Definition of an algorithm for the management of common skin diseases at primary health care level in sub-Saharan Africa

Abstract

In order to help primary health care (PHC) workers in developing countries in the care of common skin diseases, an algorithm for the management of pyoderma, scabies, superficial mycoses, contact dermatitis and referral of early leprosy cases (based on the identification of diseases through the presence of objective key signs, and on treatments by generic drugs) was elaborated. One thousand patients were seen by trained dermatologists, who established diagnoses and treatments; in addition, there was systematic recording of each key sign, according to the successive algorithm steps. We compared the diagnostics and treatments obtained for several combinations of diagnostic signs, with those of the dermatologists. Sensitivity, specificity, positive predictive value and negative predictive value of defined combinations were high for pyoderma, scabies and superficial mycoses. Values were less exact for dermatitis and leprosy, but were considered sufficient for the level of health care targeted. The apportionment of treatments between the algorithm and the dermatological approaches was considered appropriate in more than 80% of cases; mismanagement was possible in 7% of cases, with few predictable harmful consequences. The algorithm was found satisfactory for the management of the dermatological priorities according to the standards required at the PHC level.

Knowledge, Attitude, and Practice of Primary Care Physicians Regarding Common Dermatological Disorders in Abha City, Kingdom of Saudi Arabia

“…The positive results of PHC training in dermatology was attributed to the chosen strategy such as targeteing the quality of care in primary health care centres rather than prevalence in the general population, using a simplified approach to dermatology, which was derived from similar approaches to other health problems, [44,45] in which they defined a small group of priority diseases and used a specific flowchart adapted to the targeted care level. [46] with the use of a range of visual aids to facilitate assimilation and finally informal talks with health care workers and the high attendance at sessions suggested a high demand for training in skin diseases added to rapid and visible improvements in practice after training. [39]Following a training course, an overall diagnostic agreement between PHC physicians and dermatologists of 65.52% has been reported.…”

Ivermectin versus benzyl benzoate applied once or twice to treat human scabies in Dakar, Senegal: a randomized controlled trial

“…vesicles, papules, nodules or pustules) on at least three sites of predilection for scabies (i.e. the interdigital folds of the hands, the elbows, the wrists, the buttocks, the axillary folds, the nipple areolas in women and the male external genitalia), as assessed by a trained health-care worker; 6 and they were willing to participate in the study.…”

“…10 We included in the study only patients whose diagnosis of scabies was certain in accordance with objective clinical criteria whose validity has been established in the same setting. The criteria were applied by trained observers, 6 and if any doubt about the diagnosis existed, the patient was excluded. Although the parasitological examination gave a positive result in only 39% of cases, a negative result did not preclude a diagnosis of scabies, since the sensitivity of this test is known to be less than 50%, according to previous studies.…”

Scabies in a 2-month-old Infant Successfully Treated with Lindane

“…On the other hand, lesions in children are usually more inflammatory than in adults and are often vesicular or bullous 4 . Though scabies in young children are different from adults, the combination of a pruritic eruption with characteristic manifestations, and family involvement are usually sufficient to establish the diagnosis 5 . In the present case, the relevant family history and detection of a scabies mite led to the correct diagnosis, despite the highly varied, polymorphic lesions.…”