[Assessment of dermatological emergencies in a French university hospital]. / Evaluation d'une consultation d'urgences en dermatologie.

INTRODUCTION: The aim of our study was to understand the motivations of outpatients who come to dermatological emergencies in a university hospital. PATIENTS AND METHOD: This 6-week prospective study included outpatients who came to the dermatology emergency unit. This consultation is proposed each morning (from 8 to 9), from Mondays to Fridays. A questionnaire was distributed to outpatients. They answered questions on the functioning of this consultation and their own symptoms. The consulting dermatologist answered questions on the referring physician, the really urgent characteristics of the disease and the diagnosis. RESULTS: Patients were satisfied by the functioning of the consultation. Indeed, 59 p. 100 of outpatients thought that the timetable was convenient and 70 p. 100 that the delay before getting a consultation was rapid. 75 p. 100 felt they needed treatment rapidly. Nonetheless, 45 p. 100 did not think they had a serious disease. More than half of the outpatients were referred by their general practitioner; the others came spontaneously, or were referred by other departments or general emergencies. The most frequent diagnoses were cutaneous infections (27.6 p. 100), eczema (21 p. 100), then benign tumors, psoriasis, physical dermatoses, viral eruptions... DISCUSSION: A consultation for dermatological emergencies appears to reply to patients' demands. Nonetheless, most of these outpatients do not present with real dermatological emergencies. Criteria for real emergencies needs to be further defined and understood by citizens.

[Ultrastructural study of a case of Miescher-Leder granulomatosis disciformis chronica et progressiva]. / Etude ultrastructurale d'un cas de granulomatose disciforme chronique et progressive de Miescher et Leder.

Ultrastructural study of a case of granulomatosis disciformis occurring on the legs of a 62-year-old woman. The diagnosis is based upon the contrast between the clinical aspect of necrobiosis lipoidica and the histologic aspect of inflammatory granulomatous infiltrate of dermis without necrobiosis nor palisading. Electron microscopic findings are: perivascular mixed cell infiltrate and histiocytic granuloma with lysosomial and phagocytic activity; degenerative and necrotic cellular alterations; modifications of collagen fibres with two types of fibres: the thinnest are the most numerous and have a mean diameter of 50 nm, the thickest of 110 nm; no significant lesions of capillary walls. These findings suggest the following succession of pathological events: cellular necrosis, lysosomial and phagocytic activity, scarring. Some descriptions of necrobiosis lipoidica and granuloma annulare seem to be quite similar and our findings are in favour of the unity of these three illnesses.