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INTRODUCTION

The African continent is the second largest continent in the world, at 11.7 million miles squared, which is 20.4% of the Earth’s total land surface.1 Fittingly, it is also the second most populous continent, with 853.6 million inhabitants, which is 14.72% of the world’s human population.1 The continent is divided into 54 recognized countries, and the average life expectancy at birth is 58 years.2a There are six African countries that lie directly on the equator, and this has implications on the inhabitants’ exposure to ultraviolet (UV) rays. The Nile River is the longest river in the world and runs a course of 4.132 miles through Africa, providing a valuable source of nourishment, but at the same time acting as a breeding ground for transmittable skin diseases in certain regions.2 This continent is considered by most paleoanthropologists to be the oldest inhabited place on Earth, with many considering Africa to be the area where the human species originated.1

The majority of common skin conditions in Africa are attributable to infections and infestations and hence are preventable. Transmissible skin conditions account for up to 85% of skin conditions in Tanzania, 78% in Malawi, 71.5% in Ethiopia, and 40% in Uganda.2

The aim of this chapter is to discuss conditions that either are unique to Africans or have an extremely high prevalence in Africa due to the high transmission rate of infections (eg, human immunodeficiency virus (HIV) and other infections that have always been endemic in Africa). In addition, the pigmentary conditions that have long plagued Africans will be highlighted. The conditions and diseases that will be focused on in this chapter are PPE, Kaposi sarcoma, acquired epidermodysplasia verruciformis syndrome, chromomycosis, leprosy, and albinism.

HUMAN IMMUNODEFICIENCY VIRUS

KEY POINTS

  • With human immunodeficiency virus (HIV), the most common skin conditions are infections and infestations, which are preventable.

  • Approximately 69% of the global total of HIV-infected individuals are in sub-Saharan Africa.

  • HIV and acquired immunodeficiency syndrome have changed the landscape of skin diseases in Africa.

  • The most common conditions stemming from HIV are Kaposi sarcoma, papular eruptions, herpes zoster, dermatophyte infections, and molluscum contagiosum.

  • In children with HIV, the most common conditions are tinea capitis, molluscum contagiosum, verruca vulgaris, plane warts, and seborrheic eczema.

  • Highly active antiretroviral therapies are associated with the increased prevalence of drug reactions and immune reconstitution inflammatory syndrome-related cutaneous events.

The HIV/acquired immunodeficiency syndrome (AIDS) endemic has wreaked havoc in Africa. Currently, there are 30.4 million infected people worldwide, with sub-Saharan Africa experiencing the greatest toll, with 69% of the global total and every 1 in 20 adults infected.3 Of the 1.7 million people who died of AIDS-related causes in 2011, 70% were from Africa.3 Sub-Saharan Africa is one of the regions that has shown the sharpest decline in the number of new infections (25% since 2001) and has ...

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