THB-INMP-IISMAS-Cooperazione Italiana Mekelle, Tigray, November 2009
ACKNOWLEDGMENTS
This book has been designed based on the experience developed in Tigray region as a collaborative effort of Tigray Health Bureau (THB), International Institute of Social, Medical and Anthropological Sciences (IISMAS), National Institute for Health, Migration and Poverty (NIHMP) and Italian Development Cooperation, for improving dermatological care and making it accessible to the population at the grass‐root level. This was done in the framework of an Operational Research on “Training Activities and Anthropological Studies in Dermatology” agreed upon between the Italian Embassy inAddis Ababaand the Tigray Health Bureau, with the technical and financial support of the “Italian Contribution to Health Sector Development Programme (HSDP)”. In this context, the Italian Dermatological Centre (IDC) ofAyderHospitalin Mekelle played the role of referral centre under the direction of Dr. Federica Dassoni (IISMAS) who was the principal contributor to these algorithms. The technical review team was composed of Dr. Gebre Ab Barnabas (THB), Dr. Kassahun Desalegn Bilcha (University of Gondar), Prof. Aldo Morrone (NIHMP), Drs. Pasquale Farese and Sandro Accorsi (Italian Contribution to HSDP), Dr. Vincenzo Racalbuto (Italian Development Cooperation) and Prof. Terence Ryan (University of Oxford). We wish to thank all theAyderHospitalstaff members, Tigray Health Bureau and Tigray District officers who contributed with their commitment and daily work to this effort.
FOREWORD
I am pleased to see that my colleagues from the Italian Cooperation Ethiopia together with IISMAS – the Italian Dermatologic Centre (IDC) atAyderReferralHospital, Mekelle, Tigray, and the National Institute for Health, Migration and Poverty (NIHMP) developed the Algorithms on Skin Lesions in order to improve diagnostic and management skills of our Health Workers in Tigray. These flowcharts will be part of the Algorithms developed by our staff from internal Medicine, Surgery, Child Health and Obstetrics/Gynaecology. Flow charts not only make diagnosis and treatment simple but also systematic and standardized.
Algorithms are not formulae but guidelines that help improve the definition of the problem. They also help the busy clinicians from making hasty conclusions. Personal experience, the support of laboratory confirmation where possible and consultation through the telephone or telemedicine are always open options. Referring to relevant manuals and/or textbooks is, of course, mandatory. I wish all practicing and teaching staff good luck.
Gebre Ab Barnabas MD, PhD
Head, Tigray Health Bureau
Mekelle, Tigray
November 2009
TABLE OF CONTENT
Acknowledgments
Foreword
Abbreviations
Algorithms & Atlas
1. Generalized itching
2. Localized itching
3. Changes of skin pigmentation
4. Plaques
5. Elevated (nodular and papular) lesions
6. Hair diseases
7. Ulcers
8. Blisters
9. Burns
10. Skin diseases of hands and feet
Technical advice