Dermatology in private practice in France in 2000

OBJECTIVES: Data regarding French dermatological practice are scarce. Our objective was to identify the skin disorders most commonly diagnosed by office-based dermatologists. We also documented the severity of these skin disorders, as reflected by the repercussions on patient's everyday life, and the way physicians managed patients. DESIGN: We carried out a one-day survey of visits to a randomly selected sample of 900 French office-based dermatologists. The randomization was stratified according to the five French different dialing area codes. RESULTS: Office-based dermatologists saw 6411 patients with 7839 skin disorders during the survey. The daily number of visits to French dermatologists was estimated at 47 000 and the annual number between 12 and 14 millions. Office-based dermatologists mostly managed warts, acne, nevus, dermatitis, malignancies and pre-malignancies, fungal infection and psoriasis. Repercussions on patients'everyday life were assessed by physicians as important or very important in 28 p. 100 of cases. Half of the patients received topical treatment, 20.5 p. 100 a systemic drug and 40 p. 100 a minor surgical procedure (including cryotherapy). CONCLUSION: Although dermatologists frequently see benign skin disorders such as warts or nevus, more severe diseases represent an important part of their activity.     

Pentoxifylline in reactions in leprosy

A study was conducted to assess the response of reactions in leprosy to pentoxifylline therapy. Ten cases were studied; 8 cases had type 2 reaction and 2 cases had type 1 reaction. Pentoxifylline was given orally 400 mg three times daily. In patients with type 2 reaction, good response was observed within one week. There was near complete regression of ENL lesions within one month. Cases with type 1 reaction did not respond to pentoxifylline.     

Leukocyte migration in vivo and in vitro in patients with psoriasis

Leukocyte migration in vivo was studied with a skin chamber technique in 21 patients with active psoriasis vulgaris and 18 with cleared psoriasis vulgaris. Measuring over 24 h, no difference was found between healthy volunteers and most patients with active psoriasis, although a subgroup of patients with long-lasting relapses showed subnormal migration values. In patients with cleared psoriasis on the other hand the in vivo leukocyte migration values were increased. In addition, leukocyte migration in vitro under agarose was studied, but no difference was found between healthy controls and patients with psoriasis, active or cleared.     

Ocular changes in reactions in leprosy

A study of ocular changes in reactions in leprosy was undertaken to assign these changes, their proper place in the wide spectrum of ocular morbidity in leprosy. 76.1% of eyes of Type I reaction and 89.7% of eyes with Type II reaction showed some ocular involvement. Corneal hypoaesthesia, superficial punctate keratitis, a decrease of corneal film break up time (BUT), prominent corneal nerves, pigment on the endothelium of the cornea and a pigmented trabecular meshwork were the common ocular findings. The incidence of iridocyclitis in Type II reactions was low (8.1%). The significance of the ocular involvement in reactions in leprosy and the pathogenesis of iridocyclitis in Type II reactions is discussed.     

Decrease in neutrophils observed in vivo in psoriatics after PUVA therapy

Summary In 56 patients leucocyte and differential counts were done before and at weekly intervals during PUVA treatment of chronic recalcitrant psoriasis. A statistical significant (P<0.01) decrease in the percentage of neutrophils was observed during the first week of the PUVA therapy. This observation could be closely related to the clinical clearing of psoriasis (P=0.02).The effect of PUVA therapy in psoriasis may be due to a decrease in the number of immunocompetent neutrophils demonstrated in psoriatic lesions.     

Changes in sodium-potassium ratio in guinea pig epidermis in n-hexadecane-induced hyperplasia

A transient epidermal hyperplasia was induced in guinea pig epidermis by a single application of n-hexadecane. The epidermal response was analysed by light microscopy and by energy dispersive X-ray microanalysis (EDX). The epidermal hyperplasia reached a maximum between 96 and 192 h after the application. The hyperplastic response was associated with a depressed sodium-potassium ratio (increased potassium, decreased sodium) in the keratinocytes at 96 h, beginning already at 48 h. At 24 h there were no major differences in elemental content, compared the controls. The result of the present study is consistent with the hypothesis that alterations in the functional state of the epidermal keratinocytes are associated with changes in the sodium-potassium ratio in the cells. The absence of major elemental changes at 24 h indicates that the initiation of the hyperplastic response occurred prior to this time point.     

Absenteeism in leprosy patients in a rural area in Tamil Nadu

Of the 3382 leprosy patients taking treatment in Hemerijckx Rural Centre Area, 150 randomly selected patients, who were irregular for treatment, were matched with 150 patients who were regular for treatment, by age, sex and type of disease. The characteristics and the reasons for regularity/irregularity in treatment of these 300 patients were studied. There were more Lepromatous patients (20%) among regulars. A greater proportion of irregulars belonged to backward (54%) and scheduled castes (35%). The proportion of irregulars were more (32%) in the initial phase of the disease. There were more irregular patients among the illiterate group (61%). The knowledge of the irregular patients about early sign, causation, spread, curability and duration of treatment were found to be lacking. The clinic timing was unsuitable for 33% of irregular patients. 23% of irregulars experienced some intolerance to DDS. When 94% of regulars attended clinic in order that they may be 'cured', 63% of irregulars stayed away because of 'work'.