Psychological and professional impact of COVID-19 lockdown on French dermatologists: Data from a large survey.

AIM: To evaluate the extent to which COVID-19-related lockdown affected dermatologists. METHODS: An anonymous online survey was proposed to all French dermatologists and dermatology residents to assess the impact of COVID-19 lockdown on their professional activity, their level of stress and their psychological state, as well as their coping strategies. RESULTS: Exactly 800 dermatologists completed the survey. The respondents noted changes in behaviour in their professional and personal environment. The number of cancelled or rescheduled appointments was very high, with a huge financial impact for private practitioners. Stigmatisation was also reported. Anxiety and a feeling of increased stress were very frequent. Increased substance use was also reported. CONCLUSION: The impact of the COVID-19 pandemic and lockdown was significant for French dermatologists, with risks to their own health, profound changes in their practice, and financial and psychological impact, but also the development of new consultation and evaluation strategies to improve their work-life balance.

[Reflections about non compliance]. / Réflexions sur la non-observance.

Throughout the follow up of a patient suffering from a chronic cutaneous disease, non compliance is rarely avoidable. It is provoked by numerous factors, which have to be looked for in the patient and the doctor, as well, and in the external reality, as in the internal, psychic, reality, both of the patient and the doctor. Being aware of these factors is fundamental for resolving the non compliance conflict. Thus, non compliance can become a chance to seize for avoiding patients' wandering and building a more dynamic, authentic and stronger doctor-patient relationship.

[Stress and seborrheic dermatitis]. / Stress et dermatite séborrhéique.

BACKGROUND: It is widely accepted that episodes of seborrheic dermatitis are frequently induced by stress, as stated in all general reviews of the subject. However, there have been no studies to confirm this view. PATIENTS AND METHODS: This prospective study was performed in two phases. An initial questionnaire collected information on patients' identity, somatic and psychiatric history and seborrheic dermatitis characteristics. Information on triggering episodes was sought by means of an open question and patients were then asked if they had experienced stress during the week or month prior to the active episode. A second questionnaire containing the same questions (except for history) was completed four months later. The two questionnaires contained psychopathological evaluation scales designed to detect symptoms of anxiety and depression among patients (HAD: Hospital Anxiety and Depression scale; Beck; STAI: State-Trait Anxiety Inventory) and determine their perceived stress (PSS: Perceived Stress Scale by Cohen and Williamson). RESULTS: Eighty-two patients (36 women and 46 men) were included in the study. 82% of patients presented involvement of scalp, 33% of the face, 19% of the chest and 13% of other sites (ears, skinfolds). Patients themselves identified stress as the main triggering factor, whether for episodes in general, for the first episode or for the current episode. A stressful event was in fact found in the majority of cases. The fact that stress was recognised as a triggering factor for episodes was not associated with a higher depression score (HAD or Beck) but was associated with a higher anxiety score (STAI). The psychological effects of the disease were pronounced in 11% of patients, moderate in 20%, mild in 35%, and nil in 25%, with 9% of patients stating no opinion. Patients with facial involvement were more depressed in terms of Beck Depression Index score. Two characteristics noted at inclusion were predictive for the onset of at least one further episode or persistence of an ongoing episode four months later: patients' designation of stress as the cause of the previous episode, and STAI score. DISCUSSION: This study confirms that seborrheic dermatitis is often preceded by a stressful event and that stress tends to suggest a poor prognosis. This is the first study to show a possible link between stressful life events and episodes of seborrheic dermatitis. It suggests the need to confirm these results through a study comparing patients with seborrheic dermatitis and subjects without the disease. It also shows that depression is more common among patients with facial involvement and that anxiety is an aggravating factor.

[Psychosomatic approach of vulvodynia]. / Approche psychosomatique des vulvodynies.

Vulvodynia is considered as a "somatoform disorder", i.e. as a somatic complaint not fully explained by a general medical condition. As any other somatoform disorder, it may reveal a depression, associated or not with anxiety. These patients always apply first to general practitioners or gynecologists and not to psychiatrists. It is, therefore, very important that these physicians could perform the diagnosis of depression, when this mood disorder is present, either by themselves or relying on the help of psychiatrists, and implement an appropriate treatment for depression. Vulvodynia is often associated with two pathological conditions: hysterical personality or hypochondriasis. It is fundamental that the doctors recognize these conditions in order to avoid the relational pitfalls, which would hinder the diagnostic and therapeutic approach.

[Psychological factors in chronic urticaria]. / Les facteurs psychologiques dans l'urticaire chronique.

Chronic urticaria is above all a cutaneous disease, affecting the skin, a visible organ, which plays a privileged role in relational life. Like any chronic disease, it raises two principal problems: preservation of the quality of life and therapeutic compliance. In chronic urticaria, psychological factors intervene on several levels: the doctor-patient relationship, the urticarian crisis itself, the onset and/or the aggravation of the disease, and the psychosocial consequences of urticaria. The role of psychological factors in the onset and/or the aggravation of the disease is variously estimated, generally based on retrospective studies and without consensus between the authors. On the other hand, the psychosocial impact of the disease is regularly mentioned: 30 to 40 p. 100 of the patients presenting with an associated depressive state. Quality of life is especially impaired in case of an associated physical urticaria. These data plead in favour of taking into account the psychological factors involved in the disease in order to propose, combined with the classical treatments of chronic urticaria and before the use of heavier treatments, a psychological treatment, i.e. a prescription of psychotropic drugs (especially antidepressants), alone or associated to a psychotherapy (a relaxation technique for example), without forgetting health education sessions.

[Psychological aspects of sexually transmitted diseases]. / Aspects psychologiques des maladies sexuellement transmissibles.

The psychological aspects of sexually transmitted diseases first refer to the psychological consequences on the patient himself and also on his affective circle. The intensity of these consequences shows the importance, in every subject, of the fantasies about sexually transmitted diseases which have always threatened sexuality. Therefore these fantasies also affect the cares. The latter's fantasies can sometimes weaken the precarious psychological balance of the patient himself and of his affective circle. This can be confirmed in the case of a sexually transmitted disease in one of the partners of a couples or in the case of a sexually transmitted disease after sexual abuse. Sometimes, psychological factors play an important role in the onset of a sexually transmitted disease in a subject. For example, adolescence which promotes acting out and taking risks exposes young people to sexually transmitted diseases. In the other respects, it has been demonstrated that recurrences of the genital herpes simplex virus could be linked to psychosocial factors. In any case, it is the doctor-patient dialogue which is the best guarantor of an effective the repeutic and preventive action.

[Acceptability, tolerance and quality of life impact of cyproterone acetate treatment in female hirsutism. Comparison of 2 protocols in combination with oral or transdermal estradiol]. / Acceptabilité, tolérance et impact sur la qualité de la vie du traitement de la femme hirsute par l'acétate de cyprotérone. Comparaison de 2 schémas l'associant soit à l'estradiol per os, soit par voie transdermique.

67 women (aged 16-40) with hirsutism and/or other signs of hyperandrogenism (acne, androgenic alopecia, cycle disturbances) have been treated for one year with cyproterone acetate + estradiol. Patients have been randomly assigned to therapy with cyproterone acetate and estradiol valerate per or cyproterone acetate and transdermal estradiol. Acceptance, tolerance and effects on quality of life of this treatment have been assessed using a self questionnaire completed with questions for assessment for compliance. Among patients who have had a full course of treatment, 54 have fulfilled the end-of-study quality of life questionnaire. The queries allow calculation of a relational well-being score and of an emotional well-being score. The answers to the initial questionnaire show in a high percentage of patients emotional trouble (depressive state, anxiety, irritability) and disturbances in relational life. The hirsutism score has been found to be significantly correlated with anxious trouble but not with the global quality of life score. The treatment has resulted in a significant improvement in acceptance of being exposed to view (p < 0.01), self-assurance (p < 0.01) as well as emotional well-being score (p < 0.05), without any significant difference between the 2 therapeutics groups. Measurement of treatment acceptance with a visual analogic scale has been found globally very satisfactory by patients from the 2 groups. Compliance of treatment with transdermal estradiol turned out to be lesser in younger patients but is better in patients in whom emotional balance has been improved by therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

[The psychology and pathology of the pilosebaceous follicle]. / Psychisme et pathologie du follicule pilo-sébacé.

The mind plays a dual role in the pathology of the hair follicle: the disease has repercussions on the mind, and the mind in turn may trigger off or exacerbate its course. As all skin diseases, those involving the hair follicles have much to do with vision, and they profoundly alter the images the subjects has of himself (self image) and offers to other persons. Repercussions on the mind are particularly intense with these diseases since they usually occur on the face and during adolescence. It results from these findings that a dual, somatic and psychological approach of the patient is indispensable. Moreover, this approach increases the patient's compliance with the treatment prescribed.