Biomedical subjects
Publications and source records attributed to S Handfield-Jones.
These guidelines for the management of cutaneous warts have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
OBJECTIVE: To describe a grading system for risk stratification of atypical Spitz tumors in children and adolescents. In some circumstances, unequivocal distinction between Spitz nevus and melanoma is practically impossible. It is likely that these lesions for which we lack specific diagnostic criteria represent a broad histological continuum extending from benign to malignant tumors. Therefore, we propose that Spitz tumors be categorized into low-, intermediate-, or high-risk categories based on the accumulation of abnormal features. DESIGN: Retrospective study. SETTINGS: Institutional practice. PATIENTS: We present 30 cases of atypical Spitz tumors in patients younger than 18 years evaluated for at least 3 years or in whom a metastatic event developed during this period. INTERVENTION: None. MAIN OUTCOME MEASURE: The grading system was formulated after data collection. RESULTS: Among the parameters studied, only diagnosis at age greater than 10 years, diameter of the lesion greater than 10 mm, presence of ulceration, involvement of the subcutaneous fat (level V), and mitotic activity of at least 6/mm2 carried a likelihood ratio greater than 1.50 and were therefore used for the grading system. CONCLUSION: The application of an objective grading system, such as the one described herein for the first time, is the first step in providing useful information for the management of atypical Spitz tumors.
We report the case of a woman who had pain in both heels which was exacerbated by long periods of exercise. On examination, there were small flesh-coloured papules which appeared over the medial and lateral aspects of the heels only on weight bearing. Coincidentally, she was noted to have larger flesh-coloured papules over the anterior surface of the shins. The diagnoses of painful piezogenic pedal papules and bilateral tibialis anterior muscle herniation, respectively, were made. After many attempts to control the pain, a course of electro-acupuncture was commenced. A good subjective clinical response was achieved which has been maintained by fortnightly treatments. We discuss the prevalence, pathogenesis and treatment of painful piezogenic pedal papules. We believe that our patient is the first to have 'herniations' at both heel and shin sites and the first to have successful sustained pain relief for painful piezogenic pedal papules.
Half of all patients with cutaneous sarcoidosis will develop pulmonary disease. We report a case of cutaneous and endobronchial sarcoidosis and describe a scheme for identifying pulmonary involvement in patients with cutaneous sarcoid.
Three cases of waxy keratoses of childhood occurring in two families are described. The disorder seen in these three cases appears to be clinically and histopathologically distinct from previously described familial disorders of keratinization, which also feature multiple discrete papules.
The development of naevus spilus-like hyperpigmentation at sites of resolving plaques of psoriasis has been reported previously. Although the mechanism is not understood, PUVA therapy has been implicated in most cases. We report an additional case in which lentigines, confined to sites of resolving psoriasis, occurred following oral PUVA. We also describe similar clinical features in two patients who had not received PUVA, which strengthens the observation that this treatment is not a prerequisite for development of this unusual pattern of pigmentation.
We report a family suffering from dominant dystrophic epidermolysis bullosa, in whom linear lichenified lesions and troublesome pruritus were prominent features. We consider that this clinical picture may constitute a separate subtype of this disorder.
An unusual pattern and type of lichen planus is described in a 57-year-old female in which the flexures were exclusively involved. The affected areas were chronically eroded and ulcerated and resistant to topical treatment. Erosive lichen planus is known to occur on mucosal surfaces and cases of ulcerative lichen planus have been described involving the feet and lower limbs. Lichen planus involving flexures alone is uncommon and for erosion and ulceration to occur at these sites seems rare. We report a case of erosive, flexural lichen planus of long standing in a middle-aged female.
The effectiveness of EMLA cream in relieving the discomfort associated with percutaneous infiltration of lignocaine was assessed in a double-blind, placebo-controlled study. Patients undergoing minor skin surgery were divided into two groups, according to the number of lesions requiring surgery. The first group had a single lesion and were randomized to apply either EMLA or placebo cream 1 h prior to infiltration, whilst the second group received EMLA to one and placebo to the other of two lesions treated at the same clinic attendance. In neither group was there a clinically useful reduction of discomfort, probably due to inadequate dermal anaesthesia, and we would not, therefore, recommend the routine use of EMLA for this purpose. The most recent evidence suggests that a 2-h application time may give more effective dermal anaesthesia, but this would probably limit its use to occasional problematical cases.
An open study of high dose nicotinamide in the treatment of 15 patients with necrobiosis lipoidica is reported. Of 13 patients who remained on treatment for more than 1 month, eight improved. Improvement took the form of a decrease in pain and soreness, a decrease in erythema and the healing of ulcers if present, although the skin did not return completely to normal in any patient. There were no significant side-effects, particularly with respect to diabetic control, an important finding as lesions tended to relapse if treatment was stopped.
The case of a burned patient, whose fluid management was complicated by the development of toxic epidermal necrolysis, a condition which itself may mimic a burn, is presented. The possible causes, together with the diagnostic and therapeutic problems posed by this combination of ailments, are discussed.
Acrokeratoelastoidosis is a chronic condition manifested by acral hyperkeratotic papules. There have been no reports of effective treatment. We report a case that responded to etretinate.
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