Traditional tattoo marks among neurological patients in Togo

In Africa, there are two types of health systems: the modern system and the traditional one. Traditional medicine attracts more patients because it is more financially accessible and corresponds to cultural representations of disease in society. Traditional therapeutic tattoos are not well known by the conventional health system in West Africa, although they are commonly u sed by traditional healers. We report here our experience of these tattoos, We examined the skin of 36 000 patients in the neurological department of the teaching hospital of Lome from 1985 to 1995. We found three types of ta ttoos amongst patients. The first are tribal or social tattoos: they are la rge, homogeneous, located on exposed parts of the body and can be seen easi ly by others (fig 1: g, h, i), whilst therapeutic tattoos are slight and hi dden under clothes and can also be repeated (heterogeneous). The second typ e of tattoo is one that reveals the patient's pathological history. The thi rd is linked to the motive of consultation. Seventy-five per cent (75%.) of patients had traditional therapeutic tattoos. Epilepsy tattoos are slim, l ocated on the forehead (fig 1a); peripheral facial paralysis tattoos are fo und on the facial nerve (fig 1b). In cases of peripheral neuropathy, tattoo s are symmetrically distributed on hands and legs (fig 1f). As for medullar compression, the highest tattoos correspond to the level of compression. S tudying the localisation, age, and aim of tattoos brings to light their dia gnostic, prognostic, and epidemiological interests. Skin can thus reveal it self to medical staff as an open, though coded, medical file. They need onl y to learn how read it.