Severe Skin Forms of Psoriasis in Black Africans: Epidemiological, Clinical, and Histological Aspects Related to 56 Cases

Abstract

Bacground. Psoriasis is an erythematosquamous dermatosis of chronic development. In sub-Saharan Africa, few studies have been focused on complicated forms of psoriasis. Objective. The aim is to describe epidemiological, clinical, and histological features of severe skin forms of psoriasis in Cote d'Ivoire. Material and Methods. The study was both cross-sectional and descriptive, that focused on patient admitted to the dermatology unit for complicated psoriasis, from January 1st, 1986, to December 31th, 2007. Results. Fifty-six patients admitted to hospital for severe skin forms of psoriasis were recorded and included in our study over 7.503 patients hospitalized during the study period. They represented 0.75% of cases. The average age was 39.6 ± 3.3 years. There were 49 male (87.5%) and 7 female patients (12.5%) with a sex ratio of 7. At socioprofessional level, 48 patients (87.5%) were from category 1. Patients' history was dominated by the psoriasis vulgaris. Physical and general signs were dominated by itching (58.9%). The three severe skin forms were observed with predominant erythrodermic psoriasis (60.7%). Fifteen patients (34.9%) were HIV positive. Conclusion. Severe skin forms of psoriasis are rare in our setting. But in the quarter of HIV-positive patients, they are dominated by the erythrodermic psoriasis.

Histopathologic diagnostic parameters of psoriasis; a clinicopathological study

“…In their study lymphocytic infiltrate (100%), dilated capillaries (63.6%) and tortuosity (36.6%) were the commonly observed dermal changes. 5 But the current study showed mixed inflammatory infiltrate as common type of dermal infiltration (66.67%).…”

“…This finding correlated with a cross-sectional study done by Kassi et al, where psoriasis vulgaris was found in 60.7% ,universal psoriasis in 37.5% and generalized pustular psoriasis in 1.8% among 56 patients. 5 Psoriasis was widely distributed in different age groups in the present study. The most common age was observed in second and fifth decades.…”

“…5,13 In the current study, 3 cases of psoriasis vulgaris presented as pustular lesions with history of drug intake. This finding was similar to the study by Grace and James on drug provoked psoriasis, where they have documented that drug intake can both exacerbate the pre-existing psoriatic lesions and also can induce new psoriatic lesions.…”

“…In the study of Kassi K et al, the average age of psoriasis was 39.6±3.3 years with extremes of 4 and 77 years. 5 In the study by Alhumidi AA the age of onset of psoriatic disease ranged between 6 and 83 years with mean of 31.5 years and a median of 33 years. 6 In the present study psoriasis was predominant in male patients (60%) and the male: female ratio was 1.5: 1.…”

“…This was similar to the observation by Kassi K et al, who have studied 11 cases and documented presence of lymphocytes, polymorphs, histiocytes and plasma cells in the dermis. 5 A study comprised of 56 cases which was conducted by Kassi K et al concluded that, hyperkeratosis and agranulosis were exclusive epidermal features of psoriasis (100%), followed by supra papillary thinning (90.9%) and Munro microabscess (72.2%). In their study lymphocytic infiltrate (100%), dilated capillaries (63.6%) and tortuosity (36.6%) were the commonly observed dermal changes.…”