Real-time mobile teledermoscopy for skin cancer screening targeting an agricultural population: an experiment on 289 patients in France.

BACKGROUND: The incidence of skin cancer has reached epidemic proportions in the white population and is significantly elevated in agricultural populations, who are exposed to ultraviolet radiation during their professional activities. In 2014, the Agricultural Social Insurance Mutual Benefit Fund (MSA) offered its customers who work in agriculture and live in rural areas with reduced access to dermatologists the ability to participate in a 1-day teledermoscopic (TDS) screening event. OBJECTIVE: This study's aim was to assess the feasibility of real-time mobile TDS triage of a large number of agricultural workers by trained medical officers and occupational physicians. METHODS: Fifteen TDS screening centres were located in different areas of France. Individuals older than 18 years who worked in agriculture and lived in rural area near a TDS screening centre were invited to participate in a 1-day screening event and were examined by an MSA physician. In cases of suspicious skin lesions, clinical and dermoscopic images were obtained and transferred immediately to four dermatologists who were simultaneously present at the tele-platform for diagnosis and decision-making. Low-quality images were retaken. RESULTS: Two-hundred eighty-nine patients underwent skin cancer screening. Among 199 patients (69%), 390 suspicious lesions were identified and generated 412 pictures. All lesions were analysed by dermatologists. For 105 patients (53%), no follow-up was required. Seventeen patients were referred to local dermatologists for rapid examination, including 12 cases of suspected malignant melanocytic lesions. Among the 12 patients with suspected melanoma, face-to-face visits were conducted within 10 days for 11 of them, and 1 case of melanoma was confirmed by histopathology. CONCLUSIONS: Our study suggests that teledermoscopy performed in the context of occupational medicine and targeted to agricultural populations is feasible and could be useful for improving skin cancer screening in at-risk populations while avoiding face-to-face examinations by a dermatologist in 53% of cases.

Efficacy and safety of a topically applied Avène spring water spray in the healing of facial skin after laser resurfacing.

BACKGROUND: Although laser resurfacing is a well-accepted treatment, tolerance problems may preclude patient's acceptance of the procedure. Post-laser protracted erythema is a prime problem, associated with the symptoms of pain, itching, stinging and tightening. OBJECTIVE: The present study was conducted to evaluate a low-salt medical spring water (Avène, Avène-les-Bains, France), in conjunction with the standard use of an emollient, to improve tolerance by hydrating the postlaser skin. METHODS: A controlled, randomized, open-labeled, multicentric and two parallel group study was completed after 84 days in 74 patients, 34 applying a petrolatum ointment alone (control group), and 40 applying petrolatum ointment in association with the Avène spring water spray ad libitum (water group). RESULTS: The water spray showed a pronounced effect on reducing erythema, from the second week of postlaser onwards, with a statistically significant difference in favor of the water group compared with the control group (p < or = 0.04 from day 14 to day 84, except a non-significant trend on day 28). In addition, the water spray was found to significantly reduce itching on day 28 (p < 0.05), and stinging and tightening on day 14 and day 21 (p < 0.05). Pain was not modified by the water. CONCLUSION: Topical water appears to be a helpful adjunctive treatment to petrolatum ointment for counteracting erythema, itching, stinging and tightening during the postlaser treatment period.

[Aggravation of acne by isotretinoin. 6 cases, predictive factors]. / Aggravation de l'acné sous isotrétinoïne. 6 cas, facteurs prédictifs.

OBJECTIVE: Acne flare-ups are frequent in the early phase of isotretinoin treatment. Severity varies from one patient to another. Clinical factors favoring a potentially severe course were assessed on the basis of 6 cases. CASE REPORTS: Six male patients, mean age 16.5 years, with inflammatory acne with a major retentional component were studied. Isotretinoin administered at a daily dose 0.5 mg/kg led to explosive development of massive nodulocystic lesions or pyogenic granulomas within two months. The lesions healed at withdrawal of isotretinoin and administration of antibiotics and antiinflammatory drugs. There was important scar sequellae. DISCUSSION: Four concomitant factors were identified which contribute to the development of acne flare-ups: sex (male), young age, retentional form of acne and daily isotretinoin dose 0.5 mg/kg.