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C L Fletcher

Publications and source records attributed to C L Fletcher.

12 recordsLinked to original sources
PubMed2004

Onychomycosis: the development of a clinical diagnostic aid for toenail disease. Part I. Establishing discriminating historical and clinical features.

BACKGROUND: The ideal method for diagnosing onychomycosis is unclear. Mycological investigation is currently the method of choice, although there is a false-negative culture rate of at least 30%. OBJECTIVES: To establish a clinical diagnostic aid which may be used alongside laboratory-based mycological tests and in epidemiological studies. METHODS: Patients with nail disease (n = 209) were enrolled in the study. The examining clinician completed a questionnaire containing four historical questions and 21 questions related to the clinical findings. All patients had samples taken for mycological analysis. The gold standard for the diagnosis of onychomycosis was a positive result on both direct microscopy and culture of nail samples. Following exclusions, questionnaire responses from 169 patients were analysed using Stata. Multiple logistic regression with forward stepwise selection of variables was performed. RESULTS: Both microscopy and culture results were positive in 32% of cases and negative in 42%. Dermatophytes formed the majority of isolates. Four parameters were found to be significantly related to positive mycology results: a history of tinea pedis in the last year, scaling on one or both soles, white crumbly patches on the nail surface, and an abnormal colour of the nail plate. CONCLUSIONS: Our results have shown one historical feature and three clinical features to be strongly associated with onychomycosis. The questionnaire has been revised to include only these stems and is being tested further with the aim of achieving a binary definition.

Adolescent↗
PubMed2003

Observer agreement in recording the clinical signs of nail disease and the accuracy of a clinical diagnosis of fungal and non-fungal nail disease.

BACKGROUND: Onychomycosis is increasing in incidence. To date, no studies have examined the detection of abnormalities of the nail apparatus, nor the accuracy of a clinical diagnosis of onychomycosis and non-fungal nail disease. OBJECTIVES: To assess the agreement between and within different groups of observers in detecting signs of nail disease, and to obtain information regarding clinical diagnostic skills. METHODS: An observational study was performed. Nine observers, including dermatologists, mycologists, general practitioners and a dermatology clinical assistant, completed a questionnaire containing 21 clinical signs of nail disease during examination of nine patients, five with onychomycosis and four with non-fungal nail disease. Observers were additionally requested to suggest the most likely underlying diagnosis for the nail dystrophy. Mean pair observer agreement values were calculated for each of the clinical signs, between all observers and within groups of observers. The chance-corrected agreement index, kappa, was determined. From the clinical diagnoses given, the positive predictive value of a diagnosis of fungal and non-fungal nail disease was calculated. RESULTS: There was substantial between-observer agreement on only three clinical signs: abnormal nails on both hands, abnormal toenails and abnormal fingernails. More specific signs of nail disease such as onycholysis elicited weaker agreement. All observers showed accuracy in making a clinical diagnosis of fungal nail disease, with a mean positive predictive value of 0.91, compared with 0.77 for non-fungal nail disease. CONCLUSIONS: Our results showed that agreement between observers, in recording signs of nail disease, was generally poor. The clinical diagnosis of onychomycosis was highly likely to be correct, suggesting that other criteria are being employed by individuals in reaching the diagnosis.

Adult↗
PubMed2001

Eumycetoma due to Madurella mycetomatis acquired in Jamaica.

We report a case of eumycetoma due to Madurella mycetomatis affecting the left dorsal forefoot in a 35-year-old woman. She had spent her childhood in Jamaica, and had been resident in the U.K. for 20 years prior to her presentation. She gave a highly suggestive history for a mycetoma, having observed the intermittent discharge of black grains from the lesion. The diagnosis was confirmed by histological and mycological analysis of the grains, and a magnetic resonance imaging scan excluded osteomyelitis. She has responded very favourably to treatment with itraconazole. Mycetomas due to M. mycetomatis have not previously been reported from Jamaica.

Adult↗
PubMed2000

Oesophageal lichen planus.

We present a case of lichen planus affecting the oesophagus of an 80-year-old woman. Symptomatically, the lesions manifested themselves as dysphagia requiring repeated oesophageal dilatations. The patient was unable to tolerate several conventional treatments and so pulsed methylprednisolone was given with some beneficial short-term effects. Due to potential for malignant change in lichen planus of the mucous membranes it is important to remember this complication and investigate patients with oesophageal symptoms.

Aged↗
PubMed1999

Unusual giant comedo naevus.

Comedo naevi are usually well circumscribed, and although extensive cases have been reported individual lesions crossing the midline are rare. Associated neurological, skeletal and ophthalmological abnormalities are also recognized. thus, the patient now reported is unusual in that she had an extensive systematized comedo naevus with crossing of the midline but no associated abnormalities. Topical tretinoin was helpful in improving the texture and appearance of the comedones, and various larger lesions responded to curettage.

Adult↗
PubMed1998

Panniculitis in association with apomorphine infusion.

This study was undertaken to ascertain the histopathology and aetiology of cutaneous nodules observed in Parkinson's patients treated with continuous subcutaneous apomorphine. Ten patients were recruited, answered questionnaires, and underwent skin biopsies and full blood count, and nine were patch tested to apomorphine and its preservative. Six had serum IgE levels measured. A florid panniculitis was seen in all biopsies; five were predominantly eosinophilic, three lymphocytic and two neutrophilic; in seven cases the panniculitis was mixed and in three it was septal. Patch testing was universally negative and the IgE levels were normal.

Antiparkinson Agents↗