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Immune-mediated dermatoses, such as psoriasis and atopic dermatitis, affect a significant proportion of the population. Although most cases are not life threatening, these diseases can have a profound effect on the sufferer's quality of life and that of their family. Systemic therapy, such as ciclosporin, is often indicated for severe or recalcitrant disease. The efficacy of ciclosporin in the treatment of psoriasis and atopic dermatitis has been established and clinical data also demonstrate its efficacy in treating less common but equally challenging conditions such as pyoderma gangrenosum, lichen planus, autoimmune bullous disease, recalcitrant chronic idiopathic urticaria and chronic dermatitis of the hands and feet. The risk of potential adverse events associated with ciclosporin is greatly reduced if current treatment and monitoring guidelines are followed. [ABSTRACT FROM AUTHOR]

The pattern of dermatoses occurring in travellers to tropical areas is poorly documented. To diagnose skin diseases in travellers to Burkina Faso by means of teledermatology; to assess the educational value of teledermatology for the local general practitioner (GP). Patients (Westerners and Burkinabese nationals) were included in the study if they presented with a cutaneous disease to the GP based in Ouagadougou, Burkina Faso. Images of the skin lesions were acquired with a point-and-shoot digital camera and sent via the Internet, together with the clinical history. Diagnostic concordance between dermatologists in France and the GP in Ouagadougou was analysed as a simple proportion of agreement and 95% confidence interval. One hundred and twenty-four patients (M/F ratio 1·17; 80·6% Westerners) were included in the study. One hundred and thirty dermatoses were identified: 73 (56%) were of infectious origin, and 19 (15%) were related to eczematous dermatitis. The skin infections were mainly due to bacteria (18%), fungi (14%) or arthropods (13%). Parasitic dermatoses were observed only in Burkinabese nationals. Among Westerners, fungal dermatoses were observed only in long-term residents. The diagnostic agreement between the local GP and the remote dermatologists was 49% overall (95% confidence interval 41–58). Agreement between the GP and the dermatologists on the dermatological category improved significantly over time ( P < 0·05). Telemedecine can improve the management of cutaneous diseases among Western travellers. Most dermatoses observed in Western travellers to Burkina Faso are of infectious origin. Teledermatology has educational value for local GPs. [ABSTRACT FROM AUTHOR]