Chronic skin ulcers, Burkina Faso: review of consultation trends and patient types treated between 2013 and 2023 in the dermatology departments of Souro Sanou and Yalgado Ouedraogo University Hospitals

This retrospective study of 104 patients in Burkina Faso from 2013 to 2023 reveals low utilization of dermatology services for chronic skin ulcers, identifies leg ulcers as the predominant condition, and confirms the presence of indigenous Buruli ulcer cases, particularly among children, underscoring the need for improved screening and strategies to address associated social stigma.

The Gist

Imagine your body is a house, and your skin is the roof that keeps everything safe and dry. Sometimes, that roof gets a hole in it—a chronic skin ulcer—that just won't heal. In Burkina Faso, these "holes in the roof" are often surrounded by a thick fog of social stigma. It's like a heavy, invisible curtain that makes people feel so ashamed of their wounds that they hide them under blankets or avoid the doctor's office entirely, hoping the problem will just go away on its own.

This study is like a detective looking back through 11 years of old logbooks (from 2013 to 2023) at two major hospitals in Burkina Faso. The detectives wanted to answer two big questions: Who is coming in with these wounds, and what is causing them?

Here is what they found, broken down into simple stories:

1. The "Slow Drip" of Patients

The researchers found that only about 9 people per year walked through the hospital doors for these specific wounds.

• The Analogy: Imagine a busy highway where a massive traffic jam should be happening, but instead, you only see a few cars trickling by. This suggests that for every person who finally gets help, many others are still stuck at home, hiding their wounds because of shame or fear.

2. Who is Getting Hurt?

Most of the people seeking help were grown-ups and seniors, and the wounds were mostly on their legs.

• The Analogy: Think of the legs as the foundation pillars of a building. Over time, if the foundation is weak or under too much pressure, cracks start to appear there first. For these patients, the "cracks" (ulcers) were happening most often on their legs.

3. The Hidden "Buruli" Surprise

Out of the 104 patients they reviewed, they found 8 cases of a specific, rare infection called Buruli ulcer.

• The Analogy: It's like finding a few rare, exotic birds in a flock of common sparrows. While most wounds were from common causes, these 8 cases were a special, distinct type of infection.
• The Twist: Interestingly, 5 of these 8 birds were young (children and teenagers). Half of them lived in the capital city, Ouagadougou. This is a big deal because it proves this disease isn't just a problem for remote villages; it's right there in the city, hiding in plain sight.

The Big Takeaway

The study concludes with a loud alarm bell: We are missing a lot of patients.

Because of the shame attached to these wounds, people are staying home. The doctors are saying, "We need to change the story." We need to:

1. Lift the heavy curtain of stigma so people aren't afraid to show their wounds.
2. Set up better nets to catch these rare "Buruli" cases early, especially in the cities and among children, before they get worse.

In short, this paper is a call to action to stop hiding the wounds and start treating them, ensuring that no one is left with a "leaky roof" because they were too afraid to ask for help.

Technical Summary

Technical Summary: Chronic Skin Ulcers in Burkina Faso (2013–2023)

1. Problem Statement
Chronic skin ulcers represent a significant public health challenge in Burkina Faso, exacerbated by deep-seated social stigma. This stigma often compels patients to conceal their wounds or significantly delay seeking medical attention, leading to advanced disease progression and poor health outcomes. Despite the prevalence of these conditions, there is a lack of comprehensive data regarding the epidemiology, patient demographics, and specific etiologies of chronic ulcers within the country's dermatology sectors. Furthermore, the presence and distribution of specific infectious causes, such as Buruli ulcer (Mycobacterium ulcerans), require continuous monitoring to inform public health strategies.

2. Methodology
The study employed a cross-sectional, retrospective design to analyze clinical data spanning an 11-year period (2013–2023).

• Setting: The research was conducted at the dermatology departments of two major university hospitals in Burkina Faso: Souro Sanou and Yalgado Ouedraogo.
• Data Source: Researchers reviewed consultation records to extract sociodemographic and clinical data.
• Sample Size: The study included 104 patients diagnosed with chronic skin ulcers over the decade, representing an average of approximately 9 consultations per year.
• Variables Analyzed: Data points included patient age, gender, residence, ulcer location, and etiological diagnosis (specifically looking for Buruli ulcer).

3. Key Contributions

• Epidemiological Baseline: The study establishes a critical 11-year baseline for chronic skin ulcer management in Burkina Faso's tertiary care settings, filling a gap in regional dermatological literature.
• Buruli Ulcer Surveillance: It provides updated evidence of indigenous Buruli ulcer cases within the country, specifically highlighting the demographic profile of affected individuals.
• Service Utilization Analysis: The research quantifies the low volume of dermatology consultations for chronic ulcers, offering a metric to evaluate healthcare access and barriers.

4. Key Results

• Patient Demographics: The patient population was predominantly adults (n=60) and older adults (n=21), indicating that chronic ulcers primarily affect the mature population in this cohort.
• Clinical Presentation: Leg ulcers were the most frequent condition, observed in 59 patients (approx. 57% of the cohort).
• Buruli Ulcer Findings:
  • A total of 8 cases (7.69%) of Buruli ulcer were identified among the 104 patients.
  • Age Distribution: A significant majority of Buruli cases (5 out of 8, or 62.50%) occurred in children and adolescents aged 0–19 years, contrasting with the general trend of older adult patients.
  • Geographic Distribution: Half of the Buruli ulcer patients resided in Ouagadougou, the capital city.
• Service Utilization: The average of 9 patients per year across two major university hospitals suggests a low utilization rate of specialized dermatology services for chronic skin conditions.

5. Significance and Implications
The findings underscore a critical disconnect between the burden of chronic skin ulcers and the utilization of specialized medical care in Burkina Faso. The study highlights two primary areas for intervention:

1. Social and Behavioral Interventions: The low consultation rates are likely driven by social stigma. There is an urgent need for public health campaigns to address misconceptions surrounding skin ulcers, encouraging early presentation and reducing the tendency to hide wounds.
2. Targeted Clinical Strategies: The identification of Buruli ulcer cases, particularly in younger populations and within the capital, necessitates enhanced screening protocols and specific management strategies for this infectious disease. The data supports the integration of Buruli ulcer surveillance into routine dermatological practice to ensure timely diagnosis and treatment.

In conclusion, this paper calls for a dual approach: reducing social barriers to care while simultaneously strengthening clinical capacity to detect and manage specific infectious etiologies like Buruli ulcer within the dermatology departments of Burkina Faso.