Faculty Bibliography

INTRODUCTION: Ghana is currently developing its provision of dermatology services. Epidemiologic studies of the skin diseases seen by Ghanaian dermatologists are needed to guide these efforts. We aimed to describe the skin conditions seen by and management practices of Ghanaian dermatologists in a specialized clinic. METHODS: We conducted a chart review of new patients presenting to the Korle Bu Teaching Hospital dermatology clinic during 2014. RESULTS: Among the 529 patients studied, 700 discrete diagnoses were made. The most commonly diagnosed skin conditions were infections (24.6%) and dermatitis (24.6%); atopic dermatitis (8.4%), acne vulgaris (5.3%) and scabies (5.1%) were the most common specific diagnoses. Among infants, children, and adolescents, the most common diagnosis was atopic dermatitis (31.7%, 30.0%, and 14.9%, respectively). Acne vulgaris (12.0%) was the most common skin condition diagnosed in young adults. Irritant contact dermatitis (6.9%) was most common among adults. Lichen planus (9.9%) was the most commonly diagnosed skin condition in the senior population. Diagnoses made by dermatologists differed from the referral diagnosis documented by primary care providers for 65.8% of patients. The most frequently recommended treatments were antihistamines (47.8%) and topical steroids (38.4%). Only 18 diagnostic biopsies were performed. CONCLUSION: Our study summarizes the skin diseases seen and management practices of Ghanaian dermatologists in a specialized clinic at a large public teaching hospital. The results of this study can help to guide future dermatology education and development efforts in Ghana.

Background: Skin complaints are a frequent cause of outpatient visits in Ghana and other developing nations. Many skin diseases pose significant health problems for local populations and a financial burden for families. However, epidemiologic studies on the true burden of disease are lacking in many regions. The WHO has therefore solicited studies that expand geographic representation and add to the growing knowledge base of skin disease epidemiology. Objective: The purpose of this study is to document the types and frequencies of skin conditions seen at the outpatient dermatology clinic at Korle Bu Teaching Hospital (KBTH), a tertiary care hospital in Accra, Ghana. This information will be valuable in guiding educational efforts and resource allocation. Methods: We performed a retrospective chart review of all new patients presenting to the KBTH Dermatology Clinic, over a 1-year time period in 2014. Patient charts were reviewed for basic demographic data and clinical information such as referral diagnosis, diagnostic tests, diagnoses, treatments and number of follow-up visits. Ethical clearance was obtained from the local and US partner IRBs. Results: 632 new patients who were seen at the KBTH dermatology clinic met criteria for inclusion, and 529 had medical records available for review. The majority of the 529 patients studied were female (56.6%) and the mean age was 32.1 +/- 23.5 years. In total, 678 discrete diagnoses were made. The most commonly diagnosed skin conditions were infections (24.6%) and dermatitis/eczema (24.4%). 18 biopsies were performed. The treatments most commonly prescribed to patients were antihistamines (44.2%), topical steroids (38.0%), and keratolytics (26.8%). Patients attended an average of 2.7 +/- 2.4 clinic visits, with many patients only attending one visit (40.6%). Conclusions: Our results are in agreement with earlier studies from Ghana and other developing countries. A 1995 study of skin disease in Kumasi, a central Ghanaian city, showed infectious etiologies and dermatitis to be common. Our study also showed that biopsies were infrequent, likely due to the lack of local dermatopathology resources. Local affordable formulary was limited, but generally adequate. Limitations: Frequency data were obtained retrospectively from a single outpatient clinic; therefore, results are subject to a selection bias and may not be generalizable to the general population

We present a 21-year-old primigravida woman with a several-week history of pruritic, edematous, targetoid plaques that appeared initially on the abdomen, flanks, and legs and that progressed to involve the inner aspects of the upper arms and lateral aspects of the chest. The histopathologic findings showed perivascular and interstitial dermatitis with eosinophils and vacuolar changes with linear C3 deposition at the basement-membrane zone on direct immunofluorescence study. A diagnosis of pemphigoid gestationis was made. Pemphigoid gestationis is a rare, bullous dermatosis of pregnancy that may be associated with prematurity and small-for-gestational age birth weights. The diagnosis is often made with direct immunofluorescence studies of perilesional skin. Oral glucocorticoids remain the gold standard of therapy in moderate-to-severe cases. The edematous papules and plaques of pemphigoid gestationis may be particularly difficult to distinguish from polymorphic eruption of pregnancy; therefore, immunofluorescence studies are prudent. Prompt recognition and appropriate management may reduce morbidity of this disease, which often recurs with subsequent pregnancies.

We present a case of scleredema with a leonine facies in a 56-year-old man with a history of poorly controlled diabetes mellitus. The patient initially presented with erythematous, edematous papules and plaques on the face, neck, and upper back.

BACKGROUND: The goal of the current study was to investigate asthma and mental health among youth in the community, and to consider the role of asthma severity and persistence in this link. Method Data were drawn from the Raine Study, a population-based birth cohort study in Western Australia. Logistic regression models and generalized estimating equations were used to examine the relationship between asthma at age 5 years and the range of internalizing and externalizing mental health problems at ages 5-17 years. Analyses were stratified by asthma severity and persistence, and adjusted for a range of potential confounders. RESULTS: More severe and persistent asthma at age 5 was associated with significantly increased odds of affective, anxiety, somatic, oppositional defiant and conduct problems at ages 5-17. Mild asthma and remitted asthma were not associated with heightened vulnerability to mental disorders. CONCLUSIONS: Our results suggest that youth with symptomatic asthma are more likely to suffer from a wide range of mental health problems, and that the likelihood of mental health problems appears to increase as a function of asthma severity. Youth with poorly controlled and/or more severe and persistent asthma may be considered a vulnerable group who might benefit from mental health screening in clinical, school and community settings.

Generalized essential telangiectasia, which is a rare condition that is characterized by the progressive development of telangiectases on the skin, is a clinical diagnosis of exclusion. We present a 65-year-old man with a ten-month history of an asymptomatic eruption of the trunk and proximal aspects of the arms and hands that was comprised of macules and patches of telangiectases. The clinical presentation, associated diseases, hypotheses regarding pathogenesis, differential diagnoses, and reports on treatment modalities are reviewed. The relatively new association of this entity with systemic signs that include hemorrhage as well as the occurrence of generalized essential telangiectasia in patients with a history of hepatitis is discussed.

Pityriasis rubra pilaris (PRP) is an inflammatory condition of uncertain etiology. We present a case of PRP that demonstrates acantholysis on histopathologic examination, which is a characteristic feature that increasingly is recognized to aid in the diagnosis. We also review the clinical presentations and treatment options for this condition.