Author(s) Muralidharan V.; Zahedi D.; Kaur B.; Goulding J.M.R.
Source Clinical and experimental dermatology; Dec 2019
Psychodermatology remains a niche sub-specialty in the United Kingdom (UK), with very few dedicated services available for patients with such problems. Despite this, up to 85% of dermatology patients say that psychosocial aspects of their skin disease are a major component of their condition, indicating an enormous unmet need.s1 Our perception is that general dermatologists and psychiatrists may lack confidence in diagnosing and managing patients with psychodermatological problems, the vast majority of whom will not be cared for in a specialist service.Copyright © 2019 British Association of Dermatologists.

• Available in full text at Clinical and experimental dermatology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Semkova K.; Calonje E.; Carr R.; Grainger M.; Green R. et al.
Source Journal of the American Academy of Dermatology; Dec 2019; vol. 81 (no. 6); p. 1257-1270
Background: We present a distinctive type of acquired vascular proliferation, for which we propose the name of poikilodermatous plaque-like hemangioma. Objective(s): The aim of this study was to summarize the clinical and histopathologic features in a case series of poikilodermatous plaque-like hemangioma.

Method(s): Sixteen cases were identified from the routine clinical and referral practices of the authors. Clinical characteristics, including demographic details and clinical morphology, were collated. The salient histopathologic features, including immunohistochemical staining results, were summarized.

​Result(s): The lesions were usually solitary erythematous-to-violaceous poikilodermatous plaques on the lower extremities and pelvic girdle, with an indolent clinical course. Mean age of affected patients was 72 (range 58-80) years, and there was a male predominance. Histology comprised a distinctive band-like proliferation of vascular channels suggestive of postcapillary venules within the superficial dermis with a background of fibrosis, edema, and loss of elastic fibers. Despite the clinical atrophic appearance, acanthosis was a frequent finding. Limitation(s): Retrospective study. Conclusion(s): Poikilodermatous plaque-like hemangioma is a distinctive and previously undescribed vascular proliferation defined by a constellation of consistent and reproducible clinical and histologic features.Copyright © 2019 American Academy of Dermatology, Inc.

Author(s) Ismail D.; Owen C.M.
Source Clinical and Experimental Dermatology; Oct 2019; vol. 44 (no. 7); p. 753-758
Publication Date Oct 2019
DOI 10.1111/ced.13894
Background: Lichen sclerosus (LS) is a chronic inflammatory dermatosis with a predilection for the anogenital region, which mainly affects prepubertal girls and postmenopausal women. The cause is unknown, but a number of potential aetiological factors have been identified.

Aim(s): To examine a cohort of patients with prepubertal-onset vulval LS (VLS) and assess baseline characteristics, clinical presentation, potential precipitating and predisposing factors, and response to treatment. Method(s): Data were collected from case notes on patients aged < 18 years diagnosed with prepubertal-onset VLS attending a specialist vulval dermatology service. Data included clinical presentation, comorbidities, family history, therapy and response to treatment.

Result(s): In total, 26 paediatric patients were identified. The median age at onset of symptoms was 5 years (range 2-8.5 years). Many previously identified potential aetiological factors for the development of VLS were identified, including family history, trauma, autoimmune disease and hormonal factors. A significant proportion of patients had a history of urinary tract symptoms, including incontinence and urinary tract infection. Most patients responded well to a standard course of induction topical therapy followed by maintenance therapy, but some, including three patients with ongoing urinary incontinence and three postpubertal patients, continued to have active disease.

​Conclusion(s): A detailed assessment is essential in patients with VLS so that potential predisposing factors and comorbidities can be identified and managed. Urinary incontinence may be implicated in the development of paediatric VLS and may prevent adequate disease control. Paediatric VLS can persist through puberty, thus long-term follow-up is advised.Copyright © 2019 British Association of Dermatologists

• Available in full text at Clinical and experimental dermatology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s): Petridis C.; Navarini A.A.; Dand N.; Saklatvala J.; Trembath R.C.; Simpson M.A.; Baudry D.; Duckworth M.; Allen M.H.; Pink A.E.; McGrath J.A.; Smith C.H.; Barker J.N.; Curtis C.J.; Lee S.H.; Burden A.D.; Layton A.; Bataille V.; Spector T.D.; Carlavan I.; Voegel J.J.; Alexandroff A.; Anstey A.; Azad J.; Aziz O.; Cutler T.; Hood S.; Rallan D.; Burrows N.; Butt A.; Cartwright P.; Chapman A.; Clayton T.H.; Cliff S.; Daly B.; Darvay A.; DeGiovanni C.; Downs A.; Dwyer C.; English J.; Ferguson A.; Fleming C.; Fraser-Andrews E.; Goodfield M.; Grattan C.E.; Hempel H.; Hughes B.; Ladoyanni E.; Lyon C.; Mahmud A.; Malik M.; Mallon E.; Meggitt S.; Messenger A.; Moosa Y.; Munn S.; Ormerod A.; Ross J.; Salvary I.; Wachsmuth R.; Wahie S.; Walton S.; Walsh S.; Williamson D.; Willis C.
Source: Nature Communications; Dec 2018; vol. 9 (no. 1)
Publication Date: Dec 2018
Publication Type(s): Article
PubMedID: 30542056
Available  at Nature Communications -  from Europe PubMed Central - Open Access
Abstract:Acne vulgaris is a highly heritable common, chronic inflammatory disease of the skin for which five genetic risk loci have so far been identified. Here, we perform a genome-wide association study of 3823 cases and 16,144 controls followed by meta-analysis with summary statistics from a previous study, with a total sample size of 26,722. We identify 20 independent association signals at 15 risk loci, 12 of which have not been previously implicated in the disease. Likely causal variants disrupt the coding region of WNT10A and a P63 transcription factor binding site in SEMA4B. Risk alleles at the 1q25 locus are associated with increased expression of LAMC2, in which biallelic loss-of-function mutations cause the blistering skin disease epidermolysis bullosa. These findings indicate that variation affecting the structure and maintenance of the skin, in particular the pilosebaceous unit, is a critical aspect of the genetic predisposition to severe acne.Copyright © 2018, The Author(s).
Database: EMBASE

​Author(s): Ahad T.; Riley A.; Martindale E.; von Bremen B.; Owen C.
Source: Pediatric Dermatology; 2018; vol. 35 (no. 1)
Publication Date: 2018
Publication Type(s): Article
PubMedID: 29159956
Available  at Pediatric Dermatology -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Vulvar swelling is a rare manifestation of metastatic Crohn's disease in children. It often predates gastrointestinal symptoms and can be the first presentation of pediatric Crohn's disease. We report three cases of pediatric Crohn's disease presenting with vulvar swelling. We discuss this rare presentation and its treatment and highlight the importance of recognizing it so that prompt investigation and appropriate management can be initiated.Copyright © 2017 Wiley Periodicals, Inc.
Database: EMBASE

Author(s): Tian T.M.; Daly B.M.; Owen C.M.
Source: BMJ (Online); 2018; vol. 361
Publication Date: 2018
Publication Type(s): Note
Available  at BMJ   
Database: EMBASE

​Author(s): Ismail D.; Owen C.M.
Source: British Journal of Dermatology; Jul 2018; vol. 179 ; p. 159-160
Publication Date: Jul 2018
Publication Type(s): Conference Abstract
Abstract:Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital region in prepubertal girls and postmenopausal women. The underlying cause is not fully known, although many aetiological factors have been implicated. It has an estimated prevalence of 1 in 900 girls (Powell J, Wojnarowska F. Childhood lichen sclerosus: an increasingly common problem. J Am Acad Dermatol 2001; 44: 803-6) and typical clinical features include white atrophic plaques, erosions, fissures and ecchymoses in the anogenital region. 

​Author(s): Jabbar-Lopez Z.K.; Smith C.H.; Yiu Z.Z.N.; Warren R.B.; Ward V.; Exton L.S.; Mohd Mustapa M.F.; Samarasekera E.; Burden A.D.; Murphy R.; Owen C.M.; Parslew R.; Venning V.
Source: Journal of Investigative Dermatology; Dec 2017; vol. 137 (no. 12); p. 2644-2646
Publication Date: Dec 2017
Publication Type(s): Article
Database: EMBASE
 

Author(s): Smith C.H.; Jabbar-Lopez Z.K.; Peleva E.; MacMahon E.; Nelson-Piercy C.; Yiu Z.Z.; Warren R.B.; Bale T.; Burden A.D.; Coates L.C.; Cruickshank M.; Pottinger E.; Samarasekera E.J.; Hadoke T.; Strudwicke C.; Murphy R.; Owen C.M.; Parslew R.; Stoddart J.; Venning V.A.; Exton L.S.; Mohd Mustapa M.F.

Source: British Journal of Dermatology; Sep 2017; vol. 177 (no. 3); p. 628-636
Publication Date: Sep 2017

Publication Type(s): Article
​
Available  at British Journal of Dermatology -  from Wiley Online Library Medicine and Nursing Collection 2017 - NHS

Database: EMBASE

Author(s): Jabbar-Lopez Z.K.; Yiu Z.Z.N.; Warren R.B.; Ward V.; Exton L.S.; Mohd Mustapa M.F.; Samarasekera E.; Burden A.D.; Murphy R.; Owen C.M.; Parslew R.; Venning V.; Smith C.H.

Source: Journal of Investigative Dermatology; Aug 2017; vol. 137 (no. 8); p. 1646-1654

Publication Date: Aug 2017

Publication Type(s): Article

Abstract:Multiple biologic treatments are licensed for psoriasis. The lack of head-to-head randomized controlled trials makes choosing between them difficult for patients, clinicians, and guideline developers. To establish their relative efficacy and tolerability, we searched MEDLINE, PubMed, Embase, and Cochrane for randomized controlled trials of licensed biologic treatments for skin psoriasis. We performed a network meta-analysis to identify direct and indirect evidence comparing biologics with one another, methotrexate, or placebo. We combined this with hierarchical cluster analysis to consider multiple outcomes related to efficacy and tolerability in combination for each treatment. Study quality, heterogeneity, and inconsistency were evaluated. Direct comparisons from 41 randomized controlled trials (20,561 participants) were included. All included biologics were efficacious compared with placebo or methotrexate at 3-4 months. Overall, cluster analysis showed adalimumab, secukinumab, and ustekinumab were comparable in terms of high efficacy and tolerability. Ixekizumab and infliximab were differentiated by very high efficacy but poorer tolerability. The lack of longer term controlled data limited our analysis to short-term outcomes. Trial performance may not equate to real-world performance, and so results need to be considered alongside real-world, long-term safety and effectiveness data. These data suggest that it is possible to discriminate between biologics to inform clinical practice and decision making (PROSPERO 2015:CRD42015017538).Copyright © 2017 The Authors
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Database: EMBASE

Author(s): Iskandar I.Y.K.; Ashcroft D.M.; Warren R.B.; Evans I.; McElhone K.; Griffiths C.E.M.; Owen C.M.; Burden A.D.; Smith C.H.; Reynolds N.J.

Source: British Journal of Dermatology; May 2017; vol. 176 (no. 5); p. 1297-1307

Available in full text at British Journal of Dermatology -  from John Wiley and Sons

Abstract:Background: Treatment modifications, including dose escalations, dose reductions, switches, discontinuations and restarts of biologics may be necessary in the management of psoriasis but the patterns of usage are incompletely defined. Objectives: To examine the treatment utilization patterns of adalimumab, etanercept and ustekinumab among biologic-naive and non-naive patients with psoriasis enrolled in the British Association of Dermatologists Biologic Interventions Register (BADBIR). Methods: The study cohort included adults with chronic plaque psoriasis who were followed up for >= 12 months. Treatment modifications were assessed during the first year of therapy. The time-trend method, comparing the cumulative dose (CD) patients received with the recommended cumulative dose (RCD), was used to assess dosing patterns. Concomitant use of other systemic treatments was also examined. Results: In total, 2980 patients (adalimumab: 1675; etanercept: 996; ustekinumab: 309) were included; 79.2% were biologic-naive. Over 12 months, 77.4% of patients continued the biologic, 2.6% restarted therapy after a break of >= 90 days, 2.5% discontinued, and 17.5% switched biologic therapy. Most patients (85.7%) received the RCD of the biologic, although 8.1% were exposed to a higher CD. In total, 749 (25.1%) patients used conventional systemic therapies concomitantly with a biologic at some stage; methotrexate was used most commonly (458; 61.2%). Of those using combination therapy, 454 (60.6%) continued the use of the conventional systemic therapy for > 120 days after the start of the biologic. Conclusions: More than one-third of patients experienced treatment modifications within the first year of initiating a biologic. Conventional systemic therapies, particularly methotrexate, were commonly used concurrently, which should be considered when evaluating treatment response and adverse events to biologics in real-world observational studies.Copyright © 2016 British Association of Dermatologists
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Database: EMBASE

Author(s): Shah M.

Source: Clinical and Experimental Dermatology; 2017

Available in full text at Clinical and Experimental Dermatology -  from John Wiley and Sons

Abstract:It is important to assess outcomes for medical interventions in order to focus scarce resources on outcomes with a known positive benefit. An open, observational study was performed to assess the clinical outcomes of 600 male patients with a genital skin problem attending a specialist secondary care dermatology facility. Patients were mainly referred by general practitioners and genitourinary medicine physicians. Outcome was measured at 3 and 6 months, and was determined by clinical examination and assessment of patient symptoms. The mean age of the group was 45.3 years. The commonest diagnoses were lichen sclerosus (30.5%), balanitis (17.3%), eczema (12.8%), lichen planus (7.3%), psoriasis (7.2%) and benign lesions (5.5%). The commonest presenting symptoms were genital rash (43%), genital soreness, pain or burning (17.5%), and penile lesions (15.7%). Lichen sclerosus and all forms of balanitis were more common in uncircumcised patients, whereas lichen planus was more common in circumcised males. Short-term outcome was excellent, with 11.5% of patients being reassured and discharged on their first visit, and after 6 months 58% of all patients were clear and 12% had improved. Only 4.5% reported no improvement in symptoms. Diagnostic biopsy demonstrated malignant or premalignant lesions in nearly a fifth of those having a procedure. Close working with urological and genitourinary medicine colleagues is important to manage the various aspects of male health.Copyright © 2017 British Association of Dermatologists.
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Database: EMBASE

Author(s): Collier, Nicholas J; Chaing, Nicole Y Z; Coulson, Ian H

Source: Journal of the American Academy of Dermatology; Feb 2017; vol. 76 (no. 2); p. e43

Publication Date: Feb 2017

Publication Type(s): Journal Article
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Database: Medline

Author(s): Singh M.; Calonje E.; Farquharson N.; Owen C.; Howat A.J.; Singh S.; Francis N.

Source: Clinical and Experimental Dermatology; 2017

Publication Date: 2017

Publication Type(s): Journal: Article In Press

Available in full text at Clinical and Experimental Dermatology -  from John Wiley and Sons

Abstract:Morphoea (localized scleroderma) is a cutaneous inflammatory condition characterized by the development of indurated and discoloured plaques. The histological features of morphoea typically include a superficial and deep perivascular and periadnexal chronic inflammatory infiltrate associated with variable degrees of dermal and/or subcutaneous sclerosis. The infiltrate is typically composed of lymphocytes, macrophages and conspicuous plasma cells. The early stages of morphoea may have a very prominent inflammatory infiltrate associated with subtle sclerosis. In addition, the inflammatory infiltrate may show a perineural and rarely intraneural distribution. We report two cases of morphoea that histologically showed plasma cell endoneuritis associated with subtle dermal sclerosis. These two cases highlight the potential for diagnostic confusion with infectious and inflammatory diseases, particularly leprosy and lupus. Copyright © 2017 British Association of Dermatologists.
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Database: EMBASE