Resigned to my fate.
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Attitude of Health Personnel↗
Biomedical subjects
J A Cotterill
Publications and source records attributed to J A Cotterill.
Copper vapour laser (578 nm) and flashlamp-pumped pulsed tunable dye laser (585 nm) treatment of port wine stains: results of a comparative study using test sites.
The copper vapour laser (CVL), emitting at 578 nm, has recently become available for treating vascular skin lesions. Its place in the management of port wine stains (PWS) requires clarification. We have compared a CVL with a pulsed tunable dye laser (PTDL; 585 nm) in 43 patients with macular, blanchable PWS. Test areas were performed with the CVL, using a Hexascan and an energy fluence just sufficient to produce immediate tissue change (mean fluence 18.2 J/cm2 and mean pulse width 50 ms). Test areas were performed with the PTDL using a 5-mm spot at 6.5 J/cm2. Assessments were made after 4 months, subjectively using a clinical fading score and objectively using an index of light absorbence derived from reflectance spectrophotometry. The fading produced by the PTDL was significantly better than the CVL, as determined by clinical assessment (mean fading scores 2.41 and 1.67, respectively, P < 0.0005) and reflectance spectrophotometry (mean absorbence index 149 and 157 respectively, P < 0.0005). These results indicate that the PTDL is the preferred treatment for most macular, blanchable PWS. However, in a proportion of lesions responses were equivalent with both lasers, and in a small proportion, the CVL produced a better response.
Adolescent↗
Immunological changes in hydroxyurea-induced collagen disease.
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Collagen Diseases↗
An audit of the factors involved in new patient non-attendance in a dermatology out-patient department.
Non-attendance at out-patient clinics, although common, has received relatively little attention. A prospective study was undertaken to assess the extent of the problem of non-attendances of newly referred dermatological patients in a single dermatological out-patient clinic over a 12-month period. The overall non-attendance rate was found to be 19%. There were no apparent significant differences between the groups of attending and non-attending patients when compared statistically. A survey of those patients who failed to attend suggested that inadequate communication between the hospital and patients (17%) and patients forgetting their appointment date (23%) may be factors that are amenable to administrative changes.
Adolescent↗
The use of calcipotriol in HIV-related psoriasis.
We report the case of a 28-year-old homosexual man with advanced HIV disease (CDC classification group IV A) who developed erythrodermic psoriasis which responded to calcipotriol, a topical vitamin D analogue. We believe this to be the first reported case of HIV-related psoriasis responsive to this form of treatment. Systemic therapy for HIV-related psoriasis is limited because of immunosuppressive effects. We suggest that calcipotriol may prove to be a useful therapeutic option in these patients.
Adult↗
Notalgia paraesthetica--report of three cases and their treatment.
Notalgia paraesthetica is a rare entity which involves the posterior primary rami of thoracic nerves T2-T6. Patients present with a localized discomfort or pruritus on the back. The condition runs a benign course and usually resolves spontaneously. However, whilst present the symptoms can be relentless and disturbing to patients. We report three patients with notalgia paraesthetica, all of whom were helped symptomatically by the topical application of the local anaesthetic cream, EMLA (2.5% lignocaine and 2.5% prilocaine).
Anesthetics, Local↗
Dermatological non-disease.
Patients with dermatological non-disease present with a rich symptomatology. These symptoms, as well as body image, psychiatric considerations, and management of these patients are discussed.
Body Image↗
Erosive pustular dermatosis of the leg--a definition.
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Humans↗
The treatment of port wine stains with the carbon dioxide laser.
The carbon dioxide (CO2) laser was used to treat 51 patients with port wine stains (PWS). Twenty-nine patients were adults who had failed to respond to argon or continuous wave dye laser therapy and 22 patients were children with pink PWS. Follow-up assessment of 40 patients 12 months after treatment revealed an excellent or good result in 74% of adults and 53% of children. The results in adult 'therapeutic failures' was encouraging and CO2 laser therapy can be advised for this group. Two children had a poor result, one with a hypertrophic scar, and treatment in this age group with the CO2 laser should be considered with caution.
Adolescent↗
Anxiety and depression in patients with chronic urticaria and generalized pruritus.
Thirty-four dermatology out-patients with chronic idiopathic urticaria and 34 with idiopathic generalized pruritus were investigated using standardized self-assessment psychological questionnaires to determine the incidence of significant symptoms of depression and anxiety. These patients were compared with age- and sex-matched but otherwise unselected general dermatology out-patients. Using the Beck depression inventory, significantly more patients with generalized pruritus (32.4%) had depressive symptomatology (score greater than 14) than controls (13.2%, P less than 0.05). Although more patients with chronic urticaria had depressive symptomatology (14.7%) than controls (4.4%), the difference was not statistically significant. Using the Speilberger state-trait anxiety inventory there were no significant differences between the patients with pruritus or urticaria and their controls with respect to state or trait anxiety scores above the upper 90% probability limit for the general population. Thus, significant depression may be expected in a substantial proportion of patients with idiopathic generalized pruritus but in a relatively small proportion of those with chronic urticaria.
Adult↗
Reduced vasoactive responses in port wine stains.
Changes in skin blood flow and haemoglobin content of port wine stains and clinically normal contralateral skin were determined by laser-Doppler flowmetry and reflectance spectrophotometry in 14 patients after application of a vasodilating cream containing methyl nicotinate 1.0%, glycol salicylate 10.0% and capsaicin BPC 0.1% (Algipan cream) and in 16 patients after application of a corticosteroid tape containing flurandrenolone (Haelan tape). Changes in blood flow measured after application of vasodilator cream were significantly reduced in port wine stains compared with contralateral skin (P less than 0.01). After application of the vasoconstrictor steroid tape changes in blood flow were significantly reduced in the port wine stains (P less than 0.05) and changes in haemoglobin content were also significantly reduced in the port wine stains compared with normal skin (P less than 0.05). These results support the concept of reduced autonomic innervation of cutaneous vasculature in port wine stains.
Adrenal Cortex Hormones↗
Ulceration of the palms and soles. An unusual feature of cutaneous T-cell lymphoma.
Two patients, one with Sézary syndrome and one with mycosis fungoides are described, in whom lesions on the palms and soles were associated with extensive ulceration and gave rise to diagnostic difficulty. Extensive ulceration of the palms and soles is uncommon; its presence should alert clinicians to the possibility of cutaneous T-cell lymphoma.
Diagnosis, Differential↗
Psychophysiological aspects of eczema.
Anxiety is a personality trait of adult patients with eczema and hyperkinesis commonly found in childhood. Eczema may be precipitated and exacerbated by stress in vulnerable individuals. Eczema, appearing on important body image areas or visible skin areas such as the face, may produce marked reactive depression. Biofeedback techniques, including habit reversal, are useful in management. Chronic intractable eczema may be a sign of impaired parent/child relationships.
Dermatitis, Atopic↗
Widespread crusted plaques and a history of blisters. Bullous ichthyosiform erythroderma.
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Child↗
The treatment of decorative tattoos with the carbon dioxide laser.
The carbon dioxide laser was used in the treatment of 51 patients with decorative tattoos. Sixty-eight treatments were performed under local anaesthesia. Morbidity from treatment was low. Results 6 months after treatment in 44 patients revealed excellent or good results in 24 patients and hypertrophic scarring in three patients. These results confirm the value of this laser in the treatment of tattoos and demonstrate the advantages of this therapy over other treatments currently employed.
Adolescent↗
Continuous wave dye laser therapy of port wine stains.
A continuous wave dye laser emitting light at 577 nm has been used in the treatment of 100 patients with port wine stains. Subjective assessments in 92 patients revealed an excellent or good result in 63% and a fair result in 17%. There was a 5% incidence of hypertrophic scarring and a 5% incidence of post-inflammatory hyperpigmentation. Overall, 12% of patients experienced a poor result. The best results were obtained in older patients with purple port wine stains.
Adolescent↗