Comorbidité entre dermatite atopique et lèpre chez un jeune Malgache
Speaker

Tsiory Iarintsoa Razafimaharo
Madagascar
Tsiory Iarintsoa RAZAFIMAHARO is a medical doctor graduated from the Faculty of Medicine of Antananarivo, 2021, qualified intern in Dermatology-Venereology, Faculty of Medicine, University of Antananarivo since 2020, member of SOMADER (Malagasy Society of Dermatology) and co-author of 6 scientific articles
Source event

SOMADER | XXth International Congress of Dermatology
For its XX th Hybrid Congress and its IVth World Skin Health Day (WSHD), the Malagasy Society of Dermatology (SOMADER) has chosen the theme:”Dermatology in the Tropics in the Age of Artificial Intelligence (AI)”.
On the first hand, any dermatological diseases pose challenges for healthcare systems, particularly in Africa, Asia and Latin America. Neglected tropical diseases (NTDs) with skin manifestations, such as deep mycosis (including chromoblastomycosis, sporotrichosis and mycetoma), as well as other infectious dermatoses such as scabies, leprosy, lymphatic filariasis, cutaneous leishmaniasis, etc., affect vulnerable populations in resource-limited countries. These conditions are often underdiagnosed and inadequately treated, then exacerbating patient suffering. In the other hand, other dermatosis such as atopic dermatitis, are currently under consideration to integrate in the list of skin NTDs, with the collaboration between ISAD, ASDV and WHO. Meanwhile, Albinism, which has a particularly high prevalence in sub-Saharan Africa, presents major new social challenges, such as stigmatization and occult beliefs.
However, nowadays we stand at a historic turning point, where science and technology are converging to redefine medical practices. Once confined to the realm of science fiction, artificial intelligence (AI) has now become a tangible reality, an invaluable tool to help in the diagnosis, treatment, and prevention of dermatological diseases.
This year, as part of our 20th anniversary celebrations, this International Dermatology
Congress will be held in the capital at Carlton Anosy and online on Global Dermatology website. As every year, we will welcome speakers from multiple countries in collaboration with the WHO, Global Dermatology, ISAD, ASDV, and ILDS. Presentations will be delivered in English or French, with subtitles in multiple languages, to raise awareness and maximize the impact of this event—a symbol of our collective commitment to improve the health of the most vulnerable populations.
The participation of numerous experts from around the world not only facilitates the exchange of knowledge and best practices but also fosters the exploration of innovative solutions, including AI, to address the shortage of human and material resources in remote areas.
This congress marks a significant milestone, solidarity, and commitment to equitable and accessible healthcare. It represents a crucial step toward achieving the objectives outlined in the 2021-2030 Roadmap, which aimed to eliminate NTDs and other dermatological challenges, ultimately improving the health and well-being of millions worldwide.
Together, let us work hand in hand to create a more inclusive, accessible, and innovative future for medicine.
Enjoy the conference !
Description
Introduction : La dermatite atopique (DA) est une dermatose inflammatoire chronique récidivante liée à l’atopie. La lèpre est une infection à tropisme cutanéo-muqueuse, et nerveuse due à Mycobactérium leprae. La lèpre et bientôt la DA sont intégrées dans le groupe des maladies tropicales négligées à expressions cutanées. Nous rapportons un cas d’association entre lèpre et DA vu au service de dermatologie de Befelatanana, Antananarivo, Madagascar. Observation : un jeune homme de 21 ans est venu en consultation en dermatologie pour une dermatose prurigineuse. Depuis 2 ans, apparition progressive d’érythème prurigineuse de la joue droite, avec extension sur le reste du visage, du tronc et des membres. Les épisodes étaient accompagnés de rhinite congestive à répétition, sans notion de paresthésie ni de troubles de la sensibilité. Le patient présentait une DA depuis l’enfance, qui s’était stabilisée pendant l’adolescence, puis récidive à 18 ans. Il était traité par dermocorticoïdes uniquement. Il était également asthmatique connu et traité par Ventoline spray. Une histoire familiale de lèpre était également évoquée. A l’examen, on objectivait des lésions érythémateuses infiltrées annulaires, normoesthésiques au niveau du visage sans atteintes des lobules des oreilles, et des lésions hyperpigmentés suintantes crouteuses du tronc et des membres. Il présentait également un œil rouge isolé et une xérose cutanée. L’examen neurologique était normal, mise à part une hypotrophie des loges thénariennes et hypothénariennes. Devant le tableau une poussée de DA a été évoquée, mais devant l’histoire familiale de lèpre, des investigations ont été faites. L’examen direct à la recherche de BAAR de la biopsie cutanée était négatif, mais la PCR positive. Le diagnostic de lèpre Borderline tuberculoïde était posé, associé à une poussée de DA sévère. L’évolution du patient était marquée par une réaction lépreuse à 2 mois de la polychimiothérapie avec une réponse favorable sous corticothérapie, suivi d’une guérison marquée par la négativation des prélèvements de contrôle de la lèpre à 12 mois. Par ailleurs, devant la DA sévère et réfractaire au traitement local, il a été mis sous traitement systémique par méthotrexate jusqu’à 15 mg/sem, avec une réponse thérapeutique modérée à 6 mois. Conclusion : L’association à une maladie atopique et d’une lèpre est possible. La prise en charge diagnostique et thérapeutique est difficile. D’une part, la dysrégulation de la réponse inflammatoire TH2 lors de la DA, peut nuire à la réponse TH1 protectrice contre la lèpre. D’une autre part, l’ichtyose acquise au cours de la lèpre peut exacerber les poussées de DA. Mots clés : Dermatite atopique, Comorbidité ; Lèpre ; Madagascar
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