6th Genodermatoses in Mediterranean working session 1st ... · •Daily care: sterile compresses,...
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6th Genodermatoses in Mediterranean working session1st TAG meeting
May 22 - May 25, 2009, Greece
Tunisian Genodermatoses GroupRepresented by Monia Kharfi,
Dept. of DermatologyHôpital Charles Nicolle
Tunis, Tunisia
TAG 2007 335
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Initiatives for a better healthcare of severe
genodermatoses in Tunisia
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Law widening the notion ofhandicap (2006)
• Genodermatoses recognised as disabling diseasesand enabling the grant of the « handicap card »
– Care within health public structures are free ofcharge
– Drugs usually available in hospitals (such as theNéotigason*) are free of charge
– Means of transportation are free of charge (urbanand 50%off inter-urban)
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• Epidemiological data
• Assessment of the health care cost
• Referral centers for health care of patients and theirfamilies
• Strategy for genodermatoses’ health care
• National network
• Collaboration on the European level
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Epidemiological data• No national prevalence established for the different
genodermatoses in Tunisia
• Cartography for XP
• Studies and reports of University Hospitaldermatology departments
• 7 University Hospital dermatology departments inTunisia– Tunis (4)
– Sousse
– Monastir
– Sfax
• We have the data from 4 departments:
H. Charles Nicolle, Hopital Militaire, H. of Sousse and H.of Sfax
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Epidemiological data
• Data from 4 departments on 7– Tunis
• H. Charles Nicolle• H. Militaire
– Sousse– Sfax
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Epidemiological data
• Epidermolysis Bullosa (EB): 107 patients• Data from 4 departments (on 7)
– Tunis:• H. Charles Nicolle: 38 patients• H. Militaire: 14 patients
– Sousse: 15 patients– Sfax: 40 patients
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Epidemiological data
• Ichthyosis 325 patients• Data from 4 departments (on 7)
– Tunis:• H. Charles Nicolle: 148 patients• H. Militaire: 17 patients
– Sousse: 60 patients– Sfax: 100 patients
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Epidemiological data
• KPP: 141 patients• Data from 4 departments (on 7)• Tunis:
– H. Charles Nicolle: 49– H. Militaire: 2
• Sousse: 40• Sfax: 50
– 2 main families of Meleda– 1 family of Buschke-Fischer
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Assessment of health care cost
• Evaluation of genodermatoses’ healthcare needs per patients and per year– Epidermolysis bullosa– Ichthyosis– KPP
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Assessment of health care cost
EB:• Daily care: sterile compresses, sofra-tulle,
gauzes, cleansing products, antiseptics,emollients, local antibiotics
• Antibiotic treatments• Vitamin supplement
2000 dt/year/patient 1100 euros
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Assessment of health care cost
Ichthyosis:• Acitrétine (Neotigason*)• Emollients• Antimycotics and antihistamines
4000 dt/year/patient 2200 euros
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Assessment of health care cost
KPP:• Acitrétine (Neotigason*)• Emollients• Antimycotics and antihistamines
2100 dt/year/patient 1150 euros
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Referral centers for health care ofpatients and their families
• Center of XP expertise mainly at Habib Thameur Hôpital• Specialised consultations of pediatric dermatology
– Hôpital Charles Nicolle (90% genodermatoses)– Hôpital d’Enfants de Tunis– Hôpital Militaire– Hôpital la Rabta: new since a few weeks
• Several departments of medical genetics: Tunis, Sousseand Sfax
• Molecular biology laboratories– Tunis: Institut Pasteur, Medical faculty and a private one– Sousse– Sfax
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Strategy for genodermatoses healthcare
• Individual actions according to thedepartments and the recruitment
• Stimulation of the interest ongenodermatoses in the different medicalteams
• No codified national strategy
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Strategy for genodermatoses healthcare
• Education of the patients and theirfamilies by the doctors and the medicalstaff of each dermatology department
• Health care training in the hospital
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Genodermatoses health care training forthe medical staff
• EB: Hôpital Charles Nicolle
– Education of the families for the care of new-bornEB and ichthyosis
– Day hospital with a care room– Trained nurse– Checking the first weeks to evaluate the quality of
the health care– Psychological support and care for the family
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• Ichthyosis:– Neonatal period:
• Health care in the different neonatology departments ofthe CHU of Tunis, Sousse, Monastir and Sfax incollaboration with the dermatologist
• Education of the families
– After:• Reimbursment of health care at home• Regular medical checking in outpatients department
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Education of patients
• KPP:
– Symptomatic treatment at home– Reduction of skin thickness– Regular consultations– Treatment of frequent fungic secondary infections antifungals
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Improvement of the health care’squality
• Explainations and doctor-patient communication
• Education of families (support for the parents of EBbabies to help handle the situation)
• Advice
• Help for health care at home by providing sterilecompresses and dressings for EB (Sfax , HCN , HM)
• Providing of sun screen thanks to laboratories’ help
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National network
• Reinforced collaboration betweendermatology departments for the health careof genodermatoses
• Development of a closer collaborationbetween dermatology, genetics andmolecular biology derpartments– Institut Pasteur, genetics departments of Hopital
Charles Nicolle and different dermatologydepartments of Tunis
Development stage
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Collaboration on a Europeanlevel
• Several teams are in touch and havepersonal collaborations with foreignteams, French essentially
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Development of patients’organisations
• « Les enfants de la lune »: XP
• EB organisation: in Sfax, in process
• Genodermatoses organisation: in Tunis,in process
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Conclusion
• Since the project « Génodermatoses etMéditerrané »– Reinforcement of the individual initiatives (training,
research, care) improving genodermatoses healthcare
– A better awareness-raising of decision-makers,health actors and families
– Initiatives need to be put together and structuredon a national level to optimize the efforts