Organisation of combined follow-up by hospitals and private dermatologists

Systemic therapy of psoriasis with biologics or cyclosporine requires combined follow-up of patients by hospitals and dermatologists in private practice. Initiation of therapy and the laboratory examinations required before starting treatment are carried out in a hospital setting, and subsequent follow-up may be carried out by a dermatologist in private practice. Successful combined follow-up depends on certain key points, chiefly good knowledge by the independent dermatologist of the systemic therapies available for psoriasis, and smooth working of the hospital-dermatologist interface. It is essential to develop training and information tools in order to optimise joint therapy. This may also be formalised by the creation of a healthcare network as provided for in French legislation (law of 4 March 2002).     

Rosacea-like demodicidosis and chronic blepharitis

Demodicidosis is a parasitic skin disease caused by the follicle mites Demodex sp. In this article, we present a case of rosacea-like demodicidosis, discuss the clinical features of Demodex infestation in man and review their diagnosis and therapeutic modalities. A 37-year-old woman presented in our department with chronic blepharitis present for one year. On physical examination, the patient presented blepharitis and papulovesicles with fine scaling limited to the face. There was no telangectasia. The patient did not report flushing episodes or any kind of photosensitivity. A diagnosis of rosacea-like demodicidosis and Demodex blepharitis was based on the presence of numerous Demodex folliculorum in the eyelashes and scrapings of skin lesions. The patient was put on topic and oral metronidazole for 2?months and on yellow mercury ointment for 15?days. The course involved disappearance of the facial mites and complete remission without recurrence. Screening for Demodex sp is essential to establish the correct diagnosis and ensure suitable treatment.     

Psoriasis: Practical pre-therapeutic assessment

Psoriasis is a chronic disease for which treatment is not definitive and is likely to vary over time. A number of parameters must be taken into consideration for the initial assessment of psoriasis patients requiring systemic therapy, with the latter being based primarily on the previous drug history, objective medical evaluation of the psoriasis and comorbidities, and determination of any medical contraindications to the various treatments available. However, social factors, the patient's lifestyle, level of understanding and compliance, as well as various economic factors must also be borne in mind when deciding upon a therapeutic approach. A complete dossier setting out the patient's drug history and disease history forms the key reference and is essential for treatment monitoring and adjustment, reflecting changes in the course of the skin disease and in the patient's medical history. This information must be made available to all doctors involved in the patient's treatment in order to ensure optimal management.