C. Taïeb

A survey was performed in 5 European countries (France, Germany, Italy, Portugal, and Spain) to estimate the prevalence of fibromyalgia (FM) in the general population.In each country, the London Fibromyalgia Epidemiological Study Screening Questionnaire (LFESSQ) was administered by telephone to a representative sample of the community over 15 years of age. A positive screen was defined as the following: (1) meeting the 4-pain criteria alone (LFESSQ-4), or (2) meeting both the 4-pain and the 2-fatigue criteria (LFESSQ-6). The questionnaire was also submitted to all outpatients referred to the 8 participating rheumatology clinics for 1 month. These patients were examined by a rheumatologist to confirm or exclude the FM diagnosis according to the 1990 American College of Rheumatology classification criteria. The prevalence of FM in the general population was estimated by applying the positive-predictive values to eligible community subjects (ie, positive screens).Among rheumatology outpatients, 46% screened positive for chronic widespread pain (LFESSQ-4), 32% for pain and fatigue (LFESSQ-6), and 14% were confirmed FM cases. In the whole general population, 13 and 6.7% screened positive for LFESSQ-4 and LFESSQ-6, respectively. 3The estimated overall prevalence of FM was 4.7% (95% CI: 4.0 to 5.3) and 2.9% (95% CI: 2.4 to 3.4), respectively, in the general population. The prevalence of FM was age- and sex-related and varied among countries.FM appears to be a common condition in these 5 European countries, even if data derived from the most specific criteria set (LFESSQ-6) are considered.

Abstract Background The assessment of the prevalence of diseases is of primary importance in planning health policies. No complete data on the prevalence of skin diseases across European countries are available. Objective To estimate the prevalence of the most frequent skin conditions or diseases in 27 European countries (24 EU countries, plus Norway, Switzerland, and the United Kingdom). Methods We conducted a population‐based study on representative and extrapolable samples of the general population aged 18 years or more in each of the 27 countries surveyed. Participants were selected using stratified, proportional sampling with a replacement design. Data were collected using a web‐based online survey. All participants were asked to fill in a questionnaire with sociodemographic data and to declare if they have had one or more skin conditions or diseases during the previous 12 months. Results A total of 44 689 participants from 27 countries responded to the questionnaire, 21 887 (48.98%) men and 22 802 (51.02%) women. The proportion of participants who reported having suffered from at least one dermatological condition or disease during the previous 12 months was 43.35% (95% CI: 42.89%, 43.81%). The projection in the total population of the 27 countries included in the study resulted in 185 103 774 individuals affected by at least one dermatological condition or disease. Accordingly, we can estimate that more than 94 million Europeans complain of uncomfortable skin sensations like itch, burning, or dryness. The most frequent conditions were fungal skin infections (8.9%), acne (5.4%), and atopic dermatitis or eczema (5.5%). Alopecia, acne, eczema, and rosacea were more common in women, whereas men were more likely to suffer from psoriasis and sexually transmitted infections. Conclusion Skin diseases are an important public health concern. Their high prevalence has to be taken into account in planning access to dermatological care to address patient needs.

Abstract Objective To investigate the impact of a diagnosis of fibromyalgia (FM) in clinical practice on health care resource use in the UK. Methods Rates of visits, prescriptions, referral, and diagnostic testing were estimated in patients who had been diagnosed as having FM between 1998 and March 2003 in UK primary care and compared with those in matched controls. Rates were calculated in 6‐month intervals from 10 years before until 4 years after the FM diagnosis. Results Patients (2260) were newly diagnosed as having FM; 81.3% were women. Their mean age was 49 years. FM patients had considerably higher rates of visits, prescriptions, and testing from at least 10 years prior to diagnosis compared with controls. By the time of diagnosis, FM patients had 25 visits and 11 prescriptions per year compared with 12 visits and 4.5 prescriptions per year in controls. Visit rates were highest for depression, followed by fatigue, chest pain, headache, and sleep disturbance. Following diagnosis, visits for most symptoms and health care use markers declined, but within 2–3 years, most visits rose to levels at or higher than those at diagnosis. Conclusion Primary care patients who had been diagnosed as having FM reported higher rates of illness and health care resource use for at least 10 years prior to their diagnosis, which suggests that illness behavior may play a role. Being diagnosed as having FM may help patients cope with some symptoms, but the diagnosis has a limited impact on health care resource use in the longer term, possibly because there is little effective treatment.

Abstract Objective To evaluate the use and costs of medical resources before and after a diagnosis of fibromyalgia syndrome (FMS) in a large primary care population in the UK. Methods We applied an existing data set for medical resource use among patients with a coded diagnosis of FMS. The observed quantities of 157 types of medical resource use before and after the diagnosis of FMS were multiplied by unit costs in order to calculate the cost of care (general practitioner [GP] visits, drugs, referrals, and diagnostics) within the National Health Service, excluding hospital costs. Costs before diagnosis were used in a trend analysis to predict later costs, assuming the diagnosis had never been made, and these predicted costs were compared with the observed costs after diagnosis. Results Following a diagnosis of FMS, a decrease in costs as compared with the predicted trend was observed. In the 4 years after diagnosis, the average difference between the predicted and observed cost was £66.21 per 6 months per patient. This suggests that making the diagnosis leads to savings and a decrease in resource use. The main effect was observed for tests and imaging (£24.02 per 6 months), followed by pharmaceuticals (£22.27), referrals (£15.56), and GP visits (£4.36). Conclusion Failure to diagnose a true case of FMS has its own costs, largely in excess GP visits, investigations, and prescriptions.

Abstract Introduction Sensitive skin appears as a very frequent condition, but there is no comparative data between countries. Objectives To perform an epidemiological approach to skin sensitivity in different European countries. Methods An opinion poll was conducted in eight European countries: Belgium, France, Germany, Greece, Italy, Portugal, Spain and Switzerland. This sample (4506 persons) was drawn from a representative sample of each population aged 15 years or older. Results Sensitive or very sensitive skin was declared by 38.4% and slightly or not sensitive skin by 61.6%. Women declared more sensitive skin than men. A dermatological disease was declared by 31.2% of people with very sensitive skin, 17.6% of those with sensitive skin, 8.7% of those with slightly sensitive skin and 3.7% of those who do not have sensitive skin. A history of childhood atopic dermatitis was more frequent in patients with sensitive or very sensitive skin. The interviewees who declared that they had dry or oily skin also reported significantly more frequently sensitive or very sensitive skin than those with normal skin. Sensitive and very sensitive skins were clearly more frequent in Italy and France. Discussion This study is the first study that compares skin sensitivity in European countries. Prevalence is high, but significant differences are noted between these countries. Dermatological antecedents (or treatments?) could be involved in the occurrence of skin sensitivity. Conflicts of interest None declared

Vitiligo has a major impact on health-related quality of life. Although a few vitiligo-specific quality of life instruments exist, there is no specific vitiligo burden tool. We developed and validated a specific vitiligo burden tool according to skin phototype. In total, 301 patients completed 35 items of the Vitiligo Impact Patient scale, of whom 235 were of skin phototype I to III and 66 of phototype IV to VI. The dimensionality of the items was evaluated using factor analyses, with results suggesting three factors in fair- and dark-skinned patients ("Psychological effects on daily life," "Relationships and Sexuality," and "Economic Constraints, Care & Management of Disease"). Unidimensionality was confirmed by higher order factor analysis. Cronbach's α were high-and intradimensional coherences all demonstrated good reliability (α > 0.8). The final instrument consists of 29 items (19 items common to all patients, 3 specific to fair skin, and 7 to dark skin). The test-retest reliability demonstrated very good reproducibility. The intraclass correlation of each dimension was greater than 0.90 for each population. External validity was confirmed by the correlation coefficients and Bland and Altman plots of the Vitiligo Impact Patient scale-Fair Skin and Vitiligo Impact Patient scale-Dark Skin versus the Short-Form-12, PVC Metra, Body Image States Scale, and Daily Life Quality Index assessment tools.

<i>Background:</i> The impact of atopic dermatitis (AD) on the patient’s quality of life is relatively well known. However, the influence on the patient’s spouse has never been studied. <i>Objective:</i> To evaluate the impact of AD on the quality of life, sleeping and sexual life of patients and their partners. <i>Methods:</i> In this cross-sectional study, patients and their partners completed a number of questionnaires asking about their general health and their quality of life [Short Form 12, Epworth, Dermatology Life Quality Index (DLQI)] and completed an idiosyncratic measure asking about their sexual functioning. AD severity was clinician rated using Scoring atopic dermatitis (SCORAD). <i>Results:</i> A total of 266 patients were included. The mean DLQI score was 8.8. The physical and mental composite 12 scores were 50.7 and 39.5, respectively. These 3 scores were significantly related to SCORAD. A decrease in sexual desire due to AD was noted in 57.5% of patients. The quality of life of partners did not appear to be particularly impaired, but 36.5% reported that the appearance of eczema had an impact on their sex life. <i>Conclusion:</i> The influence of AD on sex life is significant both for the patients and their partners.

To estimate the prevalence of fibromyalgia (FM) syndrome in the French general population.A validated French version of the London Fibromyalgia Epidemiology Study Screening Questionnaire (LFESSQ) was administered via telephone to a representative community sample of 1014 subjects aged over 15 years, selected by the quota method. A positive screen was defined as: (1) meeting the 4-pain criteria alone (LFESSQ-4), or (2) meeting both the 4-pain and 2-fatigue criteria (LFESSQ-6). To estimate the positive predictive value of LFESSQ-4 and LFESSQ-6, this questionnaire was submitted to a sample of rheumatology outpatients (n=178), who were then examined by a trained rheumatologist to confirm or exclude the diagnosis of FM according to the 1990 American College of Rheumatology criteria. The prevalence of FM in the general population was estimated by applying the predictive positive value to eligible community subjects (i.e., positive screens).In the community sample, 9.8% and 5.0% screened positive for LFESSQ-4 and LFESSQ-6, respectively. Among rheumatology outpatients, 47.1% screened positive for LFESSQ-4 and 34.8% for LFESSQ-6 whereas 10.6% were confirmed FM cases. Based on positive screens for LFESSQ-4, the prevalence of FM was estimated at 2.2% (95% CI 1.3-3.1) in the French general population. The corresponding figure was 1.4 % (95% CI 0.7-2.1) if positive screens for LFESSQ-6 were considered.Our findings suggest that FM is also a major cause of widespread pain in France since a point prevalence of 1.4% would translate in approximately 680,000 patients.

Abstract Introduction Sensitive skin is a complex dermatological condition, defined by abnormal sensory symptoms. The aim of this epidemiological survey was to assess the prevalence of sensitive skin and collect data on sensitive skin in the US population. Methods A phone survey was conducted in the USA by a poll institute in 2007. A sample was drawn from a representative national cohort of the American population at least 18 years of age through the quota method. Data on demographic characteristics, environmental and climatic factors, skin characteristics, dermatological disorders, cosmetics use, and visits to the dermatologist were collected. Results Of 994 subjects who answered (495 men and 499 women), 44.6% declared having “sensitive” or “very sensitive” skin. Women were more concerned than men (50.9% vs. 38.2%, P < 0.0001). There was no significant difference related to geographic localization, age, or ethnic distribution. Subjects with sensitive skin had mainly dry (34.5%) or mixed skin (35.7%), fair phototypes, dermatological disorders, higher skin reactivity to cosmetics and various environmental factors in comparison with subjects who stated having only a “slightly” sensitive or not sensitive skin. The dermatologist had a strong influence on subjects with “sensitive” or “very sensitive” skin through the prescription of skin care products. Conclusion This study, based on a representative sample of the American population, reveals a high prevalence of sensitive skin in the USA. Sensitive skin is mainly associated with dry skin, fair phototype, reactivity to climatic and environmental factors, and cosmetics. American dermatologists seem largely involved in the care of this condition.

Abstract Background. Hand–foot syndrome (HFS) is a common reaction to certain chemotherapies and new targeted therapies, impairing patient quality of life (QoL). However, there is currently no specific tool to measure QoL in patients with HFS. Objective. The objective was to develop and validate a HFS-specific QoL questionnaire (HFS-14). Patients and Methods. From a list of 31 items identified from a literature review and patient interview notes, item reduction and pilot testing by cognitive debriefing resulted in a final 14-item questionnaire with excellent internal reliability. Clinical validity was assessed in 43 patients with HFS by comparing the HFS-14 score according to HFS clinical grade based on the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 3.0, and by measuring its correlation with the Dermatology Life Quality Index (DLQI), Skindex-16, and short-form 12 health-related questionnaires and pain measurement. Results. The mean HFS-14 score was significantly higher in patients with clinical grade 2 and grade 3 HFS than in those with grade 1 HFS. The higher the HFS-14 score, the greater the QoL impairment. The HFS-14 score was highly correlated with the DLQI and Skindex-16 scores. In the population of patients with severe grade 3 NCI-CTCAE HFS, the HFS-14 score was significantly higher in patients having both hands and feet severely involved than in those with severe involvement of one limb (hands or feet) with the other one less severely affected. Conclusions. This scale specifically developed for patients with HFS is a valid and valuable tool for measuring HFS-related QoL impairment.

Abstract Background There are few population‐based studies assessing the prevalence of skin diseases. Objectives To estimate the prevalence of five chronic skin inflammatory diseases, i.e. atopic dermatitis (AD), psoriasis, alopecia areata (AA), vitiligo and hidradenitis suppurativa (HS) in France, using validated self‐diagnostic questionnaires. Methods Population‐based study using a representative sample of the French general population aged more than 15 years and sampling with replacement design. All participants were asked (ii) to fill in a specific questionnaire including socio‐demographic characteristics, (ii) to declare if they have been diagnosed with one or more skin problem or skin diseases during their life, and (iii) to fill in five validated self‐reported questionnaires for AD, psoriasis, AA, vitiligo and HS. Results A total of 20.012 adult participants responded to the questionnaire of whom 9760 were men (48.8%) and 10.252 (51.2%) were women. We identified a prevalence of 4.65% for AD (931 individuals), 4.42% for psoriasis (885 individuals), 1.04% for AA (210 individuals), 0.46% for vitiligo (93 individuals) and 0.15% for HS (29 individuals), respectively. Limitations Questionnaire‐based study and possible disease misclassifications. Conclusion This is the largest population‐based study aiming to estimate the prevalence of five chronic skin inflammatory diseases.

Journal of the European Academy of Dermatology and VenereologyVolume 33, Issue 12 p. e484-e486 Letter to the Editor The prevalence of tattooing and motivations in five major countries over the world N. Kluger, Corresponding Author N. Kluger nicolas.kluger@hus.fi orcid.org/0000-0002-5225-8316 Department of Dermatology, Venereology, Allergology, Helsinki University Central Hospital, Helsinki, Finland "Tattoo" Consultation, Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cedex 18, France Correspondence: N. Kluger. E-mail: nicolas.kluger@hus.fi.Search for more papers by this authorS. Seité, S. Seité La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, FranceSearch for more papers by this authorC. Taieb, C. Taieb FIMARAD, Hopital Necker Enfants Malades, Paris, France European Market Maintenance Assessment, Fontenay sous Bois, FranceSearch for more papers by this author N. Kluger, Corresponding Author N. Kluger nicolas.kluger@hus.fi orcid.org/0000-0002-5225-8316 Department of Dermatology, Venereology, Allergology, Helsinki University Central Hospital, Helsinki, Finland "Tattoo" Consultation, Department of Dermatology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Cedex 18, France Correspondence: N. Kluger. E-mail: nicolas.kluger@hus.fi.Search for more papers by this authorS. Seité, S. Seité La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, FranceSearch for more papers by this authorC. Taieb, C. Taieb FIMARAD, Hopital Necker Enfants Malades, Paris, France European Market Maintenance Assessment, Fontenay sous Bois, FranceSearch for more papers by this author First published: 16 July 2019 https://doi.org/10.1111/jdv.15808Citations: 32Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume33, Issue12December 2019Pages e484-e486 RelatedInformation

Acne is a common skin disease that mostly affects teenagers, with a negative impact on quality of life. Recently, adult acne and acne relapses have increased in frequency, for yet unknown reasons.This non-interventional, real-life study sought to investigate the rate of acne relapses and their impact on quality of life and productivity (loss/absenteeism) among teenagers and adults.An online self-administered questionnaire was proposed to ≥15-year-olds suffering from acne who spontaneously consulted their dermatologist. To ensure homogeneous assessment of acne severity, the global acne severity scale was applied. Quality of life was assessed via Cardiff Acne Disability Index (CADI), SF12-physical score and SF12-mental score questionnaires. Productivity loss or absenteeism in middle/high school was estimated based on the number of days off work or school over the last 30 days.Overall, 1048 questionnaires were considered assessable, with 448 (43%) mild acne, 434 (41%) moderate acne and 166 (16%) severe acne. Overall, 755 (72%) participants were in middle/high school, 267 (25%) employed and 26 (3%) with no professional activity. Considering the population by age groups, 68% (n = 716) were ≤20-year-olds and 32% (n = 332) >20-year-olds, with a mean age of 20.26 (SD: 7.43) years. Acne relapses were reported by 44% of respondents. Analyses revealed that poorer quality of life scores was observed in acne relapsers vs. non-relapsers, with a significant difference for CADI scores (P < 0.01) in >20-year-olds. Acne-related absenteeism was recorded in 5.7% of cases. On multivariate analyses, after adjusting for other variables, acne relapse was proven a significant determinant of absenteeism/productivity loss.This real-life study first demonstrated acne relapse rates of 44%, which appeared to be generation-dependent, affecting 39.9% of ≤20-year-olds vs. 53.3% of >20-year-olds. Acne relapses were significantly associated with impaired quality of life and productivity loss/absenteeism.

Amyloidosis is a complex group of rare conditions. For patients, amyloidosis is severely debilitating: physically and psychologically. Currently, data are lacking to evaluate the medical, economic, and social burden of systemic amyloidosis.To analyse the patient burden according to the main types of systemic amyloidosis.The French Daily Impact of Amyloidosis study was an observational, cross-sectional and non-interventional study. Adults diagnosed with light chain (AL), transthyretin (ATTR), amyloid A (AA) and other rare forms of amyloidosis were eligible. Data regarding amyloidosis prevalence, diagnosis, management, and impact on everyday life were collected using a study-specific survey built by the Association Française Contre l'Amylose (AFCA) and the four French National Referral Centres for Amyloidosis.A total of 603 patients, predominantly male (65%) with an average age of 66.8 years, including 170 AL, 224 ATTRv, 109 ATTRwt and 25 AA amyloidosis patients, completed the study-specific survey. The median delay from presentation to confirmed diagnosis was 27.4 months but varied according to amyloidosis type. Patients before diagnosis had breathlessness (49%), tingling sensation (33%), pain (28%), difficulty in walking (28%) and weight loss (22%). Amyloidosis was most frequently suspected (49%) and confirmed (57%) in local hospitals but managed in French amyloidosis referral centres (58%). Patients often reported problems with mobility, usual activities, pain/discomfort and anxiety/depression, but not with self-care.Systemic amyloidosis severely impacts daily life. The delay to confirmed amyloidosis diagnosis needs to be reduced. Early, effective treatment is required to optimise patient benefits.

Psoriasis alters patients' quality of life. Among the disorders associated with psoriasis, sleep disorders are common, although they are not directly assessed by most quality-of-life scores. Thus, the specific evaluation of sleep disorders using dedicated scores is necessary, especially because such disorders alter patients;' physical and psychological health. The relationship between psoriasis and sleep disorders has been shown in numerous studies, but has not yet been fully elucidated. The aim of this study was to update knowledge of sleep disorders in patients with psoriasis, through a review of the scientific literature since 1980. This work covers several topics of interest, such as sleep assessment methods, the prevalence of sleep disorders in patients with psoriasis, factors predictive of sleep disorders in patients with psoriasis, the impact of sleep disorders on comorbidities and quality of life, pathogenic mechanisms, obstructive sleep apnoea and restless leg syndromes, and the impact of biotherapy treatments on sleep disorders in patients with psoriasis.

Abstract Introduction Sensitive skin is a frequent disorder, but its effects and its variability are unknown. Objectives To investigate the effects of sensitive skin first on quality of life and the psyche, and secondly, on seasonal changes. Methods The French Opinion Poll Institute (IPSOS) conducted two opinion polls in March and July 2004. Samples included, respectively, 1006 and 1001 individuals, from a representative national sample of the French population aged 15 years or older. The polling subjects were interviewed by phone and selected by the quota method (gender, age, occupation of household head, type of geographical area and region). Questions about their perception of their sensitive skin and about potential aggravating factors were asked. Quality of life was assessed using the SF‐12 questionnaire and depressive symptoms using the Hospital Anxiety and Depression (HAD) rating scale. Results The characteristics of the two samples were strictly similar. Persons with sensitive skin and very sensitive skin were more numerous in summer than in winter. In both surveys, the degree of sensitivity was significantly higher in the female population. Quality of life was worse in people with sensitive or very sensitive skin, above all in its psychological component – the more sensitive the skin, the more the quality of life deteriorated. There was no significant relationship between depressive symptoms and skin sensitivity in the ‘very sensitive’ or ‘sensitive’ groups. Conclusion Our study was the first to show seasonal changes in skin reactivity and to study the psychological impacts of sensitive skin.

Les peaux sensibles sont un désordre cosmétique fréquemment évoqué mais dont la prévalence est inconnue en France. Nous avons recherché par un sondage sur un échantillon représentatif de la population française de plus de 15 ans réalisé par IPSOS Santé à évaluer la fréquence de la peau sensible. Nous avons employé la méthode des quotas (sexe, âge, profession du chef de ménage) et la stratification par région et catégorie d’agglomération. Mille six personnes ont été sondées. Le taux de non-réponse était inférieur à 1 p. 100. 52 p. 100 estimaient avoir une peau sensible ou très sensible. Les femmes se disaient plus atteintes (59 p. 100 contre 44 p. 100 ; p < 0,0001). Il n’y avait pas de différence significative entre les catégories socio-professionnelles. 28 p. 100 des sujets déclarant avoir une peau très sensible déclaraient une maladie dermatologique associée alors qu’ils étaient 14 p. 100 pour les peaux sensibles, 7 p. 100 pour les peaux peu sensibles et 2 p. 100 pour les peaux non sensibles. La sensibilité cutanée était à l’émotion, au froid, au chaud ou aux cosmétiques. Une évaluation de la qualité de vie par l’échelle SF-12 a montré une altération significative de la dimension mentale (mais non physique) du score pour les peaux sensibles et très sensibles par rapport aux autres, surtout chez les femmes (p < 0,0001). Cette étude trouve une prévalence de la peau sensible en France équivalente à celle qui a déjà été trouvée en Angleterre. Elle ne mesure que la peau sensible telle qu’elle est ressentie par les sujets puisqu’il n’y a pas eu d’examen médical. Le phénomène paraît très fréquent. Bien que les femmes soient plus fréquemment atteintes, on note une importante proportion d’hommes concernés. Sensitive skin is a frequently evoked cosmetic disorder, but its prevalence in France is unknown. Using a survey of a representative sample of the French population aged over 15 carried out by ISPSOS-Santé, we assessed the frequency of sensitive skin. We used the quota method (gender, age, occupation of the head of the family) and stratification by area and category of the agglomeration. One thousand and six persons were surveyed. The non-response rate was less than 1 p.cent. Fifty-two percent claimed they had sensitive or very sensitive skin. Women were predominantly concerned (59 vs. 44 p.cent, p < 0.0001). There was no significant difference between the socio-professional categories. Twenty-eight p.cent of the population claiming their skin was very sensitive declared they had a concomitant dermatological disease, whereas 14 p.cent with sensitive skin, 7 p.cent with not very sensitive skin and 2 p.cent with normal skin declared likewise. Skin sensitivity was triggered by emotion, cold, heat or cosmetics. A quality-of-life assessment using the SF-12 scale showed significant alteration in the psychological dimension (but not physical) of the score for those with sensitive and very sensitive skin compared with the others, notably in the women (p < 0.0001). This survey revealed a prevalence of sensitive skin in France equal to that found in England. It only measured the subjective feeling of sensitive skin experienced by those surveyed, since there was no clinical examination. The phenomenon appears frequent. Although women appeared to suffer more, a large proportion of men also suffered from sensitive skin.

Background: The concept of the ‘sensitive scalp’ is vague. However, the ‘sensitive skin syndrome’ is probably not limited to the face. Objectives: To evaluate and analyse sensitive scalp conditions. Patients and method: 1011 individuals, representative of the French population, were investigated. Results: 44.2 % declared suffering from a ‘sensitive scalp’ (47.4% of women versus 40.8% of men). Of these subjects, 11.5% reported having an associated scalp disease versus 1.1% of non‐sensitive subjects. Hair loss was significantly associated with scalp sensitivity. The scalp was dry for 24%, normal for 58%, greasy for 16% and mixed for 1%. 13% complained of prickling, 25% of itching and 2% of burning or pain. These symptoms were more frequent among those with a ‘sensitive scalp’. The main triggering factors were considered to be pollution, heat, emotions and shampoos. No other area of skin sensitivity was specifically associated with scalp sensitivity. Conclusion: ‘Scalp sensitivity’ exists and occurs frequently. Triggering factors are numerous. Symptoms appear different from those of facial skin sensitivity. Further studies to define and assess sensitive scalp conditions are needed.

Abstract Background The chronic and treatment‐resistant nature of nail psoriasis affects patients’ lives not only physically but also psychologically. Although there are scoring systems available for disease severity, there is as yet no scale to evaluate the impact of this condition upon the patients’ quality of life. Objectives This study aims to develop and validate a quality of life scale specifically for nail psoriasis. Methods A questionnaire was developed during a study conducted in France between 2004 and 2005. With the cooperation of l’Association Pour la Lutte Contre le Psoriasis, the questionnaire was sent to a random sample of 4000 of its 17 000 members. Results The response rate was 33%. Of the 1309 questionnaires returned, 795 showed the presence of nail psoriasis and these were eligible. The scale score is obtained by adding together the responses to the 10 questionnaire items and the result is expressed as a percentage. The value of the score obtained is proportional to the functional difficulty experienced. The determination of Cronbach's α coefficient and a Principal Component Factor Analysis show, respectively, very good internal consistency and the unidimensional nature of the scale. Test–retest results on 15 patients showed good reproducibility. Results were validated with reference to the Dermatology Life Quality Index. In this study, the NPQ10 score is significantly influenced by gender (women have a higher score) and by the duration of psoriasis (recent onset implies greater functional difficulty). Finally, the score is much higher when the nail psoriasis affects both the hands and the feet. Conclusion This study confirms a change in the quality of life of patients who have nail psoriasis. The NPQ10 scale, specific to this condition, is simple to use and has the attributes needed in a quality of life scale. The scale must now be tested in longitudinal studies (such as clinical trials) to confirm its ability to measure a change in status.

Sensitive skin syndrome was first described in 1977; however, no robust study has been carried out to evaluate its prevalence in Japan. A national representative sample of the Japanese population over the age of 18 years was taken. Individuals were questioned by telephone and selected according to the quota method. When asked "Do you have a sensitive skin?", 52.84% of men and 55.98% of women answered "rather sensitive" or "very sensitive". There was no significant difference (P = 0.22) between the two sexes. The non-response rate among respondents was zero, suggesting that the term "sensitive skin" held a meaning for the majority of the population. Concerning questions about the onset of a rash, tingling or irritation in the presence of various factors, such as emotional issues, cold, heat, sun, dry air, air-conditioning, water, air pollution and temperature variations, respondents with rather sensitive or very sensitive skin responded "yes" more often than others: approximately three-times more often for water (18.97%/6.15%), air pollution (39.29%/12.45%) and warm climatic conditions (29.74%/9.8%). To our knowledge, this epidemiological study is the first to focus on sensitive skin among Japanese people of this century. It is of particular interest for two reasons: (i) it was conducted on a representative sample of the Japanese population; and (ii) the methodology used was identical to that used for sensitive skin assessment studies conducted in Europe and the USA, making it possible to draw certain comparisons.

Abstract Background Among localizations of sensitive skin, scalp is one of the less known. Objectives We performed a study for a better understanding of sensitive scalp and proposed a new score: the 3S score. Methods An opinion poll was conducted on 2117 persons, which were representative of the French population. The total score was obtained by multiplying score severity of abnormal sensations by the number of these sensations. Results About one‐third of the population declared to suffer from a sensitive scalp. It was increasingly frequent with age. The 3S questionnaire allowed discrimination among subjects with slightly sensitive, sensitive and very sensitive scalps. Itching and prickling were the most frequent symptoms. Sensitive scalp was sometimes associated with some scalp diseases. Dandruff cannot be considered as a symptom of sensitive scalp. Conclusions This study is only the third reported study about sensitive scalp. The 3S questionnaire is a convenient and effective tool for investigating the severity and symptomatology of the sensitive scalp.

Abstract The skin is the largest organ of the body, providing a protective barrier against bacteria, chemicals and physical insults while maintaining homeostasis in the internal environment. Such a barrier function the skin ensures protection against excessive water loss. The skin's immune defence consists of several facets, including immediate, non‐specific mechanisms (innate immunity) and delayed, stimulus‐specific responses (adaptive immunity), which contribute to fending off a wide range of potentially invasive microorganisms. This article is an overview of all known data about ‘fragile skin’. Fragile skin is defined as skin with lower resistance to aggressions. Fragile skin can be classified into four categories up to its origin: physiological fragile skin (age, location), pathological fragile skin (acute and chronic), circumstantial fragile skin (due to environmental extrinsic factors or intrinsic factors such as stress) and iatrogenic fragile skin. This article includes the epidemiologic data, pathologic description of fragile skin with pathophysiological bases (mechanical and immunological role of skin barrier) and clinical description of fragile skin in atopic dermatitis, in acne, in rosacea, in psoriasis, in contact dermatitis and other dermatologic pathologies. This article includes also clinical cases and differential diagnosis of fragile skin (reactive skin) in face in adult population. In conclusion, fragile skin is very frequent worldwide and its prevalence varies between 25% and 52% in Caucasian, African and Asian population.

Funding sources: Funding support for editorial assistance was provided by Pierre Fabre SA, France. Conflicts of interest: C.T. is employed by Pierre Fabre SA. Dear Editor, Vitiligo, an acquired, idiopathic skin disease characterized by a generally progressive loss of inherited skin colour, has an estimated worldwide prevalence of 0·5–1%.1 2 Although vitiligo is more noticeable in individuals with dark skin, the prevalence is similar to that in the overall population.3 Despite not being life threatening, vitiligo is a serious skin disorder and the overall disease burden in individuals with vitiligo is often underestimated.3 The current study determined the burden, in the broadest sense (including impact on quality of life, self‐perceived stress and self‐image) of vitiligo on daily life and, in particular, assessed differences in the perception of vitiligo and its management in fair vs. dark skin phototypes. We conducted a cross‐sectional monocentric study in 300 patients with vitiligo, within the framework of developing a new specific vitiligo burden questionnaire. Consulting dermatologists recorded patient demographic/clinical characteristics, and classified patients as having ‘fair skin’ (phototype I–III) or ‘dark skin’ (phototype IV–VI). This study was approved by the Commission Nationale Informatique et Libertés and by the local ethics committee of the University Hospital of Bordeaux.

Many epidemiological studies have been performed, but a potential increase in the prevalence of sensitive skin, its relationship with age and skin type and the impact of sensitive skin on quality of life are still debated.To answer these unresolved questions.An opinion poll was conducted on a representative French 5000 person sample.Fifty-nine per cent of the people declared very sensitive or fairly sensitive skin (together: sensitive skin), and women (66%) declared sensitive skin more frequently than men (51.9%). The results also showed that sensitive skin is more common (more than 60%) in younger people (<35 years old), and there was a decrease in the following age groups. The univariate analysis demonstrated that sensitive skin was more likely to be reported by people with fair skin (OR = 1.83) and by people with an atopic predisposition (OR = 2.51). The risk of sensitive skin is higher for people with dry skin (OR = 6.18 compared with normal skin), but sensitive skin can occur in other skin types (OR = 2.45 for mixed skin and OR = 2.16 for greasy skin). Quality of life was clearly altered in patients with sensitive skin, as assessed by SF-12 and DLQI.This large study demonstrates that sensitive skin can alter quality of life and is more common in young people and in women as well as patients with dry skin or fair skin or an atopic predisposition. It also suggests that there is an increase in the prevalence of sensitive skin.

Sensitive skin is characterized by the occurrence of sensations of tingling, prickling, heat, burning, pain or itching and, on occasion, erythema, in response to multiple physical, chemical or hormonal factors that do not have irritant properties by themselves.We chose here to evaluate sensitive skin in two countries with very different populations, climates and lifestyles: Russia and Brazil.Representative nationwide samples of the Russian and Brazilian populations aged 15 and over were selected. The same methodology was used: the individuals were questioned by telephone and selected as per the quotas method (sex, age, householder profession, rural/urban location and region).In the Brazilian population, 22.3% versus 45.7%, in favour of women, reported having a "sensitive" skin. Significant differences were only observed by geographic residence. In the Russian population, 25.4% versus 50.1%, in favour of women, reported having a "sensitive" skin. Significant differences were observed in skin sensitivity according to social-professional categories, region of residence and subject age. The same results were found in both populations for sensitivity to cosmetics and food intake.Respondents with rather sensitive or very sensitive skin are 2 or 3 times more reactive to climatic, environmental factors, cosmetics and food intake.

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Dietary factors and smoking play a role in acne. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; CSA Santé conducted a survey in France in 2012. Each individual answered a questionnaire to report acne, with associated epidemiological variables. Data on subjects between 15 and 24 years of age were extracted. The characteristics of subjects reporting acne were compared to subjects reporting no acne, using univariate and multivariate analysis. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; The daily consumption of chocolate and sweets was independently and highly associated with acne, with an odds ratio of 2.38 (95% CI: 1.31-4.31). Smoking more than 10 cigarettes a day was highly associated with no acne, with an odds ratio of 0.44 (95% CI: 0.30-0.66). The regular use of cannabis was associated with acne, with an odds ratio of 2.88 (95% CI: 1.55-5.37). &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Chocolate, sweets and cannabis smoking are associated with acne. We found tobacco to be protective. We failed to investigate the respective roles of sugar, lipids and milk.

Abstract Background Acne severity and its response to treatment may be influenced by internal and external factors: the exposome. Objectives The aim of this international real‐life survey was to assess the most involved exposome factors in acne. Methods Eleven thousand individuals, aged between 15 and 39 years, with clinically confirmed acne or without acne, defined by age, gender and prevalence, were invited to participate in an Internet survey of 63 questions in order to assess the frequency of identified acne exposome factors. Results Data from 6679 questionnaires were used for statistical analysis purposes: 2826 from the acne group and 3853 from the control group. Nibbling, consumption of dairy products, sweets, alcohol or whey proteins, as well as exposure to pollution, stress, certain mechanical factors and humid or hot weather or sun exposure, were significantly (all P ≤ 0.05) more frequently reported for the acne group than for the control group. This was not the case for tobacco consumption. Data regarding the impact of cannabis consumption were insufficient for drawing any conclusions. Conclusions Data from this international, anonymized Internet questionnaire conducted with more than almost 6700 participants add new arguments to assumptions made that certain exposome factors have an impact on acne. Nutrition, pollution, stress and harsh skincare, as well as climate and sun exposure may be considered the most frequent factors related to acne.

Journal of the European Academy of Dermatology and VenereologyVolume 34, Issue 11 p. e676-e679 Letter to the Editor Systemic or biologic treatment in psoriasis patients does not increase the risk of a severe form of COVID-19 A.-C. Fougerousse, Corresponding Author A.-C. Fougerousse [email protected] orcid.org/0000-0002-2850-867X Dermatology Department, Military Teaching Hospital Bégin, Saint Mandé, France Correspondence: A.-C. Fougerousse. E-mail: [email protected]Search for more papers by this authorM. Perrussel, M. Perrussel Private Practice Auray, Dermatology Department, University Hospital Rennes, Rennes, FranceSearch for more papers by this authorP.-A. Bécherel, P.-A. Bécherel Dermatology Department, Private Hospital, Antony, FranceSearch for more papers by this authorE. Begon, E. Begon Dermatology Department, Centre Hospitalier Pontoise, Pontoise, FranceSearch for more papers by this authorV. Pallure, V. Pallure Dermatology Department, Perpignan Hospital, Perpignan, FranceSearch for more papers by this authorI. Zaraa, I. Zaraa Dermatology Department, Saint-Joseph Hospital, Paris, FranceSearch for more papers by this authorG. Chaby, G. Chaby Dermatology Department, University Hospital, Amiens, FranceSearch for more papers by this authorJ. Parier, J. Parier Private Practice, La Varenne Saint Hilaire, France Dermatology Department, Saint Louis Hospital, Paris, FranceSearch for more papers by this authorM. Kemula, M. Kemula Private Practice, Paris, France Dermatology Department, Tarnier Hospital, Paris, FranceSearch for more papers by this authorL. Mery-Bossard, L. Mery-Bossard Dermatology Department, Centre Hospitalier Intercommunal Poissy-Saint Germain en Laye, Poissy, FranceSearch for more papers by this authorC. Poreaux, C. Poreaux Private Practice, Nancy, Pasteur Clinic, Essey-les-Nancy, FranceSearch for more papers by this authorC. Taieb, C. Taieb orcid.org/0000-0002-5142-2479 Emma Clinic, Fontenay sous Bois, FranceSearch for more papers by this authorF. Maccari, F. Maccari Dermatology Department, Military Teaching Hospital Bégin, Saint Mandé, France Private Practice, La Varenne Saint Hilaire, FranceSearch for more papers by this authorZ. Reguiai, Z. Reguiai Dermatology Department, Courlancy Polyclinic, Reims-Bezannes, FranceSearch for more papers by this authorthe GEM Resopso, the GEM ResopsoSearch for more papers by this author A.-C. Fougerousse, Corresponding Author A.-C. Fougerousse [email protected] orcid.org/0000-0002-2850-867X Dermatology Department, Military Teaching Hospital Bégin, Saint Mandé, France Correspondence: A.-C. Fougerousse. E-mail: [email protected]Search for more papers by this authorM. Perrussel, M. Perrussel Private Practice Auray, Dermatology Department, University Hospital Rennes, Rennes, FranceSearch for more papers by this authorP.-A. Bécherel, P.-A. Bécherel Dermatology Department, Private Hospital, Antony, FranceSearch for more papers by this authorE. Begon, E. Begon Dermatology Department, Centre Hospitalier Pontoise, Pontoise, FranceSearch for more papers by this authorV. Pallure, V. Pallure Dermatology Department, Perpignan Hospital, Perpignan, FranceSearch for more papers by this authorI. Zaraa, I. Zaraa Dermatology Department, Saint-Joseph Hospital, Paris, FranceSearch for more papers by this authorG. Chaby, G. Chaby Dermatology Department, University Hospital, Amiens, FranceSearch for more papers by this authorJ. Parier, J. Parier Private Practice, La Varenne Saint Hilaire, France Dermatology Department, Saint Louis Hospital, Paris, FranceSearch for more papers by this authorM. Kemula, M. Kemula Private Practice, Paris, France Dermatology Department, Tarnier Hospital, Paris, FranceSearch for more papers by this authorL. Mery-Bossard, L. Mery-Bossard Dermatology Department, Centre Hospitalier Intercommunal Poissy-Saint Germain en Laye, Poissy, FranceSearch for more papers by this authorC. Poreaux, C. Poreaux Private Practice, Nancy, Pasteur Clinic, Essey-les-Nancy, FranceSearch for more papers by this authorC. Taieb, C. Taieb orcid.org/0000-0002-5142-2479 Emma Clinic, Fontenay sous Bois, FranceSearch for more papers by this authorF. Maccari, F. Maccari Dermatology Department, Military Teaching Hospital Bégin, Saint Mandé, France Private Practice, La Varenne Saint Hilaire, FranceSearch for more papers by this authorZ. Reguiai, Z. Reguiai Dermatology Department, Courlancy Polyclinic, Reims-Bezannes, FranceSearch for more papers by this authorthe GEM Resopso, the GEM ResopsoSearch for more papers by this author First published: 21 June 2020 https://doi.org/10.1111/jdv.16761Citations: 32Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Kalb RE, Fiorentino DF, Lebwohl MG et al. Risk of serious infection with biologic and systemic treatment of psoriasis: results from the psoriasis longitudinal assessment and registry (PSOLAR). JAMA Dermatol 2015; 151: 961–969. 10.1001/jamadermatol.2015.0718 PubMedWeb of Science®Google Scholar 2Gisondi P, Facheris P, Dapavo P et al. The impact of COVID-19 pandemic on patients with chronic plaque psoriasis being treated with biologic therapy: The Northern Italy experience. Br J Dermatol 2020. 28 https://doi.org/10.1111/bjd.19158 Google Scholar 3Balestri R, Rech G, Girarderlli CR. SARS-Cov-2 infection in a psoriatic patient treated with IL17 inhibitor. J Eur Acad Dermatol Venereol 2020. https://doi.org/10.1111/jdv.16571 10.1111/jdv.16571 Web of Science®Google Scholar 4Conti A, Lasagni L, Bigi L, Pellacani G. Evolution of COVID-19 infection in 4 psoriatic patients treated with biolocal drugs. J Eur Acad Dermatol Venereol 2020. https://doi.org/10.1111/jdv.16587 10.1111/jdv.16587 Web of Science®Google Scholar 5 Santé Publique France. Définition de cas d'infection au SARS-CoV-2 (COVID-19) - Mise à jour le 07/05/2020, Santé Publique France. www.santepubliquefrance.fr › definition-de-cas-07-05-20, last accessed 07 May 2020. Google Scholar 6Damiani G, Pacifico A, Bragazzi NL Malagoli P. Biologis increase the risk of SARS-COV-2 infection and hospitalisation, but not ICU admission and death: real-life date from a large cohort during RED-ZONE declaration. Dermatol Ther 2020: e13475. https://doi.org/10.1111/dth.13475 PubMedWeb of Science®Google Scholar 7Benhadou F, Del Marmol V. Improvement of SARS-CoV2 symptoms following Guselkumab injection in a psoriatic patient. J Eur Acad Dermatol 2020. https://doi.org/10.1111/jdv.16590. 10.1111/jdv.16590 Web of Science®Google Scholar Citing Literature Volume34, Issue11November 2020Pages e676-e679 This article also appears in:JEADV COVID-19 articles ReferencesRelatedInformation

To the Editor: Skin pain is an important symptom in dermatological conditions. It is associated with low quality of life (QoL) and high psychological distress, including suicidal ideation.1Halvorsen J.A. Dalgard F. Thoresen M. Bjertness E. Lien L. Itch and pain in adolescents are associated with suicidal ideation: a population-based cross-sectional study.Acta Derm Venereol. 2012; 92: 543-546Crossref PubMed Scopus (48) Google Scholar Chronic skin pain was reported by 36.4% of French dermatological patients,2Misery L. Saint Aroman M. Zkik A. et al.Chronic pain in patients with skin disorders.Acta Derm Venereol. 2017; 97: 986-988Crossref PubMed Scopus (11) Google Scholar with the highest prevalence in those with leg ulcers, atopic dermatitis, and psoriasis. In a group of patients with skin diseases in general practice,3Verhoeven E.W.M. Kraaimaat F.W. Van De Kerkhof P.C.M. et al.Prevalence of physical symptoms of itch, pain and fatigue in patients with skin diseases in general practice.Br J Dermatol. 2007; 156: 1346-1349Crossref PubMed Scopus (90) Google Scholar the prevalence was 23%. Pain has been reported as the most frequent symptom associated with atopic dermatitis, after itching and sleep difficulties,4Wittkowski A. Richards H.L. Griffiths C.E.M. Main C.J. Illness perception in individuals with atopic dermatitis.Psychol Health Med. 2007; 12: 433-444Crossref PubMed Scopus (54) Google Scholar and it is frequent in psoriasis, with prevalence up to 43.6%,5Patruno C. Napolitano M. Balato N. et al.Psoriasis and skin pain: instrumental and biological evaluations.Acta Derm Venereol. 2015; 95: 432-438Crossref PubMed Scopus (37) Google Scholar and in hidradenitis suppurativa. However, skin pain may be also present in the general population without dermatological disease and may be an early sign of a not-yet-diagnosed skin condition but also a symptom of nondermatological diseases, such as fibromyalgia or peripheral neuropathy. The aim of the present observational study was to investigate the presence of skin pain (by the question “do you feel pain in your skin?”) in persons with and without skin conditions (both inflammatory and noninflammatory). The study was conducted on a representative sample (guaranteed by the method of quotas stratified by age and gender with strict cross-quotas, regions, and income levels) of the population of Canada, China, France, Germany, Italy, and Spain, aged from 18 to 75 years, extracted from the Epi Database (https://kantarhealth.com/docs/datasheets/kh-epi-database, last accessed on March 30, 2022). On a total of 13,138 adults, 11.2% reported skin pain. Among those who reported at least 1 skin condition (n = 3450), the frequency of skin pain was 24.3%, while in the 9688 participants with no skin conditions, it was 6.6% (P < .001, χ2 test). There were differences in pain prevalence by age, country, and skin disease (the 5 most frequent were analyzed), and prevalence increased with the increasing number of skin conditions (Table I). When a dermatological condition was present, the mean duration of skin pain was significantly higher, and permanent or unbearable pain was more frequent than in patients with no skin disease (Table II). Also, the impact of skin pain on daily and work activities was higher in participants with skin conditions. Sensations and symptoms associated with pain differed between the 2 groups. Among patients with skin conditions reporting pain, 53.5% had a Dermatology Life Quality Index (DLQI) score >10 (ie, low dermatology-related QoL) compared to 14.7% in participants with no skin pain (P < .001, χ2 test). QoL was particularly impaired when pain was permanent, unbearable, or associated with at least 1 sensation or symptom.Table IFrequency of skin pain and mean VAS pain scores in different subgroups of patientsVariableLevelTotal nPain n (%)P (χ2 test)RRVAS pain (range 0-10)P (χ2 test)Overall13,1381478 (11.2)5.3 (2.2)SexMale6577772 (11.7).076Ref.5.3 (2.2).758Female6561706 (10.8)0.925.4 (2.2)CountryCanada2011214 (10.6)<.0011.585.2 (2.3)<.001China3050422 (13.8)2.065.5 (2.3)France2000179 (9.0)1.344.6 (2.2)Germany2037385 (18.9)2.825.8 (2.2)Italy2000134 (6.7)Ref.5.2 (2.1)Spain2040144 (7.1)1.065.2 (2.0)Age (y)15-303032493 (16.3)<.001Ref.5.2 (2.3).20231-453506490 (14.0)0.865.4 (2.1)46-603698305 (8.2)0.505.5 (2.2)>602902190 (6.5)0.405.4 (2.2)Skin diseases (SD)No9688639 (6.6)Ref.5.1 (2.2)Yes3450839 (24.3)<.0013.685.6 (2.1)<.0011 SD2461451 (18.3)2.775.2 (2.3)2 SD751252 (33.6)5.095.7 (2.0)3 SD17589 (50.9)7.716.0 (2.0)>3 SD6347 (74.6)<.00111.306.4 (2.0)<.001Skin diseaseCompared to « no skin disease »Compared to « no skin disease »Compared to patients without this diseaseAcne60693 (15.3)<.0012.355.0 (2.2).504Eczema717130 (18.1)<.0012.795.3 (2.1).346Hand eczema13839 (28.3)<.0014.355.4 (1.9).472Psoriasis32061 (19.1)<.0012.945.1 (2.3).937Rosacea16632 (19.3)<.0012.974.8 (2.1).489 Open table in a new tab Table IICharacteristics of skin pain in participants with and without skin diseaseNo skin diseaseWith skin diseaseP (χ2 test)Mean duration (mo)19.031.3.002 (t-test)N%N%Permanent26341.241849.8<.001Transient37658.842150.2Unbearable.006 Yes51077.570383.2 No14822.514216.8Localization Face16125.228534.0<.001 Hands26441.336243.1.392 Body31449.143251.5.334It does not interfere with any activity26140.825029.8<.001It interferes with professional activities12719.924729.4<.001It interferes with family activities16425.720824.8.815It interferes with daily activities17327.134140.6<.001Sensations None19831.013015.5<.001 Burning24538.343652.0<.001 Cold14422.520724.7.271 Electric discharge14422.524829.6.001Symptoms None15924.9718.5<.001 Tingling16225.325830.7.014 Stinging18929.634541.1<.001 Numbness11818.521826.0<.001 Itch18128.341949.9<.001 Open table in a new tab Limitations of the study are that it is possible that some of the patients may perceive skin pain with other types of pain, that we do not know if the pain was felt on the surface of a normal-looking skin or a lesional skin, and that the dermatological diagnosis was not verified by a clinical examination. In conclusion, skin pain is a frequent symptom in patients with dermatological conditions and should be considered in the management of the disease, in order to improve a patient’s QoL and well-being. Marketa Saint Aroman and Fabienne Carballido are employed by Pierre Fabre. The authors thank Catherine Baissac and Helene Passerini, who supported and largely participated in this work, the study participants, as well as Michael Fijnvandraat for writing assistance.

Abstract Background Several large studies on the burden of skin diseases have been performed in patients recruited in hospitals or clinical centres, thus missing people with skin diseases who do not undergo a clinical consultation. Objectives To evaluate the burden of the most common dermatological diseases in adult patients across Europe, in terms of quality of life, work life, and stigmatization. Methods Population‐based survey on a representative sample of the European general population aged 18 years or older. Participants who declared to have had one or more skin problem or disease during the previous 12 months completed the Dermatology Life Quality Index questionnaire, and answered questions regarding the impact of their skin disease on daily and work life, anxiety/depression, and stigmatization. Results The study population included 19,915 individuals, 44.7% of whom were men. Quality of life was particularly impaired in people with hidradenitis suppurativa (HS), and sexually transmitted diseases. About a half of participants with acne, alopecia, or chronic urticaria, and about 40% of those with atopic dermatitis (AD), skin cancers, or psoriasis reported a modest to extremely large effect of the disease on their quality of life. Overall, 88.1% of participants considered their skin disease as embarrassing in personal life and 83% in work life. About half of the respondents reported sleeping difficulty, feeling tired, and impact of the disease on taking care of themselves. Concerning stigmatization, 14.5% felt to have been rejected by others because of the skin disease, and 19.2% to have been looked at with disgust. Anxiety and depression were frequently reported by patients with all the diseases. Conclusions Skin diseases may heavily affect patients' daily and work life, and cause feelings of stigmatization. An early intervention is needed to avoid consequences on the patients' life course.

To describe the profile and management of patients medically treated for benign prostatic hyperplasia (BPH) in primary care in four European countries, as the diagnosis and management of BPH have developed dramatically in the last decade, and recent information from actual practice is insufficient.This observational, cross-sectional study was carried out by general practitioners in France (141 patients), Spain (127) and Portugal (50), and by office-based urologists in Germany (162 patients) between July 2005 and June 2006. The physicians were unaware of the study sponsor. Patients aged >or=50 years were recruited if a decision for medical treatment of BPH was taken for the first time on that day. The patient and the investigator had to complete one questionnaire each.The physicians included 480 patients, with a mean (sd) age of 65.0 (7.8) years. The mean (sd) International Prostate Symptom Score (IPSS) was 16.0 (7.3). There were geographical differences in age (P = 0.009; patients in Germany being the youngest), IPSS (P = 0.017; patients in Spain having the highest score), quality of life (QoL; IPSS item 8, P < 0.001, the least altered being in Germany), and sexual activity (P = 0.010; the highest proportion of sexually active patients being in Portugal), but not for comorbidities and concomitant medication. The IPSS correlated poorly with age (r = 0.21) and moderately with QoL (r = 0.47). Severe symptoms (IPSS > 19) were not linked with sexual activity (age-adjusted P = 0.378). Serum prostate specific antigen testing, although not recommended for BPH, was widely used (83.8% overall). All other examinations were carried out disparately depending on the country (P < 0.001 each). Digital rectal examination (DRE) and excluding urinary tract infection (urine culture) were used in approximately 75% of study patients, but only half the patients in France had a urine culture, and 52% in Portugal had a DRE. A standardized assessment of symptoms and/or QoL was reported in 45% of study patients, with wide discrepancies among countries, i.e. 77.2% in Germany and 6.0% in Portugal. alpha-blocker monotherapy was the most frequently prescribed treatment (62.5% overall, 87.1% in Germany, 46.1% in France), followed by phytotherapy (23.5%), and 5 alpha-reductase inhibitor monotherapy (3.75%); combinations were rare. Treatment varied according to the severity of the symptoms (P = 0.008), phytotherapy being given to patients with the lowest IPSS, and combinations to those with the highest IPSS.There were geographical discrepancies that could be attributed to either different cultural habits or merely organisational differences, e.g. the presence of office urologists in Germany or diverse modes of access to phytotherapy (prescription vs 'over the counter') in the various countries.

Abstract Background The concept of individual burden, associated with disease, has been introduced recently to determine the “disability” caused by the pathology in the broadest sense of the word (psychological, social, economic, physical). Inherited ichthyosis belong to a large heterogeneous group of Mendelian Disorders of Cornification. Skin symptoms have a major impact on patients’ Quality of Life but little is known about the burden of the disease on the families of patients. Objectives To develop and validate a specific burden questionnaire for the families of patients affected by ichthyosis. Methods Two steps were required. First, the creation of the questionnaire which followed a strict methodological process involving a multidisciplinary team and families. Secondarily, the validation of the questionnaire, including the assessment of its reliability, external validity, reproducibility and sensitivity, was carried out on a population of patients affected by autosomal recessive congenital ichthyosis. A population of parents of patients affected by ichthyosis was enrolled to answer the new questionnaire in association with the Short Form Q12 questionnaire (SF-12) and a clinical severity score was filled for each patient. Results Ninety four families were interviewed to construct the verbatim in order to create the questionnaire and a cognitive debriefing was realized. The concept of burden could be structured around five components: “economic”, “daily life”, “familial and personal relationship”, “work”, and “psychological impact”. As a result, “Family Burden Ichthyosis” (FBI) reproducible questionnaire of 25 items was created. Forty two questionnaires were analyzable for psychometric validation. Reliability (Cronbach’s alpha coefficient = 0.89), reflected the good homogeneity of the questionnaire. The correlation between mental dimensions of the SF-12 and the FBI questionnaire was statistically significant which confirmed the external validity. The mean FBI score was 71.7 ± 18.8 and a significant difference in the FBI score was shown between two groups of severity underlining a good sensitivity of the questionnaire. Conclusions The internal and external validity of the “FBI” questionnaire was confirmed and it is correlated to the severity of ichtyosis. Ichthyoses, and other chronic pathologies, are difficult to assess by clinical or Quality of Life aspects alone as their impact can be multidimensional. “FBI” takes them all into consideration in order to explain every angle of the handicap generated.

Abstract Objectives To investigate the prevalence and the factors related to the sensitive skin in China. Methods A community‐based study was undertaken in three major cities in China, Beijing, Shanghai and Guangzhou, from November 2009 to January 2010. The participants in the study were screened by cluster sampling, and were investigated by interview at their own homes. A questionnaire, including skin sensitivity, the occurrence of burning, prickling or irritating sensations correlated with the factors, history of skin diseases and skin types, was given to each participant aged over 15 years. Results Totally 9154 questionnaires were completed (3931 men and 5223 women). The mean prevalence of very sensitive and sensitive skin in three cities was 13% (17.12% in Beijing, 9.10% in Shanghai and 22.39% in Guangzhou.) The mean prevalence was 8.62% in men and 15.93% in women, with significant difference between men and women in three selected cities ( P &lt; 0.001). The total prevalence of very sensitive and sensitive skin was 16.44% in &lt;25 years group, 14.14% in 25–49 years group and 9.73% in ≥50 years group. Moreover, 18.54% of participants claimed with dry skin, 16.70% with greasy skin and 8.04% with normal skin claimed to have the symptoms of sensitive skin. Conclusions The prevalence of sensitive skin in the three cities of China is much lower than that in Europe and the United States. There was significant difference of the prevalence of sensitive skin among three cities located in different climatic and latitude regions and between men and women. The prevalence gradually decreased with the increasing age. The skin sensitivity was associated to the positive history of atopic dermatitis.

Acne is a common disease among young people, which could have a serious impact on quality of life. Based on a survey using the quotas method on a large sample of the French population, we studied the impact of acne on feelings of stress, fatigue upon waking, sleep disorders and sexual activity. We did not establish any relationship to sleep disorders, but clearly ascertained that people with acne (n = 1,375) feel more stressed and have less sexual intercourse. Hence, 18% of people from acne group declared to be stressed every day (13.9% in control group) and 37.5% had no sexual intercourse (20.4% in control group; n = 891). To our knowledge, this is the first study to show that fatigue upon waking is strongly associated with the presence of acne (65.4% versus 58.4%). This study emphasises the fact that acne could have a deep resounding impact on the lives of people suffering from the disease.

Sexual health is frequently affected by chronic diseases but has been poorly investigated in patients with atopic dermatitis (AD).To evaluate the risk factors for impaired sexual desire and its relationship with the burden and quality of life of patients with AD.A multicentre prospective transversal study in patients with AD. Socio-demographic and clinical data were obtained from all patients using a specifically developed questionnaire. In addition, patients were asked to answer validated scales, that is ABS-A, DLQI, SF-12 and EQ-5D.A total of 1024 patients participated in the study. Severity of AD, sites involved and treatment type was found to negatively impact the sexual desire of patients and their partners. In addition, the involvement of the genital and visible areas was associated with a higher burden and more significant alterations in quality of life.The results of this study are substantial and clearly demonstrate the deep impact of AD on sexual health, its relationship with disease-related burden and alterations to quality of life. Psychosociological as well as neurosensory phenomena could help to understand these data.

To the Editor: The prevalence of tattooing in France was estimated at 14% in 2016.1,2 We report a national survey among a nonselected sample of the general French population. The survey was conducted online between April and August 2017 among 5000 individuals age 15 years and older who were selected with use of a stratified random sampling method from a database including more than 1 million Internet users who agreed to participate in various panel surveys. We inquired about sociodemographics, smoking, skin conditions, tattoo(s) and body piercings (ear lobe excluded), motivations for getting tattooed, and cutaneous side effects.

Atopic dermatitis has a negative impact on quality of life in patients and their families. However, there have been very few studies of the impact of atopic dermatitis on adolescents and their relatives. The objective of this study was to evaluate the impact of atopic dermatitis in the daily lives of adolescents between 12 and 17 years of age in the French population and to assess the burden of the disease on their families. Quality of life was measured in 399 parents of adolescents with atopic dermatitis and in the adolescents themselves. Impairment of quality of life in the adolescents was associated with disease severity. Moreover, in children aged 12-14 years, quality of life was worse with increasing age, with decreasing disease duration, and when parents had atopic dermatitis. In children aged 15-17 years quality of life was worse when the parent who answered the questionnaire was male and when the parent was < 45 years old. The burden of atopic dermatitis was higher in parents of older children, in parents with children with higher disease severity, with shorter disease duration, in male parents, and in parents aged <45 years. The burden of atopic dermatitis in adolescents and their parents is considerable and should be taken into account in the management of atopic dermatitis.

Skin conditions such as acne, atopic dermatitis, skin toxicity from oncology treatment, and scars are among the most common health conditions and negatively impact quality of life (QoL).Yet the physician perception of this impact often varies greatly from the patient perception.This is important because patient illness perception is closely linked with seeking help and treatment adherence behaviors.The objective of this review is to better understand the impact of these four highly prevalent skin conditions on QoL including their health-related economic factors to improve treatment outcomes.The literature search included literature published on QoL with acne, atopic dermatitis, scars (from any cause) and skin toxicities on PubMed between 2015 and 2020.We found that patients with skin conditions have a much higher frequency of altered QoL and psychological distress than those without.Also, skin conditions negatively impact self-image and can cause feelings of isolation, loneliness, lower self-esteem, and lower body satisfaction.Additionally, physical discomfort adds to the psychological distress.These physical and psychological impacts are an enormous financial burden on patients, their families and society.We found evidence that holistic treatment including treating the skin condition itself, providing wider peer and psychological support as well as shared decision-making, therapeutic patient education and dermatologist involvement improves outcomes.Holistic history-taking, checklists, or the use of more formal QoL scoring tools can be incorporated into routine consultations to better assess patient well-being and provide clinicians with important information for adapting treatment to individual patient requirements.In conclusion, this review highlights the overall impact of skin conditions (including psychological and QoL impacts) and the importance of providing holistic care to optimize treatment outcomes.A comprehensive QoL screening tool would be useful to help provide patient-centered treatment.

Scars are visible marks from various causes, including surgery, skin injury, burning or dermatological disease, and may impact the quality of life.To assess the impact of scars on quality of life (QoL).Data about sociodemography, presence, origin, and symptoms of scars were collected using an Internet survey between April and May 2020. Overall, 11,100 individuals answered the survey. In total, 48.5% of the responders had at least one scar of less than 1 year of age. Scars were mainly reported on the abdomen and face. Globally, 28.9% of subjects with recent scars reported pain, 23.7% reported burning, 35.0% reported itching, and 44.1% reported redness. Subjects were most frequently bothered by the visibility of their scars and the presence of marks. Incidences were significantly higher than for those with older scars. The average DLQI score was 7.44; it decreased to 2.90 after 1 year. Subjects with scars aged less than 3 months had their QoL more frequently impacted (33.9%) than those with scars aged 12 months or more (10.2%). In subjects reporting skin discomfort, clinical symptoms significantly impacted body movement, choice of clothes, leisure activities, and sexual life more than in those reporting no skin discomfort. Moreover, subjects felt significantly more impacted in their daily lives due to their skin discomfort. When feeling bothered by the visibility of their scars, significantly more subjects were also impacted in their body movement, choice of clothes, leisure activities, and sexual life than those subjects who did not feel bothered. Moreover, significantly more subjects felt embarrassed.Scars significantly impact the subjects' quality of life. This impact is even more important when caused by recent and visible scars, with a lower DLQI score in subjects with more aged than in those with recent scars.

Abstract Background The journey of patients with skin diseases through healthcare has been scarcely investigated. Objective To analyse the journey of people with skin diseases in the different healthcare environment in Europe. Methods This multinational, cross‐sectional, European study was conducted on a representative sample of the adult general population of 27 European countries. The prevalence of the most frequent skin diseases was determined. Information was collected on the patient journey from the first medical consultation to the diagnosis, and the reasons for not consulting a healthcare professional. Results On a total of 44,689 individuals, 30.3% reported to have consulted a dermatologist during the previous 2 years. Participants consulted mainly for mole control or skin cancer screening (22.3%), followed by chronic skin diseases (16.2%). The diagnoses of acne, atopic dermatitis, psoriasis and rosacea were made most frequently by a dermatologist, while fungal skin infections were diagnosed more often by a general practitioner (GP), and sexually transmitted diseases (STD) by other specialists. The diagnosis was not always definitive at the first consultation, in particular for STD. The percentage of people who did not consult a healthcare professional for their skin disease was particularly high for acne (36.4%), alopecia (44.7%) and fungal infection (30.0%). Moreover, 17.7% of respondents with psoriasis did not consult. A high percentage of participants with alopecia thought that the disease was not worrying, while patients with psoriasis often answered that they were able to manage the disease since they had already consulted a doctor. Many patients with acne (41.1%) and fungal infection (48.2%) thought that they were able to handle the disease by themselves. Conclusion The analysis of the self‐reported medical journey of patients with common skin diseases may allow to understand the unmet needs of patients, thus improving outcomes and reducing expenses.

Atopic dermatitis (AD) occurs in approximately 2-3% of adults.The aim of this study was to develop and validate the self-administered Atopic Dermatitis Burden Scale for Adults (ABS-A).Patients were enrolled consecutively from those attending the Station Thermale Avène for a diagnosis of AD.ABS-A was developed using standard methodology, and consisted of 3 phases: exploratory, development, and validation.Internal consistency (Cronbach's α), concurrent validity (Spearman's correlation between ABS-A, SF-12 and Dermatology Life Quality Index [DLQI)]), and discriminant validity, were analysed.A total of 128 adults (68.8% females) completed the ABS-A, consisting of 18 items grouped into 4 domains.ABS-A showed good internal coherence (Cronbach's α, 0.89) and was correlated with both SF-12 components [r = -0.36,p < 0.0001 (Physical); r = -0.52,p < 0.0001 (Mental)] and DLQI (r = 0.78; p < 0.0001).The ABS-A score varied significantly according to AD severity.To our knowledge, ABS-A is the first specific tool for assessing AD burden in adult patients.

Abstract Background/Purpose Sensitive skin is characterized by uncomfortable sensations in response to multiple factors that do not normally have irritant properties. We used an epidemiological approach to evaluate the prevalence and characteristics of sensitive skin in a Korean population, and compared the results with those of populations from other countries. Methods A representative nationwide sample of 1000 Koreans aged ≥15 years was selected. The methodology used in this study (questionnaires) was the same as that used in similar studies conducted in other countries. Results Sensitive skin was present in 56.8% of the Koreans. The prevalence of sensitive skin was highest among countries such as the USA (44.6%), Europe (38.4%), Russia (39.7%), Brazil (34.2%), and Japan (54.5%). Participants with sensitive skin were more likely to accompany skin disorders than those with non‐sensitive skin (72.3% vs 38.0%; P &lt; .001). Sensitive skin group were 2‐3 times more reactive to climatic and environmental factors, cosmetics, and food items than non‐sensitive skin group. Conclusion The prevalence of sensitive skin in Korea is the highest among countries in which such investigation has been conducted. The sensitive skin group appears more likely to experience dermatological reactions to unexpected factors than the non‐sensitive skin group.

Currently, few studies investigated the economic burden of atopic dermatitis (AD) in adult patients and specifically the estimation of out-of-pocket costs. Patients with skin disorders primarily use comfort care to ease dryness, itch or pain, and the costs of comfort care are not subject to any reimbursement from mandatory or complementary insurance.The purpose of this study was to measure the medical and non-medical expenses paid by the patient.Eczema Cohort Longitudinal Adults was a non-interventional study that aimed to assess the burden of AD in terms of quality of life and financial consequences. A self-assessment questionnaire was distributed to adult patients who were cared in four French hospitals. Patients were asked to list the resources consumed for the treatment of AD during the last 12 months and to estimate the corresponding amount of money they had to pay out of their own pockets. The severity of AD was subjected to a stratification based on the PO-SCORAD score.A total of 1024 patients answered the questionnaire: 31.9% with severe AD, 40.4% with moderate AD and 27.6% with mild AD. The mean annual out-of-pocket cost was €462.1 for severe AD and €247.4 for moderate AD. Emollients were the most commonly used product: 74.4% for an average out-of-pocket cost of €151.4. The out-of-pocket costs increased significantly with the severity: 27% of patients with severe AD declared having bought specially textured clothes, while 19% of patients with moderate AD reported the same. The corresponding mean out-of-pocket costs were €162 and €91, respectively.The amount of out-of-pocket costs for patients with AD for essential medical and non-medical expenses is relatively high, compared to the average out-of-pocket cost for French households. Integration of these essential resources into the list of reimbursed products and services appears necessary for a better coverage of AD.

Incontinentia pigmenti (IP) is a rare multisystemic X-linked dominant genetic disorder characterized by highly diagnostic skin lesions. The disease can be misdiagnosed in infants, and complications affecting the eyes and/or the brain can be severe. Our objective was to highlight the urgency of an appropriate diagnosis and management strategy, as soon as the first symptoms appear, and the need for a well-codified monitoring strategy for each child.An in-depth literature review using a large number of databases was conducted. The selection criteria for articles were literature review articles on the disease, case series and retrospective studies based on the disease, clinical studies (randomized or not) on treatment, articles discussing patient care and management (treatment, diagnosis, care pathways), and recommendations. The research period was from 2000 until 2018. A group of multidisciplinary experts in IP management was involved, issued from different healthcare providers of the European Network for Rare Skin Diseases (ERN-Skin). The final recommendations have been submitted to two patient representative associations and to a general practitioner and a neonatal specialist prior to their finalization.The diagnosis of IP must be promptly performed to detect potential extracutaneous manifestations, thus allowing the timely implementation of specific therapeutic and monitoring strategies. Eye involvement can be a therapeutic urgency, and central nervous system (CNS) involvement requires a very rigorous long-term follow-up. Assessments and patient support should take into account the possible co-occurrence of various symptoms (including motor, visual and cognitive symptoms).

Chronic venous disorders (CVD) have an impact on quality of life (QoL), both physically and psychologically. As of now, several vein specific QoL scales exist, but no patient-reported outcome (PRO) is available which takes into account altogether symptoms, impairment of activities, appearance of the legs and concerns regarding health risk. Since clinical severity and disability are mostly evaluated in severe patients, where the main outcome — namely skin changes — is obvious but rare, the authors considered that a reproducible and clinically relevant survey that could account for specific patients' complaints was needed, particularly for CEAP C0s–C3 patients. The objective of this study was to build a specific autoquestionnaire and to establish its statistical validity and clinical relevance. A review of existing questionnaires and an analysis of relevant literature were carried out by a committee of experts. The committee then developed a questionnaire of 46 items, with special attention to relevance for venous disorders and patients' main complaints. After construction, the French version was field-tested and results statistically analyzed. In the specific QoL & Outcome Response – Venous (SQOR-V), each item is given a value by the patient and items are grouped in five dimensions. Each dimension is weighed to a maximum value of 20, yielding an overall maximum score of 100. Two hundred and two questionnaires were analyzed for the initial evaluation and 152 at a second (test–retest). Determination of the Cronbach's alpha coefficient (0.96) and structural analysis demonstrated an excellent internal and structural coherence. Test–retest comparisons confirmed good reproducibility. Comparison with SF-12 and CED-D questionnaires and with CEAP classification groups verified both structural and clinical validity. This study demonstrates QoL impairment in patients suffering from chronic venous disorders (CVD). It also verifies the statistical validity of the SQOR-V questionnaire. More studies are needed to demonstrate the improvement in specificity and accuracy this questionnaire provides compared to existing vein-specific QoL scales, and to determine its ability to assess efficacy of any kind of treatment at any stage of the disease. Provided adequate acknowledgment of its authors, the use of SQOR-V is free. An English version is available, currently pending validation. Les affections veineuses chroniques ont un impact sur la qualité de vie, tant au plan physique qu'au plan psychologique. À ce jour, il existe un certain nombre d'échelles de qualité de vie, mais aucun « Patient Reported Outcome » (PRO, qu'on pourrait traduire par « résultat rapportés par le patient ») qui prenne en compte à la fois les symptômes, la limitation des activités, l'aspect des membres et la crainte de menaces sur la santé. Étant donné que la sévérité clinique et l'invalidité sont essentiellement évaluables chez les patients souffrant de formes sévères, où le critère typique est constitué par les troubles trophiques cutanés, les auteurs ont considéré qu'il était nécessaire de mettre au point un autoquestionnaire spécifique, prenant en compte les problèmes de chaque patient et adapté aussi aux patients C0 s–C3 de la CEAP. Construire et valider tant au plan statistique qu'au plan clinique un autoquestionnaire d'évaluation des répercussions des affections veineuses chroniques. Un comité d'experts a analysé la littérature et les questionnaires existants, et a ensuite élaboré un autoquestionnaire de 46 items prenant en compte les éléments cliniques les plus spécifiques et les préoccupations principales des patients. Après construction et rédaction en anglais, une traduction française a été testée et sa validité statistique évaluée. Dans le SQOR-V (Specific Quality of Life & Outcome Response – Venous), chaque item est noté de 0 à 5 par le patient et les items sont regroupés en cinq dimensions. Chaque dimension est recalculée sur une valeur maximum de 20, la valeur maximum du score total est donc de 100. Deux cent deux autoquestionnaires ont été analysés pour l'évaluation initiale et 152 lors de la deuxième application (test–retest). La détermination du coefficient alpha de Cronbach (0,96) et l'analyse structurelle ont démontré une excellente cohérence interne et structurelle. La comparaison avec les questionnaires SF-12 et CES-D (symptomatologie dépressive) ainsi qu'avec la classe CEAP ont permis de vérifier la validité structurelle et la validité clinique. Cette étude démontre l'altération de la qualité de vie chez les patients souffrant d'affections veineuses chroniques. Elle vérifie également la validité statistique du questionnaire SQOR-V. Plus d'études permettront de confirmer l'amélioration des performances par rapport aux échelles existantes et de vérifier son aptitude à évaluer tous les types de traitement à tous les stades de ces affections. À condition d'en informer ses auteurs, l'emploi de SQOR-V est libre.

Abstract Background Atopic dermatitis and psoriasis engender a significant deterioration in patients’ quality of life. Although the efficacy of patient management at the Avène hydrotherapy centre has been demonstrated by clinical studies, few data relating to changes in the quality of life following therapeutic management are available. The objective of this study was to evaluate the short‐ and medium‐term effects of hydrotherapy not only on the patients’ quality of life, but also on the quality of life of the parents of the treated children. Methods In this 6‐month longitudinal observational study, adult ( n = 174) and paediatric ( n = 212) atopic patients and psoriatic patients ( n = 262) had to complete questionnaires relating to the quality of life at the beginning (D0) and after 3 weeks hydrotherapy (W3), and then, 3 (M3) and 6 months (M6) later. The dermatology life quality index (DLQI) and the Short‐Form‐12 Health Survey (SF‐12) generic questionnaire were given to adult patients. The children’s dermatological life quality index (CDLQI) was given to paediatric patients, and the SF‐12 to their parents. Results At D0, the DLQI score was 29.7 ± 20.1 and 26.9 ± 18.9 for atopic and psoriatic patients, respectively. At W3, this score had decreased significantly to reach 16.8 ± 14.9 ( P &lt; 0.01) and 10.0 ± 10.5 ( P &lt; 0.001) for atopic and psoriatic patients, respectively. The DLQI scores at M3 and M6 were 20.7 ± 16.4 and 23.1 ± 18.8 for atopic patients and 18.8 ± 16.7 and 21.9 ± 19.6 for psoriatic patients and remained significantly lower in comparison with D0 values ( P &lt; 0.05). Conclusion A 3‐week course of treatment at the Avène hydrotherapy centre significantly improved the quality of life of patients suffering from skin diseases. This improvement persisted 3 and 6 months after management by hydrotherapy.

Journal Article Development and validation of an epidermolysis bullosa family/parental burden score Get access H. Dufresne, H. Dufresne Department of Dermatology Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC) Institut Imagine Hôpital Universitaire Necker‐Enfants Malades 149 Rue de Sèvres 75015 Paris France Correspondence Hélène Dufresne. E‐mail: helene.dufresne@nck.aphp.fr Search for other works by this author on: Oxford Academic Google Scholar S. Hadj‐Rabia, S. Hadj‐Rabia Department of Dermatology Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC) Institut Imagine Hôpital Universitaire Necker‐Enfants Malades 149 Rue de Sèvres 75015 Paris FranceNSERM U1163, Université Paris Descartes ‐ Sorbonne Paris Cité, Institut Imagine 149 Rue de Sèvres 75015 Paris France Search for other works by this author on: Oxford Academic Google Scholar C. Taieb, C. Taieb Public Health and Quality of Life Pierre Fabre Paris France Search for other works by this author on: Oxford Academic Google Scholar C. Bodemer C. Bodemer Department of Dermatology Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC) Institut Imagine Hôpital Universitaire Necker‐Enfants Malades 149 Rue de Sèvres 75015 Paris FranceNSERM U1163, Université Paris Descartes ‐ Sorbonne Paris Cité, Institut Imagine 149 Rue de Sèvres 75015 Paris France Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 173, Issue 6, 1 December 2015, Pages 1405–1410, https://doi.org/10.1111/bjd.14072 Published: 01 December 2015

Atopic dermatitis (AD) is one of the most common skin disorders in Europe.1 In the United States, most healthcare visits for AD occur with primary care physicians (PCPs), with fewer visits to dermatologists.2 Data on the care pathway patterns in AD patients in France are lacking. In the era of biologics, characterizing the care trajectories of patients and their satisfaction with their disease management are essential to design future patterns for correct referrals and prescriptions. In this context, the aim of our study was to assess the current care pathway and patient satisfaction with AD management in France. The French Eczema Association sent an online survey in 2022 to AD patients over 18 years old with questions regarding symptoms, visited physicians and satisfaction regarding their AD management. The severity of AD was assessed via the Patient-Oriented Eczema Measure (POEM) score.3 Treatment satisfaction (TS) was defined as the proportion of patients who declared being satisfied with their AD management. In total, 1251 patients with AD responded to the survey, of whom 455 (36%) with an additional dermatosis were excluded. Therefore, 796 patients were included in the study. Characteristics of patients are represented in Table 1. The types of healthcare professionals consulted are represented in Table 2. Among the patients consulting a hospital-based dermatologist, 24.2% consulted on their own [27.3% mild AD (MAD) and 22.7% moderate-to-severe AD (MSAD) patients], 50% were referred by a general physician and 25.8% by a dermatologist in private practice (22.7% of MAD and 27.3% of MSAD). The referral purpose was to improve management in 62% of cases (50% of MAD and 67.7% of MSAD) and to change treatments in 32% of cases (43.8% of MAD and 26.5% of MSAD). The mean number of consultations per year with a general physician was 4 ± 2.4, 2.1 ± 2 with a hospital dermatologist and 1.8 ± 1 with a private dermatologist. For patients who declared to have been doctor shopping (n = 501), 54.3% of them declared that it was the dermatologist who prescribed the suitable treatment: hospital dermatologist in 10.8% (7.5% MAD vs. MSAD 13.4%) and private dermatologist in 43.5% (45.1% MAD vs. 42.2% MSAD) of cases. On the contrary, 36.4% of these patients declared that it was the general physician that prescribed the suitable treatment (40.4% MAD vs. 32.2% MSAD). The general satisfaction of AD management is represented in Table 2. In the United States, the most visited physician by AD patients is the general practitioner. This is explained by a long-standing relationship between patients and their PCPs, as well as a shortage of dermatologists in France.4 Some studies have suggested that PCPs lack confidence in the diagnosis and management of skin disease.5 In fact, dermatology placements are not frequent in junior doctor rotations, and as such, the bulk of dermatology learning takes place in-practice during the postgraduate term.6 Therefore, skin disease remains a learning need for PCPs, and it is paramount to ensure that PCPs are able to manage AD within the scope of their practices. For both, MAD and MSAD, the visited dermatologists are mostly those in private practice rather than those in hospitals. For those who have been doctor shopping, the type of visited physician has an impact on MAD and MSAD patients' satisfaction. For MAD, satisfaction is highest with private dermatologists. Surprisingly, for MSAD, it is highest with PCPs. While MSAD patients' needs seem to be met upon consulting PCPs, it is important to highlight that with a breadth of management options available, more complex or problematic AD should seek a specialist's opinion for optimal results. Exploring the AD care pathway and patients' satisfaction in France should promote the reinforcement of PCPs' skills in diagnosing and treating this condition. In France as in the United States, PCPs are allowed to prescribe systemic immunosuppressants7 but have a high level of discomfort in doing so in real-life practice. Initiation of systemic immunosuppressants by PCPs can be validated by teledermatologists through tele-expertise, and renewal can subsequently be done under joint supervision. Given the shortfall in dermatology workforce, pathway schemes in atopic dermatitis can rest on the efficacy of teledermatology8-10 in designing these models. Finally, European clinical practice guidelines for referral patterns can help optimize patients' access to new biologics when needed. The authors would like to thank Dr Marketa Saint Aroman (Foundation Eczema Pierre Fabre), Dr Claire Thenié (Sanofi) and Dr Jean Michel Joubert (Almirall) for their support in the implementation of this project. Almirall, Fondation Eczema Pierre Fabre, Sanofi. None. Data can be provided for valid scientific noncommercial purposes.

Background Inherited ichthyoses are associated with impaired quality of life (QoL). Objectives The aim of this study was to create and validate a QoL questionnaire specifically dedicated to patients with ichthyosis. Methods A prequestionnaire was drawn after selecting items from a verbatim transcript. It was then subjected to a cognitive debriefing. During the validation step, this questionnaire was sent to patients with the Dermatology Life Quality Index, Short Form-12 health-related questionnaire, and severity scores (global severity: mild/moderate/severe/very severe; clinical severity evaluated by 6 visual analog scales). A shortened version of the questionnaire was designed. The validity of the tool was confirmed: for its structure and 1-dimensional nature (Cronbach α), convergent (Spearman correlation) and discriminating (Tukey test) validity; α risk was fixed at 5%. Results The initial questionnaire included 60 items. During the validation phase, 59 subjects were tested. The shortened version included 32 items (IQoL-32) and 7 dimensions (Cronbach α: 0.94). The higher the score, the more impacted the QoL. IQoL-32 was positively correlated to Dermatology Life Quality Index (P < .0001) and negatively to Short Form-12 health-related questionnaire (P < .0001). IQoL-32 was highly correlated to clinical severity: overall analysis (Spearman ranking: 0.72; P < .0001) or analysis per dimension (highest correlations: discomfort, pain, interpersonal relations). IQoL-32 demonstrated a higher correlation with visual analog scale compared with Dermatology Life Quality Index and Short Form-12 health-related questionnaire. It also showed a good discriminating power (P < .0001) according to overall severity levels. Limitations Only patients residing in France were included. Conclusion IQoL-32 is a specific and validated questionnaire for inherited ichthyosis. It will be very useful for patient care and research. Inherited ichthyoses are associated with impaired quality of life (QoL). The aim of this study was to create and validate a QoL questionnaire specifically dedicated to patients with ichthyosis. A prequestionnaire was drawn after selecting items from a verbatim transcript. It was then subjected to a cognitive debriefing. During the validation step, this questionnaire was sent to patients with the Dermatology Life Quality Index, Short Form-12 health-related questionnaire, and severity scores (global severity: mild/moderate/severe/very severe; clinical severity evaluated by 6 visual analog scales). A shortened version of the questionnaire was designed. The validity of the tool was confirmed: for its structure and 1-dimensional nature (Cronbach α), convergent (Spearman correlation) and discriminating (Tukey test) validity; α risk was fixed at 5%. The initial questionnaire included 60 items. During the validation phase, 59 subjects were tested. The shortened version included 32 items (IQoL-32) and 7 dimensions (Cronbach α: 0.94). The higher the score, the more impacted the QoL. IQoL-32 was positively correlated to Dermatology Life Quality Index (P < .0001) and negatively to Short Form-12 health-related questionnaire (P < .0001). IQoL-32 was highly correlated to clinical severity: overall analysis (Spearman ranking: 0.72; P < .0001) or analysis per dimension (highest correlations: discomfort, pain, interpersonal relations). IQoL-32 demonstrated a higher correlation with visual analog scale compared with Dermatology Life Quality Index and Short Form-12 health-related questionnaire. It also showed a good discriminating power (P < .0001) according to overall severity levels. Only patients residing in France were included. IQoL-32 is a specific and validated questionnaire for inherited ichthyosis. It will be very useful for patient care and research.

To develop and validate a specific questionnaire to assess burden on families of children with infantile haemangioma (IH): the Haemangioma Family Burden questionnaire (HFB). Items were generated from a literature review and a verbatim report from parents. Subsequently, a study was implemented at the Necker Hospital and the Pellegrin Children's Hospital for psychometric analysis. The HFB was refined via item reduction according to inter-question correlations, consensus among experts and exploratory factor analysis. A 20-item questionnaire, grouped into 5 dimensions, was obtained. Construct validity was demonstrated and HFB showed good internal coherence (Cronbach's α: 0.93). The HFB was significantly correlated with the mental dimension of the Short-Form-12 (r = -0.75), and the Psychological General Well-Being Index (r = -0.61). HFB scores differed significantly according to the size and localization of the IH. A validated tool for assessing the burden on families of children with IH is now available.

Abstract Background Sensitive skin usually manifests itself as unpleasant sensations and sometimes erythema. There are various triggering factors for this condition. Although sensitive skin may alter quality of life, its burden has not yet been explored. Objective The aim of this study was to develop and validate a specific sensitive skin burden questionnaire called the Bo SS (Burden of Sensitive Skin). Methods A conceptual phase was developed, followed by a development phase, external validation, psychometric analysis, test–retest analysis and, finally, a translation, cross‐cultural adaptation and cognitive debriefing. Results A total of 6471 individuals participated in the study (4614 people in the validation study). The dimensionality of items was evaluated using factor analyses, suggesting three dimensions (self‐care, daily life and appearance). Unidimensionality was confirmed by higher order factor analysis. The overall Cronbach's α coefficient was high, and intradimensional coherences all demonstrated good reliability. The final instrument consisted of 14 items. The test–retest reliability demonstrated very good reproducibility. The intraclass correlation of each dimension was high. External validity was confirmed by the correlation coefficients of the Bo SS vs. those of the SF ‐12 and the DLQI assessment tools. Conclusion Bo SS is the first reliable tool to assess the burden of sensitive skin.

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; There are no recent data available in France regarding body piercing (BP). &lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; We examined the demographics, motivations, quality of life, cutaneous conditions, and cutaneous side effects after BP within the French population. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; A representative sample of 5,000 individuals (aged 15 and over) from the general population responded to a survey online between April and August 2017. Data regarding demographics, BP characteristics (location, age at first piercing, hesitation, regrets, motivations, cutaneous side effects), tobacco, skin conditions (acne, contact eczema, atopic eczema, rosacea, psoriasis, vitiligo), and tattoos were collected. Respondents also filled an SF-12 quality of life questionnaire. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Overall, 12% of the respondents reported at least one BP (women: 19.4%, men: 8.4%, &lt;i&gt;p&lt;/i&gt; &amp;#x3c; 0.01). The prevalence was highest among those aged between 25 and 34 years (25.8%). Individuals with BP were more likely to smoke (&lt;i&gt;p&lt;/i&gt; &amp;#x3c; 0.01). The most common body parts for piercings were the external part of the ear (42%), the navel (24%), the tongue (15%), and the nose (11%). Gender differences included localization (belly button and nose for women, eyebrows for men) and motivations (embellishment of the body for women, individuality and sexuality for men). A total of 33.6% of the study participants reported having skin problems after BP, primarily infection (44%). Individuals with BPs were more likely to report having contact eczema, atopic dermatitis, and acne. BP was associated with a lower mental quality of life score. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; This is the largest epidemiological study on BP in France to date. It allows us to draw a precise current snapshot of French indi viduals with BP.

Background There is a lack of short-form questionnaires evaluating the burden of vitiligo according to skin phototype. Objective To develop and validate a 12-item short-form of the Vitiligo Impact Patient scale (VIPs) that takes into account skin phototype. Methods Multicenter, prospective, cross-sectional study conducted in France (Créteil and Bordeaux) and the US (Worcester, Massachusetts, and Dallas, Texas). Results In total, 891 patients completed the questionnaire. Of these, 509 patients belonged to the French Development sample—313 with dark skin (DS) (phototypes IV to VI) and 196 with fair skin (FS) (phototypes I to III). The US validation sample comprised 382 patients—113 DS and 269 FS. There was a very high correlation between VIPs-FS and its 12-item short-form, VIPs-12-FS, in both the development and validation samples (respectively, rho = 0.96, P < .0001 and rho = 0.98, P < .0001). Similarly, the correlations between VIPs-DS and its short-form, VIPs-12-DS, in both the development and validation samples were very high (respectively, rho = 0.95, P < .0001 and rho = 0.96, P < .0001). Limitations Responsiveness of the 12-item short-forms should be confirmed. Conclusions These data enabled the development and validation of 12-item short-forms of the VIPs questionnaires for fair (VIPs-12-FS) and dark (VIPs-12-DS) skin. There is a lack of short-form questionnaires evaluating the burden of vitiligo according to skin phototype. To develop and validate a 12-item short-form of the Vitiligo Impact Patient scale (VIPs) that takes into account skin phototype. Multicenter, prospective, cross-sectional study conducted in France (Créteil and Bordeaux) and the US (Worcester, Massachusetts, and Dallas, Texas). In total, 891 patients completed the questionnaire. Of these, 509 patients belonged to the French Development sample—313 with dark skin (DS) (phototypes IV to VI) and 196 with fair skin (FS) (phototypes I to III). The US validation sample comprised 382 patients—113 DS and 269 FS. There was a very high correlation between VIPs-FS and its 12-item short-form, VIPs-12-FS, in both the development and validation samples (respectively, rho = 0.96, P < .0001 and rho = 0.98, P < .0001). Similarly, the correlations between VIPs-DS and its short-form, VIPs-12-DS, in both the development and validation samples were very high (respectively, rho = 0.95, P < .0001 and rho = 0.96, P < .0001). Responsiveness of the 12-item short-forms should be confirmed. These data enabled the development and validation of 12-item short-forms of the VIPs questionnaires for fair (VIPs-12-FS) and dark (VIPs-12-DS) skin.

Sensitive skin is a very frequent condition, the prevalence of this syndrome has been studied in different countries in Europe, in United States and in Japan. The aim of the study was to evaluate the epidemiology of sensitive skin in the Indian population, like this has never been studied in this country. A representative nationwide sample of the Indian population aged 15 and over was selected. Individuals were selected as per the quota method (based on sex, age, householder profession, rural/urban location, and region). In total, 27.9% of men and 36.7% of women declared having "sensitive" or "very sensitive" skin. The difference between the 2 sexes was very significant. Of these, 5.1% of men and 7.2% of women reported having "very sensitive" skin. The subjects complaining about "sensitive" or "very sensitive" skin were 2-4 times more likely to declare suffering from atopic dermatitis, acne, psoriasis, or vitiligo. They were 2 to 3 times more reactive to climatic factors, environmental factors, cosmetics and food intake. In conclusion, although less frequently reported than in other countries, sensitive skin is a frequent condition in India, affecting about one third of the population.

Dear Editor, Skin is the most vulnerable organ that is constantly exposed to potential injury, and wound healing is a vital process for the survival of all higher organisms.1 Scarring is most noticeable in the skin, but it also affects almost all adult mammalian and human tissues and organs.2 They may result from surgery, skin injury, burning or inflammatory skin diseases, such as acne, chickenpox or shingles.3 Scars may be extensive, dystrophic, appearing on areas not covered by clothes and considered embarrassing. They may also be associated with symptoms such as pruritus, pain or other discomforts. According to a study conducted in the United Kingdom, 26% and 44% of patients reported pain and itching related to their scars, impacting their physical comfort and functioning.4 Usually, scars are composed of loose fibrous connective tissue and are remodelled during healing.5 Chronic inflammation of the dermis and uncontrolled activation of myofibroblasts may result in abnormal scar overgrowth leading to a hypertrophic scar or a keloid with an excess of extracellular matrix proteins.6 Despite being common throughout the world, the epidemiology of scars has not yet been properly investigated. The aim of this international epidemiological study was to assess the prevalence of scars worldwide. The present article describes the general population with participants reporting at least one scar having appeared during the year prior to this study. Our participants were selected via a stratified random sampling method of internet users who agreed to participate in panel surveys. Data about sociodemography, presence, origin and symptoms of scars using an internet survey were collected between April and May 2020. The survey focused on the most recent scars reported in order to simplify data collection. Overall, 11 100 individuals from Brazil (2000), China (3050), France (2000), Russia (2000) and the United States (2050) answered the survey; 48.5% of subjects reported at least one scar, and in 22%, the most recent scar was less than one-year-old. The most often reported location of recent scars in women was the abdomen (20.4%) and face (15.9%); in men, it was the face (18.7%) and abdomen (13.2%). Significantly more men (13.3%, P < 0.00001) than women (8.4%) reported scars on their hands. For 50.8%, the origin of the most recent scar was accidental or due to a disease (women: 50.8%, men: 60.5%, P < 0.0001); 35% of women and 28% of men indicated that general or orthopaedic surgery caused the scarring (P < 0.0001). Details are given in Table 1. Overall, 12.3% of men and 10.7% of women who reported scars also reported pain (P < 0.03). Table 2 provides details about symptoms. In 2014, international guidelines on the management of scars were issued. However, these guidelines have not yet been updated.7, 8 Currently, some procedures are available to manage scars, such as intralesional injections of corticosteroids and/or 5-fluorouracil, cryotherapy, radiotherapy, laser therapy and surgical interventions, together with additional measures such as sun protection, silicone-based dressings or gels.9, 10 Scar management mainly consisted in the use of topical products such as healing creams (13.2%), antiseptic solutions (11.2%) or a topical antibiotic (11.9%). Medical care was significantly (P < 0.001) more frequently provided to subjects with painful scars. To our knowledge, this is the first international epidemiological survey on the prevalence, origin, location and impact of scars. Further investigations need to be performed. The authors acknowledge the technical support of G. Le Dantec and the writing support of Karl Patrick Goritz, SMWS—Scientific and Medical Writing Services, France. This project was funded by La Roche Posay. S. Seité, AL Demessant-Flavigny and C. LeFloc'h are employees of La Roche-Posay. The data that support the findings of this study are available from the corresponding author upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

&lt;i&gt;Background:&lt;/i&gt; The Cardiff Acne Disability Index (CADI) evaluates the impact of acne on the patient’s life. &lt;i&gt;Objective:&lt;/i&gt; The objective of the present study was to translate the CADI into French and to validate the French version. &lt;i&gt;Method:&lt;/i&gt; The CADI was translated into French following international methodological recommendations (translation, quality control, back-translation and pilot test). &lt;i&gt;Results:&lt;/i&gt; Compatibility difficulties between the cultural background of UK and France were identified and resolved by the translation process, which should guarantee that specific words and phrases reflect the cultures in the respective countries. A pilot test in volunteers demonstrated the clarity and understandability of the questions across social classes and ages. A preliminary test-retest comparison of the final scale showed sufficient reliability, with a correlation coefficient of 0.90 for the total CADI score of the French version. Moreover, the good internal consistency of the scale was demonstrated with a Cronbach α of 0.87. &lt;i&gt;Conclusion:&lt;/i&gt; The CADI, a valuable tool for assessing the impact of acne on a patient’s life, can now be used in French.

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain and fatigue. Its prevalence is estimated to be at 3.4% in women and 0.5% in men. It is a major cause of morbidity. Our objective was to evaluate, using a self-questionnaire sent by mail, the level of knowledge of French physicians, general practitioners, and rheumatologists on fibromyalgia and to analyse their therapeutic approach.The demographic characteristics of a sample of general practitioners and rheumatologists were compared to those of the overall data available. This comparison demonstrated the good representativeness of our sample.Fibromyalgia was considered as a disease by 23% of rheumatologists and 33% of general practitioners. While on average, each rheumatologist followed 30 fibromyalgia patients, each general practitioner followed 6.1 patients (i.e., 2 to 5% of their practice's patient base). Among rheumatologists, 6.4% made no distinction between this disease and depression vs. 13.1% of general practitioners. The diagnosis of fibromyalgia was made based on tenderness that occurs in precise, localized areas of the body (trigger points) by 94% of rheumatologists and 79.1% of general practitioners. Of general practitioners and rheumatologists, 93.7% and 73.7% respectively, have not received any medical school training on fibromyalgia or chronic fatigue syndrome.Given the lack of medical school training and continuing professional education concerning fibromyalgia (rare use of pain rating scales, confusion in the classification of rheumatic diseases), there is an urgent need to initiate an explicit teaching effort on chronic pain, and on fibromyalgia in particular.

In this study, perceived stress and quality of life were measured with PCV-Metra and SF-12 scales in outpatients consulting for different dermatoses in 5 academic dermatology departments for 5 consecutive days. 658 patients were enrolled in the study. Perceived stress was higher in women and the mental component of their quality of life was more altered. Perceived stress was higher in Paris than in other areas and was respectively 11.4, 10.4, 9.2 and 8.9 for psoriasis, acne, atopic dermatitis and pigmented tumours. Perceived stress was correlated to mental quality of life. Stress was more elevated in people with inflammatory dermatoses than in those with tumours. To our knowledge, this is the first comparative study of both stress and quality of life levels in different dermatoses. Stress levels were lower in people with pigmented tumours, suggesting that they can be used as controls in comparative studies because they can be considered as healthy subjects. On the contrary, patients with psoriasis had a very high level of perceived stress and a deeply altered quality of life.

Objectives The present study assessed the effect of Ruscus aculeatus-hesperidin-methyl-chalcone–ascorbic acid (HMC–AA) on the quality of life (QoL) of patients suffering from chronic venous disorders (CVDs). Methods An observational, multicentre and prospective study was performed with 917 Mexican patients suffering from CVD. Patients were treated with R. aculeatus–HMC–AA. After 12 weeks of treatment, the physicians then assessed the patients' symptoms and QoL using Short Form (SF-12) and Chronic Venous Insufficiency (CIVIQ) auto-questionnaires. Results Patients were mainly women (86.7%), overweight or obese (72.7%) or C2 (39.3%)–C3 (27.6%). All symptoms and ankle circumferences significantly improved over time, with increasing clinical, aetiological, anatomical and pathophysiological (CEAP) classes and body mass index (BMI) ( P &lt; 0.001). Concerning QoL, all dimensions of the SF-12 score significantly improved over time ( P &lt; 0.001). Moreover, the CIVIQ scores significantly improved ( P &lt; 0.001) with increasing BMI ( P &lt; 0.002) and CEAP classes ( P &lt; 0.05). Conclusion R. aculeatus–HMC-AA significantly improved the symptoms and QoL of CVD patients.

Abstract Background Irritable bowel and sensitive skin syndromes are common painful conditions that are poorly understood, with alterations of the peripheral (and possibly central) nervous system that lead to a lowering of perception thresholds as the main pathophysiological mechanism. Methods A cross‐sectional epidemiological study was carried out on a representative sample of French people, according to the quota method using a questionnaire. Results Among the 5,000 respondents, 48.9% were men and 51.1% were women. According to the adapted Rome questionnaire, 14.6% suffered from irritable bowel syndrome. A total of 59.1% declared very sensitive or sensitive skin. A total of 73.1% of subjects had irritable bowel syndrome versus 52.3% in the other group without an irritable colon ( p &lt; 0.001). Similarly, the frequency of irritable bowel syndrome symptoms was associated with the severity of sensitive skin syndrome. The presence of sensitive skin was highly associated with the presence of abdominal pain or discomfort, with an OR of 1.93 after adjustment for sex and age. Conclusions This study is the first study showing an association between sensitive skin and irritable bowel syndromes. Sensory symptoms are predominant in these two syndromes and transit disorders in one case and vasomotor disorders in the other could probably be considered as pathophysiological equivalents. Significance The demonstration of the association between these two syndromes can open new pathophysiological or even therapeutic pathways, since dysfunctional nerve endings and/or increased release of some neurotransmitters are likely involved.

Neurofibromatosis Type 1 (NF1) is a common genetic neurocutaneous disease, with an autosomal dominant inheritance mode. Quality of life has been shown impaired in NF1, due to severe complications, cosmetic features, and uncertainty about the disorder. This study sought to develop a self-administered questionnaire in French to assess the burden of NF1 (BoN), then translate and linguistically and cross-culturally validate it into American English, standardized methodology applied, as outlined in the report. Based on several discussions with NF1 patients, a 17-item conceptual questionnaire was first produced. Of the 91 NF1 adult patients who responded to the conceptual questionnaire, 65 (64.6% females) were accessible. Subsequent confirmatory analyses generated a 15-item questionnaire grouped into four domains, demonstrating internal consistency (Cronbach’s alpha: 091), discriminant validity, and high reliability. The BoN was likewise shown to significantly correlate with other validated questionnaires, such as Dermatology Life Quality Index, Perceived Stress Scale, and SF12 mental score, indicating good external validity. BoN is a specific tool for assessing the burden that NF1 generates on many practical aspects of the patient daily activities, beyond the notion of quality of life”. Given the increasing relevance that regulatory authorities attribute to patient-reported outcomes, the BoN questionnaire provides such supplementary information while accounting for the burden of NF1 patients in the broadest sense.

The prevalence of psychological disorders in patients with common skin diseases was assessed in a large representative sample of the French adult population. General health, as measured by the EQ5D score, was significantly lower if patients reported having rosacea, atopic dermatitis, urticaria, fungal infections, psoriasis or acne. The proportions of participants reporting being extremely anxious or depressed were higher in those who reported having rosacea, atopic dermatitis or contact dermatitis. Difficulties in sexual and conjugal life were frequently reported by people with psoriasis, atopic dermatitis, contact dermatitis, urticaria and, in particular, acne. Sleep disorders were present in 30?50% of those who reported having acne, rosacea, eczema, psoriasis or urticaria. Sleep disorders may be related not only to pruritus, but also to disfiguring skin diseases. Anxiety and depression complications were mainly reported by those with disfiguring diseases. Sexual and conjugal dysfunctions were associated with all dermatoses (with the exception of warts).

Abstract Background Sensitive skin is related to environmental factors. Objectives We aimed to investigate the roles of poorly known associated and triggering factors on sensitive skin in a large global population. Methods A survey was administrated to a representative sample of the adult population aged 18–75 years in five different countries (Brazil, China, France Russia, and the United States). All participants answered a web‐based questionnaire on sociodemographic characteristics, sensitive skin and environmental factors. Results Among the 10 743 included individuals (5285 men and 5458 women), 48.2% declared that they had sensitive skin. The group with sensitive skin reported significant increases in fatigue, dust or sweating and to a lesser extent food or tobacco consumption. The members of this group also declared that they experienced more sleep disorders than individuals without sensitive skin. Sensitive skin was very frequent in pregnant women, women with painful menstruations or women using contraceptive pills. Conclusions This large cohort study identified new factors, including female hormonal status, fatigue, sleep disorders and food, associated with sensitive skin. These associations suggest that sensitive skin is not restricted to an epidermal disorder but may be included in a larger context. The identified factors are potential upstream drivers of neurogenic inflammation in sensitive skin.

Journal of the European Academy of Dermatology and VenereologyAccepted Articles LETTER TO THE EDITOR Perceived prevalence of a sensitive scalp: a worldwide study L. Misery, L. Misery orcid.org/0000-0001-8088-7059 Department of Dermatology University Hospital of Brest Brest, FranceSearch for more papers by this authorB. Halioua, B. Halioua orcid.org/0000-0002-0823-6750 Dermatologist, Paris, FranceSearch for more papers by this authorC. Skayem, C. Skayem orcid.org/0000-0002-4498-0683 Sorbonne University, Faculty of Medicine, Paris, France Hôpitaux de Paris (AP-HP), Paris Saclay University, Ambroise Paré Hospital, Boulogne BillancourtSearch for more papers by this authorC. Baissac, C. Baissac Patient Centricity, Pierre Fabre, Toulouse, France Bio Statistician, Emma, Paris, FranceSearch for more papers by this authorM. Inane, M. Inane Data Scientist, Emma, Tel Aviv, IsraelSearch for more papers by this authorY. Ben Hayoun, Y. Ben Hayoun Head of Corporate Medical Direction Pharma, Dermocosmetics Care & Personal Care, Pierre FabreSearch for more papers by this authorM. Saint Aroman, M. Saint Aroman orcid.org/0000-0001-6124-5122 Patient Priority, Emma, Paris, FranceSearch for more papers by this authorC. Taieb, Corresponding Author C. Taieb [email protected] orcid.org/0000-0002-5142-2479 Bio Statistician, Emma, Paris, France Correspondence Charles Taieb, European Market Maintenance Assessment, 94120 Fontenay-sous-Bois, France. Email: [email protected], phone : +33 771 772 100Search for more papers by this author L. Misery, L. Misery orcid.org/0000-0001-8088-7059 Department of Dermatology University Hospital of Brest Brest, FranceSearch for more papers by this authorB. Halioua, B. Halioua orcid.org/0000-0002-0823-6750 Dermatologist, Paris, FranceSearch for more papers by this authorC. Skayem, C. Skayem orcid.org/0000-0002-4498-0683 Sorbonne University, Faculty of Medicine, Paris, France Hôpitaux de Paris (AP-HP), Paris Saclay University, Ambroise Paré Hospital, Boulogne BillancourtSearch for more papers by this authorC. Baissac, C. Baissac Patient Centricity, Pierre Fabre, Toulouse, France Bio Statistician, Emma, Paris, FranceSearch for more papers by this authorM. Inane, M. Inane Data Scientist, Emma, Tel Aviv, IsraelSearch for more papers by this authorY. Ben Hayoun, Y. Ben Hayoun Head of Corporate Medical Direction Pharma, Dermocosmetics Care & Personal Care, Pierre FabreSearch for more papers by this authorM. Saint Aroman, M. Saint Aroman orcid.org/0000-0001-6124-5122 Patient Priority, Emma, Paris, FranceSearch for more papers by this authorC. Taieb, Corresponding Author C. Taieb [email protected] orcid.org/0000-0002-5142-2479 Bio Statistician, Emma, Paris, France Correspondence Charles Taieb, European Market Maintenance Assessment, 94120 Fontenay-sous-Bois, France. Email: [email protected], phone : +33 771 772 100Search for more papers by this author First published: 20 September 2023 https://doi.org/10.1111/jdv.19527 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/jdv.19527. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Abstract Background The public perception of dermatology has been poorly investigated in Europe. Objective To determine the general public's perception of dermatologists in Europe. Methods This multinational, cross‐sectional study was conducted within the framework of the EADV population‐based survey on the ‘Burden of skin diseases in Europe’. Data were collected using a web‐based online survey on a representative sample of the general populations aged 18 years or more of 27 European countries. Proportional quota sampling with replacement design was used for each country. Results A total of 44,689 adult participants responded to the questionnaire, of whom 18,004 visited a dermatologist in the preceding 3 years. The dermatologist was the second most often visited specialist among all medical specialties, with 69.7%, 72.1%, 42.1% and 78.1% of participants in Western Europe (WE), Eastern Europe (EE), Northern Europe (NE) and Southern Europe (SE), respectively, having consulted a dermatologist over the past 24 months. Most participants across all regions agreed that the dermatologist was the first healthcare provider for chronic skin diseases (61.9% in WE, 69.8% in EE, 45.7% in NE and 60.4% in SE) and for skin cancers (65.5% in WE, 67.6% in EE, 42.4% in NE and 63.0% in SE). The five most common reasons for visiting a dermatologist among all participants were: naevi check‐up or skin cancer screening (20.2%), chronic skin diseases (16.5%), acute skin diseases (12.4%), cosmetic advice or procedure (10.2%), hyperpigmentation or congenital lesions (9.1%) and hair or nail disorder (7.7%). Most participants (84.6% in WE, 82.5% in EE, 78.3% in NE and 82.8% in SE) were very swatisfied/somewhat satisfied with the service provided. Conclusion Our study findings underscore the central role of dermatologists in skin health and highlights them as valued and trusted care providers across Europe. Understanding the perceived position of the dermatologist is the first step in improving health policy development and implementation. Notably, access to a dermatologist was lowest in NE, probably reflecting differences in healthcare organizational structures or possibly cultural differences in healthcare seeking behaviour.

Journal of the European Academy of Dermatology and VenereologyAccepted Articles LETTER TO THE EDITOR The role of physical touch during patient examination in dermatology: a worldwide study in 20 countries Bruno Halioua, Bruno Halioua orcid.org/0000-0002-0823-6750 Dermatologist in private practice, ParisSearch for more papers by this authorChristelle Le Roux-Villet, Christelle Le Roux-Villet Department of Dermatologie, Hôpital Avicenne, Université Sorbonne Paris NordSearch for more papers by this authorCatherine Baissac, Catherine Baissac Patient Centricity Manager ; Dermo-Cosmetic & Personal Care, Pierre Fabre, Toulouse, FranceSearch for more papers by this authorYaron Ben Hayoun, Yaron Ben Hayoun Data Scientist, EMMA, Tel Aviv, IsraëlSearch for more papers by this authorNuria Perez Cullell, Nuria Perez Cullell Medical Director, Pierre Fabre, Toulouse, FranceSearch for more papers by this authorCharles Taieb, Charles Taieb orcid.org/0000-0002-5142-2479 Patients Priority Dpt, EMMA, Paris, FranceSearch for more papers by this authorMarie-Aleth Richard, Marie-Aleth Richard Hôpital La Timone, APHM, Marseille, FranceSearch for more papers by this authorMarketa Saint Aroman, Corresponding Author Marketa Saint Aroman [email protected] orcid.org/0000-0001-6124-5122 Medical Director Dermo-Cosmetic & Personal Care Pierre Fabre, Toulouse, France Correspondence : Charles TAIEB, MD, European Market Maintenance Assessment, 121 rue de Sèvres, 75006, Paris- France : Email: [email protected], [email protected]Search for more papers by this authorCharbel Skayem, Corresponding Author Charbel Skayem [email protected] orcid.org/0000-0002-4498-0683 Sorbonne University, Faculty of Medicine, Paris, France Hôpitaux de Paris (AP-HP), Paris Saclay University, Ambroise Paré Hospital, Boulogne Billancourt Correspondence : Charles TAIEB, MD, European Market Maintenance Assessment, 121 rue de Sèvres, 75006, Paris- France : Email: [email protected], [email protected]Search for more papers by this author Bruno Halioua, Bruno Halioua orcid.org/0000-0002-0823-6750 Dermatologist in private practice, ParisSearch for more papers by this authorChristelle Le Roux-Villet, Christelle Le Roux-Villet Department of Dermatologie, Hôpital Avicenne, Université Sorbonne Paris NordSearch for more papers by this authorCatherine Baissac, Catherine Baissac Patient Centricity Manager ; Dermo-Cosmetic & Personal Care, Pierre Fabre, Toulouse, FranceSearch for more papers by this authorYaron Ben Hayoun, Yaron Ben Hayoun Data Scientist, EMMA, Tel Aviv, IsraëlSearch for more papers by this authorNuria Perez Cullell, Nuria Perez Cullell Medical Director, Pierre Fabre, Toulouse, FranceSearch for more papers by this authorCharles Taieb, Charles Taieb orcid.org/0000-0002-5142-2479 Patients Priority Dpt, EMMA, Paris, FranceSearch for more papers by this authorMarie-Aleth Richard, Marie-Aleth Richard Hôpital La Timone, APHM, Marseille, FranceSearch for more papers by this authorMarketa Saint Aroman, Corresponding Author Marketa Saint Aroman [email protected] orcid.org/0000-0001-6124-5122 Medical Director Dermo-Cosmetic & Personal Care Pierre Fabre, Toulouse, France Correspondence : Charles TAIEB, MD, European Market Maintenance Assessment, 121 rue de Sèvres, 75006, Paris- France : Email: [email protected], [email protected]Search for more papers by this authorCharbel Skayem, Corresponding Author Charbel Skayem [email protected] orcid.org/0000-0002-4498-0683 Sorbonne University, Faculty of Medicine, Paris, France Hôpitaux de Paris (AP-HP), Paris Saclay University, Ambroise Paré Hospital, Boulogne Billancourt Correspondence : Charles TAIEB, MD, European Market Maintenance Assessment, 121 rue de Sèvres, 75006, Paris- France : Email: [email protected], [email protected]Search for more papers by this author First published: 01 November 2023 https://doi.org/10.1111/jdv.19622 Dr Charbel Skayem and Dr Marketa Saint Aroman contributed equally as last authors. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/jdv.19622. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Sleep is a physiological process that accounts for almost one third of a person's life.1 Sleep disturbances (SDs) are distressing and disabling conditions that are frequently reported in cutaneous disorders (CD) with significant impairment in quality of life. However, predictive factors of SD in patients with CD has poorly been investigated.2-4 Our objective was to conduct a worldwide study in order to evaluate the prevalence of SD due to CD and identify predictive factors and impact on professional life. The ‘ALL PROJECT’5 involves individuals, representative of the adult populations of 20 countries spread over all five continents [China 5000, USA 5000, Brazil 4001, India 3000, Australia 2000, France 4000, Italy 4000, Canada 2500; Denmark 1000; Germany 2000; Israel 2000; Kenya 500; Mexico 2500; Poland 2500; Portugal 1000; Senegal300; South Africa 1000; South Korea 2500; Spain 2000; UAE 750], which together accounts for over 50% of the world's population. In each of the 20 countries surveyed we conducted a population-based study on representative and extrapolable samples of the general population aged 16 years or more. The questionnaire gathered information about the patients' demographic and socio-demographic profiles. Patients were considered to have SD if they reported that they had difficulty in failing asleep because of their CD. A comparison of SD and patients without SD (non-SD) was used to evaluate predictors of SD: socio-demographic and clinical parameters and specifically on professional life. A total of 50,552 individuals participated in the survey, of which 17,627 (Tables 1 and 2) had CD. There were 7514 (42.6%) males and 10,113 (57.4%) females, respectively (mean age 39.65 ± 14.97. 16–96 years). A total of 7458 (42.3%) respondents reported SD due to a CD. The SD population was, on average younger than the non-SD population (mean age 39.22 ± 14.38 years vs. 39.96 ± 15.38 years; p = 0.001). Females had more frequently SD than males (40.8% vs 43.5%. p = 0.01). 10,169 (57.7%)respondents were considered to have no SD. Symptoms such as prickles, burning sensations, tingling (16.5% vs 14.2%, p 0.001388) skin pain (6.6% vs 3.6%1.4E-16) and pruritus (60.5% vs 50.8%, p < 0.0001) were predictive factors of SD. Subjects with SD reported more frequently a feeling of fatigue as soon in the waking up (80.70% vs 63.60%, p < 0.0001) a decrease in concentration and vigilance (73.40% vs 55.10%, p < 0.0001), periods of drowsiness during the day (82.60% vs 71.00%, p < 0.0001), a tingling sensation in the eyes (58.10% vs 42.20%, p: <0.0001) and repeated yawning (71.70% vs 57.90%, p < 0.0001). SD was significantly associated with detrimental impact on work life with feeling less productive in the activity (49.2% vs 19.4%, <0.0001). This is the first study to establish the impact of SD, which affects 42.3% % of respondents with CD. While CD that cause SD may be transient, long-term or recurrent, they all lead to significant psychological complications. We reported that SD in patients with CD was significantly associated with feeling of fatigue, decrease in concentration and vigilance, drowsiness, tingling sensation in the eyes and repeated yawning. These findings suggest the importance of early detection and management of SD in patients with CD which may contribute to detrimental impact on professional life. It is important to include questions about SD in the examinations of CD patients.2, 3, 6-9 SD must be regularly assessed and managed and guidelines are needed to address the multifactorial nature of SD in patients with CD. The authors acknowledge the technical support of Helene Chevalier (HC Conseil). This project was funded by Patient Centricity of Pierre Fabre. Catherine Baissac, Nuria Perez Cullell, Marketa Saint Aroman are employees of Pierre Fabre, France. Dr Charbel Skayem, Charles Taieb, Yaron Ben Hayon, Briuno Halioua, Marie Aleth Richard, Jonathan Taieb have no conflict of interests. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Atopic dermatitis (AD) is one of the most common inflammatory diseases, and has a higher prevalence among females in adulthood. The aim of this observational, cross-sectional, survey-based study was to evaluate the impact of AD on the daily lives of adult women patients. A scientific committee composed exclusively of women constructed a specific questionnaire in partnership with the French Eczema Association. Severity of AD was evaluated with the Patient-Oriented Eczema Measure (POEM). A sample of 1,009 adult women (mean age ± standard deviation: 41.8 ± 14.2 years) with AD was identified from a representative sample of the French population (82% response rate 1,230 women surveyed). According to the POEM, 50.64% (n = 511) of subjects were identified as having mild AD, 39.35% (n = 397) moderate AD, and 10.01% (n = 101) severe AD. Overall, 67.7% (n = 682) reported that their eczema involved a visible area (face, neck or hands), and 19.6% (n = 198) a sensual area (breasts/chest, genital area or buttocks). Of the 720 women with menstrual cycles, exacerbations of AD were reported to occur mostly before (50.6%) and during (48.3%) menstruation. A small proportion of women, 7.3% (n = 74), reported being afraid of becoming pregnant because of their eczema. If AD involvement was in a visible area it had a greater impact on romantic relationships, sexual relationships and occupation. If AD involvement was in a sensual area it had a greater influence on romantic relationships and sexuality. Particular attention should be given to patients with localization of AD on the face, neck or hands, as they have a higher risk of social exclusion. Moreover, these results should encourage health professionals to ask patients with AD about the possible involvement of sensual areas.

Abstract Background As exposure to UV radiation is the primary modifiable environmental risk factor associated with skin cancer, it remains the principal focus of most prevention strategies. Numerous sun protection campaigns have been implemented worldwide; however, their impact on the actual incidence and mortality rates of skin cancer seems to be limited. To create successful skin cancer prevention campaigns, it is important to have a comprehensive understanding of individuals' attitudes and behaviours regarding sun protection. The aim of the current study was to determine and report on the prevalence of self‐reported attitudes, knowledge and behaviours regarding two of the major sun protection recommendations—avoidance of sun exposure and use of sunscreens—in an international representative sample across five continents. Methods This cross‐sectional study was conducted in 20 countries using a web‐based online survey. Findings A total of 50,552 individuals, comprising 25,388 men (50.22%) and 25,164 women (49.78%), participated in the survey. Among them, 83.2% reported having been voluntarily exposed to the sun (for sun‐basking reasons) at least once in the last 12 months, and 47.96% acknowledged being exposed to the sun between the hours of 10 AM and 4 PM. The primary reason for non‐adherence was that these hours were the most convenient times (32.28%). Only 24.05% reported applying sunscreen every 2 h when outdoors. Forgetfulness was the primary reason as provided by 27.79% of participants. Males and older age groups were less likely to adopt sun‐protective behaviours around the world. Forgetfulness and the challenges posed by time constraints seem to be the biggest barriers to proper adherence. Interpretation These findings should prompt the collaboration with health authorities and the manufacturers to enhance adherence by setting reasonable sunscreen prices and creating formulations that make their application less burdensome.

Aims On the one hand, the survey aims at the development and validation of an auto-administered questionnaire designed to measure the everyday burden caused by chronic venous disorders (CVDs). On the other hand, it aims at reporting initial epidemiological and demographic data in CVD patients and their correlations. Materials and methods After identification of 66 possible items, the elimination of redundant and less relevant questions left a questionnaire of 36 simple items, the Assessment of Burden in Chronic–Venous Disease (ABC-V) that has been applied prospectively and consecutively to a population of 328 actual chronic venous disorder (CVD) patients in eight vein-specialized centres in France. Questionnaires were completed by patients at home and returned by mail (free return envelopes). Results Significant correlation has been found between ABC-V, the Specific Quality of life &amp; Outcomes Response – Venous (SQOR-V) and the Centre for Epidemiologic Studies Depression Scale (CES-D), demonstrating the validity of the concept. ABC-V has been found increased by age ( P = 0.0127) and body mass index ( P &lt; 0.001), not by gender ( P = 0.8758). Conclusion ABC-V is a first tool to assess the burden of CVDs, it provides with individual data and will help, for instance, determining the weight of the coefficient used in the disability-adjusted life year and quality-adjusted life year formulas, thus ensuring an accurate evaluation of the Global Burden of Chronic Venous Disorders.

Abstract Importance The term dermatoporosis has been proposed to describe clinical signs and functional consequences of age‐related extreme skin fragility. Objective To create a simple dermatoporosis self‐diagnosis tool ( IDA : Index Dermatoporosis Assessment) and to use this tool to estimate the prevalence of dermatoporosis in France. Design, setting and participants A specific dermatoporosis questionnaire was developed with the help of senior dermatologists and survey experts. This questionnaire was submitted to consecutive individuals aged ≥65 years who consulted a dermatologist. At the end of the consultation, the dermatologist was asked to assess ‘whether or not’ dermatoporosis was present. In a second step, the final questionnaire was mailed to a representative sample of the French population aged ≥65 years in order to estimate the prevalence of dermatoporosis. Results The initial questionnaire, consisting of two modules (24 questions), was validated in 173 individuals aged ≥65 years) during a dermatologist consultation. Dermatologists diagnosed 46% of the individuals with dermatoporosis. The final validated questionnaire consisted of 14 items, 12 consisting in presence or absence of clinical signs and two items consisting of the self‐assessment by individuals of skin ageing on neckline and hands (none/moderate/significant/very significant). A scoring system was generated to quote quantitatively dermatoporosis (from 0 if no sign of dermatoporosis to 20 maximal dermatoporosis). The area under the receiver operator curve was 0.8535, indicating a very good ability of the questionnaire to differentiate between individuals. A cut‐off value of 11 was linked to positive and negative predictive values of 0.78 and 0.81, respectively. In a second step, using the questionnaire in a representative sample of the French population ( n = 533), the estimated overall prevalence of dermatoporosis was 37.5% in French subjects aged ≥65 years [27.5% (males) vs. 43.9% (females); P &lt; 0.05]. The estimated prevalence of dermatoporosis was twice higher in subjects with eczema or atopic dermatitis during childhood than in the population without dermatoporosis (60.6% vs. 33.4%, P &lt; 0.001). Individuals with dermatoporosis also reported a higher prevalence of itching, long‐term corticosteroid use, anticoagulant use and prior sun exposure. Conclusions and relevance Using a new simple dermatoporosis self‐diagnosis tool, this study provides a previously unprecedented insight into the high prevalence of dermatoporosis in elderly individuals. IDA questionnaire is a short (14‐item) and easy to use tool for evaluating dermatoporosis in adults and may allow an easy evaluation of each subject.

Journal Article Factors associated with sun protection compliance: results from a nationwide cross‐sectional evaluation of 2215 patients from a dermatological consultation Get access U. Sattler, U. Sattler Laboratoires Dermatologiques Avène Pierre Fabre Dermo‐Cosmétique Lavaur France Search for other works by this author on: Oxford Academic Google Scholar S. Thellier, S. Thellier Department of Dermatology Paul Sabatier University and Larrey Hospital Toulouse France Search for other works by this author on: Oxford Academic Google Scholar V. Sibaud, V. Sibaud Laboratoires Dermatologiques Avène Pierre Fabre Dermo‐Cosmétique Lavaur France Search for other works by this author on: Oxford Academic Google Scholar C. Taïeb, C. Taïeb Public Health and Quality of Life Pierre Fabre SA Paris France Search for other works by this author on: Oxford Academic Google Scholar S. Mery, S. Mery Laboratoires Dermatologiques Avène Pierre Fabre Dermo‐Cosmétique Lavaur France Search for other works by this author on: Oxford Academic Google Scholar C. Paul, C. Paul Department of Dermatology Paul Sabatier University and Larrey Hospital Toulouse France Search for other works by this author on: Oxford Academic Google Scholar N. Meyer N. Meyer Department of Dermatology Paul Sabatier University and Larrey Hospital Toulouse FranceInserm UMR 1037‐CRCT ‘Rho GTPases and Cancer’ Toulouse France Correspondence Nicolas Meyer. E‐mail: meyer.n@chu-toulouse.fr Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 170, Issue 6, 1 June 2014, Pages 1327–1335, https://doi.org/10.1111/bjd.12966 Published: 01 June 2014

Pruritus in atopic dermatitis has been studied extensively; however, evaluation of skin pain has been very limited. The aim of this study was to evaluate the presence, frequency and characteristics of skin pain in patients with atopic dermatitis. A survey was conducted of a representative sample of 5,000 18-80-year-old individuals selected from the French population according to sex, age, geographical area and socioprofessional status. Data on socio-demographic status and the presence of any skin disease were collected. Pain in the past month and health-related quality of life were evaluated. Average intensity of skin pain during the previous month was assessed with a horizontal visual analogue scale (0-10). Skin pain was reported by more than half of the patients with atopic dermatitis, at a pain intensity of almost 6/10. A neuropathic component was suggested by the Douleur Neuropathique - 4 questions (DN4) questionnaire (a tool for detection of neuropathic pain), as well as the presence of pain inside and outside of skin lesions. Severe alterations to health-related quality of life were assessed with the Dermatology Life Quality Index and Short Form 12 Health Survey (SF-12). Pain is reported frequently by patients with atopic dermatitis. Healthcare professionals should question patients about pain and provide effective treatments. Future clinical trials must take skin pain into account.

Adult acne (AA), atopic dermatitis (AD), psoriasis (P) and hidradenitis suppurativa (HS) are common and chronic, inflammatory skin diseases with an incidence that has been estimated at almost 15% of the adult population in France.1 They are often accompanied by increased psychological stress levels.2 This observational, cross-sectional, non-comparative study conducted by five patient associations in France between October 2020 and February 2021, assessed perceived stress in adults with AA, AD, P or HS, as well as self-perceived disease severity and quality of life (QoL) in a large population using a digital questionnaire. The questionnaire was distributed directly to patient association members or through social networks. The study complied with local legal requirements for the conduct of this type of study and received ethics committee approval (CPP Ile de France X, 2020-A01621-38). The questionnaire ensured that the target dermatoses had previously been confirmed by a health care professional. Stress was assessed using the validated perceived stress scale (PSS) and QoL using the DLQI.3, 4 The PSS questionnaire measures the degree to which situations in one's life are considered as stressful. Individual scores on the PSS can range from 0 to 40, with higher scores indicating higher perceived stress. Scores ranging from 0 to 13 indicate low perceived stress, scores from 14 to 26 indicate moderate perceived stress and scores from 27 to 40 indicate high perceived stress. A DLQI score above 10 designates an important or very important impact on the patient’s QoL. Moreover, patients were asked to assess the severity (mild, moderate or severe) of their dermatosis at the time the study was conducted and to confirm if they had been offered psychological support with regards to their dermatosis. Overall, 7273 subjects participated in this survey; 1605 subjects had AA, 2538 AD, 2329 P and 801 HS. The average age was 40.6 years; 69.25% were women and 54.37% were employed. The self-assessed disease severity was moderate in 49.73% of subjects. Stress according to disease is displayed in Table 1. In total, 66.3% of subjects reported stress scores above 27. Results for AA, AD and P showed that the more severe the condition, the higher the perceived stress scores. This could not be observed for HS patients. While the level of stress was very high in all groups and especially in those patients with severe disease forms, less than 15% had been offered psychological support and, when such aid was proposed, only two patients out of three had accepted it. This finding requires special attention for future patient-centred care measures to be put in place. The DLQI score was significantly higher and impacted the QoL of patients with AA, AD and P more, especially when stress scores were above 27, which should encourage health care professionals to develop a different, patient-centred treatment approach; these results paralleled results observed for perceived stress (Table 2). The main limitations of our study are that the population may be considered unrepresentative, that there was no control group and that the HS population was potentially too small to detect similar results. Moreover, subjects, as members of patient organizations, may suffer more from their disease and could, therefore, be more stressed. Moreover, the gender distribution is not representative, as a majority of women participated in the survey. Despite these limits and bias, our study shows that in patients with chronic inflammatory skin diseases, psychological stress is an important issue, requiring specific attention and personalized psychological support. Implementing a patient-centred management in chronic inflammatory skin diseases may reduce psychological stress, and potentially improve treatment adherence and improved treatment outcome. The authors express their gratitude to the 7273 patients who agreed to participate in this study and acknowledge the writing support of Karl Patrick Göritz, SMWS, Scientific and Medical Writing Services, France. The patients in this manuscript have given written informed consent to publication of their case details. None. Project funded by European Market Maintenance Assessment with institutional support from Almirall, Leo-Pharma, Pfizer, Bioderma, Pierre Fabre, Amgen, Sanofi and La Roche Posay. The data that support the findings of this study are available from the corresponding author upon reasonable request.

The skin plays an important role in establishing interpersonal relationships, and thus visible skin disorders, which have a significant impact on physical appearance, influence other people's behaviours and attitudes.To develop and validate a dermatologic-specific questionnaire to evaluate stigmatization in individuals with visible skin conditions.Items were generated by a verbatim report based on qualitative interviews with patients with various dermatologic conditions. Subsequently, a study was implemented for psychometric analysis. A dermatology-specific stigmatization questionnaire (PUSH-D) was refined via item reduction according to inter-question correlations, consensus among experts and exploratory factor analysis. Internal consistency was determined by calculating Cronbach's α. Concurrent validity was determined by calculating the correlation between PUSH-D and the Dermatology Life Quality Index (DLQI) and the Rosenberg Self-Esteem Scale (RSES).From a primary list of 22 items, PUSH-D was reduced to a 17-item questionnaire, covering two pertinent dimensions based on the exploratory factor analysis. Construct validity was demonstrated, and PUSH-D showed good internal consistency (Cronbach's α = 0.9). PUSH-D correlated strongly with the DLQI 0.72 (p < 0.001) and moderately with the RSES 0.49 (p < 0.001).PUSH-D allows a comprehensive view of the degree of stigmatization in visible skin disorders, as well as the comparability of stigmatization levels across various skin conditions.

The notion of individual burden, associated with a disease, has been introduced to determine the 'disability' in the broadest sense (psychological, social, economic and physical). Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases with an estimated prevalence of 5%-30% in children.To develop and validate a specific questionnaire which assess the burden of families of children with AD: the Atopic dermatitis Burden Scale (ABS).Items for inclusion in ABS were initially generated from a literature review and a verbatim report from parents whose child had AD. ABS was refined via item reduction according to interquestion correlations, consensus among experts and exploratory factor analysis. Internal consistency was determined by calculating the Cronbach's α, concurrent validity by calculating the correlation between ABS and the Short-Form 12 items. Discriminant validity was analysed according to the severity degrees of AD assessed by Patient-Oriented SCORing index of Atopic Dermatitis (PO-SCORAD).From an initial list of 29 items, ABS was reduced to a 14-item questionnaire, grouped into four dimensions based on the exploratory factor analysis. Construct validity was demonstrated and ABS showed good internal coherence (Cronbach's α: 0.78). ABS was significantly correlated to the mental dimension of Short-Form 12 (r = -0.49), but it was not correlated to the physical dimension (r = 0.04). ABS scores were significantly different according to the severity degrees of AD, with higher ABS score in parents whose child had severe AD.The ABS questionnaire is a validated tool for assessing the burden of families of children with AD. An implementation of a prospective study is planned to estimate sensitivity to change and to confirm its domain structure in larger samples.

Journal of the European Academy of Dermatology and VenereologyVolume 33, Issue 4 p. e157-e159 Letter to the Editor Regrets after tattooing and tattoo removal in the general population of France N. Kluger, Corresponding Author nicolas.kluger@hus.fi orcid.org/0000-0002-5225-8316 Department of Dermatology, Allergology and Venereology, Skin and Allergies Hospital, University of Helsinki and Helsinki University Central Hospital, Meilahdentie 2, PO Box 160, 00029 Helsinki, Finland Department of Dermatology, «Tattoo» Consultation, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75877 Paris Cedex 18, FranceCorrespondence: N. Kluger. E-mail: nicolas.kluger@hus.fiSearch for more papers by this authorL. Misery, Department of Dermatology, University Hospital of Brest, Brest, FranceSearch for more papers by this authorS. Seité, La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, FranceSearch for more papers by this authorC. Taieb, FIMARAD, Hopital Necker Enfants Malades, Paris, France European Market Maintenance Assessment, Fontenay-sous-Bois, FranceSearch for more papers by this author N. Kluger, Corresponding Author nicolas.kluger@hus.fi orcid.org/0000-0002-5225-8316 Department of Dermatology, Allergology and Venereology, Skin and Allergies Hospital, University of Helsinki and Helsinki University Central Hospital, Meilahdentie 2, PO Box 160, 00029 Helsinki, Finland Department of Dermatology, «Tattoo» Consultation, Assistance Publique-Hôpitaux de Paris, Bichat-Claude Bernard Hospital, 46 rue Henri Huchard, 75877 Paris Cedex 18, FranceCorrespondence: N. Kluger. E-mail: nicolas.kluger@hus.fiSearch for more papers by this authorL. Misery, Department of Dermatology, University Hospital of Brest, Brest, FranceSearch for more papers by this authorS. Seité, La Roche-Posay Laboratoire Dermatologique, Levallois-Perret, FranceSearch for more papers by this authorC. Taieb, FIMARAD, Hopital Necker Enfants Malades, Paris, France European Market Maintenance Assessment, Fontenay-sous-Bois, FranceSearch for more papers by this author First published: 05 December 2018 https://doi.org/10.1111/jdv.15385Citations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume33, Issue4April 2019Pages e157-e159 RelatedInformation

While some information on psoriasis impact on pregnancy is available, very little is known on the preoccupations of women afflicted by the disease or on the dermatologists' (D) positioning as to psoriasis and pregnancy. The 'Objectifs Peau' project demonstrated a 4.7% prevalence of psoriasis in women aged 18-45 years in France.This project sought to further address these issues in view of a targeted action plan.A questionnaire was made available to 361 D of different types.Overall, 152 D answered the questionnaire, 50.7% working in private or mixed practice and 49.3% in hospitals, with 63% females (DF) and 37% males (DM). Over the last 3 months, the mean percentage of women of child-bearing age seen by these D was 28.6%. The main issue addressed by D upon psoriasis diagnosis was the patient's wish to become pregnant in the short-term (84%), while the compatibility of drug treatment with pregnancy was the issue prioritized by patients (64%). Among DM and DF, 46% and 29% reported having been confronted with an unplanned pregnancy, with their reaction mainly dependent on the treatment taken in 66%. Regarding follow-up, 26% D declared having shared their decision-making with gynaecologists, while 56% considered the first pregnancy trimester to be the highest-risk period. Only 28% D were familiar with existing recommendations, with only 21% of them considering them appropriate.Overall, 26.2% of French psoriasis women are of child-bearing potential, in line with our dataset (28.6%). Only 56% D considered the 1st pregnancy trimester to be the highest-risk period, with only one-third familiar with existing recommendations. The gap between recommendations and actual practices must be addressed through policies that take women's preoccupations better into account.

Summary: The purpose of the study was to discover how much European patients with epilepsy and their carers understand about epilepsy. This article reports the interim results for the first four European countries recruited to the study and includes data collected from 1,920 people with epilepsy and 2,136 carers. Clinical and demographic details and data on understanding of epilepsy were collected using self‐completed questionnaires mailed to members of epilepsy support groups. There were no significant differences between people with epilepsy and carers for scores on the Epilepsy Knowledge Questionnaire, although people with epilepsy were more likely to score in the higher ranges. Higher scorers on the questionnaire were more likely to be better educated, to have lower scores on the impact of epilepsy scales, to have higher scores on the adjustment to epilepsy scale, and were less likely to report feeling stigmatized. The study confirms the findings of previous studies that people with epilepsy are reasonably well informed, although some gaps in their knowledge were evident. A comparison of country differences will be made and multivariate statistical analysis will allow a better understanding of the contribution of knowledge to people's overall adjustment to their condition.

Albinism comprises a group of autosomal recessive diseases that are characterized by poor vision and a variable hypopigmentation phenotype. A comprehensive literature review showed that no tool can assess the burden experienced by individuals who present with albinism, although such a tool is needed and would be beneficial for clinicians and patients alike. The questionnaire was devised using standardized methodology for developing and validating questionnaires on the quality of life of subjects according to the following chronological structure: conceptual phase, development phase, and then validation phase. A multidisciplinary working group was assembled, including experts on questionnaire design and development, dermatologists specializing in care for patients with albinism, and representatives of the Genespoir association. Based on an initial verbatim report, the workgroup compiled a list of items that were transcribed and reformulated into questions. During the validation phase, principal component analysis (PCA) was conducted on the 24 items, which allowed the questionnaire to be reduced to 20 questions [Q]. The standardized regression coefficients were all greater than 0.5 for their corresponding factors. Based on their normalized regression coefficients, each group of questions was linked to one of the following four dimensions, with each dimension consisting of at least three questions: “Live with” (8 Q), “Daily life” (3 Q), “Resignation” (3 Q), and “Fear of the future” (6 Q). All dimensions correlated well with the overall BoA score. Cronbach’s α was 0.92 for the entire BoA scale, confirming excellent internal coherence. Intradimensional coherences all demonstrated excellent reliability (α > 0.65). The BoA questionnaire was highly correlated with the SF12, RSES and DLQI validated questionnaires. This outcome confirmed the external validity. This questionnaire represents the first specific assessment tool for evaluating the burden of albinism. It is easy to use and relatively quick to complete, which will allow the burden to be evaluated over time with a reproducible questionnaire. To ensure that this questionnaire can be used by as many people as possible, cultural and linguistic validation in US English was conducted with the original French version.

The frequency of associated comorbidity and the cost of treatments in patients with atopic dermatitis (AD) followed up in primary care settings are poorly known. We carried out a retrospective cohort study on a longitudinal electronic medical records database of patients consulting a panel of general practitioners in France. All subjects with AD diagnosed during the first year of life were selected and matched with infants without the disease according to sex (1,163 vs. 1,163). Subjects were followed up for 9 years. Associated diseases, drug consumptions and available medical costs were detailed. Comparisons between subjects and controls were carried out. Subjects with AD had more comorbidities than others, especially in respiratory and ophthalmic system organs. The number of prescribed treatments in the field of skin diseases as well as overall medical costs (general practitioner consultations and prescribed drugs) were higher among atopic subjects, but differences were attenuated with age.

Abstract Background The public perception of dermatologists, highly relevant for implementing strategies to improve dermatological care, has been scarcely investigated in France, in regard to the background where the number of active dermatologists is continuously decreasing. Objective This study sought to investigate the French public's perception of dermatologists, as well as the physician–patient relationship in dermatology area. Methods A sample of 5000 inhabitants (aged ≥15–80 years) of Metropolitan France, seeking medical advice for a skin condition, were invited in July 2018 to fill in a digital structured questionnaire. Results The sample's gender ratio and geographical distribution proved representative of the French general population. Compared to 33.2% of respondents having consulted a general practitioner ( GP ), 20.6% had consulted a dermatologist over the past 12 months, the main reasons being a chronic skin condition (37%), surgical intervention (18%) and naevi check‐up (15%). When confronted with acute skin problems, survey participants stated their GP was the first healthcare reference (54% of cases). This may be explained by two distinct phenomena: the declining demography of dermatologists and specific peculiarities of the French healthcare system. Contrarily, the dermatologist was the first care provider for chronic skin problems (47% of cases). On answering the question whether they were satisfied with their last dermatological consultation, 76% declared to be very satisfied/satisfied, vs. 24% dissatisfied/very dissatisfied. Some 78% were given a prescription at consultation end, considered efficacious by 91% and well tolerated by 98%. Conclusion Our study findings underline the central role of dermatologists in skin care as valued and trusted care providers in France. Further educational and political strategies appear warranted to improve patient referral to dermatologists and decrease waiting times, thereby improving patients’ well‐being and satisfaction, as well as care quality provided.

Abstract Background Sensitive scalp or irritable bowel syndrome has been previously shown to be associated with sensitive skin. We wondered whether sensitive eyelids and sensitive eyes could also be associated with sensitive skin. Methods A cross‐sectional epidemiological study was carried out on a representative sample of French people, according to the quota method, using a questionnaire. Results A total of 2048 subjects were included in the present study. Notably, 52.2% declared sensitive eyes, which was more frequent in women than in men. The subjects who reported sensitive eyes were more numerous according to the severity of skin sensitivity, the severity of sleep disorders and the presence of bright eyes. More than half of the subjects with sensitive eyes thought that they were sensitive to sun exposure, dust, computer or touch pads or dry air. The presence of sensitive eyelids was reported by 18.65% (more frequent in women) and was associated with sensitive skin and sensitive eyes, sun exposure and exposure to dust. Conclusion This study is the first to investigate sensitive eyelids or sensitive eyes. Sensitive eyelids can be considered a localization of sensitive skin. The concept of sensitive eyes is not commonly used by ophthalmologists and remains to be more precisely defined.

Atopic dermatitis (AD) and psoriasis (Pso) are highly prevalent chronic inflammatory skin diseases. They share similarities regarding severity and impact on quality of life but display differences regarding risk factors, comorbidities, and pathogenesis.This study sought to assess the prevalence of AD and Pso among the French population, along with associated comorbidities, and to compare these data with those of the age- and gender-adjusted French population with neither AD nor Pso.The survey was conducted by a polling institute between September 1 and November 30, 2016, with proportional quota sampling being applied to render the study population representative of the French population. In all, 20 012 individuals were selected from among 900,000 internet users aged≥15years.Overall, 20,012 adults (48.8% men; 51.2% women) completed a digital questionnaire. The prevalence of AD was 4.65% [95% confidence interval (CI) 4.36%-4.94%] and that of Pso was 4.42% [95% CI: 4.14%-4.71%]. More AD patients presented≥1 comorbidity compared to subjects without AD (57.04% vs. 49.2%, P<0.0001) and more Pso patients presented≥1 comorbidity compared to subjects without Pso (60.68% vs. 49.05%, P<0.0001). After adjustment for gender and age, hypertension and dyslipidemia, a greater prevalence of osteoarticular, respiratory and psychiatric diseases was noted in both AD and Pso patients, whereas increased prevalence of obesity was seen only in Pso patients. The prevalence of components of metabolic syndrome was higher among Pso than AD patients.Further studies are required to consolidate these findings, to better characterize the entire spectrum of AD and Pso comorbidities, and to better identify determinants and risk factors, along with targeted therapies.

Previous studies showed more sleep disturbance (SD) in patients with cutaneous disorders (CD). During CD, unpleasant subjective symptoms [USS], such as itch, pain and others (tingling, burning, or tightness) have a negative influence on sleep quality. This study aims to evaluate the prevalence of SD in CD patients and to identify the influence of itch, pain and other unpleasant sensations on SD.An international, anonymized real-life survey was conducted with individuals [18-75 years], with physician-confirmed CD, or without CD. The 25 items covered sociodemographic characteristics, feeling of overall sleep quality and skin unpleasant sensations. Severity of SD and unpleasant sensations were assessed using a 10-cm Visual Analogue Scale (VAS).From 3834 analyzed questionnaires, 2871 (67.3%) were in the CD group and 863 (32.7%) in the control group. Patients with CD had significantly more SD (71.2% vs 32.7% in the control group, p<0.0001). CD patients without any reported unpleasant sensation were at higher risk for SD than control subjects (OR 1,362 [95% CI 1.975-2.405] p=0.0013). SS were highly associated with SD (OR 1.641 [95% CI 1.393-1.933] p<0.0001). Pruritus, pain and intermediate sensations were significant predictors of SD, with odds ratios of 1.670, 1.625 and 1.326, respectively. VAS sleep scores were strongly associated with pruritus (r: 0.25, p<0.0001) and pain (r: 0.25 p<0.0001) severity ratings.SD is a common problem for patients with CD. Patients with subjective symptoms suffer more from SD, suggesting that they are aggravating factors, but are likely not the only reason for SD in CD patients. We found that during CD, intermediate sensations also contribute to SD. Despite some limitations and the potential bias due to the study design, our results confirm for the first time on an international level the influence of subjective symptoms on sleep quality in patients with CD.

The prevalence and impact of pruritus, pain, and other sensory symptoms in skin diseases are poorly known.To assess the frequency of these symptoms with dermatoses and their association with depression using data from the "Objectifs Peau" survey.A representative sample of 20,012 French individuals was created using the usual quota method.When patients suffered from both pruritus and skin pain, they had a higher relative risk of psychological suffering (2.9) than those who suffered only from pruritus (1.4) or skin pain (1.2). Pruritus was reported in 48.55% of patients with acne, 43.24% with mycoses, 44.35% with warts, and 36.51% with rosacea. For skin pain, the results were 11.22%, 27.59%, and 16.13% for atopic dermatitis, acne, and warts, respectively. Other unpleasant sensations, such as tingling or burning, were also frequently reported.Pruritus, pain, or other sensory symptoms were found to be common not only in classic pruritic skin diseases but also in acne, rosacea, or warts. The association of pruritus and pain dramatically increased psychological suffering. These symptoms must be systematically searched for in patients, especially since new therapeutic possibilities are emerging for the symptomatic treatment of pruritus.

The International Prostatic Symptom Score (IPSS) evaluates urinary disorder symptoms frequently associated with benign prostatic obstruction, but does not take into account the bothersomeness they induce. The Symptom Problem Index (SPI) evaluates the degree of discomfort associated with each question on the IPSS. Our objective was to explore the relationships between these two rating scales.The IPSS and SPI self-administered scores were administrated to a cohort of 907 patients presenting with LUTS suggestive of BPO (Benign Prostatic Obstruction), for which 722 patients were evaluable. This diagnosis was made by GP (General Practitioner) in the 3-month period before their inclusion in the study. The correlation between SPI and IPSS was investigated and each symptom was classified according to its frequency and according to the bothersomeness it induced. The degree of bothersomeness associated with each IPSS symptom was evaluated and quantified based on quadratic function estimates.The mean IPSS score was 12.6+/-6.4, the mean SPI score was 12.2+/-6.5. The correlation coefficient between the IPSS and SPI scores was 0.70; the scores from the 2 rating scales showed a very high variability. On a 0-100% scale, where 100% represents a maximum bothersomeness, the induced bothersomeness ranged from 0 to 22.6% depending on the 7 symptoms.The two questionnaires do not collect the same information. The extent of variability between the two scales confirms that one scale cannot be replaced by the other. Considering the importance of bothersomeness associated with lower urinary tract symptoms for the therapy decision, the joint use of the IPSS and SPI seems appropriate.

Les maladies dermatologiques modifient et altèrent l’image de soi et peuvent provoquer une souffrance psychologique notable. Le but de cette étude était de mesurer la prévalence de la symptomatologie dépressive chez des malades ayant une pathologie dermatologique et consultant pour celle-ci. Une étude prospective a été effectuée pendant 5 jours consécutifs à la consultation dermatologique de l’hôpital Saint-Louis. Un questionnaire permettant d’évaluer la symptomatologie dépressive, le CES-D, a été remis à tous les malades consultant pendant la durée de l’étude. Cette échelle d’auto-évaluation de la dépression a été élaborée par le « National Institute of Mental Health » et validée depuis plus de vingt ans par des centaines d’études épidémiologiques réalisées à grande échelle sur des populations générales ou choisies. Au terme des 5 jours de l’étude, 879 questionnaires ont été recueillis. Le sex-ratio était de 53,4 p. 100 de femmes pour 46,6 p. 100 d’hommes. La prévalence de la symptomatologie dépressive évaluée par le questionnaire était de 23,6 p. 100 sur un total de 774 dossiers analysables. Les malades consultant sans rendez-vous (n = 172) représentaient 22 p. 100 des malades contre 78 p. 100 consultant de façon programmée (n = 602). Une symptomatologie dépressive était trouvée chez 31,4 p. 100 des malades consultant sans rendez-vous contre 21,4 p. 100 des malades de la consultation programmée (p < 0,01). Les hommes consultant sans rendez-vous étaient le sous-groupe le plus fragile avec 38,8 p. 100 de dépression. La prévalence de la symptomatologie dépressive dans une consultation dermatologique hospitalière a été évaluée à 23,6 p. 100 dans cette étude. Elle est significativement plus importante chez les malades consultant sans rendez-vous et chez les hommes en particulier. Elle est comparable ou supérieure à celle de maladies considérées comme plus invalidantes ou plus algiques évaluées par le même questionnaire. La fréquence de cette comorbidité dépressive invite le dermatologue à savoir la dépister et à prendre les mesures thérapeutiques appropriées afin de diminuer la souffrance psychique de leurs malades. Dermatological diseases modify and impair patients’ self-image and can result in considerable psychological suffering. The purpose of this study was to determine the prevalence of depressive symptoms in patients consulting for dermatological diseases. A prospective study was carried out on 5 successive days at the dermatology department of the Saint-Louis Hospital in Paris. A questionnaire designed to assess depressive symptoms, the CES-D, was given to all patients consulting throughout the study period. This self-assessment scale for depression was devised by the National Institute of Mental Health and has been validated over more than 20 years by means of hundreds of large-scale epidemiological studies in both general and selected patient populations. On completion of the 5-day study, 879 questionnaires had been collected. The sex-ratio was 53.4% women to 46.6% men. The prevalence of depressive symptoms as evaluated by the questionnaire was 23.6% for a total of 774 evaluable dossiers. Patients consulting without an appointment (n = 172) represented 22% of study subjects versus 78% attending a scheduled visit (n = 602). Depressive symptoms were found in 31.4% of patients consulting without an appointment versus 21.4% of patients with an appointment (p < 0.01). Male patients consulting without an appointment constituted the most fragile group, with depressive symptoms being seen in 38.8% of this population. The prevalence of depressive symptoms among patients seen at a hospital dermatology department was 23.6% in this study. This figure was significantly higher among patients consulting without an appointment, and among men in particular. It was equal to or higher than that seen among patients considered as having more incapacitating or painful conditions as assessed using the same questionnaire. The incidence of concomitant depression should prompt dermatologists to investigate for its existence and to take appropriate therapeutic measures in order to reduce the mental suffering of their patients.

BACKGROUND Clinical classification (C) of patients suffering from chronic venous disorders according to the Clinical, Etiology, Anatomy, and Pathophysiology Classification takes into account signs and symptoms, but the C3 (venous edema) class has been identified as poorly specific. Patients in whom physicians fail to observe significant edema (sign) frequently report a feeling of swelling (symptom). Previous studies of venoactive drugs have demonstrated significant reduction in leg volume, but the correlation with a clinical improvement was lacking. OBJECTIVE To describe the clinical status of a sample of Argentinean patients presenting with venous symptoms and signs. To demonstrate the relationship between the reduction of leg swelling and the improvement of symptoms of chronic venous disorders (CVDs) and quality of life (QoL) in patients with CVD. MATERIALS AND METHODS One thousand thirty-six patients were included prospectively and submitted to medical interrogation and examination and specific and generic self-questionnaires. Patients included were reassessed using the same tools after phlebotropic treatment (Ruscus+hesperidin+ascorbic acid), the prescription of which was expected to induce variations in clinical status. RESULTS Significant correlations were observed between ankle circumference reduction and improvement of all symptoms in C2 to C3 patients: heaviness, pain, paraesthesia, and cramps. Such correlations were found in C0 to C1 patients. There was a correlation between improvement attained in QoL and the physical dimension of the Chronic Venous Insufficiency Questionnaire. CONCLUSIONS Our results demonstrate the relevance of moderate ankle swelling, which is not usually described clinically as edema and is probably a typical symptom of chronic venous disorders. Future studies should focus on this insufficiently analyzed clinical feature and put to better use more specific QoL questionnaires.

Ichthyoses are a heterogeneous group of rare genodermatoses. Patients and their families face difficulties related to daily care and management that may be aggravated by social isolation. To evaluate the impact of therapeutic educational programs in improving the knowledge of ichthyosis patients, and their relatives, about their disease. We organized a two sessions-program of "know-how" dedicated to the overall management of ichthyoses. These sessions were conducted based on a tool specifically designed for the study, which addressed our various areas of expertise through a collective game. The participants (patients and their parents and siblings) were divided into groups, and the questions were tailored according to the participants' age. The program was conceived as a knowledge reinforcement program that took place during a weekend of education and rest, organized away from healthcare structures. Our aim was to facilitate the program in a neutral place to encourage respite care and to ensure the availability of a multidisciplinary healthcare team. After the reinforcement session, children aged from 6 to 12 years and their families acquired the targeted know-how and social skills. Benefits of TPE in the management of ichthyoses are the following: (1) the trust between patients their families and the caregivers was strengthened; (2) the context of the program encouraged self-expression, answered questions and provided mutual aid; and (3) the more self-sufficient families could better manage emergencies.