Dermatology is not my strength, so skin diseases continue to
keep me humble. I read in one manual that skin diseases make up 20% of
outpatient visits in the developing world. That’s more than I see, but there
isn’t a day that goes by without at least one patient with concerns regarding
the body’s biggest organ. Here are three of many patients I have seen. . . .
This is a young lady who had lived further in the interior
of the country for a couple years and came because she was having an itchy rash
all over her body (except her head). These lesions were tight and were not
fluid-filled.
She had a slide of her blood prepared and reported to have
microfilaria whipping around. Diagnosis: Loiasis. Since we don’t have the first
line treatment, DEC, available, the royal we prescribed a 3-week course of
albendazole. She hasn’t returned, so we hope it worked.
This 45-year-old gentleman has a rash I’ve seen several
people with. It started on his shins 10 years ago and gradually has spread up.
He had a (successful?) ligature of his veins on the right leg that stopped the
spread, but had an unsuccessful attempt on this left leg. He also went a
6-month treatment course for pulmonary TB but this rash continued to spread
during that time. He is in the hospital for a skin graft of a part of the rash
that had ulcerated; he was treating that area with cow dung—to no avail. He had
a couple checks for lymphatic filariasis that were negative (and he’s HIV and
VDRL non-reactive, too). Diagnosis: not sure, and we welcome your thoughts!
Being a surgical hospital, his skin grafting will be prioritized.
The right leg (like his other side) had a saphenous vein
ligation.
We frequently find this strange boy waddling around in our
kitchen, getting his hands, feet and face into anything he can find. The
lesions on his face tested positive for chocolate. Diagnosis: bagunça