Management and clinical practice of multiple face and scalp actinic keratosis in France.

Background: Actinic keratosis (AK) is characterized by the occurrence of thick and scaly skin areas caused by damage from ultraviolet radiation. The management of AK aims to reduce lesions and prevent their recurrence by regular monitoring. French guidelines, last updated in 2009, reflect European guidelines for the management of face and scalp AK. However, they do not address all current, available options. Objective: To assess the management of face and scalp AK in French clinical practice. Methods: A two-part online questionnaire comprising a survey among French dermatologists and an analysis of patient medical records was performed to describe AK patients treated with topical therapy, patients' profiles, and characteristics of the affected lesion areas. Results: Decisions for topical treatments for face and scalp AK made by dermatologists were mainly driven by the lesion size. According to the last 10 patients they have seen, dermatologists were prescribing physical therapy in 53% of the cases, a combination of topical and physical therapy in 27% and topical only in 20%. Patient records revealed the average surface area targeted for treatment was 139 ± 113cm2. Conclusions: Discrepancies between the guidelines on the treatment of face and scalp AK and clinical practice exist. Further research may help to standardize the treatment.

The Emervel French survey: a prospective real-practice descriptive study of 1,822 patients treated for facial rejuvenation with a new hyaluronic acid filler.

BACKGROUND: Emervel consists of a range of 5 hyaluronic acid (HA) fillers (Touch, Classic, Lips, Deep, and Volume), with a fixed HA concentration (20 mg/mL), and various degrees of cross-linking and calibration. OBJECTIVES: To describe the current use of Emervel fillers in France. METHODS: Prospective multicenter, cross-sectional, real-practice, descriptive survey, including 1,822 patients injected with Emervel fillers for face rejuvenation by 58 French physicians between September 2010 and July 2011. The injection modalities were left to the respective physician's discretion. RESULTS: The physicians were dermatologists (52.3%), surgeons (43.8%), or general practitioners (14.1%). Nasolabial folds (NLF) with a mean severity 2.4 were mainly injected with Emervel Deep (51.0%) and Emervel Classic (36.0%) (mean volume: 1.0 mL), and primarily with the linear retrograde (LR) technique (89.3%). Marionette lines (ML), with a mean severity 2.6 were mainly injected with Emervel Deep (52.5%) and Emervel Classic (34.6%) (mean volume: 0.8 mL), and mainly with the LR technique (79.5%). More than 90% of patients had scores of 0 or 1 for erythema, bruising, edema, and pain. No serious adverse events were reported up to 15 months after the injection. CONCLUSION: These data could contribute to upcoming international consensus on optimal injection modalities of the Emervel range of HA fillers.

The France-PDT study: a national prospective observational cohort survey on the use of methyl-aminolevulinate photodynamic therapy in France, with up to 6-month follow-up.

BACKGROUND: The efficacy and safety of MAL-PDT have been shown in actinic keratoses (AK), basal cell carcinoma (BCC), and Bowen's disease (BD). OBJECTIVES: To appraise the current use of MAL-PDT in France. METHODS: National prospective cohort survey, including 583 patients treated for the first time with MAL-PDT. Clinical and treatment data were collected at baseline, month 3, and month 6 if applicable. The primary objective was to estimate the rate of misuse of MAL, defined as divergence from the French Summary of Product Characteristics. RESULTS: Of 174 contacted physicians, 66 agreed to participate in the study, and 56 included at least one patient. Among the 456 patients included in the observational cohort, 203 had AK, 130 had BCC, and 63 had BD. Referring to the French SPC of Metvixia®, the MAL-PDT was misused in 48.7% of BCC, 25.6% of AK and 23.4% of BD. The main criteria for misuse in BCC were the performance of two rather than one lighting sessions at baseline cure. The main criteria for misuse in AK were the duration of lighting and the performance of 2 rather than 1 lighting sessions at baseline cure. The main criteria for misuse in BD were the performance of 1 rather than 2 lighting sessions at baseline cure and the duration of illumination. CONCLUSION: Contrasting with the French label, nearly one third of French dermatologists treat BCC with two sessions, as recommended at European level and in Australia. International consensus guidelines are needed to homogenize and rationalize current use of MAL-PDT.