[Isotretinoin and adolescent depression]. / Isotrétinoïne et dépression à l'adolescence.

BACKGROUND: Isotretinoin, indicated in France in the treatment of severe acne (e.g. nodular acne, acne conglobata or acne likely to result in permanent scarring) resistant to adequate cure by standard systemic antibiotic therapy and topical treatments, has on occasion been suspected of being associated with suicide. A study involving collective reflection on this issue is presented herein. METHODS: The Psychodermatology Group of the French Dermatology Society, made up of dermatologists, psychiatrists, paediatric psychiatrists, psychoanalysts and clinical psychologists, met several times and views were exchanged by e-mail. The first two authors drafted the present article, which was then re-read, modified and approved by the members of the Psychodermatology Group, in particular by the co-authors. The article was then modified at the request of the proofreaders of the Annales de Dermatologie and re-read once more by members of the Psychodermatology Group. RESULTS: Psychological disturbances, including depression and other suicidal tendencies, are extremely common during adolescence and are clearly increased by acne, particularly where it is severe. Isotretinoin does not appear to increase this risk. CONCLUSION: Routine screening should be performed for psychological disturbance in adolescents, particularly among those presenting acne. Prescription of isotretinoin is not contraindicated in subjects presenting depression.

Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency.

BACKGROUND: Topical corticosteroids remain the mainstay of atopic dermatitis therapy. Many atopic dermatitis therapeutic failures appear to be attributable to poor adherence to treatment due to topical corticosteroid phobia. OBJECTIVES: To assess the facets, origins and frequency of fear of topical corticosteroid use among patients with atopic dermatitis. METHODS: A questionnaire comprising 69 items, generated from information gathered during interviews with 21 patients and 15 health professionals, was given to consecutive patients consulting at the outpatient dermatology departments of five regional university hospitals or with 53 dermatologists in private practice. RESULTS: A total of 208 questionnaires were analysed (including 144 from parents and 87 from adult patients, 27 of whom were also parents); 80·7% of the respondents reported having fears about topical corticosteroids and 36% admitted nonadherence to treatment. A correlation was found between topical corticosteroid phobia and the need for reassurance, the belief that topical corticosteroids pass through the skin into the bloodstream, a prior adverse event, inconsistent information about the quantity of cream to apply, a desire to self-treat for the shortest time possible or poor treatment adherence. Topical corticosteroid phobia was not correlated with atopic dermatitis severity. CONCLUSION: Topical corticosteroid phobia is a genuine and complex phenomenon, common among French patients with atopic dermatitis, that has an important impact on treatment compliance.

[Adherence to treatment in chronic skin disorders]. / À propos de l'adhésion au traitement dans les dermatoses chroniques.

Numerous studies report poor therapeutic adherence in chronic disorders, including chronic skin disorders. This article reviews compliance issues in a psychological perspective (mainly through the patient-physician relationship). Potential factors that could influence adherence to treatment related to the disease itself, the treatment, the patient, the physician and the patient-physician relationship are discussed. These different factors may be used to help the patient towards a better observance. Adherence to treatment is necessary in the long-term and has to be managed and reinforced all along. Listening is necessary from the beginning of the treatment in order to identify the specific demands of the patient, representations of the disease and its consequences on quality of life. The dermatologist has to detect and accept inescapable gaps in the follow-up of patients suffering from chronic disease, and try to understand them without discouraging. A genuine therapeutic alliance built through global care, is necessary to obtain adequate adherence to treatment.

[Patient's information and announcement of a serious disease]. / Information du patient et annonce du diagnostic de maladie grave.

INTRODUCTION: The announcement of a serious disease to a patient and an adequate information are never easy. Some physicians are more comfortable than others. However, some knowledges on usual reactions of patients and on new rules could be useful. CURRENT KNOWLEDGE AND KEY POINTS: The complete information of the patient is a duty with regard to the law, although it could be facultative in some rare circumstances. The medical confidence has to be respected with all persons, even among close relations of the patient. It is not contradictory with a therapeutic alliance with these close relations. The announcement must be provided by the doctor who first suggested the diagnosis. An anxious reaction is normal. Mechanisms of defence, appropriate or not, are developed by the patient. Nonetheless, precise information seems to be less anxiogenic than non resolved questions. Fears of some physicians, who avoid information, often appear linked to their own anxiety. Nevertheless, good information is associated with adequate words and adequate choice of news. There is need to evaluate knowledges of the patient on his/her disease. FUTURE PROSPECTS: Complete and adequate information must be associated with an early psychological (and sometimes social) help. It appears necessary for well-being of the patient but also maybe for his/her prognosis.