[Teledermatology in a prison setting: A retrospective study of 500 expert opinions]. / Télédermatologie en milieu carcéral : étude rétrospective de 500 télé-expertises.

BACKGROUND: Fresnes prison is one of the largest penitentiary centres in France (around 2300 inmates). Since dermatological consultations are not possible on site, a teledermatology agreement was signed in 2008 between the Kremlin-Bicêtre hospital, used by the Fresnes consultation unit and outpatient care (UCSA) and the Saint-Louis hospital for remote dermatological expertise. We report the results of the last 3 years of teledermatology activity in this prison. PATIENTS AND METHODS: All teledermatology consultations from September 2010 to September 2013 were analysed. The teledermatological consultations requested by UCSA doctors included photos of lesions, patient history and disease history. Applications were sent by e-mail via the secure AP-HP (Paris Hospitals) intranet. In all instances, patients had consented to being photographed and these photos were transmitted for remote expertise. The answers were given in a maximum period of 5 working days. The following data were studied: sex, age, phototype, medical history, diagnoses, assessments requested and treatment received. RESULTS: Five hundred teledermatological consultations were analysed. Among the patients, 94.1% were male with a mean age of 34 years. Phototypes IV and VI constituted the majority, with respective percentages of 30.6% and 28.6%. The dermatoses diagnosed were for the most part mild and varied: cutaneous infections (20.2%), monitoring of nevi (11.5%), genital warts (10%), eczema (8.5%), acne (8.1%) and psoriasis (4.2%). Two cases (basal cell carcinoma and lupus) required ablation. Systemic treatments such as methotrexate and isotretinoin were initiated and monitored remotely. DISCUSSION: The most frequently observed diagnoses were not significantly different from those observed in the general population with comparable characteristics. The high phototype of patients requires extensive experience of the dermatology of black skin. Teledermatology is also important in monitoring nevi among prisoners. The low incidence of scabies is due to its systematic detection in prisoners on initial entry into prison. Furthermore, teledermatology is actively used in the teaching of prison doctors requiring training, and whose requests are becoming more and more relevant with time. CONCLUSION: This study provides greater knowledge of dermatological diseases in prison and shows teledermatology to be a tool suited to the specific constraints of this universe, while providing inmates with medical care as close as possible to that of the general population, and it thus helps ensure that their fundamental human rights are upheld.

[Dependence for daily life activities in the prison population in Western France]. / Dépendance pour les actes de la vie quotidienne en milieu carcéral dans la région pénitentiaire Ouest.

OBJECTIVE: As the mean age of the penitential population rises and the duration of imprisonment grows longer, health services are confronted with the problem of prisoners dependent for daily life activities. The purpose of this study was to determine the number of prisoners dependent for daily life activities and quantify their dependency on human and material support. METHODS: A survey was conducted in the summer of 2,000 in the western region of France (19 prisons in the following regions: Pays-de-Loire, Brittany, Lower Normandy). RESULTS: Among the 4,168 persons incarcerated in these regions, 32 dependent prisoners were identified: 21 men (mean age 57 years) and 11 women (mean age 48 years). Among these persons, 19 suffered from major or moderate dependence (GIR 1-4). The main problems involved toilet facilities, dressing, transfers, and moving about. When human support was available, it was generally provided by other prisoners. Material help was scarce. DISCUSSION: The questions of prisoner's rights, human assistance, the status of caregivers, and the need for adapted architectural, material, and medical facilities are discussed. The information collected here provides a better knowledge of prisoners' needs for support and for changes which would be necessary in the prison environment.