Exploring the EQ-5D Dimension of Pain/Discomfort in Dermatology Outpatients from a Multicentre Study in 13 European Countries

Pain and discomfort are important symptoms in dermatology. The aim of this cross-sectional, multicentre study was to describe the prevalence of pain/discomfort and its associations in patients with several dermatological conditions across 13 European countries. The outcome was the prevalence of pain/discomfort according to a question of the EQ-5D questionnaire. Data collected from November 2011 to February 2013 were complete for 3,509 consecutive outpatients. Moderate or extreme pain/discomfort was reported by 55.5% of patients and 31.5% of controls with no skin conditions. The highest proportions were reported by patients with hidradenitis suppurativa (92.9%), leg ulcer (81.4%), prurigo (80%) and lichen planus (75.6%). Pain/discomfort was associated with older age, low educational level, clinical severity, flare on scalp or hands, itch, depression, anxiety, low quality of life, and thoughts of suicide. It is important to enquire specifically about pain/discomfort during clinical consultations and to address it when planning a patient's care.publishedVersio

The psychosocial burden of hand eczema: Data from a European dermatological multicentre study

Background: The essential physical role, visibility and social importance of the hands place a major psychological burden on patients with hand eczema. Objectives: The aim of this study was to identify the psychological, social and clinical characteristics of patients with hand eczema, in particular the prevalences of depression, anxiety, suicidal ideation, and comorbidities. Materials and methods: Data on patients with hand eczema were analysed from a large European multicentre study conducted with dermatology outpatients from 13 countries. Groups of patients and controls were compared to analyse the psychological burden of hand eczema. Results: Female patients with hand eczema had higher Hospital Anxiety and Depression Scale (HADS) scores for anxiety (n = 86, median = 7.0) than controls (n = 900, median = 5.0, P =.02), and for depression (median = 4.0) than controls (3.0, P 1, P =.038, P <.001, and P <.001, respectively]. The median Dermatology Life Quality Index score was 7.0 (n = 68). Discussion: This study identifies a specific psychological burden experienced by hand eczema patients, highlighting the need for focused psychosocial interventions. Physicians in particular should be aware of the need to identify anxiety and depression in female patients.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Global variability in leaf respiration in relation to climate, plant functional types and leaf traits

• Leaf dark respiration (Rdark) is an important yet poorly quantified component of the global carbon cycle. Given this, we analyzed a new global database of Rdark and associated leaf traits. • Data for 899 species were compiled from 100 sites (from the Arctic to the tropics). Several woody and nonwoody plant functional types (PFTs) were represented. Mixed-effects models were used to disentangle sources of variation in Rdark. • Area-based Rdark at the prevailing average daily growth temperature (T) of each site increased only twofold from the Arctic to the tropics, despite a 20°C increase in growing T (8–28°C). By contrast, Rdark at a standard T (25°C, Rdark25) was threefold higher in the Arctic than in the tropics, and twofold higher at arid than at mesic sites. Species and PFTs at cold sites exhibited higher Rdark25 at a given photosynthetic capacity (Vcmax25) or leaf nitrogen concentration ([N]) than species at warmer sites. Rdark25 values at any given Vcmax25 or [N] were higher in herbs than in woody plants. • The results highlight variation in Rdark among species and across global gradients in T and aridity. In addition to their ecological significance, the results provide a framework for improving representation of Rdark in terrestrial biosphere models (TBMs) and associated land-surface components of Earth system models (ESMs)

Psychodermatologie

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

What a dermatologist needs to know to transfer dermatological patients to the psychiatrist or psychologist

SCOPUS: re.jinfo:eu-repo/semantics/publishe

Le retentissement psychologique des pathologies chroniques du cheveu

The author is looking to the psychological consequences of chronic hair diseases through a review of the recent literature. In general those consequences are depending on the coping skills and on the personality traits. The effect of hair loss on the quality of life is similar to that of a severe psoriasis. The most important effect is a loss of self-confidence. This is enhanced by an insecure or ambivalent attachment pattern. The coping skills will therefore be different and less flexibles. Two psychiatric syndromes are first mentioned: the body dysmorphic syndrome (very slight or imaginary defect in appearance) and trichotillomania. Androgenetic alopecia leads to an important suffering in women mostly. Alopecia induced by cancer chemotherapy has been reported to cause changes in self-concept and body image. This does not return to the previous state after regrowth of hair for a majority of patients. A cosmeto-oncologic care strategy is developed in our department to improve the quality of life of the patients during this difficult coping period. Alopecia areata has an important psychiatric comorbidity: mostly anxiety and depression. Old stressful life events are frequently reported at the onset of the disease revealing a chronic stress. Those patients have difficulties to express their feelings (what is called alexithymia). With a systemic vision this is interpreted as an unconscious task of avoiding family conflicts. This conflicts are raising the anxiety of family splitting coming from early loss or death in the previous generations. A cautious family therapy helps to change those unconscious myths.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Psychodermatology in daily practice

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Transdisciplinarity - An essential prerequisite for psychodermatological healing

SCOPUS: ed.jinfo:eu-repo/semantics/publishe

Doctor-patient relations in dermatology: Obligations and rights for a mutual satisfaction

The author examines different aspects of patient-doctor relationship in dermatological consultations. At first, a definition of patients satisfaction is given, based on available literature. It has been shown that satisfaction depends on diagnosis, but also on the doctor's ability to provide explanations on the probable cause of the illness, information on how long the symptom will probably last, and if she/he demonstrates empathy. Satisfaction also increases if the illness is serious, but decreases if quality of life linked to the symptom is underestimated by the doctor. After providing a philosophical definition of ethics, which emphasizes the importance of mutual satisfaction of patient and doctor, the concepts of empathy and compassion in patient-doctor relations are defined. Their importance in consultations is underlined, reporting, for example, that doctors with good communication skills experience fewer difficult consultations (8% vs. 23%). Afterwards, the dermatological consultation is analysed in its practical aspects, trying to define a good-quality consultation. First of all, the pitfalls that can affect good time management are analysed, suggesting to structure the consultation using the Soap method. Particular situations are analysed, such as announcing bad news and dealing with borderline patients. Finally, the concept of transference is defined, remembering that doctor-patient relationships can replay some difficult relationship coming from the past, and thus doctors need to be aware of this possibility and learn how to manage it. © 2009 European Academy of Dermatology and Venereology.SCOPUS: re.jFLWINinfo:eu-repo/semantics/publishe

How to be a happy dermatologist

SCOPUS: ed.jinfo:eu-repo/semantics/publishe