Dermatological practice in Guadeloupe (French West Indies)

A. Mahe and E. MancelDermatology Department, Centre Hospitalier Universitaire de Pointe-a-Pitre, Guadeloupe, French West Indies

Summary Guadeloupe is a French Caribbean island, with a population of mainly African ancestry,and a high standard of living. We recorded the dermatological diagnoses in 5000 newpatients attending dermatologists. The main diagnoses were acne (16.4%), superficialmycoses (12.8%), and eczema (10.5%). Diseases considered to be specific to the tropicswere scarce. The main dermatoses attributable to a tropical environment were super-ficial mycoses, and prurigo. Concerning ethnicity, the majority of Afro-Caribbeans andresident Caucasians visited dermatologists for the same diseases. The main differenceattributable to ethnicity was a high rate of visits by Caucasians for melanocytic naevusand malignant/premalignant neoplasms. Dermatoses restricted to Afro-Caribbeanswere only secondary ailments. The spectrum of diseases registered in our study wassimilar to that in Northern countries; this probably reflects the influence of the highstandard of life in Guadeloupe.

Introduction

Guadeloupe is a French Caribbean island. Most of itspopulation is of African ancestry. Dermatological prac-tice in this island may differ noticeably from thatobserved in Northern countries, as tropical environ-ment1 and black skin2 are factors known to influencedermatology. The aim of this study was to evaluate thedermatological practice of this island, and to discuss theinfluence of certain epidemiological factors.

Patients and methods

The climate in Guadeloupe is tropical (mean tempera-ture, 26 8C; mean annual rainfall, 2000 mm). Its popu-lation of 440 000 is < 90% Afro-Caribbean; other ethnicgroups are native Caucasians descending from formersettlers, resident Caucasians originating from mother-France, and tourists (mainly Europeans). Guadeloupe isa French Department. The Gross Domestic Product percapita in the island is 8215 $US.

Ten out of the 11 dermatologists of the island par-ticipated in the study. Each one recorded prospectivelythe dermatological diagnose(s) in every new patientattending his office, in addition to age, sex, and ethnicgroup. The study was completed when 5000 patientswere included, and lasted from January to May, 1996.

Results

A total of 5761 dermatoses were recorded in 5000patients (mean age, 30.5 years; female, 64%). Themost frequent diagnoses were: acne (16.4% of all diag-noses), superficial mycoses (12.8%), eczema (10.5%;including contact dermatitis, 3.7%; atopic dermatitis,2.1%; unspecified type, 4%), seborrheic dermatitis(4.2%), primary disorders of pigmentation (4%; includ-ing vitiligo, 0.6%; melasma, 0.8%), pyoderma (3.8%),and pityriasis alba (3.4%). Other noticeable diagnoseswere: prurigo secondary to arthropod bites (2.9%);psoriasis (1%); scabies (0.6%), cutaneous larva migrans(0.3%); leprosy (0.06%). The most frequent diagnoses inthe four main ethnic groups are shown in Table 1. In the207 native Caucasians, the 50 recorded cases of malig-nant and premalignant neoplasms (24.2% of all diag-noses in this group) consisted mainly of cases of actinic

Clinical dermatology • Concise report

q 1999 Blackwell Science Ltd • Clinical and Experimental Dermatology, 24, 358–360358

Correspondence: A. Mahe, BP 16705, Dakar-Fann, Senegal. Tel./fax: +221 825 96 54.

Accepted for publication 15 February 1999

keratoses (n ¼ 29), and of basal cell carcinoma (n ¼ 17).In the 3795 Afro-Caribbeans, nine cases of actinickeratoses, three cases of basal cell carcinoma, andthree cases of malignant melanoma (involving thesoles) were recorded. Diseases recorded exclusively inAfro-Caribbeans were keloids (0.9% of all diagnoses inthis group), dermatosis papulosa nigra (0.9%), acnekeloidalis (0.7%), and pseudofolliculitis barbae (0.6%).

Discussion

This study is limited in its ability to make assertionsabout the true pattern of disease in the community as itrelies on data from people who present themselves todermatologists. There are many factors that could deter-mine whether one person with a particular skin diseasepresents to a dermatologist whereas another does not,e.g. socio-economic class, cultural beliefs, severity, acces-sibility to health care. Nevertheless, the study doesprovide some information about the spectrum of skindiseases that dermatologists in Guadeloupe see.

On the whole, the majority of the dermatologicaldiagnoses recorded in Guadeloupe was more similar tothose observed in dermatology clinics in Northern coun-tries3 than to those usually reported in tropical areas,where infectious diseases predominate.1 Diseases con-sidered as specific to the tropics were scarce. Actually, theonly common diseases that could be attributed to atropical environment were prurigo and superficialmycoses. In our opinion, this predominance of ‘North-ern’ diseases probably reflects the influence of the highstandard of living in Guadeloupe, and consequentimproved hygiene and easy access to care.

Concerning ethnicity, it was noticeable that the

majority of Afro-Caribbeans and resident Caucasiansvisited dermatologists for the same diseases. Dermatosesrestricted to Afro-Caribbeans, such as keloids, weresecondary ailments. The main difference attributable toethnicity was the high rate of visits by Caucasians formelanocytic naevus, and for malignant and premalig-nant neoplasms. Especially in native Caucasians, life-long exposure to tropical sun led to a high frequency ofskin cancer. Furthermore, although disorders of pigmen-tation have been reported to be especially commonin African–Americans,2 we found that primary disordersof pigmentation were almost as common in Afro-Caribbeans as in Caucasians. However, it should benoted that we recorded only dermatological diagnoses,not the patients’ complaints: in our experience, the‘colour dimension’ of consultations is strong in Afro-Caribbeans for several dermatoses not classified as dis-orders of pigmentation, such as acne.

A most original group was European tourists: prurigosecondary to arthropod bites, pyoderma (often related toprurigo), and acute sun-reactions, were very common inthis group. Obviously, this reflects an abrupt exposure toa potentially agressive environment.

In conclusion, we believe that our study providessome clues to how certain epidemiologic factors mayinfluence our dermatologic practice: tropical environ-ment and ethnicity were expected factors, but socio-economic and cultural factors also appear to have astrong influence.

Acknowledgements

This study was supported by the Societe de Dermatologiede la Guadeloupe.

Dermatology in Guadeloupe • A. Mahe and E. Mancel

q 1999 Blackwell Science Ltd • Clinical and Experimental Dermatology, 24, 358–360 359

Table 1 The most frequent dermatologic diagnoses recorded in four ethnic groups of patients attending dermatologists in Guadeloupe (resultsare expressed in percentages of the total diseases in each group).

Afro-Caribbeans Resident caucasians Native caucasians Touristsn ¼ 3795 n ¼ 571 n ¼ 207 n ¼ 99

Acne – 19.5 Superficial mycoses – 11 MPMN – 24.2 Photoreactions (including sunburn) – 11Superficial mycoses – 13.1 Acne – 10.4 Verrucae – 7.5 Prurigo – 9.1Eczema – 11.1 Eczema – 9.3 Acne – 7.1 Melanocytic naevus – 9.1Seborrheic dermatitis – 6 Verrucae – 9.1 Superficial mycoses – 6.3 Pyoderma – 8.1PDP (4.4) Melanocytic naevus – 6.3 Eczema – 5.7 Superficial mycoses – 8.1Pityriasis alba – 3.8 Seborrheic dermatitis – 4.4 Melanocytic naevus – 3.8 Eczema – 7.1Pyoderma – 3.6 Cutaneous cyst – 4.2 Pityriasis alba – 3.8 Verrucae – 5.1Prurigo – 3.2 Pyoderma – 3.5 Seborrheic dermatitis – 3.8 Acne – 5.1Alopecia – 3.2 PDP – 3.5 Seborrheic keratoses – 3.1 MPMN – 5Verrucae – 2 MPMN – 3.4 Pyoderma – 3.1

Pityriasis alba - 2.3

PDP: Primary disorders of pigmentation; MPMN: malignant and premalignant neoplasms.

References

1 Canizares O, Harman R, eds. Clinical Tropical Dermatology,2nd edn. Oxford: Blackwell Scientific Publications, 1992.

2 Halder RM, Grimes PE, McLaurin CI et al. Incidence of

common dermatoses in a predominantly black dermatolo-gic practice. Cutis 1983; 32: 388–90.

3 Fleischer AB, Feldman SR, Bradham DD. Office-based phy-sician services provided by dermatologists in the UnitedStates in 1990. J Invest Dermatol 1994; 102: 93–7.

Dermatology in Guadeloupe • A. Mahe and E. Mancel

q 1999 Blackwell Science Ltd • Clinical and Experimental Dermatology, 24, 358–360360