited ALERT hospital in the time frame mentioned above . The data was collected by using a structured self-administered questionnaire. Then was analyzed using SPSS Version 25. The results will be shared to ALERT hospital, AAU College of Health Sciences, department of Dermatovenerology, School of Public health and FMOH. Results: Among 260 study participants, 249 (95.76%) of them had heard about leprosy. Among the study participants who had heard of leprosy, only 25 (10%) of them had high level of knowledge of leprosy. Binary logistic regression revealed that study participants who completed primary, secondary school and Diploma and above(P=0.007,0.003 and 0.023 respectively) were significantly associated with high level of knowledge of leprosy. Out of 249 study participants who had heard of leprosy, 183 (73.5%) had a favorable attitude toward leprosy. Study participants who are in age range between 18-25 and not educated (P=0.011 and 0.044) and those who completed grade 1–8 and farmers (P= 0.003)were significantly associated with favorable attitude toward leprosy. Having high knowledge of leprosy was NOT associated with favorable attitudes toward leprosy Conclusion: This study revealed low overall knowledge of Leprosy among the non Leprosy patients visiting Alert Hospital . Having a high overall knowledge level on leprosy has not been shown to support a favorable attitude toward leprosy.
Magnitude and Clinical pattern of cutaneous Tuberculosis among patients attended Dermatology Clinic at ALERT center from April 2016March 2021 GC, Addis Ababa, Ethiopia
(Addis Abeba University, 2021-11) Miressa, Beshana; Melaku, Aklilu(MD,Assistant professor of Dermatovenereology and Dermatopathology); Yosef, Tizita(MD, Assistant professor of Dermatovenereology and Dermatosurgery)
Background: - Cutaneous tuberculosis is an infection caused by M. tuberculosis complex, M. bovis and Bacillus Calmette-Guérin, which depending on individual immunity, environmental factors and type of inoculum may present varied clinical and evolutionary aspects(3). Cutaneous TB is one of the most elusive and more difficult diagnoses to make for dermatologists practicing in developing countries because of the difficulty in obtaining a microbiological confirmation(3).Cutaneous TB comprises only a small proportion (1%- 2%) of all cases of TBnevertheless, bearing in mind the high prevalence of TB in many developing countries, these numbers become significant (19). Method: - Hospital based retrospective cross sectional study was conducted with secondary data of patients who were diagnosed to have cutaneous tuberculosis diagnosed with different diagnostic modalities. All the data were collected from the patient’s chart. Socio demographic, diagnosis and diagnostic modality related to the patient were included. Data were compiled, checked, coded, entered and cleaned using Epi Data 4.4.1 and all statistical tests were done using version 26 SPSS software. Result: - A total of 81 patients were found to have a cutaneous TB. The mean age was 32.3 (±18.63) years. The age ranges from 2 year to 77 years. Out of 81 patients, 41(50.6%) were female and 40(49.4%) were male. The overall magnitude of Cutaneous TB was 0.13%. The most clinical pattern was scrofuloderma (n=39, 48.2%) followed by TB abscess 8/81, lupus vulgaris 7/81. Cutaneous TB clinical pattern were not specified in 14/81, 17.3%. The most commonly employed diagnostic modality was FNAC (n=32, 39.5%), AFBsmear was positive in 12/81. Commonly body site affected were neck and face (n=27, 33.3%) followed by axilla and trunks (n=26, 32.1%). Only 5/81cases of cutaneous TB and HIV identified. Conclusion: - In this study the observed number of patients shows that cutaneous TB is still the existing medical problem despite promising achievement in reducing TB incidence annually by 9% at national level. Scrofuloderma is a form of cutaneous tuberculosis, most prevalent in children and adult age groups. For diagnosis of cutaneous TB FNAC used as the main diagnostic modality
Knowledge ,Attitude and Practice of Non-physician Female Health Care Professionals on Sun Screen Usage Alert Center
(Addis Ababa University, 2021-11) Baraki, Misgana; Hiletework, Mengistu
Back ground The earliest form of sunscreen was created by Franz Greiter in 1938 and then Benjamin Green in 1944 who used a mixture of cocoa butter and veterinary petrolatum to protect his skin from the sun. Sun screen provides a barrier which prevents the UV rays from penetrating the skin. Excessive ultraviolet light (UV) can cause premature skin aging and potentially skin cancer. Currently there seems to be lack of awareness among health care professionals and the public on sun screen usage for sun light protection. Objective To assess knowledge, attitude and practice of female non-physician health care professionals at ALERT center on sun screen usage. Materials and methods A cross sectional quantitative study was conducted among female non physician health professionals at ALERT center, in September 2021G.C. The data was collected by using self- administered questionnaire and analyzed by using SPSS version 25. First descriptive analysis was determined then association of independent variable and outcome variable was determined using logistic regression. Results A total of 135 participants filled the questionnaires. The participants consisted of 65 nurses (48.1%), 18 pharmacists (13.3%), 25 midwifes (18.5%), 11 health officers, 11 laboratory technicians (8.1%), and 5 (3.7%) were from other health care professions. 79.3 % of respondents has 1st and/or 2nd degree, 17% have diploma and the remaining 3.7 % have certificate. The age group of participants ranged between 24 and 48 years old. Among 135 respondents 128 heard about sun screen and 7 reported never heard of sun screen products. 44.5% of respondents had good knowledge about sun screen and the remaining 55.5 % has poor knowledge. The higher knowledge score was reported for pharmacists, which was 55.5% of pharmacists had good knowledge about sun screen products.39.8% of respondents had negative attitude towards sun screen use and 60.2% had positive attitude. Though 10.2% of respondents use sun screen, only 1 respondent (a nurse with a degree) uses the right way. 7 (53.8 %), from the 13 respondents who practice sun screen, was persuaded to use sun screen by their physician. The remaining was persuaded by friends and family. The most common reason for not using sun screen which respondents mention was: 38(33%) said they had no skin problem, 15(13%) said they usually stay in door during the day, 8(6.9%) said sun screen gives them a look they are not comfortable with. Other reasons mentioned where: sun screen creams are expensive, I don’t know which one to use, I did not get the one which fits my skin, I am allergic to sun screens and I uses an umbrella. Conclusion This study demonstrated a lack of knowledge and poor practice of sun screen among female non physician health care professionals. This finding supports medical education program on this topic to female non physician health professionals
Pattern of Skin Diseases in Patients Admitted to Dermatology Wards at ALERT Center from January, 2016 to December, 2020
(Addis Abeba University, 2021-11) Busser, Mehbuba; Dr.Solomon, Rahel (Assistant Professor, Dermatovenereology); Dr.Melaku, Mahlet (Assistant Professor, Dermatovenereology)
Background: Inpatient dermatology pattern has been described only in few countries, similarly it has not been done for ALERT Center. Epidemiological studies to determine the pattern of skin diseases are important for proper health care planning and management. Identifying the patterns will help to stress on groups of common skin diseases at all levels of health care so that proper diagnosis, treatment, and referral can be practiced. Objective: To evaluate the pattern of skin diseases of inpatients at ALERT Center Addis Ababa Ethiopia Methodology: A retrospective analysis of admission and discharge record of Dermatology inpatient department at ALERT Center from January 2016 to December 2020 was done. The five years record of patients was analyzed focusing mainly on the number of admission, demographic profile of patients, clinical diagnosis, readmission rate, length of hospital stay, and outcome. Result: A total of 1823 cases admitted during this 5 years period were identified for analysis. The common age group is 11 to 20 in females with 296 admissions and 21 to 30 in males with 156 admissions. 508 (27.92%) admissions were in pediatric age group i.e. below 18 years. The most common admission is for infection 1250(68.57%) followed by Erythroderma 170(9.33%), Inflammatory Skin Diseases 106(5.81%), Bullous Diseases 99 (5.43%), Connective Tissue Disease 27 (1.48%), Drug Reaction 95 (5.21%), Ulcer 11 (0.6%) and Malignancy 6 (0.33%). The remaining 59(3.24%) cases are others. Among infection diagnostic groups Cutaneous Leishmaniasis is the most common with 787 (62.96%) followed by Leprosy 218(17.44%) and Cellulitis 175 (14%). There were 12 cases of Wound infections consisting 0.96% of infection cases. Classifying infections in four major categories namely fungal infection, viral infection, bacterial infection and parasitic infestation, parasitic infestations are the common once followed by bacterial infections. The numbers of parasitic infestations are almost twice as much as the bacterial infections. The mean length of stay in hospital was 29.52 ± 42.76 days (Ranging from 1 day to 1312 days). 545 (29.9 %) patients stayed 21 to 30 days which is the common length of stay. Out of 1823 admissions there were 1584 (87.04%) discharges after improvement, 29 (1.59%) patients left against medical advice, 25 (1.37%) referred to other facilities and 6(0.33 %) transferred to other wards. 35 (1.92%) died and 42(2.30%) patients discharged with the same status. 102(5.60) patients are with missing outcome data. Conclusion: Infection, Erythroderma, Inflammatory Skin Diseases, Bullous Diseases, Drug Reaction, Connective Tissue Disease, Ulcer and Malignancy were the common conditions for the admission in a descending order. Policy makers could take these data as evidence to allocate beds and other facilities for Dermatological patients for better management of these subsets of patients. 68.57% of admissions were because of infections. Among the infection admissions the top three cases are Cutaneous Leishmaniasis, Leprosy and Cellulitis.
Magnitude and Clinical Pattern of Vitiligo at ALERT Center Addis Ababa, Ethiopia.
(Addis Abeba University, 2021-11) Demere, Lishan; Dr.Mohammed, Ahmed(MD,Assistant professor of dermatovenereology); Dr.Mehari, Bethlehem(MD,Assistant professor of dermatovenereology)
Abstract Background: Vitiligo is an acquired, idiopathic, and worldwide common depigmentation disorder with an estimated prevalence from 0.5 to 2%. The total number of people suffering from vitiligo is estimated at around 65-95 million people worldwide and little known about Vitiligo in Ethiopia Objective: To determine the magnitude and clinical pattern of vitiligo in ALERT hospital Methodology : A retrospective cross-sectional descriptive study of medical records of patients diagnosed with vitiligo was conducted from January 2019 to December 2020 Results: The Hospital magnitude of vitiligo was found to be 2.8 % and there was a slight female preponderance with 529(48.8%) males and 554(51.2) females, giving a male to female ratio of 1: 1.05. The commonest clinical form of vitiligo was vitiligo Vulgaris type 50(33.3%) followed by focal vitiligo40 (26.7%), acrofacial vitiligo 19 (12.7%), mucosal 21(14%) The most common site of the presentation was combination face& neck+trunk+limb 51(34%), head and neck 32 (21.3%), periorificia+distal finger20 (13.3%), followed by the mucosa 17(11.3%). Conclusions vitiligo on the skin of color is usually a very striking disease .our findings that the pattern of vitiligo is similar to that reported from the other parts world.

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