BackgroundAbscess formation is a frequent local complication of leg erysipelas. In this study we aimed at identifying factors associated with abscess formation of leg erysipelas in patients in sub-Saharan African countries.MethodThis is a multicenter prospective study conducted in dermatology units in eight sub-Saharan African countries from October 2013 to September 2014. We performed univariate and multivariate analysis to compare characteristics among the group of patients with leg erysipelas complicated with abscess against those without this complication.ResultsIn this study, 562 cases of leg erysipelas were recruited in the eight sub-Saharan African countries. The mean age of patients was 43.67 years (SD =16.8) (Range: 15 to 88 years) with a sex-ratio (M/F) of 5/1. Out of the 562 cases, 63 patients (11.2 %) had abscess formation as a complication. In multivariate analysis showed that the main associated factors with this complication were: nicotine addiction (aOR = 3.7; 95 % CI = [1.3 – 10.7]) and delayed antibiotic treatment initiation (delay of 10 days or more) (aOR = 4.6; 95 % CI = [1.8 – 11.8]).ConclusionDelayed antibiotics treatment and nicotine addiction are the main risk factors associated with abscess formation of leg erysipelas in these countries. However, chronic alcohol intake, which is currently found in Europe as a potential risk factor, was less frequent in our study.

INTRODUCTIONErysipelas also called bacterial dermo-hypodermitis is an infection of deep skin layers, mainly due to streptococcus [1,2]. Facial localization became become less frequent while the infection is currently developed on the leg [3,4]. Erysipelas of the leg is a common skin infection in dermatology consultation in sub-Saharan Africa [5][6][7][8]. However monocentric studies are rather conducted in these areas instead of multicentric type studies. We aimed at describing the epidemiological and clinical characteristics of erysipelas of the leg, and ABSTRACT Introduction: Erysipelas of the leg is a common and serious infection. We carried out this study aiming at describing the epidemiological and clinical characteristics, and assessing the risks factors associated with the local complications of erysipelas of the leg in sub-Saharan Africa. Methods: This was a prospective multicentric study carried out in the dermatology units of Hospitals located in seven sub-Saharan African countries during a period of 12 months. Patients aged 15 and above with a first episode of erysipelas of the leg were recruited. Results: In this study, 562 patients were recruited, having a mean age of 43.7±16.9 years and a sex-ratio (M/F) of 0.67. Patients infected on one leg were 562 while those infected with two were 27. Bullous forms of the disease were observed in 95 patients, while purpuric forms were observed in 167 patients. The existence of a point of entry (485 cases), obesity (230), lymph edema (130) and the use of bleaching agents (97) were the mains risk factors. Complications during the course of the infection such as necrotizing fasciitis (34 cases) and abscesses (63 cases) were observed. They were due to the use of antibiotics and non-steroidal anti-inflammatory treatments, and the use of cataplasm. Conclusion: This study reveals that existence of a point of entry, obesity and lymph edema, and the use of bleaching agents were the mains risk factors influencing the local complications of erysipelas of the leg. Necrotizing fasciitis and abscesses were influenced by the use of antibiotics and non-steroidal anti-inflammatory treatments, and the use of cataplasm.

Background: The aim of this study was to describe the epidemiological, clinical aspects, and outcome of necrotizing fasciitis (NF) in sub-Saharan Africa. Patients and Method: We conducted a descriptive study in hospital dermatology departments in five sub-Saharan African countries over a two-year period (April 2017 to July 2019). Patients over fifteen years of age received for NF were included. Results: During the study period, 224 patients with NF were included. Their mean age was 51.9 ± 18.3 years and their sex ratio (M/F) was 1.3. NF was present in the lower limbs in 88.8% (n = 199) of the patients. The main local signs of NF were cutaneous necrosis (83.9%; n = 188) and spontaneous intense pain (75.9%; n = 170). NSAIDs (32.6%; n = 73), obesity (16.5%; n = 65), the use of decoctions/poultices (21.4%; n = 48), diabetes (16.5%; n = 37), nicotine addiction (11.6%; n = 26), alcoholism (8%; n = 18), voluntary cosmetic depigmentation (6.7%; n = 15), and HIV infection (3.8%; n = 8) were the main comorbidities. We recorded 14.7% (n = 33) of deaths. Conclusion: This study shows that NF of the lower extremities is the most often observed clinical form in sub-Saharan Africa. Some factors or comorbidities (diabetes, obesity, alcoholism, nicotine addiction) seem to be relatively frequent.