Working Group · Uganda

Diseases

Contact person for the working group

Dr. med. Claudia El Gammal, Siegen

Infectious diseases

Infectious diseases play a far greater role than in the highly developed countries and are particularly widespread among children.

Fungal infections

Most children suffer from fungal infections of the scalp (tinea capitis), which are transmitted mainly through close contact with animals (e.g. goats, cats). They can take a mild course and heal spontaneously at puberty, but if left untreated they can also leave permanent scarring of the scalp with hairless patches or lead to further infections.

Toddler with a fungal infection of the scalp

Back of a child’s head with extensive fungal infection of the scalp

Scabies

This skin disease, caused by mites, is transmitted through close physical contact; often entire families are affected. The agonising itching in particular is very distressing, and those affected can hardly sleep. Scabies is very readily curable with appropriate creams or a single dose of medication. In addition, patients must be carefully informed about appropriate hygiene measures (washing and hot ironing of clothing and bed linen). Distinguishing it from atopic dermatitis or other eczemas is often difficult, which is why trained doctors are very important.

Back with skin lesions caused by scabies

Bacterial skin infections

Here too, instructing patients in suitable hygiene measures is very important. Good wound care and topical treatment can in some cases avoid the use of antibiotics. If left untreated, serious complications such as inflammation of the heart and kidneys with permanent damage can result.

Infected, non-healing wound after an injury to the lower leg

after cleaning of the wound bed and disinfection

after wound dressing (complete healing after approx. 3 weeks) — after wound dressing
(complete healing after approx. 3 weeks)

In HIV-infected people, skin diseases almost always occur and take a particularly severe course.

Patients whose entire body is covered with viral warts are found mainly among those with HIV infection present since birth

Lichen planus in a 49-year-old HIV-positive female patient

Black skin frequently tends to form pronounced raised scars (keloids)

Keloids of the earlobes after ear piercing

Keloids after a burn (burns are common in Uganda because of cooking over an open flame and often lead to severe, extensive keloids)

Malignant skin tumours

are fortunately much rarer in Ugandans than in white people, owing to the strong pigmentation of their skin. The patients almost always come to the Skin-Clinic with findings that are already very advanced.

Melanoma that had been growing for 4 years on the heel of a 45-year-old female patient, surgical removal at the Skin-Clinic with a good course so far

Girl with albinism. On the scalp and the rims of the ears several rough actinic keratoses (actinic precancerous lesions), on the forehead pigmented naevi with the risk of malignant transformation

Malignant skin tumours are, by contrast, very common in people with albinism, a metabolic disorder that prevents the formation of skin pigment (melanin). These patients are extremely sensitive to the sun and often develop squamous cell carcinomas and basal cell carcinomas at a young age; they are also at risk of malignant melanoma.

Severe adverse drug reactions

Because there are only a few doctors in Uganda, patients in health centres are often treated on the basis of their symptoms according to so-called flow charts, which leads to uncontrolled use of medicines, especially antibiotics. Severe adverse drug reactions, above all on the skin, are correspondingly common.

Severe skin reaction to an antibiotic on areas exposed to the sun

Traditional medicine

To treat skin diseases, traditional African herbal medicine is often used first, unfortunately often by completely unqualified lay people. The herbal mixtures worsen the condition through additional severe skin irritation, which frequently becomes infected.

Fungal infection of the cheek, worsened by the application of a skin-irritating herbal mixture

Ulcerating skin infection after treatment of atopic dermatitis with traditional herbal medicine

2 days later already a marked improvement

Tropical diseases

that do not occur in Europe also play a role.
Infestation with sand fleas (tungiasis, “jiggers”) is very common among the rural population, who often go barefoot.

Chronic sand flea infestation itches severely and leads to skin growths, inflammation and foot deformities

Photos: Dr. med. Claudia El Gammal