C Paul

Paul Sabatier University - Toulouse III, Tolosa de Llenguadoc, Midi-Pyrénées, France

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Publications (170)363.73 Total impact

  • Journal of the European Academy of Dermatology and Venereology 09/2014; · 2.69 Impact Factor
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    ABSTRACT: Background Secukinumab is a fully human anti–interleukin-17A monoclonal antibody.Objective Determine the efficacy, safety and usability of secukinumab administered via autoinjector/pen.Methods This phase III trial randomized subjects with moderate to severe plaque psoriasis to secukinumab 300 mg, 150 mg or placebo self-injection once weekly to Week 4, then every 4 weeks. Co-primary end points at Week 12 were ≥75% improvement in Psoriasis Area and Severity Index (PASI 75) and clear/almost clear skin by investigator's global assessment 2011 modified version (IGA mod 2011 0/1). Secondary end points included autoinjector usability, assessed by successful, hazard-free self-injection and subject-reported acceptability on Self-Injection Assessment Questionnaire.ResultsWeek 12 PASI 75 and IGA mod 2011 0/1 responses were superior with secukinumab 300 mg (86.7% and 73.3%, respectively) and 150 mg (71.7% and 53.3%, respectively) vs. placebo (3.3% and 0%, respectively) (P < 0.0001 for all). All subjects successfully self-administered treatment at Week 1, without critical use-related hazards. Subject acceptability of autoinjector was high throughout 12 weeks. Adverse events were higher with secukinumab (300 mg, 70.0%; 150 mg, 63.9%) vs. placebo (54.1%), with differences largely driven by mild/moderate nasopharyngitis.Conclusion Secukinumab delivered by autoinjector/pen is efficacious, well-tolerated and associated with high usability in moderate to severe plaque psoriasis.
    Journal of the European Academy of Dermatology and Venereology 09/2014; · 2.69 Impact Factor
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    ABSTRACT: Background Some international guidelines have been published to provide the best care for patients with psoriatic arthritis (PsA) but little is known about their quality.Objective The primary aim of this study was to examine the quality of guidelines that concern treatment (biotherapy exluded) of PsA. The secondary aim was to review studies published since the publication of the most recent guideline.MethodsA systematic literature search was carried out from 2007 to February 2013, in the Embase, Medline and Cochrane Library databases, in English and French using a combination of keywords including ‘Arthritis, Psoriatic/therapy’ NOT ‘Biological Therapy’ OR ‘Antibodies, Monoclonal’ OR ‘Recombinant Fusion Proteins’ OR ‘tumour necrosis factor-alpha’. The AGREE instrument (Appraisal of Guidelines Research and Evaluation) was used by four reviewers to evaluate the quality of selected guidelines according to the proposed methodology.ResultsOf the 518 identified references, six guidelines and two studies were selected. There was considerable variation in the quality of clinical guidelines across the AGREE domains. The least well-addressed domains were ‘applicability’, ‘stakeholder involvement’, ‘scope and purpose’ and ‘quality of development’, whereas ‘editorial independence’ and ‘clarity and presentation’ were less problematic.Conclusion Although guidelines development was of good quality, many of the studies that they included are of poorer quality. This work indicates that the current guidelines can be improved, particularly the stakeholder domain and the applicability domain. The prospective use of the AGREE instrument should improve the guideline quality. More controlled trials should be required but are unlikely to be conducted, given the lack of interest in studying old drugs.
    Journal of the European Academy of Dermatology and Venereology 08/2014; 28(s5). · 2.69 Impact Factor
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    ABSTRACT: Background Psoriatic arthritis (PsA) can develop at any time during the course of psoriasis.AimsThe aims of these practical recommendations are to help dermatologists identify patients at risk of PsA, to diagnose PsA in collaboration with rheumatologists and to gain a better understanding of initial PsA management.Materials and methodsA scientific committee consisting of 10 dermatologists and a rheumatologist selected clinically relevant questions to be addressed by evidence-based recommendations using the DELPHI method. For each question, a systematic literature review was performed in Medline, Embase and the Cochrane Library databases. The levels of evidence of all selected and reviewed articles were appraised according to the Oxford levels of evidence.ResultsAn expert board of 30 dermatologists reviewed and analysed the evidence and developed recommendations for the selected questions. Agreement among participants was assessed on a 10-point scale, and the potential impact of the recommendations on clinical practice was evaluated. Among the 6960 references identified, 190 relevant articles were included in the reviews. Three recommendations regarding risk factors for PsA and one regarding PsA prevalence were issued. The mean agreement score between participants varied from 7.8 to 9.6. Three recommendations on PsA screening tools that can be used by dermatologists were issued. The mean agreement score between participants varied from 7.7 to 9.4. Initial PsA treatment options according to published guidelines were critically appraised for axial and peripheral involvement and enthesitis/dactylitis. Three recommendations were issued. The mean agreement score between participants varied from 7.6 to 8.7.DiscussionThe systematic literature research and meta-analyses did not provide high-quality evidence to support recommendations regarding PsA screening. Conversely, PsA treatment options were supported by strong evidence.Conclusion Cooperation between dermatologists and rheumatologists should be emphasized to better identify and manage PsA patients.
    Journal of the European Academy of Dermatology and Venereology 08/2014; 28(s5). · 2.69 Impact Factor
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    ABSTRACT: Background Up to 29% of patients with psoriasis seen by dermatologists have undiagnosed psoriatic arthritis (PsA). As early detection of PsA may be associated with improved joint and skin outcomes, it is essential for dermatologists to improve their ability to diagnose PsA. Skin and nail features of psoriasis associated with PsA are well known to dermatologists but they may feel less confortable assessing other symptoms and they rarely use PsA screening questionnaires.Objective To develop a limited list of clinical signs and symptoms that a dermatologist should be looking for in a psoriasis patient in addition to specific skin features and nail involvement, to improve PsA detection.MethodsA systematic search was performed in Pubmed, Cochrane and Embase databases to identify clinical key symptoms associated with PsA. It yielded 27 studies in which we extracted a list of clinical signs and symptoms observed in PsA and submitted it to a panel of dermatology experts through a DELPHI selection process. The experts had to determine which minimal set of signs and symptoms dermatologists should look for in daily practice to improve detection of PsA in patients with psoriasis.ResultsThe four items that received a score higher than 90% in the DELPHI process were finally selected. Those items were as follows: peripheral inflammatory pain (100%), axial inflammatory pain (95.3%), dactylitis (93%), buttock and sciatic pain (90.7%). The remaining items: distal interphalangeal joints (DIPs) involvement (83.7%), Talalgia (79.1%), swollen Achille's tendon (41.9%), costo-chondral involvement (32.6%), uveitis (7%), mouth ulcerations (2.3%), were not retained.Conclusion We propose a set of four items to screen psoriasis patients for psoriatic arthritis for routine clinical use by dermatologists.
    Journal of the European Academy of Dermatology and Venereology 08/2014; 28(s5). · 2.69 Impact Factor
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    ABSTRACT: Psoriatic arthritis (PsA) is associated with psoriasis with a prevalence varying from 5.94% to 23.9%. The aim of this study was to assess if some psoriatic skin features are associated with a higher risk of PsA. A systematic literature search was carried out from 1980 to January 2013, in the Embase and Pubmed databases, using a combination of keywords including (Psoriasis) AND (PsA). Of the 2746 articles retrieved, 25 references were selected. Meta-analysis was performed when possible. Mean age at psoriasis onset appeared to be similar among patients with skin disease alone and in those with PsA. There was no clinical type of psoriasis specifically associated with PsA, including pustular psoriasis of palms and soles. Nonetheless specific psoriasis localizations were significantly associated with an increased risk of developing PsA in one cohort study: scalp lesions [Hazard Ratio (HR) 3.89 (95% confidence interval (CI):2.18–6.94)] and intergluteal/perianal lesions [HR 2.35 (95%CI:1.32–4.19)]. A similar association was found in two cross-sectional studies. Nail involvement was significantly associated with PsA in the meta-analysis [Odds Ratio (OR) 2.92 (95% CI 2.34–3.64)], particularly onycholysis [OR 2.38 (95% CI 1.74–3.26)]. Moreover, nail psoriasis was also associated with distal interphalangeal joint arthritis. The extent of psoriasis appeared to be associated with PsA in one cohort study [≥3 sites: HR 2.24 (95% CI 1.23–4.08)], one case–control study [body surface area >75%: OR 2.52 (95% CI 1.33–4.75)] and three cross-sectional studies. The meta-analysis suggested a trend for an association between high PASI and PsA risk [mean difference 3.39 (95% CI 0.94–5.83)]. Therefore, psoriasis patients with such clinical features may require a particular attention for early and close detection of PsA during the course of the cutaneous disease.
    Journal of the European Academy of Dermatology and Venereology 08/2014; 28(s5). · 2.69 Impact Factor
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    ABSTRACT: Background Palmoplantar pustular psoriasis (PPPP) is a variant of psoriasis whose the association with psoriatic arthritis (PsA) has been recently described. There is limited evidence regarding how to best reduce palmoplantar pustular psoriasis severity and to maintain remission once achieved.Objective The aim of this study was to elaborate evidence-based recommendations for PPPP treatment supported by a systematic literature review.MethodsA systematic literature search was carried out in Embase, Medline and Cochrane Library databases from 1980 to February 2013 searching for any trial in patients with PPPP assessing therapeutic interventions not including a systemic biotherapy. The selection of articles was limited to human subjects and English or French languages.ResultsAmong the 675 articles identified, 29 including one Cochrane review were analysed. The Cochrane review summarised 23 randomised controlled trials (RCTs) in chronic PPPP until February 2003, including 724 patients. The authors concluded that oral retinoid therapy (acitretin), photochemotherapy or combination of both, low dose of ciclosporin or topical corticosteroids under occlusion appeared to be helpful in relieving symptoms of PPPP. Since the publication of this review, 9 open studies on PPPP treatment have been published. Three new studies evaluated the benefits of PUVA on PPPP. They all showed a better efficacy of PUVA compared to UVB therapy. One open study concluded that a retinoid treatment with an arotinoid ethylesther showed a good efficacy. Five prospective studies (level of evidence of 3) assessed Laser Excimer UVB-NB (Excimer 308 nm) in PPPP. The combined analysis of these studies showed that 64% of patients experienced an improvement of 70% at the end of treatment.Conclusion Phototherapy, ciclosporin and topical corticosteroids seem to be able to control PPPP. However, the standard of care for PPPP remains an issue and there is a strong need for reliable RCTs to better define treatment strategies for PPPP.
    Journal of the European Academy of Dermatology and Venereology 08/2014; 28(s5). · 2.69 Impact Factor
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    M.‐A. Richard, C. Paul
    Journal of the European Academy of Dermatology and Venereology 08/2014; 28(s5). · 2.69 Impact Factor
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    ABSTRACT: Background To date, there is no global consensus on the definition of the severity of psoriasis. The REFlective evaLuation of psoriasis Efficacy of Treatment and Severity (REFLETS) questionnaire has recently been developed to provide a better understanding of plaque-type psoriasis severity and treatment efficacy from both patient and clinician perspectives.Objective This study aimed to develop and psychometrically validate the new REFLETS questionnaire to evaluate patient and clinician perceptions of plaque-type psoriasis severity and treatment efficacy.Methods Two similar versions of the REFLETS questionnaire were developed following a rigorous methodology for clinicians and patients, referring to ‘the psoriasis of your patient' or to ‘your psoriasis’, respectively. An observational, longitudinal, multicentre study was conducted in France with 34 dermatologists and 430 mild to severe plaque-type psoriasis patients to finalize the questionnaire and evaluate its psychometric properties.ResultsTwo dimensions were defined – severity and treatment efficacy – with three subdimensions within severity (impact of psoriasis, symptoms and disease course), and two individual items on joint pain. The questionnaire was well accepted by clinicians and patients. Excellent internal consistency (Cronbach's alpha = 0.66–0.98) and test–retest reliability (intraclass correlation coefficients = 0.83–0.94) were demonstrated. REFLETS scores were moderately to highly correlated to Psoriasis Area and Severity Index (r = 0.35–0.70), Skindex-29 (r = 0.46–0.82) and DLQI scores (r = 0.36–0.82). Patients with decreased psoriasis severity and those with increased treatment efficacy, according to patient global evaluations, had lower severity and higher treatment efficacy REFLETS scores, respectively.ConclusionREFlective evaLuation of psoriasis Efficacy of Treatment and Severity is a promising tool for assessing plaque-type psoriasis severity and treatment efficacy from patient and clinician perspectives. It may help to improve patient and clinician communication in treatment decision making.
    Journal of the European Academy of Dermatology and Venereology 06/2014; · 2.69 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 05/2014; 141(5):374-5. · 0.60 Impact Factor
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    ABSTRACT: Background Early diagnosis and rapid surgical excision are essential for improving the prognosis of melanoma patients. Reflectance confocal microscopy has been validated as a feasible procedure for in vivo diagnosis of melanoma but cannot be used to measure tumour thickness. However, ultrasonography and optical coherence tomography may allow melanoma thickness to be measured in vivo.Objectives Primary: To validate the accuracy and reliability of high-frequency ultrasonography and optical coherence tomography for assessing melanoma thickness in vivo.Methods We conducted a prospective study on 131 patients with at least one equivocal melanocytic lesion. Each lesion underwent optical coherence tomography and high-frequency ultrasonography assessment, followed by excision and pathological examination. Histopathology was considered as the gold standard for assessing melanoma thickness. Repeatability, inter- and intra-rater reproducibility and reliability were evaluated for each imaging procedure.ResultsUltrasonography showed a good level of agreement with histology (ICC: 0.807; [95% CI: 0 .703; 0.877]) and excellent inter-rater reproducibility (G=0.97), resulting in reliable in vivo assessment of melanoma thickness. 930nm-Optical coherence tomography showed a poor level of agreement with histopathology (ICC: 0.0; [95%CI: -0.2; 0.2]) and the inter-rater reproducibility was null (G=0.00).ConclusionHFUS is a reliable and reproducible non-invasive method for assessing melanoma thickness. Routine use of HFUS may allow single-step excision of equivocal melanocytic lesions, with surgical margins determined by in vivo assessment of tumour thickness.This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 05/2014; · 3.76 Impact Factor
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    ABSTRACT: Background Methotrexate is one the most commonly used systemic therapies for psoriasis. Despite its widespread use in psoriasis therapy, dermatologists' practice regarding the use of methotrexate has not been investigated on global scale.Objective To evaluate the real life use of methotrexate for psoriasis treatment in the dermatological community worldwide.MethodsA questionnaire consisting of 41 questions was designed by the Psoriasis International Network (PIN). Questions focused on safety, dosing, administration, folic acid supplementation and combination therapy aspects of methotrexate use. The anonymous web-based survey was distributed to dermatologists by the national coordinators of PIN.ResultsBetween 2 April and 7 August 2012, 481 dermatologists from 63 countries completed the questionnaire. Most respondents were from European and South American countries, whereas the response rate from Central America and the Near East was lowest. The majority of responders were experienced dermatologists (86% had more than 5 years of experience in psoriasis treatment). Starting and maintenance doses of 10 mg of methotrexate or lower were reported by 67% and 42% of respondents respectively. Thirty-eight per cent of respondents stop treatment at a cumulative dose of 2 g, whereas 36% did not consider cumulative dose important in this respect. The primary mode of administration was oral, and the majority of respondents administer folic acid supplementation. Almost all respondents monitored full blood count, liver and renal function tests, whereas procollagen 3 amino terminal peptide measurement and transient elastography is used by only a minority of dermatologists. There were significant differences concerning the doses, routes of administration and safety monitoring among the clinical practices in different geographical locations.Conclusion Current clinical practice of methotrexate use in psoriasis is not uniform, depends on geographical location, and is not in full agreement with clinical guidelines.
    Journal of the European Academy of Dermatology and Venereology 04/2014; · 2.69 Impact Factor
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    ABSTRACT: Campaigns designed to promote sun protection often fail to induce long-term change in behavior. There is limited information on patients with low compliance to sun protection recommendation by dermatologists. The aim of this study was to characterize dermatology patients at higher risk of low compliance to sun protection measures. We also intended to investigate the relationship between sun protection behavior, knowledge about accurate sun protection recommendations, UV-associated risks and level of UV exposure. An anonymous self-administered multiple-choice questionnaire was distributed by dermatologists to patients receiving a sunscreen prescription. Four domains were explored: sun protection behavior, sun protection knowledge, level of UV exposure, and knowledge about UV-associated risks. We modeled sun protection behavior and determined factors associated with low compliance to sun protection measures. A total of 2215 questionnaires were analyzed. Patients who better complied with sun protection measures had a better knowledge of UV-associated risks (mean score 14.45 +/- 3.20 versus 12.75 +/- 3.29 and 11.20 +/-3.80 respectively; p<10-4) and sun protection measures (mean score 12.08 +/- 2.79 versus 10.68 +/- 3.11 and 9.00 +/-3.63 respectively; p<10-4). Patients who better complied with sun protection measures also reported a higher level of sun exposure (mean score 4.24+/- 2.26 versus 4.02 +/- 2.05 and 3.34 +/-2.14 respectively; p<10-4). Factors associated with low adherence to sun protection behavior were age below 20 or over 64 years, male sex, lower knowledge about accurate sun protection recommendations and UV-associated risks and low UV-exposure. The study shows the complex relationship between UV-exposure, knowledge about UV-associated risks, knowledge about sun-protection recommendations and sun-protection behavior. Future skin cancer prevention programs should focus on specific populations with low sun-protection behavior and high UV-exposure. This article is protected by copyright. All rights reserved.
    British Journal of Dermatology 03/2014; · 3.76 Impact Factor
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    ABSTRACT: Abstract Psoriasis is an immune-mediated inflammatory disease (IMID) which may have a major impact on a patient's life, especially when the disease is moderate to severe. There is evidence that treatment of psoriasis during the first years is conservative and frequently based on topical agents which rarely clear lesions. Treatment with systemic agents including biologics is often undertaken only when topical agents have proved unsuitable, even in patients with moderate to severe disease. However, there is evidence that in other IMIDs (rheumatoid arthritis and Crohn's disease), targeted systemic treatment given early in the treatment pathway may improve long-term patient outcomes. We hypothesize that a patient-centered therapeutic approach, undertaken early in the psoriasis treatment pathway ("early intervention") with the goal of complete clearance, may improve control of cutaneous symptoms and may also modify disease course and burden. Critical points to address when designing an early intervention study would include: the definition of psoriasis disease activity; patient selection; intervention selection; and dosing strategies.
    Journal of Dermatological Treatment 02/2014; · 1.50 Impact Factor
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    ABSTRACT: Background Psoriasis affecting sites such as the hands, feet and nails can be particularly difficult to treat. There are limited data on the efficacy of biological agents to treat these specific localizations. Objective This analysis of a phase 2 regimen-finding study evaluated the efficacy of secukinumab in subjects with moderate-to-severe psoriasis and non-pustular involvement of the hands, feet and/or nails. Methods Subjects were randomized (1 : 2 : 2 : 1) to one of three subcutaneous secukinumab 150-mg induction regimens [Single (Week 0), Monthly (Weeks 0, 4, 8), Early (Weeks 0, 1, 2, 4)] or placebo. In the subgroup (n = 131) with hand and/or foot psoriasis [baseline 5-point hand/foot Investigator's Global Assessment (IGA) score ≥2], efficacy was assessed as percentage of subjects achieving an IGA response [a score of 0 (clear) or 1 (minimal) and an improvement of ≥2 points on the 5-point hand/foot scale vs. baseline] at Week 12. In the subgroup (n = 304) with fingernail psoriasis (baseline composite score ≥1), efficacy was assessed as mean percentage change from baseline to Week 12 in a composite score. ResultsAt Week 12, a markedly higher percentage of subjects with hand and/or foot psoriasis achieved an IGA response with the Early regimen vs. placebo (54.3% vs. 19.2%, P = 0.005). The composite fingernail score improved with the Early and Monthly regimens, but worsened with placebo [percentage mean change from baseline (SE): −19.1% (6.12) and −10.6% (7.06) vs. 14.4% (11.92); P = 0.010 vs. placebo for Early, P = 0.027 for Monthly). Secukinumab was well tolerated. Conclusion Secukinumab demonstrated a beneficial effect on psoriasis of the hands/feet/nails in this short-term assessment.
    Journal of the European Academy of Dermatology and Venereology 01/2014; · 2.69 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 01/2014; · 0.60 Impact Factor
  • Annales de Dermatologie et de Vénéréologie 12/2013; 140(12):S365–S366. · 0.60 Impact Factor
  • Journal of the European Academy of Dermatology and Venereology 11/2013; · 2.69 Impact Factor
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    ABSTRACT: Biological drugs have dramatically improved the management of moderate to severe psoriasis. Little is known about their economic impact in daily clinical practice. The aim of this study was to estimate the costs of biological drugs, in term of health resources consumption, and to compare it with costs induced by traditional systemic treatments. This cohort study was built from the French health insurance database in the Midi Pyrénées area (2.8 million inhabitants, South West of France). We compared health care costs between 'exposed' patients treated with biological drugs (adalimumab, etanercept, infliximab or ustekinumab) and 'unexposed' patients defined as patients who received traditional systemic treatments (phototherapy, acitretin, methotrexate or cyclosporin) during a 6-month period. A total of 1924 patients met the inclusion criteria. Sixty-nine patients were 'exposed', whereas 1855 patients were 'unexposed'. 'Exposed' patients had a mean total healthcare cost of 8107€ vs. 1678€ (P < 0.001) for 'unexposed' patients. They had higher costs concerning inpatient admission, medication and consultations including dermatology consultations, laboratory, non-medical care and transportation. Biological drug prescription was associated with an increase in the use of anti-infective drugs and with a reduction in the use of psychoactive drugs. The mean total health care expenditure in patients treated with biological drugs was five times higher as compared with patients treated with traditional systemic treatments. The limitation of the study is the short duration of follow-up comprising a loading dose period for some biological drugs. This may have contributed to an overestimation of drug-related costs.
    Journal of the European Academy of Dermatology and Venereology 11/2013; · 2.69 Impact Factor
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    ABSTRACT: Anaphylaxis is a severe, generalized, life-threatening reaction of rapid onset. We report the case of a patient presenting several systemic anaphylactic reactions over many years, initially ascribed to a cereals allergy but which finally proved to be due to systemic mastocytosis hidden for a long time. A 53-year-old man consulted for an eruption consisting of monomorphic pigmented maculopapular lesions on the trunk associated with itching and urticaria. He was a farmer and presented severe sensitivity to cereals, with anaphylaxis, which continued despite withdrawal of these allergens. Skin and bone marrow infiltration, abnormal mast cells, positivity for c-kit 816 mutation and the persistent elevation of serum tryptase enabled a diagnosis of indolent systemic mastocytosis to be made. In systemic mastocytosis anaphylaxis is an expected complication relating to the proliferation of mast cells and a massive increase in mediator release (non-immunological mechanism). All patients with severe and recurrent anaphylaxis should be analyzed for underlying mastocytosis by careful physical examination and assay of baseline tryptase.
    Annales de Dermatologie et de Vénéréologie 10/2013; 140(10):641-644. · 0.60 Impact Factor

Publication Stats

1k Citations
363.73 Total Impact Points


  • 2007–2014
    • Paul Sabatier University - Toulouse III
      • Faculté de médecine Purpan
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2013
    • University of Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
  • 2012–2013
    • Aix-Marseille Université
      Marsiglia, Provence-Alpes-Côte d'Azur, France
    • University of Verona
      • Section of Dermatology and Venereology
      Verona, Veneto, Italy
  • 2010–2012
    • University of Nice-Sophia Antipolis
      Nice, Provence-Alpes-Côte d'Azur, France
  • 2011
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
  • 2009
    • Centre Hospitalier Victor Dupouy
      Argenteuil, Île-de-France, France
  • 2006
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
  • 1999–2006
    • Novartis
      Bâle, Basel-City, Switzerland
  • 2005
    • Medical University of Vienna
      • Universitätsklinik für Dermatologie
      Vienna, Vienna, Austria
  • 2003–2004
    • Mulhouse Hospital Center
      Mulhousen, Alsace, France
  • 1999–2001
    • Vancouver General Hospital
      Vancouver, British Columbia, Canada
  • 1995–1997
    • Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor)
      • Service de Dermatologie
      Créteil, Ile-de-France, France