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Biomedical subjects

Anne Howard

Publications and source records attributed to Anne Howard.

12 recordsLinked to original sources
PubMed2006

Follow up of 12 patients with trachyonychia.

A follow-up study was performed to determine the outcomes of all patients (five males and seven females, mean age 18.4 years) who were referred to a specialist nail clinic with trachyonychia. The average number of affected nails per patient was 8.8 fingernails and 6.2 toenails. None of our patients tested positive for onychomycosis. Nail biopsies were performed in two patients, revealing non-specific changes. Eight patients did not present with or develop accompanying skin or mucosal disease. Two patients presented with alopecia areata and two others with psoriasis. Of our patients, 50% showed total resolution or marked improvement in their nail disease within the first 6 years regardless of treatment.

Administration, Topical↗
PubMed2005

Intervention groups for adolescents with conduct problems: is aggregation harmful or helpful?

Past research has suggested that the aggregation of deviant peers during treatment may cause harmful effects (T. J. Dishion, J. McCord, & F. Poulin, 1999). This study compared the effectiveness of problem-solving skills training groups in which all members had conduct problems ("pure" group condition) with groups that consisted of adolescents with and without behavior problems ("mixed" group condition). Participants were 139 sixth- and seventh-graders (mean age = 12.7; 63% male; 55% White) enrolled at public middle schools. Pre-, post-, and 6-month follow-up data were collected, along with intervention process variables. Results showed that, contrary to the deviancy training hypothesis, adolescents in the pure-group condition engaged in more adaptive in-session behavior and received lower scores on the parent and teacher ratings of externalizing behavior at postintervention than those in the mixed-group condition. Mediation analyses showed that the deviancy training that occurred in the mixed-group condition accounted for their worse postintervention scores, findings consistent with the deviancy training hypothesis.

Achievement↗
PubMed2004

Circulating basement membrane zone antibodies are found in lichen sclerosus of the vulva.

This study was undertaken to investigate the prevalence of basement membrane zone (BMZ) antibodies, their subtypes and clinical correlations in 96 patients attending the Oxford vulval clinic with lichen sclerosus (LS) of the vulva. Indirect immunofluorescence of serum (intact and split skin) to immunoglobulin (Ig)G was performed looking for the presence or absence of staining at the BMZ. Eighteen patients' sera (14 with positive indirect immunofluorescence to IgG) were examined for IgG antibodies of subclasses IgG1, 2 and 3, and 23 sera were examined for IgG4 subclass. Immunoblotting was performed in seven patients, and showed antibodies to BP180 in six patients and BP230 in one. One-third of patients with vulval LS had BMZ antibodies binding to the epidermal side of salt split skin. Immunoblotting showed antibodies to BP180 collagen XVII (six of seven patients) and BP230 in one. The subclasses were chiefly IgG1 and 2, different from those seen in bullous pemphigoid. No clinical correlation was found between the presence of antibodies and the presence of erosions, severity of scarring, age of onset of disease or response to treatment. These antibodies may be a reflection of a tendency to produce autoantibodies or be relevant to pathogenesis.

Adolescent↗
PubMed2004

Vulval itch.

BACKGROUND: Vulval itch is common. Patients presenting with this symptom can have a long history involving visits to several general practitioners. Self diagnosis as thrush is common, and inappropriate use of over-the-counter antifungal preparations can lead to further irritation and distress. Excoriation, rubbing, maceration, secondary infection and the effects of topical applications frequently complicate matters. OBJECTIVE: This article identifies the common causes of vulval itch in adults and children, and highlights key features of the diagnosis and management of these conditions. Vulval pain syndromes are beyond the scope of this article and are therefore not discussed. DISCUSSION: The cause of vulval itch can often be multifactorial, but with careful assessment, a primary diagnosis can be reached in most cases. A good history requires patience, and gentle direct questioning, as patients often feel uncomfortable discussing their problems and may not disclose self applied remedies. Care should be taken during examination, as vulval rashes may be subtle. All postpubertal patients should have a low vaginal swab to diagnose candidiasis rather than treating empirically.

Adult↗
PubMed2003

Twenty-nail dystrophy in a girl with incontinentia pigmenti.

A 9-year-old girl with incontinentia pigmenti (IP) diagnosed soon after birth subsequently developed 20-nail dystrophy at the age of 3 years. This persists unchanged 6 years later, and she has no other evidence of any other cutaneous disease, nor a family history of IP or nail dystrophy. Twenty-nail dystrophy has been associated with a number of diseases including eczema, lichen planus, alopecia areata and psoriasis and a number of other congenital associations, but the association with IP appears to be unique.

Child↗
PubMed2002

Diseases of the generative nail apparatus. Part I: Nail matrix.

Disorders of the generative structures of the nail produce a characteristic set of outcomes. The matrix is the seat of nail development and diseases or insults of this germinative epithelium will tell a story in the signs that unfold in the ensuing nail growth. This story will be influenced by the intensity, duration and extent of this pathology. A method of categorizing changes associated with the generative matrix of the nail will be presented.

Humans↗
PubMed2002

Diseases of the generative nail apparatus. Part II: nail bed.

Nail bed insults may affect the resultant nail product in a number of ways. If focal in nature, the severity and duration of the insult will determine the appearance of the nail product. Widespread insults may alter the size, shape or colour of the nail plate. Nail bed insults tend to present with more immediacy than nail matrical insults, as there is no need to wait until the nail grows out until the sign is obvious. We are less interested in the history of the event, than we are with the clinical sign being presented to us. Should treatment be required for focal nail bed insults, treatment is likely to be local and curative. Widespread nail bed insults may be associated with systemic diseases and if a result of local problems these may be difficult to treat.

Australia↗
PubMed2002

Efficacy, cutaneous tolerance and cosmetic acceptability of desonide 0.05% lotion (Desowen) versus vehicle in the short-term treatment of facial atopic or seborrhoeic dermatitis.

The differences between topical corticosteroids are based mainly on their potency, safety and patient acceptability. The aim of this study was to evaluate a mild- to mid-potent topical corticosteroid, desonide 0.05%, on these three parameters in an Australian cohort of patients with facial seborrhoeic or atopic dermatitis. Eighty-one adult patients were randomized to receive desonide 0.05% lotion or its vehicle, applied twice daily for 3 weeks under double-blind conditions. In the active treatment group, 88% of patients had their skin condition cleared or almost cleared and only two patients experienced cutaneous adverse events (rash and pruritus). The acceptability of the lotion was high; 95% of patients stated they would use this topical corticosteroid again. These data support the short-term use of desonide 0.05% lotion as a suitable agent for the short-term treatment of facial dermatitis.

Administration, Topical↗
PubMed2002

Docetaxel-induced nail dystrophy.

A 73-year-old man with metastatic prostate cancer treated with weekly docetaxel chemotherapy for 5 months developed an acute nail dystrophy restricted to the fingernails. This was characterized by onycholysis, subungual haemorrhage and acute paronychia, progressing to a subungual abscess of the right index finger. Nail bed hyperaemia and haemosiderin-like nail bed discoloration were present. Nail plate avulsion was performed to decompress the acutely painful subungual abscess. The right thumb, middle finger and left index finger demonstrated early, proximal white subungual collections of pus obscuring the lunula (onychophosis). Central nail plate fenestrations with a surgical drill led to exudation of purulent material. Cultures of the subungual abscess material yielded mixed organisms, possibly related to administration of flucloxacillin for 1 week prior to presentation. The patient completed a further two courses of docetaxel without sequelae, and the nail dystrophy appears to be resolving. Docetaxel-induced nail changes are a common adverse effect, occurring in 30-40% of patients. Mild changes do not usually warrant the discontinuation of treatment.

Acute Disease↗
PubMedDate not supplied

Developing palliative care practice in the community.

The inadequacy of some areas of palliative care provision was acknowledged in the NHS Cancer Plan (DoH 2000). Many patients would prefer to die at home, but only one quarter are able to do so because of the lack of community or specialist palliative care teams in some parts of the country. The Lancashire and South Cumbria Cancer Services Network developed an initiative to meet the educational and training needs of practitioners delivering palliative care in the community.

Clinical Competence↗