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Biomedical subjects

E M Higgins

Publications and source records attributed to E M Higgins.

At least 55 records · Page 3Linked to original sources
PubMed1994

Urticaria pigmentosa--response to topical steroids.

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.

Adult↗
PubMed1993

Subcutaneous sarcoidosis.

Subcutaneous sarcoid appears to be rare, particularly in Caucasians. When it does occur, it usually heralds systemic involvement. A case of subcutaneous sarcoid is reported, which is unusual both in its extent, and by its lack of demonstrable extra-cutaneous disease. Cutaneous sarcoid is well recognized, but subcutaneous sarcoid has rarely been described. We report only the fourth case of subcutaneous sarcoid from the UK.

Female↗
PubMed1992

Brain metastases from transitional cell carcinoma of urinary bladder.

Of 293 patients with transitional cell carcinoma of the bladder seen at our institution between April 1977 and December 1987, 9 patients were found to have brain metastasis. Seven of 9 patients were found to have a solitary brain lesion, and in 4 of these, no other site of metastatic disease was identified. Five patients received palliative whole brain irradiation, 3,000 cGy in 10 fractions, due to the presence of multiple lesions of the central nervous system (CNS) or metastases to other sites. The average survival for this group was seven weeks. One patient with a solitary brain metastasis and no other documented metastatic site was hospitalized at another institution, and was managed expectantly receiving only parenteral steroid therapy and survived four weeks. Three patients with solitary lesions and no evidence of other metastatic sites were treated with a combined surgical and radiotherapeutic approach receiving 4,000-5,000 cGy to the lesion site postoperatively. The average survival of that group was twenty-nine months, with one five-year survivor and 1 patient with no evidence of disease fourteen months after treatment. It appears that survival is longer in those patients with solitary lesions, perhaps due, at least in part, to a more aggressive therapeutic approach.

Aged↗
PubMed1992

The application of the seven-point check-list in the assessment of benign pigmented lesions.

One hundred consecutive histologically benign lesions seen at a pigmented lesion clinic were studied prospectively to assess the diagnostic accuracy of the seven-point check-list. Lesions were scored by both patient and physician. Thirty per cent of lesions attained a suspicious score. While there was a high level of agreement between patient and clinician regarding the individual characteristics of a lesion as defined in the check-list, final assessments differed. Most patients considered their lesions suspicious, whereas the clinicians correctly recognized that in 94% cases they were benign. The seven-point check-list often fails to exclude common benign pigmented lesions. The revised (1989) check-list is even less specific (70% of lesions achieving a suspicious score). Such check-lists are difficult for the inexperienced to interpret. Clinical familiarity is required in order to provide a confident diagnosis. Future emphasis should be directed towards improving screening in primary care.

Adolescent↗
PubMed1992

Possible induction of malignant melanoma by sunbed use.

Malignant melanoma of the female genitalia is rare. A patient who regularly used a sunbed developed a malignant melanoma after 4 years. The possible aetiological role of sunbeds in the development of such a malignancy is discussed.

Adult↗
PubMed1992

Alcohol and the skin.

The cutaneous stigmata of chronic alcoholic liver disease have been well recognised since the nineteenth century. However, it is now clear that the skin may be affected as an early feature of alcohol misuse. In particular, psoriasis, discoid eczema and superficial infections are more common in heavy drinkers. Awareness of these early associations can alert physicians to patients at risk of future complications of alcoholism. Great advances have been made in the understanding of the physiological and pathological effects of ethanol. The implications of these changes in the skin are discussed with reference to both the new and established cutaneous signs of alcohol misuse.

Alcoholism↗
PubMed1991

Oral cyclosporin inhibits the expression of contact hypersensitivity in man.

The expression of delayed contact hypersensitivity was studied in 6 patients with chronic contact dermatitis treated with cyclosporin A (CsA) 5 mg/Kg/day. Quantitative patch test challenge was used to establish individual dose-response curves and threshold concentration to certain allergens in the European Standard Battery. In all 6 patients, responses were reduced over the whole range of allergen concentrations, and in the 5 in whom the threshold for expression of contact hypersensitivity could be determined, the threshold was raised by CsA therapy. In addition, the clinical manifestations of allergic contact dermatitis underwent complete resolution within 2-3 weeks of CsA therapy. It was concluded that CsA inhibits expression of delayed contact hypersensitivity reactions in human skin.

Administration, Oral↗
PubMed1991

Pheomelanin as well as eumelanin is present in human epidermis.

There are two types of melanin in mammals, the brownish black eumelanin and the reddish yellow pheomelanin. Eumelanin and pheomelanin are present in human hair and this study was carried out to see whether both pigments are also present in human epidermis. Samples of epidermis were obtained from suction blisters raised in the upper arm of 13 Caucasian subjects of skin types I, II, and III and analyzed for both eumelanin and pheomelanin using a procedure involving high-performance liquid chromatography. Eumelanin and pheomelanin were found in all epidermal samples and their relative proportions correlated well with those found in samples of hair taken from the same subjects. The lowest concentrations of eumelanin were found in subjects of skin type I, with higher levels in skin types II and III. The concentrations of pheomelanin were more variable and showed no relationship to skin type. Increases in the concentrations of both pigments occurred following PUVA therapy, but whereas the largest increases in eumelanin were seen in skin types II and III, the increases in pheomelanin showed little relationship to skin type. Unlike eumelanin, epidermal pheomelanin also showed little relationship to PUVA-induced tanning. The present findings could be particularly significant in view of recent suggestions that pheomelanin, rather than protecting the skin against UV radiation, may actually contribute to UV-induced skin damage.

Epidermis↗
PubMed1991

The action spectrum between 320 and 400 nm for clearance of psoriasis by psoralen photochemotherapy.

We have compared the effectiveness of oral 8-methoxypsoralen photochemotherapy (PUVA) using ultraviolet fluorescent lamps with peak emission at either 325, 352 or 370 nm in the treatment of 24 patients with psoriasis. The forearms of each patient were treated three times weekly with two of the three lamps. The erythemal sensitivity of each patient was tested before the first treatment to ensure that equally erythemal doses of radiation were given from each of the lamps. A side-to-side comparison was used to assess response to treatment at weekly intervals for the 6 weeks of the trial. The lamp with peak emission at 325 nm was shown to be significantly superior to either of the other lamps in terms of response assessed at weekly intervals, and time to clearance of psoriasis. An action spectrum, constructed from the median doses required for clearance of psoriasis using each of the lamps, showed that the effectiveness of the radiation decreased exponentially with increasing wavelength throughout the UVA waveband, such that radiation at 320 nm was an order of magnitude more effective than at 360 nm. This suggests that lamps with peak emission around 325 nm will be more effective than those conventionally used in PUVA units with a peak emission at 352 nm. Lamps with peak emission around 325 nm are also highly effective in the treatment of psoriasis with phototherapy alone. Thus a single treatment unit containing these lamps could be used either for PUVA or ultraviolet phototherapy of psoriasis, avoiding duplication or irradiation equipment.

Adolescent↗
PubMed1991

Cyclosporin A in atopic dermatitis: therapeutic response is dissociated from effects on allergic reactions.

Fourteen patients with severe chronic atopic dermatitis were treated with cyclosporin A (CyA, Sandimmun; 5 mg/kg/day) for 7-16 weeks. All showed a marked clinical improvement and half could omit topical corticosteroid treatment during therapy. Adverse effects were minor, but two patients relapsed despite continued treatment. In the others, the disease recurred soon after stopping CyA. Serum IgE levels and prick-test responses were unchanged by CyA. Immediate and late-phase cutaneous responses to intradermal house dust mite antigen (HDM) were significantly increased during treatment; but a delayed response, present at 24 and 48 h, was unaffected. Four of six patients challenged with HDM patch tests to tape-stripped skin during treatment showed eczematous reactions at 48 h. Thus, cyclosporin A has a powerful therapeutic effect in atopic dermatitis but does not reduce allergic responses to inhalant antigens.

Adolescent↗
PubMed1991

Angina bullosa haemorrhagica--a possible relation to steroid inhalers.

Angina bullosa haemorrhagica (ABH) is a recently recognized condition, characterized by benign subepithelial blood-filled blisters in the mouth. The history is characteristic and distinction from other causes of oral blistering can be made by simple clinical signs or on histological grounds. This condition does not appear in standard dermatology texts, yet patients with ABH usually present to a dermatology clinic. A case with typical history is reported in an asthmatic patient who very regularly used a steroid inhaler. The possible aetiological role of such steroid-based inhalers is discussed.

Adult↗
PubMed1991

How do malignant melanomas present and does this correlate with the seven-point check-list?

A pigmented-lesion clinic was established in the skin department at King's College Hospital to coincide with the British public-education campaign on malignant melanoma. One-hundred cases of malignant melanoma have subsequently been seen and evaluated prospectively with regard to the usefulness of the Glasgow seven-point check-list as a guide to diagnosis. The most-frequently reported patient observations were growth of the lesion (74%) and change in its colour (53%) (especially darkening). However, 50% of the lesions were smaller in size than the 1 cm referred to in the check list and 15% were less than 0.5 cm. Itching was noted in 24% and bleeding and crusting were remarked upon in 18% of cases. Abnormal shape was noted in 20% of the patients. Inflammation was visible in only 11%. Seventy-three per cent of our patients had early lesions (less than 1.5 mm Breslow thickness) and nearly half presented at the insistence of their relatives or friends or because of the family doctor's incidental diagnosis. They stated they would not otherwise have attended the hospital and many had noticed nothing untoward even on direct questioning. Half of the patients scored less than three on the check list and 10 out of the 22 cases of nodular melanoma might not therefore have been referred to our clinic. The check list has subsequently been revised and now provides a more-sensitive guide.

Adult↗