Skin Manifestations of HIV Infection in Children in Pediatric Services of Conakry University Hospital (Guinea)

Introduction: Dermatological manifestations during HIV infection play a diagnostic and prognostic role. They are observed in 83% - 98% of patients at the late stage of AIDS and 58% - 75% at an early stage of AIDS. The objective of this study was to determine the prevalence of skin diseases in HIV in children, describes the demographic profile and identify key dermatoses. Material and methods: This was a prospective study of descriptive kind conducted from August 25, 2009 to February 25, 2010. It involved children infected with HIV followed in pediatric services at the University Hospital of Conakry. All children were examined by an experienced dermatologist. The diagnosis of dermatosis was made according to the clinical signs. The stages of HIV infection were determined according to the WHO classification. Each child received retroviral serology rapid tests according to national algorithm. Results: Among 119 HIV-positive children 65 showed mucocutaneous manifestations, there are 34 girls and 31 boys, all HIV-1 infected with 66.16% in stage III disease. The average age was 7 years, ranging from 11 months to 15 years. 66.15% of the children were from married mothers and more than half of the mothers were illiterate. They were all positive for HIV1. Oral candidiasis (38.46%), prurigo (29.23%) and molluscum contagiosum (7.69%) were the most common skin diseases;52.31% had at least two associated dermatoses. The candidiasis-prurigo combination (26.47%) was the most common. Dermatosis was often associated with other conditions: malaria (30.76%), pulmonary tuberculosis (25.61%) and malnutrition (12.30%). Discussion: With 65 cases diagnosed in six months our study shows that skin diseases are common in HIV among children in Guinea. The prevalence and socio-demographic characteristics are close to those reported by sub saharian and North African authors. A special feature of the study is that most mothers are illiterate and are infected with HIV, which would have favored the contamination of these children. Conclusion: In Sub-Saharan Africa where the rate of pediatric HIV infection is increasing, it is important to identify the mucocutaneous manifestations for optimal care.

Cutaneous manifestations during recent pandemic,co-infection or pre or post COVID-19 manifestation-managed by Ayurveda

Background:Unique cutaneous manifestations simulating viral infection like intense itching,rashes,maculo popular eruptions etc are noted.Etiological factors,underlying pathology,prevalence,whether it manifests in initial stage or post covid or if it predicts associated severity,linked symptoms,later complications,adverse drug reactions and many other associated issues need to be reported and evaluated.Method:Reporting five cases with varied cutaneous manifestations during July 2020 from India.Frostbite like skin lesion,maculo papular eruptions in two cases,two rash like manifestations were considered and managed by Ayurveda.Patient who lived in same house as covid infected person,travelled from red zone,who tested positive for COVID-19 infection.Results:Itching and redness were the predominant symptoms which reduced quickly in 6 to 8 hours,eruptions gradually reduced in 3 to 6 days.Conclusions:Cutaneous mani-festations during the pandemic suspected or confirmed COVID-19 infection 5 cases reported from India,managed by Ayurveda indicates post COVID-19 needs to be managed to improve quality of life and prevent further complications.

Concentric Centrifugal Figurate Erythema as an Unusual COVID-19 Evanescent Skin Manifestation in a Patient With CD3^(+)/CD45^(+)Lymphocyte Infiltration:A Case Report

Introduction:Coronavirus disease 2019(COVID-19)may be associated with various skin manifestations.Among them,figurate erythema(FE)is rare;only a few clinical reports have been published.Herein,we reported an unusual concentric FE lesions and their immunohistochemical profile in a patient with COVID-19.Case presentation:A 52-year-old woman was diagnosed with COVID-19.One month later,she developed asymptomatic annular erythematous concentric ring lesions on her inner right thigh.The margin of every ring increased in coloration,and the lesions then completely resolved in 2 weeks.A biopsy revealed vasculitis of small vessels,an increase in the fluorescence intensity of CD3 and CD45,and negativity for COVID-19 RNA.Discussion:The results showed an unusual FE that has a clinical mixed type between erythema annulare centrifugum and erythema gyratum repens;the physiopathological mechanism in the FE due to COVID-19 is unknown;one theory involves rapid viral passage into the cutaneous vascular system that triggers an immune and inflammatory response.Although the results exhibited a negative COVID-19 RNA in the tissue,the CD3^(+)/CD45^(+)lymphocyte infiltration could explain the clinical pattern as a direct inflammatory response in the small vessel or as a delayed immune response.Conclusion:Our findings suggest an immunohistochemical small vessel vasculitis pattern with an unusual clinical FE that differs from other types of COVID-19-associated FE or erythema reported previously.

Cutaneous lesions and visceral involvement of tuberous sclerosis

Tuberous sclerosis (TS) is an autosomal dominant disorder with a significantrange of clinical expressions. The involvement of vital organs, such as the brain, kidney, heart andlung is the main cause of death in patients with TS. The aim of this study is to summarize thecharateristic cutaneous features and common extracutaneous involvement of TS, which are helpful tothe early detection of visceral involvement. The analyzed clinical data from 78 patients with TSincluded those from detailed history, physical and dermatological examination, cranial computedtomography ( CT) and magnetic resonance imaging ( MRI) , abdominal ultrasonography, chestroentgenography, hand and foot X-ray and ophthalmologic examination. The skin, brain and kidney wereinvolved frequently in TS patients. Hypomelanotic macules were the most common and earliestcutaneous lesions. Their number was more than 3 in 81. 5% of'the patients. They were followed byfacial angiofibromas and Shangreen' s patch in a decreasing frequency. Forehead plaque, facialangiofibromas and Shagreen's patch appeared in patients at mean age of 2. 6, 6. 0 and 8. 1 yearsrespectively. Cranial CT showed a high positive rate in TS patients . Cutaneous features of TS arehelpful in the early diagnosis of the disease. Hypomelanotic macules are especially important forpatients with epilepsy or babies whose number of hypomelanotic malues is more than 3. Cranial CT isof great value in the diagnosis of TS. The involvement of visceral organs such as the brain andkidney should be examined in TS patients.