'The psychosocial burden of alopecia areata and androgenetica': a cross-sectional multicentre study among dermatological out-patients in 13 European countries.

BACKGROUND: Hair diseases play an important burden on patients' lives, causing significant emotional and psychosocial distress. However, the impairment due to different hair conditions, such as alopecia areata (AA) and androgenetic alopecia (AGA), has rarely been compared. OBJECTIVE: The aim of this study was to assess the psychological burden of subgroups of patients with different hair diseases and to compare them to a healthy population. METHODS: In this study, we analysed a subgroup of patients with hair diseases from patients of a large multicentre study including 3635 dermatological patients and 1359 controls from 13 European countries. In the subgroup of patients with hair diseases, we analysed the socio-demographic characteristics, the stress level, and the impact of hair diseases on quality of life (QoL), anxiety, and depression and we compared them among patients with AA, AGA and healthy controls. RESULTS: The study population included 115 patients (77% women, 23% men) with hair diseases, 37 of whom with AA and 20 with AGA. Patients with hair diseases had a lower education level than healthy controls (medium educational level: 43% vs. 28%). Overall, 41% of the patients reported stressful life events during the last 6 months compared with 31% of the controls. Patients with the same age, sex, depression level and comorbidities had a worse QoL when suffering from AA than from AGA (Mean Dermatology Life Quality Index score: 5.8 vs. 2.5). CONCLUSION: Patients with hair diseases are more anxious, depressed and have a lower QoL than controls.

[A 74-year old woman with orofacial granulomatosis]. / Granulomatose oro-faciale chez une femme de 74 ans.

INTRODUCTION: Orofacial granulomatosis represents a group of pathologies characterized by a granulomatous inflammation of the face and the oral mucosa. Its etiology is unknown. Since the macrocheilitis resulting from an inflammation could be associated to different pathologies, an accurate diagnosis has to be established. OBSERVATION: A 74-year old woman developed a swelling of the inferior lip spreading towards the chin. No lesions was present on the oral mucosa. No other symptoms were reported. The biopsy and further exams concluded to an idiopathic orofacial granulomatosis. Triamcinolone 10 mg/ml was used as treatment and has allowed a lasting improvement of the swelling. DISCUSSION: This rare observation, especially with an older patient, has allowed to illustrate the importance of an accurate diagnosis when facing a macrocheilitis. Indeed, macrocheilitis can be associated to pathologies such as Crohn disease, sarcoidosis or tuberculosis, requiring an appropriate care.

[Psoriasis and depression]. / Psoriasis et depression.

Psoriasis is a common inflammatory disease affecting 2%-5% of the population of industrialized countries. Although the association between psychiatric pathologies and dermato- logical conditions is well known, the dermato- logist fails to indentify the psychological distress and when he identifies it, he doesn't take care of this suffering. The biological links between psoriasis and depression are now well-established. The impact on the quality of life (QoL) is studied for several years. In this vast domain of the QoL, the first problem revealed by the patients is the feeling of stigmatization. In psoriasis, the psychiatric comorbidity is estimated approximately at 30 %. The psychiatric troubles the most associated with dermatological conditions in general are depression, anxiety and suicidal ideations. The prevalence of depression in patients with psoriasis is estimated between 10 % and 62 % according to different studies. The patient's psychological distress is not correlated to the intensity of the clinical symptoms and the treatment does not modify either this distress, the coping mechanism, or the patient's opinion about his skin condition. Furthermore, it is necessary to know that the dermatological diseases affecting the patients during their childhood or adolescence will have a significant effect on the formation of their personality. However, personality will have an influence on the psychological morbidity. Therefore, it is important to take care of young people. To help the physician to recognize these difficulties, we propose a review of the literature and a method for a better management of the psychological suffering often experienced by the patients with psoriasis.

[Rheumatoid neutrophilic dermatitis]. / Dermatose neutrophilique rhumatoïde.

BACKGROUND: Rhumatoid arthritis (RA) is a chronic inflammatory joint disease. It appears to be caused by a combination of genetic and environmental factors. It may be accompanied by well-known extra-articular damage (e.g. lung, kidney, heart), while cutaneous involvement such as rheumatoid neutrophilic dermatitis (RND) is much less frequent. PATIENTS AND METHODS: A 64-year-old woman was referred by rheumatologists after she developed a cutaneous eruption on the forearms, elbows and scalp in a setting of progressive RA. A skin biopsy showed a dermal neutrophilic infiltrate throughout its entire thickness as well as leukocytoclasia, with fibrinoid material visible in certain areas. No vasculitis was observed. This histological examination led to a diagnosis of RND. The eruption was successfully treated with topical corticosteroids. COMMENTS: RND is a rare sign in RA that presents clinically as plaques, erythematous nodules or urticarial lesions. The lesions tend to disappear naturally or on treatment of RA. Topical corticosteroids or systemic therapy, in particular dapsone, may be suggested to treat cutaneous damage.