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Biomedical subjects

D J Gawkrodger

Publications and source records attributed to D J Gawkrodger.

At least 91 records · Page 5Linked to original sources
PubMed1995

Neuropeptides and general neuronal marker in psoriasis--an immunohistochemical study.

Nerve fibres immunoreactive to antibodies to vasoactive intestinal polypeptide (VIP) and substance P (SP) were increased in lesional psoriatic skin when assessed semiquantitatively. Biopsies from psoriatic plaques on the arm were studied in 13 patients and compared with biopsies from non-lesional areas (in three of the same psoriatic subjects) and from normal skin in seven non-psoriatic controls. Immunohistochemical methods were used on cryocut skin sections to demonstrate the neuropeptides SP, VIP, calcitonin gene-related peptide and neuropeptide Y, and the general neuronal marker protein gene product (PGP) 9.5. The immunofluorescence was examined by semiquantitative and, for PGP 9.5, by quantitative methods. VIP reactive nerve fibres were increased at areas of eccrine sweat glands throughout the dermis, at the dermo-epidermal junction, and in the epidermis, in psoriasis lesional skin. SP reactive nerve fibres were increased at the dermo-epidermal junction, where the nerves ran parallel with and perpendicularly through the junction. PGP 9.5 reactive nerve fibres showed an increase at the dermo-epidermal junction, in the papillary dermis, and at the eccrine sweat glands in lesional psoriatic skin but not in non-lesional, or in control skin. These findings support the hypothesis that neuropeptides may be involved in the pathogenesis of psoriasis.

Adult↗
PubMed1995

Survey of quality issues in dermatology service contracts. Audit Subcommittee of the British Association of Dermatologists.

Most hospitals now have acquired trust status and managers have started the process of setting contracts with purchasers. In order to assess quality content of contracts for dermatology services, a survey was performed on behalf of the British Association of Dermatologists' (BAD) Audit Subcommittee. A letter was sent to 278 consultant members of the BAD, requesting a copy of their contract: 171 (62%) replies were received. Seventy-four consultants had formal contracts with purchasers, but only 25 (34%) of these had been involved in contract preparation. Several consultants were unsure whether formal contracts existed and many had difficulty in obtaining the documents. The 20 contracts received were highly variable, with a median of 13 (range 0-89) quality clauses per contract. These mostly related to the process of care, particularly waiting times and communication with general practitioners (GPs). Sometimes the structure for delivering care was specified, but only occasionally were outcome measures mentioned. The specified maximum waiting time for a new patient appointment ranged between 4 and 30 weeks (median 13). GPs were to be sent out-patient letters within 3-10 days (median 10) of patient attendance. Following in-patient care a notification was to be sent within 1-3 days (median 2) of discharge and a full summary within 7-21 days (median 12). A requirement for patient satisfaction surveys was included in only six contracts. Greater involvement of consultant dermatologists in setting contracts with purchasers should lead to the inclusion of more consistent and appropriate quality clauses.(ABSTRACT TRUNCATED AT 250 WORDS)

Contract Services↗
PubMed1995

Morphologic observations on the dermal nerves in vitiligo: an ultrastructural study.

BACKGROUND: Vitiligo is a common idiopathic skin disorder. The etiology is unknown, although various hypotheses have been advanced. These include the neuronal hypothesis, where neuronal factors are thought to play a role in the pathogenesis of this disease. METHODS: Skin biopsies were taken from marginal and central parts of four vitiligo patients. Biopsies were also taken from nonvitiliginous skin of each patient and from four normal control subjects. Sections were examined under the electron-microscope. Nerve fibers in the superficial dermis were examined. RESULTS: Subtle ultrastructural changes, including regeneration and degeneration, were consistently found in dermal nerves of vitiligo lesions. The most consistent feature, seen in all four vitiligo patients studied (in both lesional and marginal areas), was an increased thickness of the basement membrane of Schwann cells. This change was found in approximately three-quarters of all dermal nerves in vitiligo biopsies, but in only about one-quarter of dermal nerves in normal control skin. About half the abnormal dermal nerves in vitiligo skin showed minor axonal damage, although indicators of regeneration (increased mitochondria and rough endoplasmic reticulum) predominated. The dermal nerves in vitiligo showed no difference in fiber diameter or fiber density in comparison with controls. CONCLUSIONS: In vitiligo both axonal degeneration and nerve regeneration may occur, with the latter possibly being a reactive change to earlier axonal damage. These findings support the hypothesis that there is a neuronal component to this disease.

Adult↗
PubMed1995

The prevention of nickel contact dermatitis. A review of the use of binding agents and barrier creams.

Chelating agents and other substances can be used to bind nickel or reduce its penetration through the skin, and hence to reduce the symptoms in subjects with nickel sensitivity. Topical usage is mostly described but, in some studies, chelating agents have been given systemically. The most effective ligand for nickel so far described is 5-chloro-7-iodoquinolin-8-ol. Although normally regarded as safe, its usage in some situations may be limited by concerns about its toxicity. Other ligands with demonstrable effect include ethylenediaminetetraacetic acid in various forms, diphenylglyoxime and dimethylglyoxime. Cation exchange resins can effectively bind nickel and work both in vitro and in vivo. Propylene glycol, petrolatum and lanolin reduce the absorption of nickel through the skin. Corticosteroids and cyclosporin work in nickel dermatitis by suppressing the immunological reaction rather than through an effect on nickel. Studies of the oral administration of ligands such as tetraethylthiuram disulphide have given conflicting results but the use of these agents is limited by hepatoxicity in any case. Some compounds offer potential for use in the prophylaxis of nickel dermatitis. Further work is required to develop the existing agents and to look at the use of novel combinations, such as that of a cation exchanger with a ligand.

Chelating Agents↗
PubMed1994

The prevalence of childhood atopic eczema in a general population.

BACKGROUND: Atopic eczema has become more common during recent decades, but few studies have looked at its prevalence in the general community. OBJECTIVE: Our purpose was to ascertain the prevalence of atopic eczema, its age of onset, and its relationship to breast-feeding and ear piercing in a general practice population. METHODS: Children (N = 1104), aged 3 to 11 years, were identified from a computerized register in a socially and ethnically mixed English general practice population of 13,314. Of these, 1077 children (97.6% recruitment) were interviewed with parents or guardians, and the resultant data were recorded on a survey form. RESULTS: The lifetime occurrence of atopic eczema was 20% in boys (12% in the past year) and 19% in girls (11% in the past year). Prevalence in the past year was 10% to 14% in boys aged 3 to 11 years but fell in girls from 15% at 3 to 5 years to 8% at 9 to 11 years. Atopic eczema developed in the first 12 months of life in 60% of the children who had the condition, and it developed in the first 6 months of life in three quarters of these children. Ear piercing had been performed in 35% of girls and 3% of boys and was most prevalent in social classes 3, 4, and 5. More than half the girls aged 9 to 11 years had pierced ears. Breast-feeding did not affect the prevalence of atopic eczema. CONCLUSION: The lifetime prevalence of atopic eczema was 20% in children aged 3 to 11 years. There was no evidence that ear piercing perpetuated eczema in this age group. Breast-feeding did not protect against the development of atopic eczema.

Asthma↗
PubMed1994

The relationship between stress and the onset and exacerbation of psoriasis and other skin conditions.

The role of stressful life events in the progress of various skin conditions was studied retrospectively in patients who presented with either psoriasis (where there is some agreement about the importance of stress), urticaria, acne, alopecia and non-atopic eczema (where there is some uncertainty regarding the role of stress), or malignant melanoma, fungal infection, basal cell carcinoma and melanocytic naevi (where stress is considered less relevant). When patients in the three groups were matched for age, those with psoriasis were more likely to report that the experience of stress pre-dated the onset and exacerbations of their condition than patients with other skin diseases. For the psoriasis patients the most common types of life events were family upsets (such as bereavements), and work or school demands, but chronic difficulties were also common. There was no relationship between the severity of stress and time to onset or exacerbations. The results support the notion that stress is more likely to be associated with the onset of psoriasis than other conditions, but also that there may be considerable individual variation in the ability to cope, suggesting that psychological interventions may be helpful for particular patients.

Acne Vulgaris↗
PubMed1994

Neuropeptide and neuronal marker studies in vitiligo.

Neuropeptide and neuronal marker immunoreactivity was studied in skin biopsies from lesional and marginal areas in 12 patients with vitiligo, and in seven normal controls. The vitiligo was active in seven, static in two, and of unknown activity in three. Antibodies against general neuronal marker PGP 9.5 (PGP 9.5), substance P (SP), calcitonin gene-related peptide (CGRP), vasoactive intestinal polypeptide (VIP), and neuropeptide Y (NPY), were used. The epidermis, dermo-epidermal junction, papillary and reticular dermis, and appendages, were assessed semiquantitatively for reactivity with each antibody. Staining with PGP 9.5 in the upper dermis was assessed quantitatively by image analysis. An increase in reactivity against NPY antibody was seen in five of 10 cases (three with active vitiligo) in the marginal areas, and in three of 12 subjects (all with active vitiligo) in the lesional vitiligo areas. VIP antibody reactivity showed a minimal increase in the marginal and lesional vitiligo areas (in two cases each, both of whom had active vitiligo). SP and CGRP reactivities did not differ from normal. PGP 9.5 staining was minimally increased at the dermo-epidermal junction and lower Malpighian layer in biopsies from marginal areas in three of 10 subjects (all with active vitiligo). Quantitative analysis of PGP 9.5 reactivity in the upper dermis showed no difference between vitiligo and normal biopsies. These findings support the concept of neuronal or neuropeptide involvement in vitiligo, and in particular suggest that NPY may have a role in the pathogenesis of the disease.

Biomarkers↗
PubMed1994

Pemphigoid nodularis: a report of two cases.

Pemphigoid nodularis is a rare variant of bullous pemphigoid characterized by the development of pruritic hyperkeratotic nodules. These nodules may be the presenting feature of the disease, and may precede the development of bullae by several years. The condition appears to be more common in females than males, and is often resistant to treatment. We report two definite cases and one possible case of pemphigoid nodularis, and review the literature relating to this disorder.

Aged↗
PubMed1994

An audit of the value of patch testing: the patient's perspective.

Evaluation of the benefits of patch testing has been difficult. We have attempted to establish patients' views on patch testing and to assess the effectiveness of advice given in the clinic. Postal questionnaires were sent to 135 patients. A total of 105 replies were received (77.8% response rate). 42 patients (40.4%) reported improvement in their skin condition after testing. Of the 43 patients with a final diagnosis of allergic contact dermatitis (ACD), 31 (72%) believed that patch testing had helped. About 1/2 of these were able to avoid the allergens concerned and had made changes in their lifestyle. This contrasts with the group of patients with final diagnoses other than ACD, in whom only 20 of 62 (32%) recorded patch testing as helpful. Similar numbers in both groups had improved sufficiently to be discharged from the clinic. 91 of the patients were entirely correct in their knowledge of the patch test results. 39 felt that the results had not been explained in sufficient detail. This study shows that patch testing is beneficial, especially for those with ACD. Patients' knowledge of the results was good but education could be improved.

Adolescent↗
PubMed1994

Squamous cell carcinoma complicating lichen planus: a clinico-pathological study of three cases.

Squamous cell carcinoma complicating lichen planus is described in 3 patients. In 2, the cancers developed on the lower leg in chronic and hypertrophic lichen planus. In the other case, the cancer complicated lichen planus of the lip mucosa in a smoker. In the two cutaneous cases, the tumour and the adjacent skin showed features of lichen planus, including hypergranulosis, cytoid bodies and a lichenoid infiltrate. The association, though rare with cutaneous lichen planus when it tends to affect chronic hypertrophic lesions on the lower legs, is now well recognized with oral lichen planus. Patients with oral involvement warrant long-term follow-up, especially if they have other risk factors such as smoking or excessive ultraviolet exposure. Chronicity of lichen planus at other skin sites may also be a risk factor.

Aged↗
PubMed1993

Allergy to octyl gallate causing stomatitis.

Octyl gallate is an antioxidant (European Community number 311). It is used as a preservation agent in a wide variety of foods and other non-dietary substances. We report a case of a 49-year-old female with a 10-year history of 'burning mouth' and clinical erythema of the tongue, who, after investigation, proved to be allergic to octyl gallate. Management with an exclusion diet proved effective in both controlling the burning sensation and resolving the erythema of the tongue.

Antioxidants↗
PubMed1993

Light cautery and EMLA in the treatment of chloracne lesions.

We report six patients with chloracne, unresponsive to conventional therapy, whose lesions were cleared by treatment with EMLA (eutectic mixture of lignocaine [lidocaine] 25 mg/g and prilocaine 25 mg/g) topical anaesthesia and light cautery. To the best of our knowledge, this form of treatment for chloracne has not previously been reported.

Adult↗