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S H Wakelin

Publications and source records attributed to S H Wakelin.

At least 19 recordsLinked to original sources
PubMed2005

Mucosal vulval lichen planus: outcome, clinical and laboratory features.

BACKGROUND: Mucosal lichen planus of the vulva is a rare but increasingly recognized condition. It has potentially severe complications such as fusion of the labia and vagina; the risk of developing squamous cell carcinoma (SCC) may be increased. An association between hepatitis B and C infection and skin or oral lichen planus appears to exist in certain geographical areas. OBJECTIVE: To investigate the course of mucosal vulval lichen planus, its response to treatment and associated laboratory features. SUBJECTS AND METHODS: Forty-four women with mucosal vulval lichen planus were studied between 1997 and 2000 and laboratory data were collected. RESULTS: Thirty of 44 patients had additional oral lesions, only nine had cutaneous findings compatible with lichen planus. We did not find an association with antibodies to hepatitis B or C virus in this British study population. All women were treated with potent to very potent topical corticosteroids; however, in the majority of patients symptoms persisted. In seven (16%) patients vulval lichen planus was in remission after a disease duration between 2 and 18 years (mean 10.6 years). One patient developed a vulval SCC. CONCLUSIONS: Screening for hepatitis B and C in women with mucosal vulval lichen planus in the UK seems unnecessary. We recommend long-term follow-up, and that all non-healing ulcerative and papular lesions should be biopsied.

Adrenal Cortex Hormones↗
PubMed2003

Molecular prenatal diagnosis in a case of an X-linked dominant chondrodysplasia punctata.

X-linked dominant chondrodysplasia punctata, (CDPX2-MIM302960) also known as Conradi-Hünermann-Happle syndrome, is a rare form of skeletal dysplasia that affects the skeleton, skin, hair, and eyes. The disorder is caused by mutations within the emopamil binding protein (Ebp) that functions as a delta(8), delta(7) sterol isomerase in the cholesterol biosynthesis pathway. To date, over 40 separate mutations have been reported in the Ebp gene, EBP, with no obvious correlation between the molecular defects and the severity of the clinical phenotype. We have studied a 30-year-old woman who presented in adulthood with skin, hair, and mild skeletal defects but no ocular abnormalities and have identified a heterozygous missense mutation within the third transmembrane domain of the protein. In addition, we have performed molecular prenatal testing on her unborn fetus. The results demonstrate inter-familial variability for missense mutations within the emopamil binding protein and add to the molecular data for CDPX2.

Adult↗
PubMed2002

Comparative frequency of patch test reactions to topical antibiotics.

BACKGROUND: Neomycin, clioquinol and fusidic acid are all topical antibiotics widely used in dermatological practice in the U.K., either as a single agent or in combination with topical corticosteroids. However, an adverse effect of topical antibiotics is contact sensitization. OBJECTIVES: To examine the frequency of positive patch test reactions to fusidic acid, clioquinol and neomycin. METHODS: To compare the frequency of allergic patch test reactions over 1 year, we patch tested all patients attending the St John's Institute of Dermatology contact dermatitis clinic for one calendar year with fusidic acid, neomycin and clioquinol. RESULTS: We patch tested 1119 patients. Positive patch test reactions to neomycin were noted in 40 patients (3.6%), compared with eight patients (0.7%) to clioquinol and three patients (0.3%) to fusidic acid. The frequency of medicament allergy to neomycin was thus five times more common than to clioquinol and ten times more common than to fusidic acid. Although fusidic acid is not part of our extended standard series, it is in our medicaments series. Therefore, in the second part of our study, we reviewed all cases of positive patch test reactions to fusidic acid over the last 20 years. We found that the frequency of hypersensitivity has decreased since the early 1980s despite increasing usage; the current average frequency being 1.62 patch-tested patients per year (1.45%) of those patch tested to the medicaments series). The most common diagnosis in such patients was stasis dermatitis (54.2%). CONCLUSIONS: The frequency of fusidic acid allergy in an eczema population is low and is comparable with published data from over 10 years ago.

Administration, Topical↗
PubMed2002

A case of childhood sarcoidosis.

Cutaneous sarcoidosis is rare in children. We report a case of a 5-year-old Bangladeshi girl who presented with fever, a papular eruption on the lower limbs and trunk, malaise, anorexia and weight loss. There was multisystem involvement with marked hepatosplenomegaly, generalized lymphadenopathy, parotid fullness and chronic uveitis. Pulmonary infiltrates were seen on the chest X-ray. Histology of a skin biopsy showed naked noncaseating granulomata and PCR for Mycobacterium tuberculosis was negative. A clinical diagnosis of sarcoidosis was made. The patient was treated with oral prednisolone (2 mg/kg per day). An excellent clinical response with resolution of the rash and improvement of extracutaneous signs was noted within 3 months and she remains well on low-dose prednisolone on alternate days. We discuss the presentation and management of sarcoidosis in children, and highlight the potential difficulty in differentiating this from disseminated tuberculosis.

Anti-Inflammatory Agents↗
PubMed2001

A retrospective analysis of contact allergy to lanolin.

BACKGROUND: Lanolin is often stated to be an important sensitizer but some of the available literature is based on the analysis of high-risk patients. OBJECTIVES: To analyse the frequency of contact allergy to lanolin (wool alcohols) in a central London teaching hospital patch-test population. METHODS: Review of 24,449 patients recorded on our database during 1982--96 who were tested with a standard series containing 30% wool alcohols. RESULTS: The mean annual rate of sensitivity to this allergen was 1.7%. The wool alcohols-allergic group contained a higher proportion of females (P < 0.05), and the mean age of both males and females (48.4 and 49.2 years) was higher than that of non-wool alcohols-allergic patients (41.4 and 35.9 years; P < 0.0005). There was no difference in atopic eczema status between these groups. The highest prevalence of allergy to wool alcohols was among patients with lower leg dermatitis (6.0%; 95% confidence interval, CI 4.46--7.54), followed by those with anogenital dermatitis (3.23%; 95% CI 1.81--4.65). There was an unexplained decline in the rate of positive patch tests to Amerchol L-101. However, some patients who reacted to this were negative with wool alcohols, so it may be a useful additional test reagent. The mean rates of allergy to Eucerin (0.65% per annum) and 50% hydrogenated lanolin in petrolatum (1% per annum) were low, and we no longer use these as test reagents. CONCLUSIONS: This study illustrates that lanolin sensitization has remained at a relatively low and constant rate even in a high-risk population (i.e. patients with recent or active eczema).

Adolescent↗
PubMed2001

Contact urticaria.

Contact urticaria has been reported following skin contact with a multitude of substances ranging from simple chemicals to macromolecules. Its prevalence amongst the general population is unknown, but it may be a relatively common and under-recognized phenomenon. Non-immunological (irritant) causes typically elicit mild localized reactions, which clear within hours. Such agents can be found widely in food, cosmetics and medicaments. The lower diagnostic end-point for nonimmunological contact urticaria has been the subject of debate, which makes interpretation of the literature difficult. Immunological (allergic) contact urticaria is due to immediate-type hypersensitivity, and occurs most commonly in atopic individuals. It is mediated primarily by histamine, and may be associated with systemic, and potentially life-threatening symptoms. Natural rubber latex is one of the most important causes today, and the recent 'epidemic' of latex protein allergy has helped draw attention to this subject. Immunological contact urticaria to animal or vegetable matter may occasionally affect those who handle food, and other occupations such as agricultural and veterinary workers. This may be associated with development of a protein contact dermatitis. The diagnosis of immunological contact urticaria can often be confirmed by simple investigations such as skin prick testing or measurement of specific IgE.

Dermatitis, Allergic Contact↗
PubMed2000

Association of TNFA gene polymorphism at position -308 with susceptibility to irritant contact dermatitis.

Mechanisms underlying susceptibility to skin irritants are not clearly understood. Cytokines play a key role in inflammation, and functional polymorphisms in cytokine genes may affect responses to irritants. We investigated the relationship between polymorphism in the tumor necrosis factor (TNF) alpha-chain gene and responses to irritants. Volunteers (n=221) tested with sodium dodecyl sulfate (SDS) and benzalkonium chloride (BKC) were divided into responders and nonresponders and high and low irritant-threshold groups. DNA was assayed for the TNF-308 polymorphism by a polymerase chain reaction-restriction fragment length polymorphism method. There was a significant increase in the A allele (P=0.030) and AA genotype (P=0.023) in both the SDS low irritant-threshold group and in SDS responders (A allele P=0.022, AA genotype P=0.048). In the BKC low irritant-threshold group, we found a significant increase in the A allele (P=0.002) and AA genotype (P=0.016). Individuals with a low threshold to both irritants demonstrated a significant increase (P=0.002) in the A allele. This is the first description of a nonatopic genetic marker for irritant susceptibility in normal individuals. Genotyping for the TNF-308 polymorphism may thus contribute to screening of individuals deemed at risk of developing irritant contact dermatitis.

Adolescent↗
PubMed2000

The frequency of fragrance allergy in a patch-test population over a 17-year period.

Fragrances are widely encountered in our daily environment and are known to be a common cause of allergic contact dermatitis. We have reviewed our patch test data from 1980 to 1996 to establish whether the pattern of fragrance allergy has changed with time. During this period, 25,545 patients (10,450 male, 15,005 female) were patch tested with the European standard series. The mean annual frequency of positive reactions to the fragrance mix was 8.5% in females (range 6.1-10.9) and 6.7% in males (range 5.1-12.9). Females were 1.3 times more likely to be allergic to fragrance (P < 0.001, 95% confidence interval, CI 1.17-1.41). Males with fragrance allergy were older than females by 5.6 years (mean age 48.2 vs. 42.6 years; P < 0.001, 95% CI 3.9-7.3). The incidence of a concomitant positive patch test to balsam of Peru in fragrance-sensitive patients showed wide variation, suggesting that it is not a reliable marker of fragrance allergy. There was a positive correlation between the isomers isoeugenol and eugenol. Oak moss remained the most common overall allergen throughout the study, positive in 38.3% of females and 35.6% of males who were tested to the constituents of the fragrance mix. During the period of the study the incidence of positive tests to oak moss increased by 5% yearly (P = 0.001, 95% CI 2.2-8.7). The frequency of allergic reactions to eugenol and geraniol remained relatively constant. Isoeugenol and alpha-amyl cinnamic aldehyde sensitivity increased and hydroxycitronellal showed a slow decline. There was a striking reduction in the frequency of sensitivity to cinnamic aldehyde (by 18% yearly; P < 0.001, 95% CI 14.3-21.0) and cinnamic alcohol (by 9% yearly; P < 0.001, 95% CI 5.2-12.9); these are now uncommon fragrance allergens. These data show temporal trends which may reflect the frequency of population exposure to individual fragrances.

Acrolein↗
PubMed2000

Descriptive epidemiology of hand dermatitis at the St John's contact dermatitis clinic 1983-97.

For 15 years, hand dermatitis accounted for a quarter of patients seen in this clinic. The highest proportion occurred in women aged 17-30 years. Overall, the male to female ratio was 0.8, which contrasts with population-based studies. Catering was most frequently associated with occupational hand dermatitis. Other frequent occupational associations included metalworking, hairdressing, healthcare and mechanical work.

Adult↗