[Indicators in teledermatology: A literature review]. / Indicateurs en télédermatologie : une revue de la littérature.

AIM: Over the last two decades teledermatology has become one of the most widely used applications in telemedicine. Wide-ranging medico-economic evaluations are necessary to facilitate its deployment. "Accurate and measurable" indicators must be defined in order to enable high-quality assessments to be performed. The objective of this study is to identify all indicators allowing evaluation of teledermatology procedures and to assess the relevance and results thereof. MATERIALS AND METHODS: A literature search until September 2017 was conducted in PubMed using the following MeSH search terms: "telemedicine", "dermatology" and "quality improvement". RESULTS: The search identified 372 articles, of which 127 were included. Fourteen indicators were identified and split into 4 categories: processes indicators, quality indicators, cost indicators and satisfaction indicators. Reliability of diagnosis was the most widely evaluated indicator (49 studies). It was good overall compared to conventional consultations. Costs were generally reduced. Due to the absence of a validated measuring tool, it was difficult to compare the results for certain indicators, particularly satisfaction, and thus to make any generalizations. CONCLUSION: Teledermatology is a promising tool. Its deployment must be adapted to the various needs in the field and achievement of this goal requires consultation with patients and with the different healthcare professionals involved. Its evaluation must also be specific to each terrain and must employ standardized measuring instruments.

[Characteristics of chronic wounds in substance abuse: A retrospective study of 58 patients]. / Caractéristiques des plaies chroniques chez les toxicomanes : étude rétrospective de 58 patients.

BACKGROUND: Drug addiction causes chronic wounds (CW) responsible for severe complications. Very few studies are available on this topic. The aim of our study was to describe the demographic, clinical and etiological characteristics as well as the course of CW in drug addicts. PATIENTS AND METHODS: This was a retrospective and prospective multicenter study including all drug addicts with CW. RESULTS: We included 58 patients (17 prospectively), 84.5% of whom were male, of median age 43 years, presenting multiple CW as a result of intravenous (78.2%), inhaled (41.1%) and/or snorted (20%) drug abuse. Addiction to opioids (68.4%), cocaine (47.4%) and/or cannabis (40.4%) was ended and/or treated through substitution in 79.3% of patients. CW were fibrinous and necrotic (42.9 to 53.6%), recurrent (54.2%), and in some cases had been present for more than 1 year (61.5%). Intravenous drug addiction was associated with large, fibrinous, ulcers in a setting of venous and lymphatic insufficiency (74%). Only 23% of these wounds involved the upper limbs. Necrotic ulcers associated with clinical arteriopathy were described mainly with inhaled addiction. Abscesses (50%) and erysipelas (29.3%) were the most common cutaneous complications. After 3 months, 50% of CW were improved and 29.2% of patients were lost to follow-up. DISCUSSION: Drug abuse-related CW occurred preferentially in young men with history of intravenous abuse. For the most part, CW were seen on the legs and were associated with venous and lymphatic insufficiency, and the resulting major risk for cutaneous infection increased morbidity and mortality in this population in whom medical follow-up is inherently complicated.