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Diagnosis

  • Severe itch with scratch marks

  • Dry skin with lichenification (thickened skin)

  • Soft feeling nodules, often darker coloured

  • Later atrophy (thinning) of the skin

  • Lymphatic blockage leads to ‘hanging’ of the skin in the groin

  • Skin colour changes

  • The disease can cause blindness (river blindness)

Management
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Diagnosis

  • Redness and superficial erosions or white thickened areas in mouth

  • Lesions can be itchy and painful, which may cause difficulty in eating/swallowing

  • You can scrape off the whitish surface of a patch

  • Common in babies, in which case it is usually harmless

 

Oral candidiasis can be a sign of HIV infection in older children and adults

Management

  •  Below 4 months of age: nystatin (100.000E per ml): swirl and swallow 1-2ml suspension around the mouth 4 times per day. Do not use oral gel in small babies, because of the risk of suffocation

  • Above 4 months of age: miconazole (Daktarin®) oral gel 20 mg/ml. Apply 4 times a day 1.25 ml with a clean finger. Avoid suffocation by not using too much

  • When breastfeeding, clean and dry nipples after feeding and apply miconazole (Datarin®). 

  • Clean pacifiers and milk bottles in cooking water after usage

  • More information: Common skin diseases in Africa: an illustrated guide | Infolep (leprosy-information.org)

  • Perform HIV test if:

    • Above infant age

    • Lesions are extensive

    • Resistant to treatment, even in small children 

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Diagnosis

  • Many small (5-10 mm) spots, small macules with lighter or darker skin-colour

  • Fine scaling (when stretching the skin)

  • Mostly on the upper back, chest and neck

  • Sometimes dandruff on the scalp

 

When the lesions have reduced or no sensitivity, it could be leprosy: check the “Leprosy page”

Management

  • Local treatment

    • Local miconazole or clotrimazole 2 times a day for 2 weeks

    • If scaling on the scalp: selenium sulphide (Selsun® shampoo) for scalp and affected skin daily, or ketoconazole shampoo 2 times a week 

  • Systemic treatment

    • If local treatment did not work, ketoconazole or itraconazole tablets 200 mg once daily for 7 days

  • Treatment is complete when the scales are gone; the colour change of the skin can take up to 6 months to disappear

  • More information: Common skin diseases in Africa: an illustrated guide | Infolep (leprosy-information.org)

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Diagnosis

  •  Oedema/swelling (lymphedema) of legs that can be painful

  • First the swelling comes and goes, later it stays continuously

  • Nodules may appear

  • Lichenification (thickened skin)

  • Only legs (usually both upper and lower leg) and feet are affected 

Management
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Diagnosis

  •   Very itchy papules (little bumps) existing since weeks or months

  • Severe itching day and night

  • Symmetric on both sides of the body

  • Often mixed with darker coloured scars and scratch marks

  • Not scabies or onchocerciasis

May look exactly like papular urticaria / insect bite reaction which is common in children < 5 years

Pruritic papular eruption can be a sign of HIV infection  

Management

  •  Local: apply calamine or menthol lotion against itchiness

  • Tablets: chlorpheniramine 4 mg before sleeping or 2 times a day up to 2 weeks

  • Topical corticosteroids (betamethason) for severe itchiness once daily until the itch is gone

  • Severe itching at night

    • Advise the patient to put socks over the hands to stop from scratching during the night

    • Promethazine 10 mg or chlorpheniramine 4 mg before sleeping

  • More information: Common skin diseases in Africa: an illustrated guide | Infolep (leprosy-information.org)

 

  • Perform HIV test

    • Pruritic popular eruption (PPE) generally disappears once HIV is treated. 

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Diagnosis

  

  •  The skin has red, inflamed patches or plaques with thick whitish scales

  • When scratching on a patch, it becomes silvery-white (i.e. candlewax phenomenon)

  • Locations are mainly on the scalp, the extensor areas of arms and legs, especially elbows and knees, the umbilicus and the buttocks

  • Finger - and toenails may show pitting and distal detachment

  • Palms and soles may also show thickening, scales and cracks

  • Psoriatic arthritis (inflammation of joints) can be severe  

  

Management
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Diagnosis

  • Itching at 2 or more sites of the body

  • Itching is especially severe at night

  • Itching, and papules, pustules, burrows and scratch marks

  • Locations are mainly between fingers, on wrists, in armpits, elbows, between and on the buttocks, genital or nipple area. In small children also on palms, soles, head and neck

  • Other family members / roommates with similar complaints

 

Crusted scabies is severe scabies with grey crusts instead of papules on typical locations and can be seen in malnourished or HIV-infected

Management

  •  Treat all family members at the same time

  • Wash the bedsheets, towels and clothing used for sleeping with hot water or iron them

  • First option: Benzyl benzoate emulsion

    • Apply benzyl benzoate (adults 25%; children 12.5%) from the neck down to the toes and allow the medicine to stay 24hrs before washing with soap and reapply againfor three days.

    • If for example the hands are washed, reapply that skin area again immediately 

    • In children < 1 year, also treat the scalp

  • Second option: Ivermectine (Stromectol®) according to weight. Do not give to children <15kg or pregnant women.

  • Advise the patient to put socks over the hands to stop from scratching during the night

  • More information: Common skin diseases in Africa: an illustrated guide | Infolep (leprosy-information.org)

 

Perform HIV test in case of crusted scabies  

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Diagnosis

  •  Greasy scales and redness on typical sites: scalp, forehead, behind ears, above and in between eyebrows, around the nose, in nasolabial folds, the chest, upper back, shoulders; sometimes armpits and groin areas

  • Often dandruff on the scalp

Seborrhoeic eczema can be a sign of HIV infection 

Management

 

  • Perform HIV test if: 

    • Lesions in armpits, groins, genital area

    • Widespread/generalized lesions

    • Lesions become easily infected 

    • Treatment was not effective

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Diagnosis

  • Scalp disorder most common in children <15 years

  • Lesions on the scalp with loss of hair

  • Often scaling, crusts or pustules and papules and nodules

  • Lymph nodes in the neck may swell

  • There may be fever and headache

  • Often epidemics at school or in the family
Management
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Diagnosis

Lesions are mainly found on exposed surfaces of the body: face, arms and shoulders

  • Skin lesion with raised active border, often with round shape

  • Often scratch marks, because of itching

  • Sometimes in a skin-fold

  • Check for fungal infection between the toes: tinea pedis 

 

If there is widespread or large size fungal infection of the skin, this may indicate an HIV infection.

 

When the lesions have reduced or no sensitivity, it could be leprosy: check the “Leprosy page”.

Management

  • Local miconazole (Datarin©) or clotrimazole 2 times a day until symptoms are gone 

  • Treat at least until one week after symptoms are gone

  • If local treatment is not available, give ketoconazole or griseofulvin tablets for 2 weeks

  • More information: Common skin diseases in Africa: an illustrated guide | Infolep (leprosy-information.org)

  • Perform HIV test if:

  • > 5 circular skin lesions

    • > 5 circular skin lesions

    • Large lesions (>10 cm)

    • Fungal infection of the scalp in an adult

    • Recurrent

    • Treatment not effective

  • Tinea pedis: keep the area between the toes dry and apply antifungal cream 2 times a day; wear footwear/slippers to avoid infecting others.

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Diagnosis

  • Skin reaction with raised itching small bumps (wheals, hives or welts) which can have any shape or size, and may appear anywhere on the body

  • They come and go within 24 hours and recur during hours, days or years

  • Many possible causes: allergy, food (e.g. fish, nuts, eggs, certain fruit), insect sting/bite, plants (stinging nettles, etc), medications (aspirin, pethidine, morphine, hydralazine), stress, heath, sweat, exercise, sunlight, cold, physical pressure/friction, other irritants, infections, auto-immune disease, idiopathic (unknown cause), etc.

  • In the face, angioedema can be seen: swelling of the lips, tongue and throat. This is an emergency situation as the airway can become compromised!

Papular urticaria is not urticaria but a persistent form of insect bite reaction usually in children (<5 years): itchy papules, sometimes with vesicles on top are seen.

When extensive, HIV related papular pruritic eruption (PPE) (usually adults) or scabies should be ruled out. 

Management

  • Avoid or treat the cause if possible.

  • Apply calamine lotion or phenol-zinc lotion against the itchiness.

  • Antihistamines, a low or high dose may be required. Preferably, start with non-sedative antihistamines.

  • Topical steroids (start class 1-2) if necessary.

  • Avoid the use of aspirin.

  • Papular urticaria: insect repellents and impregnated bed net.

  • Angioedema is an emergency diagnosis, refer the patient to avoid breathing problems/death.

  • More information: Common skin diseases in Africa: an illustrated guide | Infolep (leprosy-information.org)

 

  • In case of papular urticaria, perform HIV test if:

    • seen in adults, or

    • very extensive, widespread lesions are seen

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Diagnosis

  •  Colour change of the skin showing white macules which start small and may become large and widespread

  • Often on hands, feet, face, back, and around body openings (eyes, nose, mouth, ears, navel and genital area)

  • Sometimes, hair in the affected area is white

  • White areas become red in the sun (sunburn)

  • Sensation is normal

 

When the lesions have reduced or no sensitivity, it could be leprosy: check the “Leprosy page” 

Management
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Diagnosis

  • The primary lesion may be either a wet, easily bleeding raspberry- like papule/nodule or a painless ulcer

  • After the primary lesion disappears, it leaves an atrophic scar

  • When the primary lesion is not treated, secondary lesions appear as generalized nodules, ulcerations and wart-like lesions 

  • Swelling of the bones in the fingers may also occur

  • Secondary yaws occurs weeks to months after the primary infection and typically presents with multiple raised yellow lesions or pain and swelling of long bones and fingers

Management

  • Refer

  • If tested positive for VDRL/TPHA, treat with either of 2 antibiotics

    • Azithromycin (single oral dose) at 30 mg/kg (maximum 2 g)

    • Benzathine penicillin at 1.2 million units per IM injection, repeat after 2 weeks.

      • For children: Benzathine penicillin at 0.6 million units per IM injection, repeat after 2 weeks

      • In case of azithromycin-allergy: Benzathine penicillin at 1.2 million units per IM injection, repeat after 2 weeks

  • The patients’ contacts should also be treated even if they are asymptomatic

  • More information: Common skin diseases in Africa: an illustrated guide | Infolep (leprosy-information.org)

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