Biomedical subjects
Publications and source records attributed to S K Jones.
The occurrence of melanocytic lesions following PUVA therapy is well documented. We describe a patient who developed similar lesions after cosmetic use of a home sun-bed without psoralen administration. Histological examination showed increased numbers of large and sometimes atypical melanocytes, which may theoretically act as precursors for melanoma.
To determine the long-term cutaneous side-effects of oral photochemotherapy (PUVA), we examined 95 patients, 59 with psoriasis and 36 with mycosis fungoides (MF). These comprised 80% and 69% respectively of the patients with these disorders treated with PUVA in our department from 1977 to 1985. Two psoriatic patients had squamous carcinomas, both of whom had received high cumulative UVA doses and also methotrexate concurrently with PUVA. Six patients with MF had actinic keratoses. The mean age of these patients (69 years) was significantly greater than the mean age of the patients without actinic keratoses (54 years), but there was no significant difference in their cumulative UVA doses. No patients developed basal cell carcinomas or malignant melanoma. 'PUVA lentigines' were found in 46% of the patients. They were most frequent in patients currently being treated and in those who had received high cumulative UVA doses, but persisted for up to 7 years after discontinuing therapy. Seventy-one patients had yearly ophthalmological examinations, or a single examination at least 3 months after commencing PUVA. This examination included retinal function tests to detect any subclinical visual impairment. Five of these patients had cataract prior to PUVA therapy, and were significantly older (mean age 71 years) than those without cataract (mean age 53 years). Three patients (mean age 61 years) developed new lens opacities whilst receiving PUVA. However, none of these patients was considered to have cataract as none had impairment of visual acuity due to lens opacity. No patients without lens opacity developed evidence of subclinical visual impairment.
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Four hundred and eighteen cases of primary cutaneous malignant melanoma of the head and neck were registered with the Scottish Melanoma Group between 1979 and 1985. Distribution of histogenetic types of melanoma was lentigo maligna melanoma 50 per cent, superficial spreading melanoma 24 per cent, nodular melanoma 20 per cent, unclassifiable 6 per cent. Annual registrations of all types increased over the seven-year period but were less for lentigo maligna melanoma than for the other types. Patients with lentigo maligna melanoma were older, and those with superficial spreading melanoma younger, than the overall average. These two features support the hypothesis that the former may be more closely related to cumulative sunlight exposure than are other histogenetic types of melanoma. The sex ratio (F:M) was 1.7:1 for lentigo maligna melanoma, 1.5:1 for superficial spreading melanoma, but 1:1 for nodular melanoma. All types of melanoma were seen most commonly on the cheek. The proportion of lentigo maligna melanoma on the cheek was significantly greater than nodular melanoma or superficial spreading melanoma. Superficial spreading melanoma was significantly increased in frequency on the neck and scalp, and nodular melanoma on the ear. Melanomas of the scalp were significantly more frequent in male patients than female. The anatomical site distribution of nodular melanoma showed considerable differences between the sexes: nodular melanoma of the ear or neck occurred more commonly in male patients and nodular melanoma of the cheek was significantly more frequent in female patients. Five-year mortality data for head and neck melanoma derived from patients registered between 1979 and 1981 revealed that mortality was greater in male than in female patients, but there was no significant difference in prognosis between the three histogenetic types of melanoma when these were stratified according to tumour thickness.
We report two siblings with Netherton's syndrome who developed hypernatraemia during the neonatal period. Although this is likely to have been due to trans-epidermal water loss in erythrodermic infants rather than to Netherton's syndrome specifically, this complication should be remembered in erythrodermic infants as a preventable cause of neonatal morbidity.
Childhood pemphigus foliaceus typically causes erythema and scaling of the scalp. Sometimes, blisters and oozing are present, which often are misdiagnosed as either impetigo or seborrheic dermatitis. The eruption may progress to involve the trunk and limbs, the lesions often having an arcuate pattern. The diagnosis can be established by histologic and immunologic evaluation. In children, the disease seems to be less severe than pemphigus vulgaris, as is the case with adults, and we recommend a trial of topical steroids before embarking on systemic therapy.
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Methotrexate sodium is a well-established therapeutic agent for severe psoriasis, but its use may be associated with hepatic fibrosis. We studied the pharmacokinetics of oral and intramuscular methotrexate in two groups of patients--those who did and those who did not develop hepatic fibrosis while receiving methotrexate therapy. Our results showed no difference between the two groups for peak or 24-hour methotrexate concentrations; for area under the curve to 24, 144, and 24 to 144 hours; or in total-body methotrexate clearance. Measurement of methotrexate plasma levels after drug administration is therefore unlikely to help in identifying those patients at risk of developing fibrosis.
We describe a child who developed chronic cutaneous periarteritis nodosa at 5 years of age and whom we have observed over a five-year period. Although intermittent oral corticosteroids have been required to control symptoms, she has not demonstrated involvement of any organ other than the skin.
Current concern over the carcinogenic potential of cytotoxic drugs and photochemotherapy used in the management of psoriasis increases the need for an accurate assessment of the 'background' incidence of carcinoma in psoriatics not receiving these modalities. This study compares the observed incidence of carcinoma in 719 tar-treated psoriatics with that expected, based on data from the West of Scotland Cancer Registry. No increase in malignancy was found in psoriasis over that expected in the general population.
Short contact (30 min) and overnight therapy with 1%, 2% and 3% dithranol in an ointment base were compared in 30 out-patients with plaque psoriasis. Both regimes produced significant clearing, there being no statistically significant difference between the two. There were three withdrawals from each group. The remaining 12 patients on the 30 min regime found it both effective and practical. It is therefore a useful alternative regime for out-patient dithranol therapy.
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Photosensitive eruptions with clinical and histologic features of subacute cutaneous lupus erythematosus and antibodies to SS-A(Ro) antigen occurred in five patients taking hydrochlorothiazide. After drug therapy was discontinued, the eruptions cleared. In one patient anti-SS-A antibodies disappeared after discontinuation of thiazide, and in another rechallenge with hydrochlorothiazide produced an acute dermatitis with a photodistribution. These eruptions may represent a new type of photosensitive drug reaction in which the photoactive drug may be synergistic with anti-SS-A antibody in producing cutaneous lesions of photosensitive subacute cutaneous lupus erythematosus.
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