[Outpatient expectations in dermatology consultations: A pilot study]. / Attente des patients consultant un dermatologue «de ville¼: une étude pilote.

BACKGROUND: Understanding patients' expectations with regard to medical care is critical as it guarantees an efficient therapeutic process. Our aim was to determine outpatients' expectations concerning clinical encounters in a dermatology clinic and to study how these matched the opinions of dermatologists regarding them. PATIENTS AND METHODS: Consecutive outpatients consulting in five dermatology centres in the Paris suburbs between February 2013 and March 2013 were prospectively included. For this pilot cross-sectional study, we used two standardized forms to collect data from patients and dermatologists. Patients' answers were compared to those of their dermatologist, and the degree of matching was calculated to assess the ability of dermatologists to accurately identify their patients' expectations. RESULTS: Two hundred and sixty-five patients were included, with a median age of 41 years (interquartile range: 25; 62), of whom 166 were women (65.4%). Patient's principal expectations concerned diagnosis (51.7%) and medication (40.8%), with 32.1% of patients requiring reassurance. The rates of matching between patients' and dermatologists' answers ranged from 33.3% to 65.7% according to the type of expectations. The highest rate concerned expectation with regard to medications, being only 52.6% and 58.8%, respectively for expectations regarding diagnosis and the need for reassurance. CONCLUSION: This study highlights the need for improved identification of outpatient expectations in dermatology consultations.

[Stress and seborrheic dermatitis]. / Stress et dermatite séborrhéique.

BACKGROUND: It is widely accepted that episodes of seborrheic dermatitis are frequently induced by stress, as stated in all general reviews of the subject. However, there have been no studies to confirm this view. PATIENTS AND METHODS: This prospective study was performed in two phases. An initial questionnaire collected information on patients' identity, somatic and psychiatric history and seborrheic dermatitis characteristics. Information on triggering episodes was sought by means of an open question and patients were then asked if they had experienced stress during the week or month prior to the active episode. A second questionnaire containing the same questions (except for history) was completed four months later. The two questionnaires contained psychopathological evaluation scales designed to detect symptoms of anxiety and depression among patients (HAD: Hospital Anxiety and Depression scale; Beck; STAI: State-Trait Anxiety Inventory) and determine their perceived stress (PSS: Perceived Stress Scale by Cohen and Williamson). RESULTS: Eighty-two patients (36 women and 46 men) were included in the study. 82% of patients presented involvement of scalp, 33% of the face, 19% of the chest and 13% of other sites (ears, skinfolds). Patients themselves identified stress as the main triggering factor, whether for episodes in general, for the first episode or for the current episode. A stressful event was in fact found in the majority of cases. The fact that stress was recognised as a triggering factor for episodes was not associated with a higher depression score (HAD or Beck) but was associated with a higher anxiety score (STAI). The psychological effects of the disease were pronounced in 11% of patients, moderate in 20%, mild in 35%, and nil in 25%, with 9% of patients stating no opinion. Patients with facial involvement were more depressed in terms of Beck Depression Index score. Two characteristics noted at inclusion were predictive for the onset of at least one further episode or persistence of an ongoing episode four months later: patients' designation of stress as the cause of the previous episode, and STAI score. DISCUSSION: This study confirms that seborrheic dermatitis is often preceded by a stressful event and that stress tends to suggest a poor prognosis. This is the first study to show a possible link between stressful life events and episodes of seborrheic dermatitis. It suggests the need to confirm these results through a study comparing patients with seborrheic dermatitis and subjects without the disease. It also shows that depression is more common among patients with facial involvement and that anxiety is an aggravating factor.

[Vulvovaginogingival syndrome. New characteristic grouping of plurimucous erosive lichen planus]. / Le syndrome vulvo-vagino-gingival. Nouveau groupement caractéristique du lichen plan érosif plurimuqueux.

The triple association of a chronic painful erosive vulvitis, an erosive or desquamative vaginitis and an erosive vestibular gingivitis constitutes a hitherto unreported syndrome. The first 19 cases of this affection seen in the Hôpital Tarnier over the last three years are presented and analyzed, the etiology of these erosive mucosal lesions, limited to three body regions, being lichen planus in each case. Detection of mucosal erosion at one of these three sites now requires clinical investigation of the other two, and biopsy of least one of them from the edge of an eroded zone, as well as search for other-possible mucocutaneous areas of lichen planus. Clinical onset is often asynchronous, one lesion appearing before the others, the simplest to recognize being gingival erosive lichen. In one case, however, peri-erosive lamellar detachments suggested chronic desquamative gingivitis of possible benign pemphigoid origin. Erosive lichen planus of vulva and vagina has not been reported previously. Knowledge of this syndrome allows correlation between lichen planus and certain cases of erosive gingivitis, erythroplastic vulvitis and desquamative vaginitis.

Inhibition of growth of B16 murine malignant melanoma by exogenous interferon.

We previously reported that polyinosinic-polycytidylic acid, a potent interferon inducer, inhibits the growth of B16 malignant melanoma in the C57BL/6 mouse. Two experiments were done to evaluate the effectiveness of interferon in tumor inhibition in vivo. In the first, mice were implanted with melanoma and divided into four groups, according to treatment: interferon preparation; interferon control preparation ("breakthrough fraction"); phosphate-buffered saline control; and murine serum albumin control. Daily, each mouse was given i.p. injections of 200,000 NIH reference units (hereafter called units) of interferon or of one of the control substances. The second experiment was similar to the first, except that bovine serum albumin was an additional control. In both experiments, the average tumor volume in interferon-treated mice was statistically significantly smaller than that of each control group. Mouse interferon preparations also inhibited the multiplication of B16 malignant melanoma cells in culture. This inhibition was statistically significant from interferon levels as low as 5 to as high as 5000 units/ml. The degree of inhibition markedly increased from 5 up to 500 units, the inhibition reaching its maximum at this concentration. The inhibitory effect of interferon was abrogated by anti-murine interferon serum produced in a rabbit. These findings suggest that the in vivo inhibition of the growth of B16 melanoma demonstrated with polyinosinicpolycytidylic acid and with exogenous interferon probably results, at least in part, from a direct effect of interferon on the tumor cells themselves.