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11 September 2020 | Story Andre Damons | Photo Francois van Vuuren (iFlair Photography)
Dr Lehlohonolo Makhakhe is from the Department of Dermatology at the University of the Free State (UFS).

A senior lecturer and specialist in the Department of Dermatology at the University of the Free State (UFS) has published the very first comprehensive African atlas on skin diseases commonly seen in the African setting. 
The African Atlas, synopsis and practical guide to clinical dermatology also contains more than 1 000 high-resolution images and is intended for medical and nursing students.

Dr Lehlohonolo Makhakhe, a full-time medical specialist (dermatologist) and the author of the book, says this is the first comprehensive full-colour atlas, with contributions from endocrinologists, haematologists, rheumatologists, psychiatrists and the UFS departments of Pharmacology, Dietetics and Paediatrics.

The project started in 2016, after Dr Makhakhe received formal approval from the UFS Ethics Committee and the provincial Department of Health and it was officially published in July 2020 by African Brilliant Minds Publishers. 

The book will have numerous benefits

Dr Makhakhe was a general practitioner with his own practice before joining the UFS to specialise. He then realised that a comprehensive manual was needed, focusing on common skin conditions in our South African setting. He further realised we lacked such a book which would be very beneficial to doctors and nurses. 

“I decided to write this book to encourage unity among doctors in different fields within medicine, particularly at the UFS, and to help promote the culture of writing and producing quality, well-researched, locally brewed content that is relevant to our setting. 
“I also wanted to play a part in providing de-commodified (affordable) books, in the hope of dispensing knowledge and promoting learning for our medical and nursing students to get sound book knowledge, so that they can better manage skin-related pathology,” added Dr Makhakhe.

He said he also aims to create revenue for the university and advance research projects through this book. It also provides an overview of the management of the conditions included in this user-friendly manual.

Challenges during the compilation of the book 

Dr Makhakhe highlighted the huge costs for the publisher, time management of the different contributors, as well as gaining the trust of the contributors for a concept that has never been done before. He aimed to change perceptions relating to dermatology as a secluded and isolated discipline, but also for the department to be seen as an integral part of the medical discipline. 

According to the author of four books (including this one), the publisher is also in talks with many nursing schools across the country to make the book available to nursing students. 

Dr Makhakhe says this atlas was by far his biggest project to date, as his first three books were short stories. He is currently working on a national project with contributors including Prof Johann Schneider (Head: Anatomical Pathology, Stellenbosch University), Prof Jacqueline Goedhals (Head: Anatomical Pathology, UFS), Prof Nndweleni Bida (Head: Anatomical Pathology, University of Pretoria), Prof Faffa Jordaan (Former head of Dermatology, Stellenbosch University) and Prof Wayne Grayson (renowned pathologist in the private sector), which will also be the first of its kind. 
“In summary, the publications are aimed at building a good name for our university through locally produced, high-quality books that are affordable. Once production costs to the publisher are settled, a sizable portion of future proceeds will then be directed to the university as per endorsement protocols.” he stated further.

Dr Makhakhe thanked the Head of the Free State Department of Health, Dr David Motau, the Rector and Vice-Chancellor of the UFS, Prof Francis Petersen, the acting Deputy Director-General of Clinical Services, Dr Marcus Molokomme, and also extended a special word of appreciation to the Head of the School of Clinical Medicine at the UFS, Prof Nathaniel Mofolo, for his assistance and support in making this project a success. He concluded by thanking all the contributors for making time for this historic project. 

The book is now fully endorsed by the UFS and will be offered as part of the curriculum for third- to final-year medical students. 

News Archive

To tan or not to tan: a burning issue
2009-12-08

 Prof. Werner Sinclair

“Some evidence exists which implies that sunscreens could indeed be responsible for the dramatic rise in the incidence of melanoma over the past three decades, the period during which the use of sunscreens became very popular,” says Prof. Werner Sinclair, Head of the Department of Dermatology at the University of the Free State. His inaugural lecture was on the topic Sunscreens – Curse or Blessing?

Prof. Sinclair says the use of sunscreen preparations is widely advocated as a measure to prevent acute sunburn, chronic sun damage and resultant premature skin aging as well as skin malignancies, including malignant melanoma. There is inconclusive evidence to prove that these preparations do indeed achieve all of these claims. The question is whether these preparations are doing more harm than good?

He says the incidence of skin cancer is rising dramatically and these tumours are induced mostly by the ultra-violet rays.

Of the UV light that reaches the earth 90-95% belongs to the UVA fraction. UVC is normally filtered out by the ozone layer. UVB leads to sunburn while UVA leads to pigmentation (tanning). Because frequent sunburn was often associated with skin cancer, UVB was assumed, naively, to be the culprit, he says.

Exposure to sunlight induces a sense of well-being, increases the libido, reduces appetite and induces the synthesis of large amounts of vitamin D, an essential nutritional factor. The use of sunscreen creams reduces vitamin D levels and low levels of vitamin D have been associated with breast and colon cancer. Prof. Sinclair says the 17% increase in breast cancer from 1981 to 1991 parallels the vigorous use of sunscreens over the same period.

Among the risk factors for the development of tumours are a family history, tendency to freckle, more than three episodes of severe sunburn during childhood, and the use of artificial UV light tanning booths. He says it remains a question whether to tan or not. It was earlier believed that the main carcinogenic rays were UVB and that UVA merely induced a tan. The increase in UVA exposure could have severe consequences.

Prof. Sinclair says the UV light used in artificial tanning booths consists mainly of pure UVA which are highly dangerous rays. It has been estimated that six per cent of all melanoma deaths in the UK can be directly attributed to the use of artificial tanning lights. The use of an artificial tanning booth will double the melanoma risk of a person. “UVA is solely responsible for solar skin aging and it is ironical that tanning addicts, who want to look beautiful, are inflicting accelerated ageing in the process,” he says.

On the use of sunscreens he says it can prevent painful sunburn, but UVA-induced damage continues unnoticed. UVB blockers decrease vitamin D synthesis, which is a particular problem in the elderly. It also prevents the sunburn warning and therefore increases the UVA dosage that an individual receives. It creates a false sense of security which is the biggest problem associated with sunscreens.

Evidence obtained from the state of Queensland in Australia, where the heaviest and longest use of sunscreens occurred, boasted the highest incidence of melanoma in the world. A huge study in Norway has shown a 350% increase in melanoma for men and 440% for women. This paralleled the increase in the use of UVB blocking sunscreens while there was no change in the ozone layer. It did however, occur during that time when tanning became fashionable in Norway and there was an increase especially in artificial tanning.

Prof. Sinclair says: “We believe that sunscreen use does not directly lead to melanoma, but UVA exposure does. The Melanoma Epidemic is a reality. Sunscreen preparations are not the magical answer in the fight against melanoma and the irresponsible use of these preparations can worsen the problem.”

Media Release
Issued by: Mangaliso Radebe
Assistant Director: Media Liaison
Tel: 051 401 2828
Cell: 078 460 3320
E-mail: radebemt.stg@ufs.ac.za
7 December 2009

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