title: [Teledermatology in a prison setting: A retrospective study of 500 expert opinions].
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dermatologie, hôpital Saint-Louis, AP-HP, 1, rue Claude-Vellefaux, 75010 Paris, France. Electronic address: boutaina.k@hotmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Khatibi
authors.affiliation: UCSA, maison d'arrêt de Fresnes, 1, allée des Thuyas, 94260 Fresnes, France.
authors.forename: A
authors.initials: A
authors.lastname: Bambe
authors.affiliation: UCSA, maison d'arrêt de Fresnes, 1, allée des Thuyas, 94260 Fresnes, France.
authors.forename: C
authors.initials: C
authors.lastname: Chantalat
authors.affiliation: Biostatistiques, hôpital Saint-Louis, AP-HP, 1, rue Claude-Vellefaux, 75010 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Resche-Rigon
authors.affiliation: Biostatistiques, hôpital Saint-Louis, AP-HP, 1, rue Claude-Vellefaux, 75010 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Sanna
authors.affiliation: UCSA, maison d'arrêt de Fresnes, 1, allée des Thuyas, 94260 Fresnes, France.
authors.forename: C
authors.initials: C
authors.lastname: Fac
authors.affiliation: Dermatologie, hôpital Saint-Louis, AP-HP, 1, rue Claude-Vellefaux, 75010 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bagot
authors.affiliation: Dermatologie, hôpital Saint-Louis, AP-HP, 1, rue Claude-Vellefaux, 75010 Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Guibal
mesh_terms: D000328:Adult; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D011329:Prisoners; D019114:Remote Consultation; D012189:Retrospective Studies; D012871:Skin Diseases / Q000175:diagnosis*
keywords: Prison; Teledermatology; Télédermatologie