Dermatology

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Acute febrile neutrophilic dermatosis (Sweet's syndrome). A report of 2 cases
(Health & Medical Publishing Group, 1989-04) Jordaan, H. F.; De Goede, F. H.; Sandler, M.
ENGLISH ABSTRACT: Two cases of Sweet's syndrome are described. The diagnostic criteria, clinical spectrum, complications, pertinent differential diagnoses and treatment modalities of this relatively rare clinical condition are described. The association of Sweet's syndrome with underlying haematological malignant disease is stressed.
Aetiopathogenesis of atopic dermatitis
(Health & Medical Publishing Group, 2014-10) Jordaan, H. F.; Todd, G.; Sinclair, W.; Green, R. J.
The aetiopathogenesis of atopic dermatitis (AD) is complex and during recent years much has been learnt regarding the genetic predisposition to the development of this condition and how its interaction with the environment influences clinical manifestations. AD is not a simple allergic condition. An inherited stratum corneum barrier defect, transepidermal water loss, early antigen exposure through the skin and over-hygienic care of the young child seem to be the major drivers in the manifestation of the disease. Many other, more specific, environmental factors may influence the clinical picture in individual patients; some of these have an allergic basis, while others do not. In this article, the terminology used in this issue of CME is explained, the evidence for the different aetiopathological factors is presented and the factors that worsen or improve AD are listed.
An analysis of biopsies for suspected skin cancer at a tertiary care dermatology clinic in the Western Cape province of South Africa
(Hindawi, 2020) De Wet, Johann; Steyn, Minette; Jordaan, Henry F.; Smith, Rhodine; Claasens, Saskya; Visser, Willem I.
Background. Skin cancer is a growing health concern worldwide. It is the most common malignancy in South Africa and places a large burden on the public healthcare sector. There is a paucity of published scientific data on skin cancer in South Africa. Objectives. To report the findings of biopsies performed in patients with suspected skin cancer attending the Tygerberg Academic Hospital (TAH) Dermatology outpatient department (OPD) in the Western Cape Province of South Africa. Methodology: A retrospective chart review identified all patients who underwent a biopsy for a suspected skin cancer diagnosis between September 2015 and August 2016 at the TAH dermatology OPD. Results. A total number of 696 biopsies from 390 participants were identified, of which 460 were histologically confirmed as malignant lesions. The proportion of clinically suspected skin cancers that were histologically confirmed as cancer was 68%. The most commonly occurring malignancies were basal cell carcinoma (BCC) (54.8%), squamous cell carcinoma (SCC) (18.9%), squamous cell carcinoma in-situ (SCCI) (8.0%), Kaposi’s sarcoma (KS) (6.7%), malignant melanoma (MM) (6.1%), and keratoacanthoma (KA) (4.6%). The number needed to treat (NTT) for all cancers diagnosed and for MM was 1.5 and 4 respectively. BCC (89.3%) and KS (67.7%) was the most common skin cancer in the white and black population respectively. The ratio of BCC to SCC was 2.03. Conclusion. This study provides valuable scientific data on the accuracy of skin cancer diagnosis, distribution and patient demographics in the Western Cape Province of South Africa, on which further research can be based. The study highlights the burden of skin cancer on this specific population group and calls for standardised reporting methods and increased surveillance of skin cancers.
Clinical and pathological features of acral melanoma in a South African population : a retrospective study
(Health & Medical Publishing Group, 2018-08-28) De Wet, J.; Tod, B.; Visser, W. I.; Jordaan, H. F.; Schneider, J. W.
Background. Acral melanoma (AM) is a rare subtype of cutaneous melanoma (CM) that disproportionately affects skin of colour and carries a poorer prognosis than other melanoma subtypes. The poor prognosis is attributed to late diagnosis and subsequent relatively high Breslow thickness, but also to an intrinsic biological aggressiveness. Scientific data on AM from the developing world are limited and a need exists to characterise the disease further in the South African (SA) population. Objectives. To describe the clinical and pathological features of AM in an SA population. Methodology. A retrospective chart review characterised the demographics, clinical features and histological data of 66 patients diagnosed with AM between January 2010 and June 2016 at Tygerberg Academic Hospital, Cape Town, SA. Results. Sixty-six patients with AM were identified from 335 patients diagnosed with CM during the set time frame. The mean age (standard deviation (SD)) was 61.5 (12.5) years. Forty-two (63.6%) of the patients were female (male/female ratio 1:1.75). The majority of patients diagnosed with AM were black (48.5%), and the proportion of AM in black patients with CM was 80.0%. Fifty-six AMs (84.8%) were located on the foot and 10 (15.2%) on the hand. The median duration of the lesion before diagnosis was 10 months (range 2 - 84) and the mean (SD) tumour size was 3.8 (2.2) cm at diagnosis. The mean Breslow thickness of all AMs at diagnosis was 5.2 mm (median 4.2 mm, range 0 - 22). Stage of disease was known in 41 patients, 23 (56.1%) of whom had at least stage III disease at diagnosis. Mean Breslow thickness for foot and hand melanomas was 4.9 mm (range 0 - 22) and 6.9 mm (range 0 - 13.3), respectively (p=0.2552). The mean Breslow thickness in the black population was 6.3 mm compared with 4.2 mm and 4.3 mm, respectively, in the white and coloured populations (p=0.178). Patients from outside the Western Cape Province (WC) presented with a mean Breslow thickness of 6.6 mm (range 0 - 14.5) and patients from the WC with a mean Breslow thickness of 4.9 mm (range 0 - 22) (p=0.3602). Conclusions. AMs accounted for a significant proportion of all CMs diagnosed. Patients presented with an advanced stage of disease at diagnosis, and further studies are needed to further investigate the reasons for delayed diagnosis.
Consensus statement of the management of severe, difficult-to-treat atopic dermatitis in adults and adolescents in South Africa and the role of biologics
(Allergy Society of South Africa (ALLSA), 2021-09) Kannenberg, Susanna M; Karabus, Sarah J; Levin, Michael; Mabelane, Tshegofatso; Manjra, Ahmed I; Pillay, Lushen; Raboobee, Noufal; Singh, Rajendrakumar; Van Niekerk, André; Weiss, Robert; Visser, Willem I
The first biological agent for treatment of moderate-to-severe atopic dermatitis (AD), dupilumab, has recently been introduced to South Africa and guidance is required as to its place in therapy. Consequently, an expert panel was convened to reach consensus on 14 statements relevant to contemporary management of AD and the use of dupilumab. In summary, the objectives of therapy are to reduce skin inflammation and pruritus, restore skin-barrier function, avoid lfares, and improve quality of life. Useful comprehensive scoring tools to assess severity of AD and guide decisions to step up from topical to systemic therapy (including to a biologic agent), include SCORing Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI). In addition, a photographic record of pre-treatment and follow-up assessments is helpful. When systemic therapy is required, options include cyclosporin, which should be limited to short-term use, and off-label use of methotrexate. Systemic corticosteroids should be considered only in short courses for rescue therapy in the event of flares. New classes of medication for the treatment of moderateto-severe AD are in various stages of development. The two most prominent classes of new therapies are biologics and small molecules. Dupilumab is the first fully humanised monoclonal antibody (MAB) biologic approved for the treatment of moderate-to-severe AD. It is an effective and well-tolerated, long-term treatment and has a favourable safety profile.
Gedissemineerde herpesvirus hominis-infeksie - 'n gevalbespreking
(Health & Medical Publishing Group, 1978) Brink, J. S. F.; Swart, E.
A case of disseminated Herpesvirus hominis (type I) in a 23-year-old White man with widespread eczema is reported. The grave prognosis of this disease is stressed.
Guideline on the management of psoriasis in South Africa
(Health and Medical Publishing Group (HMPG), 2010-04) Raboobee, N.; Aboobaker, J.; Jordaan, H. F.; Sinclair, W.; Smith, J. M.; Todd, G.; Weiss, R.; Whitaker, D.
Background. Psoriasis vulgaris is a chronic, relapsing, immunemediated, potentially devastating disease, influenced by genetic and environmental factors, that can cause substantial morbidity and psychological stress and have a profound negative impact on patient quality of life. Objective. These guidelines for the management of psoriasis have been developed in an attempt to improve the outcomes of treatment of this condition in South Africa. Psoriasis has a major impact on the quality of life of sufferers, and it is expected that these guidelines, if implemented, will play a role in achieving improved outcome. Scope. These guidelines were developed to address the diagnosis and treatment of psoriasis, of differing degrees of severity and in patients of all ages, by all health care professionals involved with its management. Recommendations. All health care workers involved in the management of psoriasis should take note of these guidelines and try to implement them in clinical practice as far as possible. All treatment methods and procedures not substantiated by evidence from the literature should be discontinued and avoided to decrease the financial burden of psoriasis treatment. Validation. These guidelines were developed through general consensus by a group of 8 South African dermatologists (the ’Working Group’) sanctioned by the Dermatological Society of South Africa (DSSA), by adaptation for the South African situation of the current guidelines used in the USA, the UK, Germany, Canada and Finland. Draft documents were made available for comment to the dermatological community as a whole via the official website of the DSSA, and the guidelines were presented and discussed at the annual congress of the DSSA in 2008. All input from these sources, where appropriate, were then incorporated into these guidelines. Guidelines sponsor. Schering-Plough initiated the project and sponsored the meetings of the working group and all costs generated by these meetings. Plans for guideline revision. The field of biologicals and cytokine modulators is in a rapid phase of development, and revision of the scope and content of these guidelines will be ongoing as longer-term data emerge.
The incidence of melanoma in South Africa : an exploratory analysis of National Cancer Registry data from 2005 to 2013 with a specific focus on melanoma in black Africans
(Health & Medical Publishing Group, 2019-03-29) Tod, B. M.; Kellett, P. E.; Singh, E.; Visser, W. I.; Lombard, C. J.; Wright, C. Y.
Background. Melanoma is an aggressive skin cancer with poor survival when diagnosed late. There are important differences in clinical and histological features of melanoma and disease outcomes in people with darker skin types. Methods. A retrospective review of data captured by the National Cancer Registry (NCR) of South Africa (SA) was performed for 2005 - 2013. Data on patient numbers, demography, location and biological features were analysed for all records. Closer analysis of melanoma of the limbs reported in black Africans was done after manually collecting this information from original reports. Results. With 11 784 invasive melanomas reported to the NCR, the overall incidence of melanoma for SA was 2.7 per 100 000. Males (51%), individuals aged ≥60 years (48%) and the anatomical sites of lower limb (36%) and trunk (27%) were most commonly affected. Melanoma incidences in the white and black populations were 23.2 and 0.5 per 100 000, respectively. Most cases were diagnosed at private pathology laboratories (73%). Superficial spreading melanoma (47%) and nodular melanoma (20%) predominated. Among 878 black Africans diagnosed in the public sector with melanoma of the limbs, females (68%) and individuals aged ≥60 years (61%) were most commonly affected. Lower-limb lesions (91%) and acral lentiginous melanoma (65%) predominated, with 74% of cases affecting the foot and 62% of cases presenting with a Breslow depth >4 mm. Conclusions. This study provides up-to-date NCR incidence and demographic data on melanoma and highlights the neglected research gaps in relation to melanoma in black Africans to provide evidence needed to address health disparities in overlooked population groups.
The incidence of skin cancer in relation to climate change in South Africa
(MDPI, 2019-10-22) Wright, Caradee Y.; Norval, Mary; Kapwata, Thandi; Du Preez, David Jean; Wernecke, Bianca; Tod, Bianca; Visser, Willem I.
ENGLISH ABSTRACT: Climate change is associated with shifts in global weather patterns, especially an increase in ambient temperature, and is deemed a formidable threat to human health. Skin cancer, a non-communicable disease, has been underexplored in relation to a changing climate. Exposure to solar ultraviolet radiation (UVR) is the major environmental risk factor for skin cancer. South Africa is situated in the mid-latitudes and experiences relatively high levels of sun exposure with summertime UV Index values greater than 10. The incidence of skin cancer in the population group with fair skin is considered high, with cost implications relating to diagnosis and treatment. Here, the relationship between skin cancer and several environmental factors likely to be a ected by climate change in South Africa are discussed including airborne pollutants, solar UVR, ambient temperature and rainfall. Recommended strategies for personal sun protection, such as shade, clothing, sunglasses and sunscreen, may change as human behaviour adapts to a warming climate. Further research and data are required to assess any future impact of climate change on the incidence of skin cancer in South Africa.
Modelling the healthcare costs of skin cancer in South Africa
(BioMed Central, 2016) Gordon, Louisa G.; Elliott, Thomas M.; Wright, Caradee Y.; Deghaye, Nicola; Visser, Willie
Background: Skin cancer is a growing public health problem in South Africa due to its high ambient ultraviolet radiation environment. The purpose of this study was to estimate the annual health system costs of cutaneous melanoma, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) in South Africa, incorporating both the public and private sectors. Methods: A cost-of-illness study was used to measure the economic burden of skin cancer and a ‘bottom-up’ micro-costing approach. Clinicians provided data on the patterns of care and treatments while national costing reports and clinician fees provided cost estimates. The mean costs per melanoma and per SCC/BCC were extrapolated to estimate national costs using published incidence data and official population statistics. One-way and probabilistic sensitivity analyses were undertaken to address the uncertainty of the parameters used in the model. Results: The estimated total annual cost of treating skin cancers in South Africa were ZAR 92.4 million (2015) (or US$15.7 million). Sensitivity analyses showed that the total costs could vary between ZAR 89.7 to 94.6 million (US$15.2 to $16.1 million) when melanoma-related variables were changed and between ZAR 78.4 to 113.5 million ($13.3 to $19.3 million) when non-melanoma-related variables were changed. The primary drivers of overall costs were the cost of excisions, follow-up care, radical lymph node dissection, cryotherapy and radiation therapy. Conclusion: The cost of managing skin cancer in South Africa is sizable. Since skin cancer is largely preventable through improvements to sun-protection awareness and skin cancer prevention programs, this study highlights these healthcare resources could be used for other pressing public health problems in South Africa.
Nuwe statistiese oorsig van velsiektes in die Wes-Kaap
(Health & Medical Publishing Group -- HMPG, 1978-02) Floter, W.
Statistics concerning dermatological disease in outpatients seen at the dermatology clinic at Tygerberg Hospital during 1975 are presented. The greatest number of patients suffered from bacterial, mycotic or parasitic infection. Acne also features high on the list. Except for the photodermatoses and acne, the difference in racial incidence of certain skin conditions, as published by Marshall and Heyl in 1963, is confirmed. More women than men were seen. This might be explained by the fact that, owing to working obligations, men often find it more difficult to attend outpatient clinics during the day. The greatest number of patients seen ranged in age from 20 to 60 years.
Pyoderma gangrenosum, acne, and suppurative hidradenitis syndrome in end-stage renal disease successfully treated with adalimumab
(University of California, 2017) De Wet, J.; Jordaan, H. F.; Kannenberg, S. M.; Tod, B.; Glanzmann, B.; Visser, W. I.
PASH syndrome (pyoderma gangrenosum, acne, and suppurative hidradenitis) forms part of the spectrum of autoinflammatory diseases. We report an unusual case of PASH syndrome in a patient with end-stagerenal disease (ESRD) who was successfully treated with the tumor necrosis factor inhibitor, adalimumab. The case underscores the challenges associatedwith the treatment of PASH syndrome as well as the ongoing search to establish a genetic basis for the syndrome. Renal impairment has been reported in association with pyoderma gangrenosum but has notbeen described in PASH syndrome. We believe this to be the first reported case of a patient who developed PASH syndrome in the setting of ESRD.
Widespread superficial thrombophlebitis as a manifestation of secondary syphilis - a new sign. A report of 2 cases
(Health & Medical Publishing Group, 1986-10) Jordaan, H. F.
ENGLISH ABSTRACT: Two patients with serologically proven secondary syphilis also showed multifocal superficial thrombophlebitis. All manifestations cleared when appropriate antisyphilitic treatment was instituted. Although Treponema pallidum could not be demonstrated in the thrombophlebitic veins, the organism was considered responsible, either directly or indirectly. Multifocal superficial thrombophlebitis should be regarded as a new sign of secondary syphilis.

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