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H C Williams

Publications and source records attributed to H C Williams.

At least 109 records · Page 6Linked to original sources
PubMed1995

A protocol for recording the sign of flexural dermatitis in children.

The presence of visible flexural dermatitis is a key feature in diagnosing atopic dermatitis. We describe a protocol for recording this sign in population-based studies, which could be used by suitably trained non-dermatologists. The protocol was developed using a standard set of photographs and accompanying instructions, which define the terms 'dermatitis' and 'flexural'. When assessed during a survey of skin disease in primary schoolchildren, there was excellent agreement between a trained nurse and a dermatologist with regard to the presence or absence of this sign in 73 consecutive children, with perfect agreement in 71 children (97%), and a chance corrected agreement index (kappa statistic) of 0.90 (95% confidence interval [CI] 0.77-0.99). Agreement between two nurses on 114 consecutive schoolchildren was not quite as good, with perfect agreement in 102 children (90%), and a kappa value of 0.51 (95% CI 0.26-0.77). The protocol is easy to perform, does not require children to undress, takes < 1 min to carry out, and is highly acceptable to children and staff. This protocol may be useful in standardizing the assessment of atopic dermatitis in population studies of children.

Child↗
PubMed1995

Myelodysplastic syndrome presenting as cutaneous vasculitis.

A patient presenting with cutaneous vasculitis was noted to be pancytopenic. Subsequent investigation showed a myelodysplastic syndrome (MDS)--refractory anaemia with excess of blasts. Within 3 months her MDS progressed to acute myeloid leukaemia.

Acute Disease↗
PubMed1995

On the definition and epidemiology of atopic dermatitis.

Hospital-derived criteria for atopic dermatitis may need to be refined before being applied to epidemiologic studies. Atopic dermatitis is a common and miserable condition, and environmental factors are probably at least as important as genetic factors in determining disease expression. These findings put us one step nearer to our dream of disease prevention.

Dermatitis, Atopic↗
PubMed1994

Childhood eczema: disease of the advantaged?

OBJECTIVE: To determine whether the increased prevalence of childhood eczema in advantaged socioeconomic groups is due to increased parental reporting. DESIGN: Comparison of parental reports of eczema with visible eczema recorded by medical officers during a detailed physical examination. SETTING: National birth cohort study. SUBJECTS: 8279 children from England, Wales, and Scotland born during 3-9 March 1958 and followed up at the ages of 7, 11, and 16. MAIN OUTCOME MEASURES: Prevalence of eczema according to parental report compared with medical officer's examination at the ages of 7, 11, and 16. RESULTS: Prevalence of both reported and examined eczema increased with rising social class at the ages of 7, 11, and 16 years. The point prevalence of examined eczema at age 7 was 4.8%, 3.6%, 3.6%, 2.4%, 2.2%, and 2.4% in social classes I, II, III non-manual, III manual, IV, and V respectively (chi 2 value for linear trend 12.6, P < 0.001). This trend persisted after adjustment for potential confounders such as region and family size and was not present for examined psoriasis or acne. CONCLUSIONS: Eczema is more prevalent among British schoolchildren in social classes I and II than those in lower classes. Exposures associated with social class are probably at least as important as genetic factors in the expression of childhood eczema.

Adolescent↗
PubMed1994

The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis.

A working party of 13 dermatologists, two family practitioners and a paediatrician was assembled, with the aim of developing a minimum list of reliable discriminators for atopic dermatitis. Each physician was asked to select 10 consecutive new cases of unequivocal mild to moderate atopic dermatitis and 10 controls with other inflammatory dermatoses. Each subject was examined by two independent observers, who were blind to the clinical diagnosis and study aim, with regard to 31 clinically useful diagnostic features for atopic dermatitis. Two hundred and twenty-four patients were studied (120 cases and 102 controls). Using the key physician's clinical diagnosis as a gold standard, the sensitivity and specificity of each of the 31 diagnostic criteria were tested. Using multiple logistic regression techniques, a minimum set of diagnostic criteria for atopic dermatitis was derived. These were: history of flexural involvement, history of a dry skin, onset under the age of 2, personal history of asthma, history of a pruritic skin condition, and visible flexural dermatitis. Adjustment for age, sex, region, social class and ethnic group did not alter the choice of final criteria. The discriminatory value of these criteria was also satisfactory when tested against a further sample of 150 patients drawn from the community, who did not have skin disease.

Adolescent↗
PubMed1994

The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. II. Observer variation of clinical diagnosis and signs of atopic dermatitis.

The level of agreement between 14 physicians as to what constitutes a case of atopic dermatitis was tested on 15 selected patients with a range of diagnoses. Between-observer agreement was good, with a mean pair agreement index (P0) of 0.94, and a chance corrected index (kappa) of 0.78. Between-observer agreement in the recording of 18 separate physical signs of atopic dermatitis was then tested by asking the 14 physicians to note the presence or absence of each sign in a different group of patients to those seen in the first part of the exercise. Substantial between-observer agreement (kappa > 0.61) was only present for truncal dermatitis. Most signs showed only fair to moderate agreement (kappa 0.21-0.60), and some signs, such as keratosis pilaris, xerosis, orbital pigmentation, fine hair, and extensor dermatitis, showed poor agreement (kappa 0.01-0.20). The findings were similar when the responses of two independent observers from the national study outlined in Paper I were compared for each sign. Within-observer variation for the recording of physical signs was substantially better than between-observer variation. Physicians interested in atopic dermatitis agree reasonably well on what constitutes a typical case of atopic dermatitis. Between-observer variation with regard to some physical signs of atopic dermatitis is of a magnitude which argues against their continued use in clinical and epidemiological studies.

Dermatitis, Atopic↗
PubMed1994

The U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation.

In order to qualify as a case of atopic dermatitis, we propose that an individual must have an itchy skin condition plus three or more of the following: history of flexural involvement, a history of asthma/hay fever, a history of a generalized dry skin, onset of rash under the age of 2 years, or visible flexural dermatitis. When tested in an independent sample of 200 consecutive dermatology outpatients of all ages, this arrangement of the diagnostic criteria achieved 69% sensitivity and 96% specificity when validated against physician's diagnosis. Based on the findings of this first exercise, minor modifications in the wording of the criteria were undertaken, and these were tested on a sample of 114 consecutive children attending out-patient paediatric dermatology clinics. Overall discrimination improved, with a sensitivity of 85% and specificity of 96%. The simplified criteria are easy to use, take under 2 min per patient to ascertain, and do not require subjects to undress. These two independent validation studies suggest that the newly proposed criteria for atopic dermatitis perform reasonably well in hospital out-patient patients. Further validation in community settings and in developing countries is needed.

Adolescent↗
PubMed1994

Livedo reticularis and massive thoracoabdominal aneurysm.

Cholesterol crystal embolization arising from an atheromatous aortic aneurysm is a potentially treatable condition. We report a 55-year old man with a sudden onset of painful livedo reticularis of the buttocks and lower limbs secondary to a massive thoracoabdominal aortic aneurysm, discovered incidentally when the patient underwent a liver ultrasound test. The diagnosis of cholesterol crystal embolization of the skin requires a high degree of clinical suspicion. Abdominal ultrasound should be considered in the routine assessment of lower limb livedo reticularis.

Acute Disease↗
PubMed1994

Psoriasis and eczema are not mutually exclusive diseases.

BACKGROUND: Some reports have suggested that psoriasis and eczema are seldom found together. Knowledge of disease co-occurrence could lead to improved understanding of shared or opposing pathological mechanisms. OBJECTIVE: We sought to determine whether psoriasis and eczema could exist simultaneously and consecutively in the same individuals. METHODS: Skin examination data relating to 9,263 British children born during March 3rd to 9th, 1958 (the National Child Development Survey), were analysed for the co-occurrence of eczema and psoriasis. RESULTS: Of 354 children with visible eczema at the ages of 11 or 16 years, 5 (1.4%) were also noted to have visible psoriasis, compared to 89 (1.0%) of 8,909 children who did not have visible eczema at 11 or 16 years. The relative risk of psoriasis in a case of eczema was 1.41, 95% confidence intervals from 0.58 to 3.46. CONCLUSION: Contrary to some hospital-based studies which have suggested that the two diseases are seldom found together, this study of a large and representative population suggests that eczema and psoriasis may co-occur concurrently and consecutively in the same individual.

Adolescent↗
PubMed1994

Turban ear.

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Adult↗
PubMed1993

Inadequate size of 'negative' clinical trials in dermatology.

Fifty-eight clinical trials with negative conclusions, published in three British dermatological journals over the last 4 years, were reviewed to determine the risk of their having missed an effective treatment. All but one of the 44 evaluable trials had a greater than 1 in 10 risk of missing a 25% relative treatment difference (median risk 81%), and 31 of the trials (70%) were so small that they had a greater than 1 in 10 risk of missing a 50% relative treatment difference (median risk 42%). The 'negative' trial result was compatible (within 95% confidence limits) with a 25% beneficial relative treatment effect in 36 studies (82%), and a 50% treatment benefit in 22 studies (50%). Only one study used confidence intervals to describe the main findings, and only three studies (7%) mentioned the basis for sample size estimation at the outset of the study. Of particular concern was that in half (23/44) of the studies there was an incorrect interpretation of the findings. It is worrying to observe such a profusion of clinical trials in dermatology which are too small to answer the questions being posed, especially when this is coupled with misreporting of results. Apart from ethical concerns, many treatments compatible with a considerable treatment benefit may have been erroneously discarded as a result of such studies. We recommend the use of confidence intervals to summarize clinical trial findings, so that readers can quickly decide whether clinically important treatment effects are plausible.

Humans↗
PubMed1993

The descriptive epidemiology of warts in British schoolchildren.

This study set out to determine the prevalence and predictors of warts in British schoolchildren by analysing medical examination data from a national birth cohort study of 9263 British children born 3-9 March 1958. The prevalence of visible warts, according to a medical officer, at the age of 11 was 3.9% (95% confidence intervals 3.5-4.3) and 4.9% (95% confidence intervals 4.5-5.4) at 16. Of the 364 children noted to have warts at the age of 11,337 (93%) no longer had warts at 16. Residence in the south of Britain, having a father with a non-manual occupation, being an only child, and belonging to an ethnic group other than white European were all associated with a decreased risk of visible warts. Region of residence was the strongest predictor of wart prevalence. There were no sex differences in wart prevalence. Warts represent a common source of morbidity in British schoolchildren. Future studies should take into account age, regional factors, social class, family size and ethnic group when comparing wart sufferers with other subjects.

Adolescent↗