6. //
Regional Dermatology Training Centre
Training programm for „Dermatology officers“
from 14 Nations from East/Southern Africa
(Commonwealth)
2-years long Curriculum: Dermatology
STI / HIV
Leprosy
Public Health
Teaching methods
7. //
Prevalence of atopic dermatitis in schoolchildren: in
North America & Euope 12 – 15 %
AD is a severe burden
10. //
Prevalence of current fl exural eczema in schoolchildren:
11.3%,
(ranging from 3.2% (Mexico) to 25.0% (Colombia).
Investig Allergol Clin Immunol 2010; Vol. 20(4): 311-323
11. //
Overall prevalence in school children
16.3%
being higher in girls (17.7&) than boys (14.8%).
The prevalence of common skin conditions in
Australian school students: 2. Atopic dermatitis.
Marks R et al. Br J Dermatol. 1999 Mar;140(3):468-73.
16. //
In Europe
> 10‘000 citations
Atopic Dermatitis and PubMed
In SubSaharan Africa
21 citations
17. //
Health system in SubSaharan Africa
About 60 EU/ Year/capita
1 MD for about 70‘000 persons
Health system in Switzerland
About 1500 EU/ Year /capita
1 MD for about 700 persons
29. //
o Lack of corticosteroid use
and
o upper respiratory tract infections
associated with
exacerbations in asthma patients
at the emergency unit of
Mulago Hospital.
39. //
Flex Ext
Knee 29% 31%
Wrist 16% 22%
Elbow 49% 33%
Cross-sectional survey in one village (Miembeni) in the
Kilimanjaro region, Tanzania. The general population was
6953. There were 3427 children aged 0-15 years
44. //
Validity of the full question-based version of the U.K. diagnostic criteria
Sensitivity 43.7% (95% CI 26.3-62.3)
Specificity 97.9% (97.3-98.4)
PPV 18.4% (95% CI 10.4-28.9)
NPV 99.4% (95% CI 99.0-99.6)
Visible flexural eczema alone
Sensitivity 81.2% (95% CI 63.5-92.7)
Specificity 99.0% (95% CI 98.6-99.3),
PPV 48.1% (95% CI 34.3-62.1)
NPV 99.8% (95% CI 99.5-99.9)
Validation of the U.K. diagnostic criteria for atopic eczema in a
Xhosa speaking South-African population
Charmers DA et al Brit J Dermatol 2007
Validation of ISAAC and the U.K. diagnostic criteria for atopic
dermatitis in Ethiopian children
Haileamlak A et al. Brit J Dermatol 2005
Brit J Dermatol 2007
45. //
Validity of the full question-based version of the U.K. diagnostic criteria
Sensitivity 43.7% (95% CI 26.3-62.3)
Specificity 97.9% (97.3-98.4)
PPV 18.4% (95% CI 10.4-28.9)
NPV 99.4% (95% CI 99.0-99.6)
Visible flexural eczema alone
Sensitivity 81.2% (95% CI 63.5-92.7)
Specificity 99.0% (95% CI 98.6-99.3),
PPV 48.1% (95% CI 34.3-62.1)
NPV 99.8% (95% CI 99.5-99.9)
Validation of the U.K. diagnostic criteria for atopic eczema in a
Xhosa speaking South-African population
Charmers DA et al Brit J Dermatol 2007 Brit J Dermatol 2007
46. //
Validation of the U.K. diagnostic criteria for atopic eczema in a
Xhosa speaking South-African population
Charmers DA et al Brit J Dermatol 2007 Brit J Dermatol 2007
Flexural eczema
as the
key diagnostic
Feature
Of
Atopic
Eczema
48. /
Brit J Dermatol 2005; 152: 202
Hygiene hypothesis dos not fit for atopic eczema
Infections may worsen AE
Early antibiotic intervention may worsen AE
60. //
pooled OR=0.69 (0.60-0.79)
Ascaris pooled OR=0.69 (0.59-0.80)
Hookworm pooled OR=0.68 (0.46-1.01)
Trichuris pooled OR=0.75 (0.65-0.86)
Schistosomiasis only 2 studies ~results
Feary J et al. 2011
63. //
Haileamlak A J Allergy Clin Immunol 2005
South african childhood atopic eczema working group South African Med J 2005
Dinkela A et al Int J Dermatol 2007
Associated with
asthma and wheezing
positive SPT
parasite infestation (Trichuris)
urbanization
De Souza East Arican Med J 1992
Associated factors with AD in SubSaharan Africa
69. //
Mod from Bieber Th. New Engl J Med 2008
Staphylococci in AD
Increased skin permeability
Increased expression of CLA
Induction of IgE
against SA
Stimulation of
T cells and DC
Upregulation of IL-31
73. //
Atopic dermatitis in
Kilombero Region,
Tanzania
Atopic dermatitis in
Zuerich,
SWitzerland
Infectious agents
play an important role
In AD
- direct effects
- Senstizitation
- for therapeutic approach
76. //
Xhosa speaking population in South Africa
With atopic eczema
72 patients with atopic eczema
(found in 3069 participants)
Mean age 17.8 years (12-51 years
Female: Male 52.4 : 47.6
Fatema Esmail
Gail Todd
Dept of Dermatology
Groote Schur Hospital
77. /
Pollen measurement in Tanzania / South Africa
Goal of the study:
Unknown data
Climate changes in Africa
ISAAC Questionaire Hard data
78. /
Xhosa speaking population in South Africa
Goal of the study:
What are the
sensitization patterns
In AD patients
?
79. //
Gray C et al Pediatric Allergy Immunol 2015
40 Xhosa children
40 mixed race
All with atopic dermatitis
Age 8 mts – 10 years
81. //
Gray C et al Pediatric Allergy Immunol 2015
The prevalence of peanut
allergy is high in South African
children with AD, but
significantly lower in blacks
compared to mixed race
patients.
The component Ara h 2 is useful
for differentiating allergy from
tolerance in both ethnic groups.
Ninety-five% PPV for peanut
allergy tests may need to be
revised by ethnic group
83. //
Subjects (n=102) with AD of Xhosa ethnic background attending a tertiary hospital were recruited.
These patients were then matched for age, sex and ethnicity and compared with 155 healthy controls.
The subjects had bloods taken
-IgE levels (both total and specific).
-ImmunoCAP® ISAC to determine specific IgE against 103 allergens.
-ImmunoCAP for HDM, peanut and egg white.
91. //
As a new finding in AD, sensitization to Mouse (Mus m 1) is
observed as a highly relevant allergen.
Seen most commonly in AD patients from lower income
areas –
as found in inner city asthma in low income patient groups
in industrialized areas.
Is mouse the allergen indicating underprivileged patient groups?
Mouse allergen is the major allergen of public health relevance in Baltimore City
Ahluwalia SK et al. J Allery Clin Immunol 2013; 132: 830-5
Role of mouse allergens in allergic disease.
Matsui EC. Curr Allergy Asthma Rep. 2009 Sep;9(5):370-5
Total IgE values are elevated in AD patients and controls (due
to parasite infestation, often Toxocara),
but specific IgE is almost exclusively present in AD.
Sensitization to house dust mites, cockroaches and
tropomyosin commonly found in AD