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V Goulden

Publications and source records attributed to V Goulden.

At least 19 recordsLinked to original sources
PubMed2001

PUVA therapy in lichen aureus.

Lichen aureus is one of the subtypes of a rare group of diseases, pigmented purpuric dermatoses. The natural course of the disease is slow evolution and slow resolution. Treatment is generally limited. We report a case of lichen aureus that responded dramatically to photochemotherapy (PUVA).

Female↗
PubMed2000

Sweet's syndrome presenting as palmoplantar pustulosis.

Sweet's syndrome was initially described as a reactive dermatosis characterized by sudden onset of fever, leucocytosis, and raised erythematous plaques infiltrated with neutrophils, and therefore called acute febrile neutrophilic dermatosis. However, later it became obvious that fever and neutrophilia are variable features, and a number of other characteristics have been described. Although the dorsa of the hands are frequently affected, the palmoplantar involvement mimicking pustulosis observed in our case appears to be unusual.

Administration, Topical↗
PubMed2000

The cutaneous microflora of adolescent, persistent and late-onset acne patients does not differ.

The cutaneous microbiology and antibody status to Propionibacterium acnes of patients with persistent (males, n = 32; females, n = 33) and late-onset (females, n = 25) acne were compared with individuals with adolescent acne (males, n = 22; females, n = 18) and normal control volunteers (persistent acne: males, n = 26; females, n = 30; late-onset: females, n = 20). Males had significantly higher grades of acne compared with females (P < 0.05). The microflora consisted in the main of propionibacteria, staphylococci and Malassezia; other bacteria represented less than 0.01% of the total microflora. At all sites for all samples there were significantly more propionibacteria than staphylococci or Malassezia (P < 0.05). There were significantly higher (P < 0.05) numbers of microorganisms in follicular casts from patients compared with their control volunteers for female facial skin and male back skin. Twenty-six papules and 48 normal follicles were analysed. A bimodal distribution of microbial colonization was noted, with about 90% of normal follicles and about 10% of acne follicles having no detectable viable microorganisms. Anti-P. acnes IgG antibody titres were measured using a secondary fluorescein isothiocyanate antibody technique, and no significant differences in titre were found between any groups of patients (P > 0.05). Correlation analysis showed no association between the population densities of P. acnes and anti-P. acnes IgG titres. There were no differences in the microbiology of skin of adolescent acne patients, persistent acne patients or late-onset acne patients which could account for these various forms of acne.

Acne Vulgaris↗
PubMed2000

Evaluation of a contact allergy clinic.

This study aims to assess the value of patch testing in a specialist contact allergy clinic as compared to testing carried out by general dermatologist for the diagnosis of contact allergy. One hundred consecutive patients referred for patch testing were tested to the European standard and specialized series. A comparison was made between patch tests read and interpreted by a consultant dermatologist with an interest in contact allergic dermatitis and by an experienced registrar who had not yet received any formalized specialized training. Results of testing with additional allergens acquired following the establishment of the specialist clinic were examined. In addition patients with a hand problem and/or symptoms suggestive of contact urticaria underwent skin prick testing. There was a variation in patch test reading and interpretation between the consultant and registrar in 10 patients. Patch testing using allergens from the additional series revealed additional relevant contact allergies in 19 patients. In 14 patients, allergies would have been missed by a limited additional series. Contact urticaria was detected in seven patients. This study has confirmed the value of a specialist contact clinic in the diagnosis of contact allergy. The importance of formalized training in patch test reading and interpretation, testing with additional series and prick testing for the diagnosis of contact urticaria are highlighted.

Ambulatory Care↗
PubMed1999

The familial risk of adult acne: a comparison between first-degree relatives of affected and unaffected individuals.

Acne is principally a disorder of adolescence but persists into middle age in a small minority of individuals. There is some evidence, primarily from twin studies, to suggest that acne may be an inherited disease. We have carried out an investigation of the familial risk of persistent adult acne by studying the occurrence of this condition in first-degree relatives of patients with adult persistent acne compared with the relatives of unaffected matched controls. Two hundred and four patients over the age of 25, referred to our department with facial acne which had persisted from adolescence, were included in the study. For each patient, a detailed pedigree which included all first-degree relatives was drawn up. For all relatives over the age of 25, demographic details and the presence or absence of facial acne was recorded. One hundred and forty-four unaffected controls were recruited. These were matched with the patient group in terms of age, social class and ethnic origin. The same questions were asked of controls as of the cases, and they provided the same information on their first-degree relatives. In total, 204 acne cases and 144 non-acne control volunteers were studied, contributing 1203 and 856 first-degree relatives, respectively. Two hundred and three first-degree relatives of cases were affected with facial acne, compared with 42 first-degree relatives of volunteers. The risk of adult acne occurring in a relative of a patient with adult acne was significantly greater than for the relative of an unaffected individual (odds ratio 3.93, 95% confidence interval 2.79-5.51; P < 0.001). Our study suggests that familial factors are important in determining individual susceptibility to adult persistent facial acne. Genetic factors may determine the failure of acne-prone follicles to evolve into acne-resistant follicles in early adult life.

Acne Vulgaris↗
PubMed1999

Prevalence of facial acne in adults.

BACKGROUND: Acne is usually considered a disorder of adolescence, and a number of studies have examined the prevalence of this condition in the adolescent population. There are, however, relatively few data on the prevalence of acne in the adult population. OBJECTIVE: A community-based study was carried out to investigate the current prevalence of facial acne in adults. METHODS: Seven hundred forty-nine persons older than 25 years were examined for facial acne by means of the Leeds acne-grading technique. RESULTS: A degree of facial acne was recorded in 231 women and 130 men, giving an overall prevalence of 54% (95% confidence interval [CI], 49-58) in women and 40% (95% CI, 35-45) in men (P <.001). The acne observed in volunteers consisted principally of physiological acne, but clinical facial acne (grade > 0.75) was recorded in 3% (95% CI, 1.2-4.8) of men and in 12% (95% CI, 9-15) of women (P <.001). The prevalence of acne did not substantially decrease until after the age of 44 years (P <.001). CONCLUSION: This study shows a prevalence of clinical facial acne in women of 12%, which is likely to persist into middle age.

Acne Vulgaris↗
PubMed1998

Patch testing for Compositae allergy.

The main allergenic constituents of Compositae plants are the sesquiterpene lactones (SLs). In recent years, a mixture of three SLs, each with a different sesquiterpene skeleton (alantolactone, dehydrocostuslactone or costunolide), has been routinely used to detect Compositae allergy. The purpose of our study was to establish the value of testing with a range of Compositae extracts. Ninety-seven consecutive patients with exposure pattern dermatitis or hand eczema and gardening as a hobby or occupation were patch tested to the European standard series including SL mix 0.1% pet., Compositae extracts and other relevant allergens. Twenty-six of the 97 patients tested showed allergic reactions to SL mix or Compositae extracts. Fifteen of these showed positive reactions to both the SL mix and Compositae extracts. Eleven patients showed a negative reaction to the SL mix but positive reaction to the Compositae extracts. Dandelion elicited a positive reaction in eight of the 11 SL mix-negative patients and three patients reacted to feverfew. The SL mix failed to detect 38% of our Compositae-sensitive patients. Dandelion extract alone detected 73% of SL-negative patients. Additional testing with feverfew extract would have detected 91% of the SL mix-negative individuals. Our study highlights the importance of testing the response of SL-negative patients to additional Compositae extracts when there is a clinical suspicion of Compositae allergy.

Adult↗
PubMed1997

Post-adolescent acne: a review of clinical features.

Acne is usually recognized as a disorder of adolescence. However, the referral of patients over the age of 25 years with acne has significantly increased over the past 10 years. The clinical features of 200 patients over the age of 25 years, referred to our department for treatment of acne, were evaluated with a view to establishing possible aetiological factors. There were 152 (76%) women and 48 (24%) men. The mean age of the patients was 35.5 years (range 25-55 years). The acne was mild or moderate in severity, consisting principally of inflammatory lesions, with mean total acne grade (Leeds Grading Scale) of 1.125 for men and 0.75 for women. Most patients had persistent acne; but true late-onset acne (onset after the age of 25 years) was seen in 28 (18.4%) of women and four (8.3%) of men. Thirty-seven per cent of women had features of hyperandrogenicity. One hundred and sixty-four patients (82%) had failed to respond to multiple courses of antibiotics, and 64 (32%) had relapsed after treatment with one or more courses of isotretinoin. External factors, such as cosmetics, drugs and occupation, were not found to be significant aetiological factors. A family history revealed that 100 (50%) of patients had a first-degree relative with post-adolescent acne. Patients with post-adolescent acne appear to represent an increasingly important population of acne sufferers. External factors do not seem to have a significant aetiological role. Two main clinical groups were identified: those with persistent acne and those with late-onset acne. A minority of women also had features of hyperandrogenicity. These patients, and those with late-onset acne, may represent a subgroup who have underlying abnormalities of ovarian, adrenal or local androgen metabolism, and require separate investigation.

Acne Vulgaris↗
PubMed1997

Treatment of acne with intermittent isotretinoin.

Adults with acne represent an increasingly important population of acne sufferers referred for treatment. Acne, in these patients, is generally mild or moderate in severity but tends to be resistant to conventional antibiotic therapy. A study was carried out to assess the efficacy of intermittent moderate dose isotretinoin as a treatment for acne. Eighty consecutive patients, over the age of 25 years, referred with acne unresponsive to, or relapsing rapidly after three or more courses of conventional antibiotic therapy were recruited. Acne severity was assessed on the face, chest and back using the Leeds grading scale and the number of inflamed lesions was counted at the site showing the highest acne grade. The patients were 22 men and 58 women. The treatment regimen consisted of isotretinoin, 0.5 mg/kg per day for 1 week in every 4 week for a total period of 6 months. Seventy-five patients completed the study. The therapy was very well tolerated with mild cheilitis as the only side-effect. At the end of treatment, both total acne grade and lesion counts were significantly reduced (P < 0.0001). The acne had resolved in 68 (88%) patients. Twelve months after treatment, acne grades and inflamed lesion counts remained significantly improved (P < 0.0001) in the 68 patients who responded; however, 26 (39%) patients had relapsed. There was a significantly higher incidence of relapse in patients with predominantly truncal acne (P = 0.01). Patients who relapsed also had a significantly higher total acne grade, lesion count (P < 0.0001) and sebum excretion rate (P < 0.001) compared with those whose acne resolved. This study suggests that intermittent moderate dose isotretinoin may be a cost-effective alternative to full dose isotretinoin in a carefully selected group of adult patients with-acne. Selection criteria should include predominantly facial acne, total acne grade less than 1, inflamed lesion count less than 20 and sebum excretion rate less than 1.25 micrograms/cm2 per min.

Acne Vulgaris↗
PubMed1996

Safety of long-term high-dose minocycline in the treatment of acne.

Minocycline is widely used as a second-line antimicrobial for acne vulgaris. Some patients require doses of up to 200 mg daily to control their acne. To assess the long-term safety of minocycline when used at higher doses, 700 patients treated with minocycline at doses of 100 mg daily, 100/200 mg on alternate days and 200 mg daily, were recruited. The mean duration of treatment was 10.5 months. Side-effects were monitored and full blood count, blood urea, electrolytes and liver function tests were carried out on 200 of the 700 patients. Side-effects were recorded in 13.6%, and included vestibular disturbance, candida infection, gastrointestinal disturbance, cutaneous symptoms (pigmentation, pruritus, photosensitive rash and urticaria) and benign intracranial hypertension. Pigmentation was the only side-effect found to be significantly increased in patients taking higher doses of minocycline, as compared with lower doses (P < 0.01). All patients with pigmentation had taken a total cumulative dose of over 70 g. No significant abnormalities were found in any of the haematological and biochemical profiles. We conclude that minocycline, at doses of up to 200 mg/day, is safe, long-term, for acne, when such doses are clinically necessary.

Acne Vulgaris↗