Jacob S. Sons

Background: The Eastern Cape is an under-resourced province and the poorest in South Africa, where little is known about the epidemiology of skin diseases. Objectives: To examine the nature and prevalence of skin diseases in two neighbouring rural villages in the Eastern Cape, South Africa. Methods: We conducted a cross-sectional point prevalence study of skin diseases of residents (adults and children) in Mtyholo Dlova and Mdolomba villages in December 2023. Through house-to-house visits, we collected data on the households, participant demographics and skin diagnoses following clinical skin examination by dermatologists. Point prevalence rates and 95% confidence intervals (CIs) were calculated for each skin condition. Results: A total of 309 households were visited with 698 participants included of whom 99% were Xhosa people, 56% were female [mean (SD) age 37.4 (24.2) years], 39% were unemployed, 18% were retired, 60% did not smoke and 69% did not drink alcohol. Seventy-five per cent of households had an average monthly income < ZAR3000 South African Rand (128 GBP). In total, 439 people had at least one skin disease with a point prevalence of any skin disease of 62.9% (95% CI 59.3–66.5). The most prevalent diseases in children (aged < 18 years) were tinea capitis (16.4%), acne vulgaris (13.0%), pityriasis alba (10.6%), prurigo (4.8%), postinflammatory hyperpigmentation (3.9%), xerosis (3.9%), atopic dermatitis (3.4%) and scabies (3.4%). In adults, the most prevalent diseases were xerosis (7.8%), acne vulgaris (7.4%), melasma (6.2%), dermatosis papulosa nigra (5.6%), scarring alopecia (3.5%), nonscarring alopecia (3.1%) and tinea pedis (3.1%). Psoriasis was rare, with a prevalence of 0.3% in the study population. Generally, skin disease was more common in female than male participants (65.8% vs. 59.2%) with sex-specific differences in the prevalence of certain dermatoses; melasma, alopecia (scarring and nonscarring), seborrhoeic dermatitis, dermatosis papulosa nigra and irritant contact dermatitis were more prevalent in female participants, whereas there was a predominance of pseudofolliculitis barbae, atopic dermatitis, postinflammatory hyperpigmentation, acne vulgaris, pityriasis versicolor, scabies, tinea pedis and tinea capitis in male participants. Conclusions: Skin disease is common in the Eastern Cape, South Africa. These findings may help strengthen the provision of dermatology services and the distribution of resources in the region, and highlight training opportunities for healthcare workers.

Background. Although leprosy, a neglected tropical disease, has been eliminated (<1 case per 10 000 population) in South Africa (SA) since 1926, according to the World Health Organization, new cases continue to be reported. The management of leprosy poses several challenges, including patient adherence, education and insufficient training of healthcare practitioners. Objectives. To describe the biographical profile, clinical manifestations and treatment outcomes in patients with leprosy in KwaZulu-Natal Province. Methods. This retrospective study aimed to analyse the clinical data of leprosy patients in SA from 2002 to 2022. Data collected included patient demographics, comorbidities, cutaneous and neurological manifestations of leprosy, complications, treatment and adverse reactions. Descriptive statistics were used to summarise the data. Results. The study analysed the clinical data of 194 leprosy patients from 2002 to 2022. The majority of patients were male and middle aged, with a disproportionate representation of black South Africans. Regarding socioeconomic status, 80% were unemployed and 40% were social grant recipients. Most cases were clustered in urban centres and diagnosed at secondary care facilities, with 15% being HIV positive. The majority of patients (90%) were classified as having multibacillary leprosy. Common symptoms included upper respiratory tract involvement, hair loss and painful nerves, with the face and limbs being most frequently affected. Cutaneous morphology predominantly included plaques and hypopigmented patches, while neurological signs included ulnar nerve tenderness, muscle weakness and sensory deficits. Debilitating neurological complications were found in one-fifth of patients. Despite initiation of multidrug therapy in most patients, a significant proportion (27.3%) did not complete the full course of treatment, and treatment reactions were noted in 33.5% of patients. Conclusion. These findings emphasise the urgent need for enhanced patient and healthcare worker education, particularly in primary healthcare settings, to improve adherence to treatment, advocate for prophylactic measures and prevent new cases. Achieving leprosy-free status in SA requires the collaboration of many role-players to address these challenges and improve healthcare practices.