Author(s) Kirby L. (lisa.kirby@nottingham.ac.uk); Gran S.; Simpson R.; Orekoya F.; Owen C.
Source British Journal of Dermatology; 2021

• Available in full text at The British journal of dermatology from Wiley Online Library Medicine and Nursing Collection 2013

Author(s) Shah M.
Source Clinical and Experimental Dermatology; Jun 2021; vol. 46 (no. 4); p. 723-726
Male genital lichen sclerosus (MGLS) is a chronic inflammatory condition that can present with a range of debilitating symptoms. Sexual dysfunction is reported by most women with lichen sclerosus but by relatively few men. This prospective study looked at 78 men with MGLS. Sexual difficulties were experienced by 64 (82%) patients, with 54 of the 64 attributing their sexual dysfunction directly to their MGLS. Sexual dysfunction appears to be more common in MGLS than other genital diseases such as psoriasis and sexually transmitted infections. Penile soreness due to active inflammation is the commonest cause of dyspareunia. Psychological factors are also important. Assessment and management of MGLS must include sexual history as men will not usually volunteer this information. Monitoring sexual function may be useful to assess disease outcome.Copyright © 2021 British Association of Dermatologists

• Available in full text at Clinical and experimental dermatology from Wiley Online Library Medicine and Nursing Collection 2013

Author(s) De Brito M.; Coulson I.H.; Dhawan G.; Alassaf J.; Bewley A.
Source British Journal of Dermatology; May 2021; vol. 184 (no. 5)
Pityriasis rubra pilaris (PRP) is a rare, papulosquamous dermatosis, which may progress to erythroderma. We present three cases of refractory type 1 PRP with complete response to ustekinumab, an anti-interleukin (IL)-12/IL-23 biologic. A 57-year-old woman presented with a pruritic psoriasiform eruption that responded incompletely to retinoid or methotrexate. It became widespread, with spared islands and palmoplantar keratoderma. Skin biopsy suggested type 1 PRP. Despite acitretin with ciclosporin, she developed erythroderma, which required hospital admission, and was refractory to azathioprine, systemic steroids and erythromycin. After her first injection of ustekinumab, her skin improved and she remains clear on ustekinumab. A 61-year-old man presented with a widespread scaling eruption diagnosed as type 1 PRP. Methotrexate was contraindicated owing to his alcohol intake. Acitretin was ineffective, with a significantly impaired quality of life [Dermatology Life Quality Index (DLQI) 16]. He became erythrodermic. After his first injection of ustekinumab, his erythema reduced by 50%. By the fourth injection, his skin was clear. He stopped ustekinumab after 18 months, and has remained clear since. A 64-year-old woman presented with type 1 PRP, with erythroderma, nail changes, orange keratoderma and spared islands over the trunk. She required admission and, despite acitretin, methotrexate, ciclosporin and infliximab, there was no improvement. Four weeks after her first ustekinumab injection, her skin was almost clear. Her DLQI reduced from 25 to 5. She stopped ustekinumab after 6 months and has remained clear since. Reports of ustekinumab in PRP are limited to case reports/case series, where 14/15 patients sustained a significant response at 4-8 weeks (Naidoo A, Sibbald C, Fleming et al. Use of biologics in pityriasis rubra pilaris refractory to first-line systemic therapy: a systematic review. J Cutan Med Surg 2020; 24: 77-8). These cases suggest that ustekinumab may be effective in refractory type 1 PRP.

• Available in full text at British Journal of Dermatology from Wiley Online Library Medicine and Nursing Collection 2013

Author(s) Muralidharan V.; Zahedi D.; Kaur B.; Goulding J.M.R.
Source Clinical and Experimental Dermatology; Jun 2020; vol. 45 (no. 4); p. 482-483
​Available in full text at Clinical and experimental dermatology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

Author(s) Smith C.H.; Mahil S.; Woolf R.T.; Yiu Z.Z.; Bale T. et al.
Source The British journal of dermatology; Mar 2020
The overall aim of the guideline is to provide up-to-date, evidence-based recommendations on the use of biologic therapies targeting TNF (adalimumab, etanercept, certolizumab pegol, infliximab), IL12/23p40 (ustekinumab), IL17A (ixekizumab, secukinumab), IL17RA (brodalumab) and IL23p19 (guselkumab, risankizumab, tildrakizumab) in adults, children and young people for the treatment of psoriasis; consideration is given to the specific needs of people with psoriasis and psoriatic arthritis.Copyright This article is protected by copyright. All rights reserved.

• Available in full text at The British journal of dermatology from Wiley Online Library Medicine and Nursing Collection 2019 - NHS

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