Wearing of examination gloves and hygiene practice among dermatologists: A national survey.

INTRODUCTION: Touch is essential for dermatologists. Differences in practice, such as whether or not to wear examination gloves, may be seen among dermatologists. To investigate this approach and its associated factors, we conducted a national survey to study hygiene measures and the wearing of gloves among dermatologists, e.g. wearing a coat, hand washing between patient visits, hand shaking and past history of infectious disease transmitted by patients. The context and circumstances in which gloves were worn was studied. RESULTS: Four hundred and seventy-four dermatologists responded to the survey (median age: 52 years). Most dermatologists reported wearing examination gloves as follows: always (21%, n=99), occasionally (76%, n=359), never (3%, n=13). Most physicians reported wearing a coat (91%, n=419) and routinely washing their hands after examination (53%, n=241). A minority of physicians reported shaking hands (36%, n=163). A significant number of dermatologists reporting that they wore examination gloves were younger and female, and these practitioners also washed their hands more frequently. The most common reason cited by dermatologists wearing gloves "occasionally" was patient hygiene (71%, n=256) rather than infectious skin disease (52%, n=186). This practice was ascribable more to concerns by dermatologists about protecting themselves (78%, n=270) rather than protecting patients (51%, n=169). Finally, it was felt that wearing gloves impaired neither the quality of clinical examination (52%, n=173) nor relations with patients (49%, n=160). CONCLUSION: Although wearing gloves is not recommended for examining unbroken skin, most of the respondents reported wearing examination gloves during their consultations. Wearing of gloves was associated with more frequent hygiene measures (hand washing, no handshaking) and was based on concern for self-protection.

[Outpatient expectations in dermatology consultations: A pilot study]. / Attente des patients consultant un dermatologue «de ville¼: une étude pilote.

BACKGROUND: Understanding patients' expectations with regard to medical care is critical as it guarantees an efficient therapeutic process. Our aim was to determine outpatients' expectations concerning clinical encounters in a dermatology clinic and to study how these matched the opinions of dermatologists regarding them. PATIENTS AND METHODS: Consecutive outpatients consulting in five dermatology centres in the Paris suburbs between February 2013 and March 2013 were prospectively included. For this pilot cross-sectional study, we used two standardized forms to collect data from patients and dermatologists. Patients' answers were compared to those of their dermatologist, and the degree of matching was calculated to assess the ability of dermatologists to accurately identify their patients' expectations. RESULTS: Two hundred and sixty-five patients were included, with a median age of 41 years (interquartile range: 25; 62), of whom 166 were women (65.4%). Patient's principal expectations concerned diagnosis (51.7%) and medication (40.8%), with 32.1% of patients requiring reassurance. The rates of matching between patients' and dermatologists' answers ranged from 33.3% to 65.7% according to the type of expectations. The highest rate concerned expectation with regard to medications, being only 52.6% and 58.8%, respectively for expectations regarding diagnosis and the need for reassurance. CONCLUSION: This study highlights the need for improved identification of outpatient expectations in dermatology consultations.

HIV-related CD8+ cutaneous pseudolymphoma: efficacy of methotrexate.

Human immunodeficiency virus (HIV)-related CD8+ cutaneous pseudolymphoma (CD8+ cytotoxic T cell skin infiltrative disease) is an inflammatory process resulting from a massive infiltration of the skin by activated, oligoclonal, HIV-specific, cytotoxic T lymphocytes. Usually, CD8+ cutaneous pseudolymphoma affects patients with a deep immunosuppression, and is rare in patients with mild immunosuppression. In deeply immunocompromised patients, highly active antiretroviral therapy (HAART) is considered as the first-line treatment. In contrast, the choice of therapy in moderately immunocompromised patients and/or patients already receiving HAART remains nonconsensual. We report a case of HIV-related CD8+ cutaneous pseudolymphoma in a moderately immunocompromised patient who was successfully and safely treated with methotrexate. We review the literature on HIV-related CD8+ pseudolymphoma and the use of methotrexate in HIV-positive patients.

[Requests for emergency appointments with dermatologists in private practice in France: the ETude Urgences en DErmatologie libérale (ET.U.DE) study]. / Demandes de rendez-vous en urgence en dermatologie libérale: ETude Urgences en DErmatologie libérale (ET.U.DE).

BACKGROUND: Requests for emergency appointments are fairly common in private dermatologic practice in France. To our knowledge the frequency and reasons for such requests have not yet been evaluated. The primary objective of our study was to provide a quantitative and qualitative evaluation of such requests and to assess the underlying reasons. The secondary aim was to investigate for an association between emergency requests where response was justified within 48 hours and the symptoms reported by patients in order to establish a predictive score for the validity of requests. METHODS: The study took place during one week in April 2004. Forty French dermatologists took part on a voluntary basis. They deliberately reduced their ongoing schedule to accommodate patients seeking an urgent appointment. We collected data regarding the normal professional activity of each dermatologist, reasons for appointments, symptoms, diagnosis and evaluation of the degree of emergency by the attending dermatologist. Univariate and multivariate analyses were performed and a score was attributed based on the results for the variables used in the logistic regression model. RESULTS: The mean number of patients seen at emergency appointments during the study week doubled in comparison with a normal period. During the week, 613 patients phoned and all questionnaires were completed for 538 (88%) patients. The most common reasons for requesting an appointment were: rash, eczema, pruritus, tumour modification, localized lesion and allergy. The most frequent diagnoses were: eczema, bacterial and viral infection, atopic dermatitis, mycosis and naevus. The dermatologists considered that the consultations were justified within 48 hours for one third of patients. In the multivariate analysis, factors significantly associated with a justified request were of a general medical rather than a dermatological nature: enlarged cysts, blisters, insomnia, impaired activity, onset or aggravation within the previous 7 days, inability to work. The score showed good specificity but poor sensitivity and discriminative value. DISCUSSION: These results suggest that requests for emergency appointments are more frequent than previously suspected (14% of all requests). Physicians considered that emergency appointments within 48 hours were justified for one third of patients. The reasons for consultation and the resulting diagnoses were similar to those seen in emergency hospital consultations. The criteria on which the need for emergency consultation was based were not for the most part dermatologic. The scoring system we established was not sensitive enough to allow reliable pre-selection of patients requiring emergency consultation by telephone.