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Child FJ, Fuller LC, Higgins EM, du Vivier AW, Mufti GJ. Cutaneous Presentation of Fusarium Solani Infection in a Bone Marrow Transplant Recipient. J R Soc Med 2018; 89:647-8. [PMID: 9135599 PMCID: PMC1296006 DOI: 10.1177/014107689608901116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- F J Child
- Department of Dermatology, King's Healthcare NHS Trust, London, England
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Fuller LC, Barton RC, Mohd Mustapa MF, Proudfoot LE, Punjabi SP, Higgins EM. British Association of Dermatologists' guidelines for the management of tinea capitis 2014. Br J Dermatol 2015; 171:454-63. [PMID: 25234064 DOI: 10.1111/bjd.13196] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 01/19/2023]
Affiliation(s)
- L C Fuller
- Department of Dermatology, Chelsea & Westminster Hospital, Fulham Road, London, SW10 9NH, U.K
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Thomas BR, Barnabas A, Agarwal K, Aluvihare V, Suddle AR, Higgins EM, O'Grady JG, Heaton ND, Heneghan MA. Patient perception of skin-cancer prevention and risk after liver transplantation. Clin Exp Dermatol 2013; 38:851-6. [DOI: 10.1111/ced.12159] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | | | - E. M. Higgins
- Department of Dermatology; King's College Hospital; London UK
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Munro CS, Higgins EM, Ramsay B, McLelland J, Marks JM, Friedmann PS, Farr PM, Dover R, Rees J, Young S, Lawrence CM, Humphreys F, Shuster S. The Mode of Action of Cyclosporin. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/bf03259395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Proudfoot LE, Higgins EM. A spiny eruption in a child. Pediatr Dermatol 2010; 27:299-300. [PMID: 20609152 DOI: 10.1111/j.1525-1470.2010.01154.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Excessive alcohol use has been implicated as a risk factor in the development of psoriasis, particularly in men. Despite this, little is known of the incidence or prevalence of psoriasis in patients who misuse alcohol. OBJECTIVE To assess the prevalence of psoriasis in patients with alcoholic liver disease. METHODS In total, 100 patients with proven alcoholic liver disease were surveyed for a history of psoriasis and a full skin examination was performed if relevant. RESULTS Of the 100 patients, 15 reported a history of psoriasis and another 8 had evidence of current activity, suggesting a prevalence (past or present) of 15% in this group of patients. CONCLUSION It would appear that the prevalence of psoriasis in patients who misuse alcohol is much higher than the 1-3% variously quoted in the general population.
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Affiliation(s)
- A M Tobin
- Department of Dermatology, Adelaide and Meath Hospital Incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
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White JML, Higgins EM, Fuller LC. Screening for asymptomatic carriage of Trichophyton tonsurans in household contacts of patients with tinea capitis: results of 209 patients from South London. J Eur Acad Dermatol Venereol 2007; 21:1061-4. [PMID: 17714125 DOI: 10.1111/j.1468-3083.2007.02173.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is currently an epidemic of tinea capitis in urban areas of developed countries caused by Trichophyton tonsurans. Recurrence or re-infection with dermatophyte is not uncommon after adequate oral treatment. Asymptomatic carriers who are household contacts may partly explain this observation by forming a reservoir for infection. PATIENTS/METHODS Two-hundred and nine household contacts of patients with tinea capitis were examined and screened for asymptomatic carriage of dermatophyte. RESULTS Only 7.2% had clinically evident disease yet 44.5% had silent fungal carriage on the scalp. Children under 16 years were much more likely to be carriers than adults (P < 0.001) and males were less likely than females to be affected (P < 0.01). CONCLUSION This evidence poses questions about factors relevant in transmission of dermatophytes. The authors propose that all household contacts of patients with tinea capitis should be offered screening to eradicate a potential reservoir of infection.
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Affiliation(s)
- J M L White
- Department of Cutaneous Allergy, St. John's Institute of Dermatology, London, UK.
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Williams JS, Mufti GJ, Powell S, Salisbury JR, Higgins EM. Saccharomyces cerevisiae emboli in an immunocompromised patient with relapsed acute myeloid leukaemia. Clin Exp Dermatol 2007; 32:395-7. [PMID: 17376213 DOI: 10.1111/j.1365-2230.2007.02375.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In humans, Saccharomyces cerevisiae (baker's yeast) is found infrequently as a commensal of mucosal surfaces and rarely causes infections. We describe a case of cutaneous septic emboli developing in a patient with relapsing acute myeloid leukaemia M6 who had recently been treated with clofarabine. Yeast forms were seen on skin biopsy and S. cerevisiae was isolated from her Hickman line. We are not aware of any previous case reports of cutaneous emboli associated with this organism.
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Affiliation(s)
- J S Williams
- Department of Dermatology, King's College Hospital, London, UK.
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10
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Abstract
BACKGROUND The surgical advances made in the area of organ transplantation along with the use of more efficacious immunosuppression have meant an increase in patient survival. This longer-living transplant population has started to exhibit cutaneous problems, some of which lead to an increased mortality while others lead to a decline in the quality of life. OBJECTIVES The primary objective was to determine the different types of cutaneous lesions encountered in the adult liver transplant population. Secondary objectives were to determine the impact, if any, of the duration of transplant, the type of immunosuppression involved and the degree of sun exposure and skin phototype, on the skin cancers encountered in this transplanted population. METHODS Two dermatologists examined 100 consecutive liver transplant recipients (LTRs) attending the transplant outpatient department. Skin examination included the face and whole body and lesions found were categorized into the following groups: cutaneous malignancies, squamoproliferative lesions, cutaneous infections and others that did not fall into any of these categories. RESULTS The reasons for organ transplantation were numerous. The mean age at transplantation was 42.5 years. The average time since transplantation was 5.5 (range 0.75-16 years). Four patients developed skin cancers; among them there were a total of seven skin cancers (one squamous cell carcinoma, six basal cell carcinomas). Fungal infections accounted for 19% of all cutaneous infections seen, viral infections 2% and bacterial infections 5%. Triple-drug immunosuppressive therapy (ciclosporin A, azathioprine and prednisolone) was used in 35% of LTR patients, while dual therapy (tacrolimus and prednisolone) was used in 48% and monotherapy (tacrolimus) was used in 17% of LTRs. CONCLUSIONS Immunosuppressive therapy is believed to be one of the most important risk factors in the development of skin cancer in solid organ transplant recipients. The relatively low prevalence of skin cancer in our liver transplant population may in part be explained by the relatively high percentage of recipients on dual and monotherapy (48% and 17% respectively), and the shorter duration of therapy. Our study suggests that although LTRs are at higher risk of developing nonmelanoma skin cancer than the general population, the risk is comparable with other solid organ transplant recipients.
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Affiliation(s)
- G K Perera
- Department of Dermatology, King's College Hospital, Denmark Hill, Camberwell, London SE5 9RS, UK.
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Abstract
We report the rare instance of four family members with numerous cutaneous lesions of Leishmania major contracted while on holiday in Algeria. Treatment was successful with oral itraconazole for the children and intralesional sodium stibogluconate for the mother. Cutaneous leishmaniasis should be considered in those with apparently sterile plaques returning from endemic areas. These results suggest that itraconazole, which is ideally suited for use in children, is an effective monotherapy for L. major.
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Affiliation(s)
- J M L White
- Department of Dermatology, King's College Hospital, London, United Kingdom.
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Abstract
We report a case of vulval squamous cell carcinoma (SCC) arising in chronic hidradenitis suppurativa (HS). The patient had a complex medical history including a 25-year-history of Crohn's disease. In addition she had recently received immunosuppressive therapy for nephrotic syndrome secondary to membranous glomerulonephritis. A painful nodule was noted on the vulva that was clinically very suspicious of SCC. An excision biopsy confirmed the diagnosis. There are few publications in the English literature citing association between HS and the development of SCC. The first report in the English literature of vulval SCC arising in chronic HS was published in 1999. We wish to draw attention to the possibility that patients with HS may develop SCC in lesional skin. A painful lump or ulcer could easily be mistaken for an inflammatory lesion and a low threshold for biopsy is warranted. We suggest constant vigilance with regard to malignant change in ano-genital HS as the diagnosis can be difficult.
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Affiliation(s)
- K A Short
- Department of Gynaecology, The Princess Royal Hospital, West Sussex, UK.
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Harman KE, Fuller LC, Salisbury JR, Higgins EM, du Vivier AWP. Trends in the presentation of cutaneous malignant melanoma over three decades at King's College Hospital, London. Clin Exp Dermatol 2004; 29:563-6. [PMID: 15347357 DOI: 10.1111/j.1365-2230.2004.01620.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this study was to examine trends in the presentation of cutaneous malignant melanoma at King's College Hospital (KCH) over the last three decades (1970-2000). KCH was one of seven centres that participated in the 1987 Cancer Research Campaign (CRC) publicity campaign aimed at promoting earlier self-recognition of melanoma. Data included patient age at presentation, sex, tumour site, Breslow thickness and histological subtype. The late 1980s saw a threefold increase in the annual number of melanomas and an eightfold increase in thin melanomas compared to the 1970s. The increase occurred in both sexes and was particularly marked after the CRC campaign but numbers had already begun to increase prior to this. The increase has predominantly been thin (Breslow < 1.5 mm) tumours of the superficial spreading variety with a resultant fall in mean Breslow thickness. There has been a decline in the annual number of melanomas since the peak in 1992 which is not explained by increased proportion of in situ tumours. The CRC campaign may have contributed to the documented increase in thin tumours but this trend had begun prior to 1987 suggesting factors other than public awareness and earlier presentation are important. It is encouraging that the number of melanomas has declined over the last 5 years at KCH but it is yet to be seen whether this reflects a real decrease in the incidence of melanoma.
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Affiliation(s)
- K E Harman
- Department of Dermatology, King's College Hospital, Denmark Hill, London, UK.
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Jayasekera S, Sissons J, Tucker J, Rogers C, Nolder D, Warhurst D, Alsam S, White JML, Higgins EM, Khan NA. Post-mortem culture of Balamuthia mandrillaris from the brain and cerebrospinal fluid of a case of granulomatous amoebic meningoencephalitis, using human brain microvascular endothelial cells. J Med Microbiol 2004; 53:1007-1012. [PMID: 15358823 DOI: 10.1099/jmm.0.45721-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The first isolation in the UK of Balamuthia mandrillaris amoebae from a fatal case of granulomatous amoebic meningoencephalitis is reported. Using primary cultures of human brain microvascular endothelial cells (HBMECs), amoebae were isolated from the brain and cerebrospinal fluid (CSF). The cultures showed a cytopathic effect at 20-28 days, but morphologically identifiable B. mandrillaris amoebae were seen in cleared plaques in subcultures at 45 days. The identification of the organism was later confirmed using PCR on Chelex-treated extracts. Serum taken while the patient was still alive reacted strongly with slide antigen prepared from cultures of the post-mortem isolate, and also with those from a baboon B. mandrillaris strain at 1:10,000 in indirect immunofluorescence, but with Acanthamoeba castellanii (Neff) at 1:160, supporting B. mandrillaris to be the causative agent. If the presence of amoebae in the post-mortem CSF reflects the condition in life, PCR studies on CSF and on biopsies of cutaneous lesions may also be a valuable tool. The role of HBMECs in understanding the interactions of B. mandrillaris with the blood-brain barrier is discussed.
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Affiliation(s)
- Samantha Jayasekera
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
| | - James Sissons
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
| | - Julie Tucker
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
| | - Claire Rogers
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
| | - Debbie Nolder
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
| | - David Warhurst
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
| | - Selwa Alsam
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
| | - Jonathan M L White
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
| | - E M Higgins
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
| | - Naveed Ahmed Khan
- School of Biological and Chemical Sciences, Birkbeck College University of London, London WC1E 7HX, UK 2Diagnostic Parasitology Laboratory, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK 3Department of Dermatology, King's College Hospital, London, UK
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Affiliation(s)
- J M L White
- Department of Dermatology King's College Hospital, Denmark Hill, London, UK.
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Affiliation(s)
- J M L White
- King's College Hospital, Department of Dermatology, London, UK.
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Abstract
The drug hypersensitivity syndrome is a severe, multisystem reaction that typically develops within 2 months of starting a drug. We describe a case which has been unusually persistent, requiring prolonged treatment with systemic corticosteroids and after 1 year, ciclosporin. To the best of our knowledge, the use of ciclosporin for the treatment of the drug hypersensitivity syndrome has not been described previously.
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Affiliation(s)
- K E Harman
- Department of Dermatology, King's College Hospital, Denmark Hill, London, UK.
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Harman KE, Higgins EM. Case 4: eruption on the face of a diabetic man suffering from retinopathy, hypertension, and nephropathy. Diagnosis: ciclosporin-associated hyperplastic folliculitis. Clin Exp Dermatol 2003; 28:341-2. [PMID: 12780737 DOI: 10.1046/j.1365-2230.2003.01276.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- K E Harman
- Department of Dermatology, King's College Hospital, Denmark Hill, London, UK.
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Fuller LC, Child FC, Midgley G, Higgins EM. Scalp ringworm in south-east London and an analysis of a cohort of patients from a paediatric dermatology department. Br J Dermatol 2003; 148:985-8. [PMID: 12786830 DOI: 10.1046/j.1365-2133.2003.05022.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Scalp ringworm or tinea capitis has become an increasingly important public health issue in the past decade in Great Britain. Recently, certain dermatology departments in London have seen a large increase in tinea capitis in all its forms. OBJECTIVES The aim of this paper is to present the detailed analysis of a cohort of 277 patients with tinea capitis seen during a 2-year period together with the latest local figures of tinea capitis cases from an inner city paediatric dermatology service. Methods Demographic, clinical and laboratory data were collected prospectively over 2 years from all cases of ringworm in patients seen in a paediatric clinic specially set up for scalp problems. RESULTS Sixty-two per cent of 277 cases of scalp ringworm were caused by Trichophyton tonsurans, occurring mainly (91%) in patients with Afro-Caribbean hair type, more often in boys (68%), and in the 3-8 year olds (70%). Only 7% of the patients had received appropriate treatment with oral griseofulvin. An additional 156 cases from the general paediatric dermatology clinic showed 91%T. tonsurans infections. CONCLUSIONS The prevalence of scalp ringworm appears to be reaching epidemic proportions in certain areas that include south-east London. The clinical problem is not yet well recognized by local general practitioners.
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Affiliation(s)
- L C Fuller
- Department of Dermatology, King's College Hospital, Denmark Hill, Camberwell, London SE5 9RS, UK.
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Affiliation(s)
- L C Fuller
- King's College Hospital, London SE5 9RS.
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22
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Abstract
BACKGROUND Gulf war veterans report more symptomatic ill-health than other military controls, and skin disease is one of the most frequent reasons for military personnel to seek medical care. AIM To compare the nature and prevalence of skin disease in UK Gulf veterans with non-Gulf veterans, and to assess whether skin disease is associated with disability. DESIGN Prospective case comparison study. METHODS Disabled (n=111) and non-disabled (n=98) Gulf veterans and disabled non-Gulf veterans (n=133) were randomly selected from representative cohorts of those who served in the Gulf conflict 1990-1991, UN Bosnia Peacekeeping Force 1992-1997, or veterans in active service between 1990-91, but not deployed to the Gulf. Disability was defined as reduced physical functioning as measured by the Short Form 36 [score <72.2]. All subjects recruited were examined by a dermatologist, blind to the military and health status of the veteran. RESULTS The prevalences of skin disease in disabled Gulf, non-disabled Gulf and disabled non-Gulf veterans were 47.7, 36.7, and 42.8% respectively. Seborrhoeic dermatitis was twice as common as expected in the Gulf veterans (both disabled and non-disabled). DISCUSSION Skin disease does not appear to be contributing to ill health in Gulf war veterans, with the exception of an unexplained two-fold increase in seborrhoeic dermatitis.
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Affiliation(s)
- E M Higgins
- Dermatology Department, King's College Hospital, London, and. Gulf War Illness Research Unit, Guy's, King's & St Thomas' Medical School, London, UK
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Abstract
Eosinophilic pustular folliculitis (EPF) of infancy is a rare disorder which may begin in the neonatal period and cause considerable parental anxiety. It must be distinguished from other causes of a pustular eruption in neonates, including infection and erythema toxicum neonatorum, and rare disorders such as transient neonatal pustular melanosis, infantile acropustulosis and Langerhans' cell histiocytosis. Skin smears and occasionally skin biopsy may be necessary to reach a diagnosis. We report a case of a Caucasian child with an unusually early onset of EPF in the first day of life. We wish to emphasize the importance of recognizing this self-limiting condition in order to prevent inappropriate antimicrobial treatment.
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Affiliation(s)
- D A Buckley
- Department of Dermatology, King's College Hospital, London, UK.
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Fuller LC, Smith CH, Cerio R, Marsden RA, Midgley G, Beard AL, Higgins EM, Hay RJ. A randomized comparison of 4 weeks of terbinafine vs. 8 weeks of griseofulvin for the treatment of tinea capitis. Br J Dermatol 2001; 144:321-7. [PMID: 11251566 DOI: 10.1046/j.1365-2133.2001.04022.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tinea capitis is a common childhood infection that has recently become more frequent in urban areas in Europe and the U.S.A. The current licensed treatment in children is griseofulvin 10 mg kg(-1) daily, which is usually given for 6--8 weeks. OBJECTIVES To compare this treatment with a 4-week course of oral terbinafine. METHODS Terbinafine was given at the following doses: in children weighing < 20 kg, 62.5 mg daily; 20--40 kg, 125 mg daily; > 40 kg, 250 mg daily. Two hundred and ten children aged 2--16 years, with mycologically confirmed tinea capitis, were randomized to 4 weeks treatment with terbinafine or 8 weeks with griseofulvin, and followed for a total of 24 weeks to determine the difference between treatments with respect to short- and long-term efficacy and tolerability. RESULTS One hundred and forty-seven patients were evaluable (terbinafine 77, griseofulvin 70). Although the 4-week course of terbinafine resulted in a trend to more rapid clearance of tinea capitis, there were no statistically significant differences between the two drugs in terms of overall outcome or tolerability, apart from in a subgroup of patients with Trichophyton infections, and weighing > 20 kg, who responded better to terbinafine than to griseofulvin at 4 weeks. By contrast, there was a better response to griseofulvin than to terbinafine in patients with Microsporum audouinii infections. CONCLUSIONS Overall, the study showed that 4 weeks of treatment with oral terbinafine has similar efficacy to 8 weeks of treatment with griseofulvin for the management of tinea capitis in children.
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Affiliation(s)
- L C Fuller
- Department of Dermatology, King's College Hospital, London SE5 9RS, UK
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27
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Abstract
These guidelines for the management of tinea capitis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
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Affiliation(s)
- E M Higgins
- King's College Hospital, London SE5 9RS, U.K
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Affiliation(s)
- D A Buckley
- Department of Dermatology, King's College Hospital, London SE5 9RS.
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Abstract
We recorded the diagnosis made in 461 black patients (187 children and 274 adults) attending a dermatology clinic between January and March 1996. In the childhood population, atopic eczema and tinea capitis were the most frequent dermatoses, comprising 63% of diagnoses recorded. In the adult population, acne and acne keloidalis nuchae were seen most frequently. Other conditions observed commonly were eczema, psoriasis, keloid scarring, pityriasis versicolor and postinflammatory changes. Our study demonstrates a wide spectrum of skin disease and includes disorders more common in black skin, disorders unique to black skin, those which present a greater cosmetic disability, and normal findings which have been mistaken for pathological disease.
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Affiliation(s)
- F J Child
- Department of Dermatology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Abstract
Recalcitrant viral warts are a troublesome therapeutic problem. Immunotherapy with the universal allergic contact sensitizer diphencyprone (DCP) has been used successfully in such cases. We have reviewed our experience of the use of DCP in the treatment of resistant hand and foot warts during an 8-year period. Sixty patients were sensitized to DCP during this time; the median duration of warts was 3 years. Twelve patients defaulted from treatment. Of the remaining 48 individuals, 42 (88%) cleared of all warts. The median number of treatments to clear was five (range one to 22) and the median time to clear was 5 months (range 0.5-14). Adverse effects occurred in 27 of 48 patients (56%), most commonly painful local blistering (n = 11), blistering at the sensitization site (n = 9), pompholyx-like reactions (n = 7) and eczematous eruptions (n = 4). Three of those who defaulted did so due to side-effects, one became pregnant and eight dropped out for unknown reasons. Three of the 48 patients who cleared or had at least six treatments also discontinued DCP therapy due to side-effects, but most tolerated treatment well. Twenty-five patients were followed up for periods of 1 month to 8 years (median 2 years) and none had a recurrence. DCP immunotherapy is an effective option for the treatment of recalcitrant viral warts but patients must be motivated to attend for sequential applications and must be warned about potential uncomfortable side-effects.
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Affiliation(s)
- D A Buckley
- Department of Dermatology, King's College Hospital, Denmark Hill, London SE5 9RS, UK
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Keane FM, Munn SE, Vivier AW, Higgins EM, Taylor NF. Analysis of Chinese herbal creams prescribed for dermatological conditions. West J Med 1999; 170:257-259. [PMID: 18751138 PMCID: PMC1305573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine whether Chinese herbal creams used for the treatment of dermatological conditions contain steroids. DESIGN 11 herbal creams obtained from patients attending general and pediatric dermatology outpatient clinics were analyzed with high resolution gas chromatography and mass spectrometry. SETTING Departments of dermatology and clinical biochemistry. ; MAIN OUTCOME MEASURE Presence of steroid. RESULTS Eight creams contained dexamethasone at a mean concentration of 456 mug/g (range 64 to 1500 mug/g). All were applied to areas of sensitive skin such as face and flexures. CONCLUSION Greater regulation needs to be imposed on Chinese herbalists to prevent illegal and inappropriate prescribing of potent steroids.
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Affiliation(s)
- F M Keane
- Department of Dermatology, King's College Hospital, London SE5 9RS
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Keane FM, Munn SE, du Vivier AW, Taylor NF, Higgins EM. Analysis of Chinese herbal creams prescribed for dermatological conditions. BMJ 1999; 318:563-4. [PMID: 10037629 PMCID: PMC27755 DOI: 10.1136/bmj.318.7183.563] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/10/1998] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether Chinese herbal creams used for the treatment of dermatological conditions contain steroids. DESIGN 11 herbal creams obtained from patients attending general and paediatric dermatology outpatient clinics were analysed with high resolution gas chromatography and mass spectrometry. SETTING Departments of dermatology and clinical biochemistry. MAIN OUTCOME MEASURE Presence of steroid. RESULTS Eight creams contained dexamethasone at a mean concentration of 456 micrograms/g (range 64 to 1500 micrograms/g). All were applied to areas of sensitive skin such as face and flexures. CONCLUSION Greater regulation needs to be imposed on Chinese herbalists to prevent illegal and inappropriate prescribing of potent steroids.
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Affiliation(s)
- F M Keane
- Departments of Dermatology and Clinical Biochemistry, King's College Hospital, London SE5 9RS.
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Affiliation(s)
- D A Buckley
- Department of Dermatology, King's College Hospital, London, UK
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Abstract
Alagille syndrome (arteriohepatic dysplasia) is a genetic disorder with autosomal dominant transmission which has been localized to chromosome 20p. Cutaneous manifestations include jaundice, pruritus, and widespread xanthomata. We report a child with severe Alagille syndrome in whom orthotopic liver transplantation caused rapid resolution of disfiguring xanthomas.
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Affiliation(s)
- D A Buckley
- Department of Dermatology, King's College Hospital, Denmark Hill, London, England
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Abstract
We report a patient with purely cutaneous Rosai-Dorfman disease (RDD) who presented with a solitary, asymptomatic plaque on the back of her left thigh, with characteristic, large histiocytoid cells exhibiting emperipolesis histologically. Cutaneous lesions occur in 27% of patients with lymph node involvement in RDD however purely cutaneous disease has only been reported on 18 previous occasions. The aetiology is unknown, although it is though to be a reactive disorder rather than neoplastic, possibly an immunological response to an infectious agent.
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Affiliation(s)
- F J Child
- Department of Dermatology, King's College Hospital, London, U.K
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Abraha HD, Fuller LC, Du Vivier AW, Higgins EM, Sherwood RA. Serum S-100 protein: a potentially useful prognostic marker in cutaneous melanoma. Br J Dermatol 1997; 137:381-5. [PMID: 9349333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
S-100, an acidic calcium-binding protein, is present within cells of neuroendocrine origin. Its value in the immunohistochemical diagnosis of tumours of melanocytic origin is well established. More recently, a potential role has been proposed for the serum concentration of this protein as a marker of metastatic melanoma disease activity. In the present study, the concentration of serum S-100 protein was measured in 97 patients with histologically proven malignant melanoma who were attending a dermatology and/or oncology department for the follow-up of their disease. Serum S-100 was also measured in 48 control subjects without malignant melanoma. The clinical stage of the patients was classified according to the criteria of the American Joint Committee on Cancer into stages I-IV. The median (range) serum S-100 protein concentration was significantly higher in stage I (0.11 (0.1-0.21) microgram/L, P < 0.001), stage II (0.11 (0.05-0.22) microgram/L, P < 0.001), stage III (0.24 (0.07-0.41) microgram/L, P < 0.0001) and stage IV (0.39 (0.06-15.0) microgram/L, P < 0.0001) compared with the control group (0.1 (0.05-0.15) microgram/L). At a threshold value of 0.2 microgram/L, the sensitivity and specificity for detection of advanced disease were 82% and 91%, respectively. Thus serum S-100 protein may be a valuable prognostic marker for malignant melanoma and for monitoring therapy. Serum S-100 protein concentration was also compared with the Breslow thickness of the tumours. There was a significant correlation between these variables (n = 72, rs = 0.32, P < 0.01). Combining a serum S-100 threshold value of > 0.22 microgram/L and a Breslow thickness of > 4 mm improved the sensitivity and specificity for the presence of secondary spread to 91% and 95%, respectively. Therefore, a combination of both baseline serum S-100 protein and Breslow thickness may provide a better indication of the prognosis at diagnosis.
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Affiliation(s)
- H D Abraha
- Department of Clinical Biochemistry, King's College School of Medicine and Dentistry, London, U.K
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Higgins EM, Fuller LC, du Vivier AW, Tovey D. GP training in dermatology. Br J Gen Pract 1997; 47:594. [PMID: 9406504 PMCID: PMC1313119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Abstract
The different isoforms of transferrin have been quantified by isoelectric focusing in the sera of psoriasis patients with and without a history of abusing alcohol. In both male and female psoriasis subjects abusing alcohol, there were significant increases in the 2-sialylated forms by comparison to the control subjects. Psoriasis patients who had no evidence of alcohol abuse had similar profile for the isoforms of transferrin to that of the controls. Other groups of patients with alcohol-induced tissue damage, i.e. liver, brain or muscle, used as positive controls, similarly showed significant increases in the 2-sialylated forms, by comparison to controls. These results substantiate the current use of carbohydrate-deficient transferrin as a sensitive marker of alcohol abuse, particularly in subjects not drinking in excess of 60 g of ethanol/day but showing alcohol-related psoriasis.
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Affiliation(s)
- P Hoefkens
- Department of Chemical Pathology, Erasmus University, Rotterdam, The Netherlands
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Abstract
There is a recognized psychiatric morbidity among those who attend dermatology clinics. We aimed to determine the pattern of psychological and social problems among patients referred to a liaison psychiatrist within a dermatology clinic. Notes from 149 patients were reviewed and more detailed assessments performed in a subgroup of 32 consecutive referrals. All but 5% merited a psychiatric diagnosis. Of these, depressive illness accounted for 44% and anxiety disorders, 35%. Less common general psychiatric disorders included social phobia, somatization disorder, alcohol dependence syndrome, obsessive-convulsive disorder, posttraumatic stress disorder, anorexia nervosa, and schizophrenia. Classical disorders such as dermatitis artefacta and delusional hypochondriasis were uncommon. Commonly, patients presented with longstanding psychological problems in the context of ongoing social difficulties rather than following discrete precipitants. Psychiatric intervention resulted in clinical improvement in most of those followed up. Of the dermatological categories 1) exacerbation of preexisting chronic skin disease; 2) symptoms out of proportion to the skin lesion; 3) dermatological nondisease; 4) scratching without physical signs, the commonest were dermatological nondisease and exacerbation of chronic skin disease. Anxiety was common in those from all dermatological categories. Patients with dermatological nondisease had the highest prevalence of depression. Skin patients with significant psychopathology may go untreated unless referred to a psychiatrist. The presence of dermatological nondisease or symptoms out of proportion to the skin disease should particularly alert the physician to the possibility of underlying psychological problems.
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Affiliation(s)
- P W Woodruff
- Department of Psychological Medicine, King's College School of Medicine and Dentistry, London, England
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Child FJ, Higgins EM. Cutaneous manifestations of non-HIV immunosuppression. Br J Hosp Med (Lond) 1995; 54:395-9. [PMID: 8535593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Advances in organ transplantation and chemotherapeutic techniques have led to an increased interest in both the early and long-term complications of immunosuppression. This article reviews many of the cutaneous complications and highlights the importance of regular skin surveillance in these patients.
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Affiliation(s)
- F J Child
- Department of Dermatology, King's College Hospital, London
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Abstract
A retrospective study of the number of patients with non-melanoma skin cancer treated over a 22-year period at King's College Hospital was carried out. There was a threefold rise in the number of patients with basal cell carcinoma and a 10-fold rise in the number of patients with squamous cell carcinoma from 1970 to 1992. This study demonstrates a marked increase in the number of patients with non-melanoma skin cancers presenting to the Department of Dermatology and reflects a national trend which underlines the need for skin cancer services to be prepared for a growing workload in this area.
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Affiliation(s)
- J R Hughes
- Department of Dermatology, King's College Hospital, London, UK
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Abstract
A case of adult-onset urticaria pigmentosa is presented, in which the eruption cleared following the application of potent topical corticosteroids. Remission could be maintained by intermittent topical treatment. Topical steroids would appear to provide a simple, cheap and effective alternative to standard therapies.
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Affiliation(s)
- E M Higgins
- Department of Dermatology, King's College Hospital, London, UK
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Hughes JR, Smith E, Higgins EM, Berry H, du Vivier AW. Pyoderma gangrenosum in a patient with rheumatoid arthritis responding to treatment with cyclosporin A. Br J Rheumatol 1994; 33:680-1. [PMID: 8019800 DOI: 10.1093/rheumatology/33.7.680] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J R Hughes
- Department of Dermatology, King's College Hospital, London
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