Impact of acne on the daily life of adult patients: building a self-administered patient questionnaire.

BACKGROUND: Acne is a long-lasting disease in adolescents and adults impacting the patient's daily life. Currently, there is no specific questionnaire that assesses its impact in adult patients. AIM: To build a self-administered questionnaire assessing the impact of acne on the daily life in adult patients. METHOD: A multidisciplinary working group was created, including 3 experts in healthcare questionnaires and dermatologists specialized in acne. A questionnaire using a standardized methodology for designing self-administered patient questionnaires according to conceptual, development and validation phases was developed. A cultural and linguistic validation into US English was conducted, based on the original French version. RESULTS: A 14-item questionnaire demonstrating consistency, reproducibility and high reliability was build. The questionnaire significantly correlated with the SF-12 mental and SF-12 physical scores and CADI, indicating good external validity. CONCLUSION: The present acne burden questionnaire AI-ADL allows the practioner to assess quickly and easily the burden of acne in patients during his daily clinical practice. Moreover, its short format allows patients to express easily and quickly their feelings and to initiate a conversation between the practioner and his patient. Thus, AI-ADL may help to better understand the multidimensional nature of acne, as well as the individual impact on the acne patient's daily life and moreover, it may play a key role in the decision-making process of treatment initiation and involvement of the patient in the management of his acne.

Impact of patient psoriasis on partner quality of life, sexuality and empathy feelings: a study in 183 couples.

BACKGROUND: The impact of psoriasis on quality of life (QoL), sexuality and empathy requires better understanding in patient-partner relationships. OBJECTIVES: To evaluate the influence of psoriasis on partner QoL, presence of sexual dysfunction (SDy) in couples and empathy in partners of psoriasis patients. METHODS: A total of 183 adult psoriasis patients and their partners participated in this observational, cross-sectional and non-comparative study. Severity of psoriasis was measured using the Psoriasis Area and Severity Index. Patient QoL was assessed using the Dermatology Life Quality Index and the Short Form-12 (SF12). The impact of psoriasis on partner QoL was measured with the Family Pso and the SF12. Presence of SDy and empathy in partners were assessed using the Family Pso. RESULTS: Overall, 49.7% of the patients had moderate-to-severe psoriasis. Patient psoriasis severity and patient QoL were correlated with partner psychological distress. The largest QoL impairment was observed in female patients with moderate-to-severe psoriasis. The stronger QoL alteration observed in female psoriasis patients, compared to their partners, was not observed in male psoriasis patients vs. their partners. There was no relationship between partner QoL and patient age and duration of psoriasis. Most patients, but less than half of the partners, reported SDy with age being a being a significantly more important impacting factor than disease severity. Both psoriasis clinical severity and/or a significant impact on QoL were associated factors for SDy in male partners of psoriasis women, but not in female partners of psoriatic men. Reporting empathy was higher among young male partners of psoriasis patients. In both male and female partners, patient psoriasis clinical severity was not associated with empathy. CONCLUSIONS: Psoriasis impact on patient-partner QoL, sexuality and empathy should be considered more thoroughly by dermatologists when formulating treatment plans and making treatment decisions.

Feelings of stigmatization in patients with rosacea.

BACKGROUND: Rosacea is a chronic facial disease that may lead to feelings of stigmatization, which can negatively impact psychological and social well-being. OBJECTIVE: The aim of this study was to evaluate different aspects of rosacea that could contribute to feelings of stigmatization. METHODS: An online survey of a representative sample of the adult population in the UK, France, Germany and US was conducted to identify patients with rosacea based on presence of three or more clinical features. RESULTS: Among the patients who completed the survey (n = 807), mean age at first sign/symptom of rosacea was 31.3 ± 14.5 years; mean duration of disease was 102 ± 119 months. One-third of patients reported feelings of stigmatization (FS; n = 275). Male patients were more likely to experience FS (49% vs. 37.2% in non-FS population; P = 0.0037). Those with FS were more likely to avoid social situations (54.2% vs. 2.0%, P < 1.00E-10 ) and had a higher rate of depression (36.7% vs. 21.1%, P < 1.00E-10 ). CONCLUSIONS: Stigmatization is important in the daily lives of those with rosacea and should be taken into consideration in the management of these patients.

Extent of misconceptions, negative prejudices and discriminatory behaviour to psoriasis patients in France.

BACKGROUND: The perception of stigmatization of patients with psoriasis is largely due to misconceptions and negative prejudice about this skin disease. 'Uneducated' judgments can give rise to discriminatory behaviours. OBJECTIVE: Evaluate the prevalence, in France, of misconceptions, negative prejudice and discriminatory behaviour towards psoriasis patients. METHODS: Online survey conducted in June 2011, aimed at 1005 persons aged 16-64 years, representative of the French population. The representativeness of the sample was ensured by quota methodology (gender, age, occupation of the interviewed person) after stratification by region and location category. The respondents were asked to respond to a questionnaire on their knowledge of psoriasis, their attitude and main feelings/perceptions towards psoriasis patients. RESULTS: About 62.4% of respondents recognize a lack of information about psoriasis and 19.7% have misconceptions about this disease. About 16.5% believe that psoriasis is contagious, 6.8% believe this skin disease is related to personal hygiene and 3.2% believe that it affects more people with low personal hygiene. About 50.0% of respondents show discriminatory behaviour towards psoriasis patients, reflected by reluctance to maintain friendship ties/a relationship of friendliness (7.6%), to have lunch or dinner with a person with visible manifestations (17.9%), to give a kiss on the cheek in greeting (29.7%), to shake hands (28.8%) and to have sexual relations/intercourse (44.1%). Patients with negative prejudice about the psoriasis frequently have misconceptions towards psoriasis patients. About 52.8% of respondents do not know anyone with psoriasis. Socio-demographic indicators such as gender, education level and rural or urban way of life are not associated with an increased prevalence of misconceptions and/or discriminatory behaviour. CONCLUSION: The lack of knowledge about psoriasis in France is important. There is an urgent need to strengthen information campaigns about psoriasis intended for the General Public.

[Hand eczema : disability and impact]. / Eczéma des mains : handicap et impact.

INTRODUCTION: Hand eczema is a dermatological condition that may lead to physical and psychological disability, with psychological impact on social relationships, daily life activities and work. OBJECTIVES: Review of the literature on the impact of eczema of the hands and resulting disabilities. METHODS: Medline and Embase search from 1990 to 2013. RESULTS: Hand eczema is a disabling disease because of its poor prognosis. It has an impact on quality of life, which has been assessed using generic scales (MOS-SF36 and EQ-5D) and generic dermatological scales (DLQI and the Skindex). There are no quality-of-life scales specific to hand eczema. This dermatosis may also have repercussions on work, resulting in absenteeism and at times requiring occupational retraining. Hand eczema has economic repercussions with several factors to be taken into account such as medical consultations, medical expenses, loss of productivity, work leave, changes in job position, compensation, and the need for occupational retraining. CONCLUSION: Management of hand eczema by a dermatologist requires taking into account the importance of the physical and psychological disability and the consequences on social relations, activities of daily life, and work. In this context, measuring quality of life is important in assessing patients'perception of the disease and their experience.

Occupational contact dermatitis in 10,582 French patients reported between 2004 and 2007: a descriptive study.

BACKGROUND: Limited epidemiological data are available in France for occupational contact dermatitis (OCD), a non- infectious inflammatory skin condition arising from direct skin contact with substances used in the workplace. OBJECTIVE: To estimate the occurrence of, and number of workdays lost to, OCD in France. METHODS: Descriptive study of all OCD declared by salaried workers and recognised as occupational disease in France over a 4-year period. RESULTS: 10,582 OCD cases were reported, representing 9.6% of all occupational diseases recognised. The estimated annual incidence of OCD recognised was 15.72/100,000 salaried workers (i.e. 146.87/100,000 employees for all occupational diseases). OCD cases were mainly in the construction and public works industries with 3,057 (36.7%) salaried workers affected. In the services sector, OCD predominantly affected employees aged less than 30 years (41%), particularly hairdressers (69%). OCD accounted for the loss of 395,069 working days. CONCLUSION: OCD represents a significant public health problem in France, particularly for construction workers and hairdressers.

[Adherence: definitions and measurement methods: characteristics of adherence to topical treatments]. / Observance: Définitions et méthodes de mesure: spécificités de l'observance des traitements topiques.

Taking into account topical treatment compliance is extremely important given its fundamental place in the dermatologist's armamentarium. After reviewing the definition of compliance, adherence, alliance, and clinical inertia, the direct methods used to measure compliance with a topical treatment (counting tubes administered, MEMS system performance, measuring circulating blood or urine rate of a medication or its metabolite, and observation of medication intake by a third party) and indirect methods (questioning the patient, the dermatologist's opinion) will be reviewed. The question of frequency, more important than compliance in cases of topical treatments compared to systemic treatments, has given rise to controversial opinions. Six factors related to topical treatment that play a role in therapeutic compliance can be cited: the perception of efficacy, the feeling of harmlessness, the treatment's simplicity, the treatment's duration, the galenic formulation, and the cost.

[Non adherent patients in dermatology]. / Les patients non-observants en dermatologie.

Non compliance to therapy is frequent in dermatological disorders. Many factors related to the disease, treatment, the physician-patient relationship, the physician, and the patient explain this poor compliance during the course of dermatological treatments. Better knowledge of the non compliant patient-related factors could improve treatment compliance, resulting in better treatment efficacy. The patient parameters playing a part in therapy compliance are numerous and closely intertwined: age, sex, marital status, employment, education level, acceptance of the disease, perception of the treatment, associated psychiatric disorders, addictive behaviors, quality of life, the environment, and the relationship with the physician. It is important to take into account these noncompliance factors related to patient typology so as to optimize management of dermatological disorders. This requires knowing the patient's situation and habits well so that the treatment can be adapted as best possible to his or her lifestyle.

[Socio-demographic study of privately practicing dermatologists in metropolitan France in 2011]. / Étude sociodémographique des dermatologues libéraux en France métropolitaine en 2011.

BACKGROUND: There is currently an alarming decrease in the number of dermatologists in private practice because of the limited number of new graduates, who are unable to compensate for departures into retirement among the "baby boom" generation. Our aim was thus to determine the socio-demographic characteristics of private dermatologists in France in 2011 to forecast the impact over the next 20 years. MATERIALS AND METHODS: Analysis was performed of socio-demographic data (age, sex, place of practice, thesis year and mode of exercise) for all private dermatologists living in France in 2011 and identified in the Rosenwald Directory of Doctors. These data were combined with those of the National Council of the Order to determine the number of GPs and those of INSEE, giving the size and number of inhabitants of each department. RESULTS: There are 3,197 privately practicing dermatologists in France, with a majority of women (65%). The average age is 52 years. Fifty-three per cent of dermatologists are aged over 55 years while 21% are aged between 50 and 54 years, 19% are aged between 40 and 49 and 5% are aged under 39 years. The density of dermatologists in France is 5.1/100,000 inhabitants. There are three types of density zone for dermatologists: high-density zones (over five dermatologists per 10(5) persons), comprising 24 departments (22% of the national territory) in which 61% of dermatologists are practicing; moderate-density zones (three to five dermatologists per 10(5) persons), comprising 41 departments (47% of the French territory in which 30% of dermatologists are practicing; low-density zones (less than three dermatologists per 10(5) persons), considered as "dermatological deserts", comprising 30 departments (31% the national territory) in which 10% of the country's dermatologists are practicing. The population projection shows a decrease in the number of dermatologists in private practice of 45% in 2020, 72% in 2025 and 84% in 2030. DISCUSSION: Our study highlights the disparity in distribution of the density of liberal dermatologists in France. The departments in which the density of dermatologists is low are those where the number of general practitioners is small. In 2021, 54% of dermatologists currently in private practice will be aged over 65 and are therefore likely to end their professional practice. How can we anticipate the fall in the number of dermatologists in private practice over the coming two decades? This question must be addressed urgently.

[Occupational dermatitis in cleaning and maintenance workers. Analysis of 769 cases declared to the Caisse Nationale d'Assurance Maladie des Travailleurs Salariés between 2004 and 2007]. / Les eczémas professionnels chez les travailleurs du secteur du nettoyage et de l'entretien. Étude de 769 déclarations à la Caisse nationale d'assurance maladie des travailleurs salariés entre 2004 et 2007.

BACKGROUND: Employees active in the cleaning and maintenance industry (CMI) are particularly exposed to occupational eczema (OE), which affects the hands in 80 to 90% of cases. This risk of OCE in France was evaluated using data collected by the Occupational Risks Division of the French National Health Insurance Fund for Salaried Workers (CNAMTS). PATIENTS AND METHODS: All cases of OE among CMI employees declared to and recognized by the CNAMTS between 1st January 2004 and 31st December 2007 were selected. The following parameters were noted in each case: age, gender, trade in question, National Health Insurance Office of residence, causal agent and number of days of sick leave. The incidence per 100,000 employees could be determined from the total number of employees followed up by occupational medicine and the numbers working in the CMI. RESULTS: For the 4 years studied, 769 cases of OE were reported in CMI workers representing 2.6% of the salaried employee population. The annual incidence of OE was 43.5 per 100,000 employees. There was a marked female predominance (75.7%). OE led to loss of 32,714 workdays. CONCLUSION: This is the first study conducted in France about OE among NIS employees. It highlights the socioeconomic impact of OE. The difficulties of interpretation show the limits of recognition of occupational disease. Analysis of cases of OE in France and monitoring require the development of a specific database to clarify risk situations and identify priority regional and national preventive actions.

Josef Mengele's research program on noma in Auschwitz.

Noma research protocol was conducted in the Auschwitz Birkernau camp by the infamous (Schutzstaffel) SS doctor Josef Mengele who was known as "the Angel of Death" in close collaboration with researchers at the Kaiser-Wilhelm Institute in Berlin Crimes. Mengele who held the post of camp doctor in the "Gypsy camp" saw an opportunity to set up a research program on gypsy children called "Nomaprojekt". The purpose of this program was to study the causes of noma and to find treatment methods. The experimental treatment protocol consisted of administering a combination of sulfanilamido-ethyl thiodiazole and nicotinic acid. Heads and selected body parts of children suffering from noma were prepared in formaldehyde jars and sent to researchers at the prestigious Kaiser-Wilhelm Institute for Anthropology, Human Heredity and Eugenics in Berlin-Dahlem, but also to the SS Medical Academy in Graz to carry out further examinations. The experimental protocol for the treatment of noma among Gypsy children is one of the most horrific crimes that Dr. Josef Mengele committed in the Auschwitz camp.