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We have focused our study on chronic inflammatory dermatoses like psoriasis and atopic dermatitis because these dermatology patients have a particular profile. Thus, we insist that dermatology residents read the medical history of a patient before the consultation instead of searching for the history while consulting the patient. [Extracted from the article]

Prompting doctors to use TD for SC diagnosis and SC pathway organization would prevent increased morbidity, mortality and health care costs. Skin cancer and COVID-19: was the diagnosis safeguarded by teledermatology? Contrary to the persistence of a general decline in skin cancer diagnoses during the second wave,6,8,9 SC diagnosis through TD showed no decrease compared to 2019. [Extracted from the article]

In conclusion, while it helped substitute many in-person consultations when necessary, TD did not to take off during the COVID-19 pandemic. The monthly number of scheduled consultations, dermatological emergency unit (DEU) visits, LI TD consultations and SF TD requests were retrieved from January 2019 to December 2020. I To the Editor, i During the first COVID-19 pandemic wave, dermatologists were urged to postpone non-urgent and outpatient visits,1 to limit COVID-19 spreading. [Extracted from the article]

At diagnosis of ECTL, only one patient displayed an enlarged node > 1-5 cm (not biopsied), and the median number of Sézary cells was 1440 per mm SP 3 sp (range 396-4930). Dear Editor, The prognosis of erythrodermic cutaneous T-cell lymphomas (ECTL) depends on lymph node (N) and visceral (M) involvement, and blood stage (B). Pathological data at progression were reviewed for eight patients: skin biopsy (four patients), node biopsy (five patients) and cerebrospinal fluid (one patient). [Extracted from the article]

Most patients presenting to the DEU neither have real emergencies nor require hospital referrals. This is comparable to the high percentage of discharged patients (87.1%) presenting to the general emergencies unit for a dermatologic condition.5 It is also consistent with a previous study in 2014 in our department.2 However, hospitalization rate from the DEU decreased from 1.2% to 0.38%. Characteristics of patients who needed a hospital referral (hospitalization, follow-up, day care hospital) were compared with those who did not. [Extracted from the article]

The causal link between chilblain-like lesion and COVID-19 is highly controversial.7 Similar to the first CLL outbreak, which was observed away from cold weather, TD networks also enabled the detection of a second CLL outbreak before the cold weather of winter and concomitant with the second peak of COVID-19 deaths in France. These findings confirmed the second wave of CLLs previously described by Piccolo et I al i .8 The clinical and histopathological features of COVID-19-associated CLLs have been described as similar to non-COVID-19-associated CLLs. Most chilblains observed during the COVID-19 outbreak occur in patients who are negative for COVID-19 on polymerase chain reaction and serology testing. [Extracted from the article]

The article discusses the issue of diagnostic wandering in patients with hidradenitis suppurativa (HS), a skin condition that affects a small percentage of the population. The study conducted in France found that misdiagnosis of HS is common, leading to delays in proper treatment. Factors such as gender, age, income, and education level were associated with diagnostic wandering, with women more likely to experience delays. The study suggests that targeted education for medical professionals could help reduce delays and improve outcomes for HS patients. [Extracted from the article]

Competing Interests: Conflicts of interest: The authors declare no conflicts of interest.

Background: Diagnosing red legs on first presentation is challenging. There exists a lack of robustly developed and validated diagnostic red leg tools in clinical practice. Physicians fear missing cases of infectious red legs and treat many patients unnecessarily with antibiotics., Objective: Develop and validate easy-to-use diagnostic tools applicable at bedside of patients to orient diagnosis of the commonest and most serious causes of infectious red legs (non-necrotizing bacterial dermohypodermitis (NNBDH), and necrotizing fasciitis (NF)) versus the commonest inflammatory cause (eczema)., Methods: We collected data of patients presenting to our dermatology department from January first 2012 until May 17th 2017 with a diagnosis of red leg. Three models were developed using fast frugal trees. Validation was performed in a second cohort of patients., Results: A total of 187 patients (mean age 56, SD = 21 years, 48.1% women) were included in the development phase and 62 patients (mean age 64, SD = 19, 52% women) in the validation phase. In the validation data set, sensitivity and specificity were respectively 67% and 91% for NNBDH, 83% and 66%, for NF and 88% and 93%, for eczema., Conclusion: Presentations of suspected lower-limb infections are commonly misdiagnosed, resulting in avoidable antibiotic prescription and hospitalization. We developed an easy-to-use clinical diagnostic tool applicable at the bedside of patients to help orient physicians in certain situations and avoid unnecessary initiation of antibiotics. Future work should focus on validating this tool in primary care to minimize misdiagnosis of red legs and overprescription of antibiotics., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Very few studies have evaluated the global prevalence of pruritus., Objectives: To assess its prevalence according to age, sex, ethnicity and geographic region., Methods: An international cross-sectional study was conducted in 20 countries from January to April 2023. Participants were asked to complete a questionnaire on sociodemographics, and to confirm the presence or absence of a skin disease in the last 12 months and the presence or absence of pruritus in the last 7 days., Results: The studied sample included 50 552 individuals. The worldwide prevalence of pruritus was 39.8%. The age group ≥ 65 years had the highest prevalence (43.3%). The prevalence was 40.7% among women and 38.9% among men (P < 0.001). There was no significant difference between ethnicities (P = 0.14). Compared with North America (41.2%), the prevalence of pruritus was significantly lower in Europe (35.9%, P < 0.001), Australia (38.4%, P = 0.017), East Asia (40.2%, P = 0.04) and Latin America (36.5%, P < 0.001), and higher in Africa (45.7%, P = 0.007). No significant difference was found with the Middle East (40.2%, P = 0.36). The prevalence of pruritus in BRICS countries (40.3%) was significantly higher than that in developed countries (38.7%) (P < 10-3)., Conclusions: Out analysis is limited because there is no information about the severity or type (acute, chronic) of pruritus. The global prevalence of pruritus revealed age, sex and geographic region differences, with no ethnic differences., Competing Interests: Conflicts of interest M.S.A., N.P.C. and C.B. are employed by the Pierre Fabre Laboratory. G.Y., C.S., C.T., M.I., Y.B.H., B.H., M.A.R. and L.M. have no conflicts of interest in this study., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists.)

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., (© 2024 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Secondary bacterial infections of common dermatoses such as atopic dermatitis, ectoparasitosis, and varicella zoster virus infections are frequent, with Staphylococcus aureus and Streptococcus pyogenes being the bacteria most involved. There are also Gram-negative infections secondary to common dermatoses such as foot dyshidrotic eczema and tinea pedis. Factors favoring secondary bacterial infections in atopic dermatitis, ectoparasitosis, and varicella zoster virus infections mainly include an epidermal barrier alteration as well as itch. Mite-bacteria interaction is also involved in scabies and some environmental factors can promote Gram-negative bacterial infections of the feet. Furthermore, the bacterial ecology of these superinfections may depend on the geographical origin of the patients, especially in ectoparasitosis. Bacterial superinfections can also have different clinical aspects depending on the underlying dermatoses. Subsequently, the choice of class, course, and duration of antibiotic treatment depends on the severity of the infection and the suspected bacteria, primarily targeting S. aureus. Prevention of these secondary bacterial infections depends first and foremost on the management of the underlying skin disorder. At the same time, educating the patient on maintaining good skin hygiene and reporting changes in the primary lesions is crucial. In the case of recurrent secondary infections, decolonization of S. aureus is deemed necessary, particularly in atopic dermatitis., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Competing Interests: Conflicts of interest Drs Baissac, Cullell, and Aroman are employees of Pierre Fabre, France. Dr Saurat, Dr Halioua, Author Hayoun, Dr Taieb, and Dr Skayem have no conflicts of interest to declare.

Competing Interests: Conflicts of interest M.S.A., C. Baissac and H.G. are employed by Pierre Fabre. The other authors declare no conflicts of interest.

Cutaneous lichen planus is a highly pruritic dermatosis with an unmet need in its management. The aim of this study was to evaluate the short-term effect and tolerance of high doses of clobetasol propionate 0.05% in cutaneous lichen planus. We conducted a single-center retrospective cohort study from 2017 to 2021. All adults treated with high-dose (>5 g/day) clobetasol propionate 0.05% for cutaneous lichen planus were included. Patients with less than 10% affected body surface area at initial presentation or who received concomitant systemic therapy were excluded. The primary endpoint was the rate of complete remission by week 16. Secondary endpoints included maximum daily and median cumulative doses, reduction in pruritus and occurrence of adverse events. Fifty-seven patients, 60% female, with a mean age of 48 years (min-max,18-83) were included. Cutaneous lichen planus had been present for a median duration of 2 months at initial presentation (min-max, 1-4) and involved a median body surface area of 27%. Pruritus was reported by 55/57 (96%) patients. At week 16, 41/57 (72%) patients had achieved complete remission without treatment modification, among whom 25/41 (61%) had achieved it at week 6. The median daily and cumulative doses were, respectively, 20 g/day (IQR, 10-20) and 560 g (IQR, 320-925). Three patients experienced mild adverse events. No statistical association was demonstrated between the duration of the disease before treatment initiation and clinical response. In conclusion, high-dose clobetasol propionate 0.05% seems to be an effective, well-tolerated, and easy-to-implement treatment for cutaneous lichen planus., (© 2022 Japanese Dermatological Association.)

The aim of this multi-centre French retrospective study was to identify severe, i.e. crusted and profuse, scabies patients. Records were retrieved from 22 Dermatology or Infectious Diseases departments in the Ile-de-France from January 2009 to January 2015 to characterize epidemiology, demography, diagnosis, contributing factors, treatment features, and outcomes in severe scabies. A total of 95 inpatients (57 crusted and 38 profuse) were included. A higher number of cases was observed among elderly patients (>75 years), mostly living in institutions. Thirteen patients (13.6%) reported a history of previously treated scabies. Sixty-three patients (66.3%) had been seen by a previous practitioner for the current episode (up to 8 previous visits). Initial misdiagnosis (e.g. eczema, prurigo, drug-related eruptions, psoriasis) was documented in 41 patients (43.1%). Fifty-eight patients (61%) had already received 1 or more previous treatments for their current episode. Forty percent received corticosteroids or acitretin for an initial diagnosis of eczema or psoriasis. Median time from the onset of symptoms to the diagnosis of severe scabies was 3 months (range 0.3-22). Itch was present in all patients at diagnosis. Most patients (n=84, 88.4%) had comorbidities. Diagnostic and therapeutic approaches varied. Complications occurred in 11.5% of cases. To date, there is no consensus for diagnosis and treatment, and future standardization of is required for optimal management.

Competing Interests: Conflicts of interest None disclosed.

Competing Interests: Competing interests: None declared.

Background: Teledermatology was raised as a potential answer to increase access and decrease delay for skin cancer management. However, its influence on non-melanoma skin cancer (NMSC) care pathway has never been studied., Objectives: To compare conventional care pathway to teledermatology (TD) in NMSC care pathways using a process modelling approach., Patients and Methods: A period study including three groups was conducted in a department of dermatology. During the first period from January till February 2013 a NMSC care pathway was mapped for a group a prior TD integration. During the second period from September 2016 till October 2018, the NMSC care pathway was determined for patients managed by a conventional care process and after TD diagnosis. Patients characteristics, type of tumors and processes were compared using time as a key performance indicator. Mean were reported with their ± SD. Linear regression was performed using time between multidisciplinary consultation and surgery as outcome adjusted on sex, age and cancer type., Results: During the first period (prior to TD) 89 NMSC patients were managed (mean age = 76 yr old ± 13) during the second period, 36 patients NMSC were managed after TD, mean age of 89 years old ± 6 and 954 patients in a conventional process, mean age of 78 years old ±12. In comparison between the two periods patient's age, sex and cancer distribution significantly differed while the rate of surgery was not significantly different (p = 0.967). Linear multivariate regression using time between multidisciplinary consultation and surgery as outcome adjusted on sex age and cancer type displayed that during the second period patients in the TD group spent 17.6 days more [0.98,34.25] while patient in the conventional care process group had 9.8 days [1.85,17.74] more than patient in the study period 1, (p = 0.04, p = 0.02) without significant difference for age and sex (p = 0.29, p = 0.51). Patients with a SCC had a decreased time between multidisciplinary consultation and surgery of -12.97 days [-17.43, -8.5], p < 10 -3 ., Conclusion: Interestingly, patients managed by TD were significantly older than those managed using a conventional care pathway. Unexpectedly their total time spent in the process was not shorter. The results of this analysis illustrated the interest of using process modelling approach to assess the impact of a healthcare innovation integration and to further rethink coordination and care pathways for NSMC post TD., (Copyright © 2020 Elsevier B.V. All rights reserved.)