Background: Skin disease is the fourth-leading cause of non-fatal disability worldwide. Granular data are limited on the skin disease burden in underserved populations. Objectives: To describe the skin disease burden among adults in rural Ghana. Methods: In this observational study, 230 adults in rural Ghana were surveyed using the Dermatology Life Quality Index (DLQI). For those reporting a skin problem in the previous week (n=117) and who had skin examination performed by a dermatology resident and/or local dermatologist (n=98), prevalences and univariate comparisons were calculated. Results: 51% (117/230) of participants reported a skin problem in the previous week with 36% (42/117) reporting at least a moderate impact on quality of life (QoL). Factors associated with a higher QoL impact included female gender (p=0.01) and living further from the city center (p=0.02). The most common dermatologic diagnoses for those with skin examination performed included acne, bacterial infection, and pruritus. QoL was most impacted (highest average DLQI scores) for those with scabies. Diagnoses were categorized by the level of treatment or medical expertise that would be required had the participant presented to a clinic. 80% (78/98) of diagnoses rendered were potentially manageable with counseling or topical medication. Limitations: The studied cohort was obtained via convenience sampling. The DLQI has not yet been validated in this population. Conclusions: Much of the QoL impact from skin disease among adults in rural Ghana resulted from diagnoses that are manageable with counseling and topical medication. Better access to basic health care and more dermatologic education among community health providers would address much of the skin disease burden in these communities. Future studies should examine best practices for addressing unmet dermatologic needs of this and other comparable populations in underserved communities.
Background and objectives: Rural areas in sub-Saharan Africa face a high prevalence and morbidity of skin disease while also lacking access to dermatologists. In Ghana, where approximately twenty-five licensed dermatologists are available for twenty-five million people, community pharmacies, called over-the-counter medical sellers (OTCMS), were established to respond to accessibility inequities, albeit without equitable training. Our study evaluates the dermatologic knowledge, attitudes, and practices (KAP) of OTCMS in Ghana’s Ashanti Region. Methods: To assess dermatologic KAP, we created a standardized questionnaire and recorded thirteen interviews with OTCMS in seven communities. Interviews were completed with help from Ghanaian translators and transcripts were transcribed verbatim, then analyzed qualitatively to determine common themes for analysis. Results: Our analysis identified six major themes: 1) prescriber qualifications; 2) diagnostics; 3) therapeutics; 4) economics; 5); health systems integration; and 6) care-seeking behavior. Analysis of these themes outlined many cultural roles and challenges of OTCMS, including serving as the primary contact for the dermatologic conditions for rural communities. While possibly necessary due to the lack of accessible dermatologists, this raises concerns for potential harm in diagnostic error and misuse of therapeutics due to the lack of formal dermatology training. Conclusion: In rural parts of Ghana, the KAP of OTCMS play a pivotal role in assessing and treating skin disease for those who might otherwise lack access to adequate dermatologic management. Furthermore, although our study identifies potential issues related to the roles played by OTCMS, it also suggests strategies to improve dermatologic health of many Ghanaians by enhancing education and healthcare delivery in rural areas.
Rhododendrol (RD) is a skin whitening ingredient that was developed in Japan. Among the 800,000 users of RD-containing cosmetics, 20,000 patients developed localized leukoderma (RD-induced leukoderma). Forty-two % of those users showed perilesional hyperpigmentation (leukomelanoderma), and 14% of them were associated with vitiligo vulgaris afterwards. The aim of this study is to investigate the risk factors affecting the severity of RD-induced leukoderma, the occurrence of leukomelanoderma, and the association with vitiligo vulgaris. For this retrospective cohort study, we abstracted data from our dermatology medical records of 101 patients who developed leukoderma after using the cosmetics containing RD from July 2013 to December 2014. Age, BMI, the number of RD-containing products they used, smoking history and depigmentation scores at their baseline visit as well as blood test data for anti-nuclear and/or anti-thyroid antibodies were analyzed. Multivariable logistic regression and linear regression were used for analyses of leukomelanoderma, vitiligo vulgaris and characteristics at the baseline visit. Age, the number of RD-containing products used, BMI, anti-nuclear and anti-thyroid antibodies were not significantly correlated with the presence of leukomelanoderma, but it appeared that leukomelanoderma was more likely to occur in patients who had a smoking history (p¼0.006). In addition, smokers showed a significant increase in their depigmentation score at the baseline visit (p¼0.03). Our study demonstrates that smoking is associated with the severity of RD-induced leukoderma and the occurrence of leukomelanoderma.
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