Biomedical subjects

D A de Berker

Publications and source records attributed to D A de Berker.

11 recordsLinked to original sources

PubMed2001

Basal cell carcinoma follow-up practices by dermatologists: a national survey.

BACKGROUND: After treatment of a basal cell carcinoma (BCC) patients are at risk of recurrence of that BCC; also, patients who have had a primary BCC are those who have an increased risk of developing a subsequent primary BCC. However, long-term hospital-based follow-up of all patients would put large strains on the U.K. health service. OBJECTIVES: To investigate the follow-up intentions of U.K. dermatologists for well-defined facial BCC and to investigate the effect that variations in site and clinical indicators might have on those intentions. METHODS: A self-completion questionnaire relating to BCC follow-up sent to 388 dermatology consultants and associate specialists in the U.K. had a response rate of 68%. The effects of treatment modality, tumour site, histology, multiple lesions and various patient variables that might alter the likelihood of follow-up were examined. General views on the subject of BCC follow-up were sought. RESULTS: Twenty-seven per cent of respondents reported that they would not review further after excision of a 'well-defined' BCC from inside a central 'T' area on the face; 37% reported that they would review on one occasion; and 36% reported that they review more than once. CONCLUSIONS: While it is currently not feasible to follow-up all treated BCCs, a strategy to identify and monitor high-risk patients and a system to gather long-term outcome data prospectively are necessary aspects of a national health service. This study illustrates that the first issue is being addressed to some extent, but at the currently reported level of BCC follow-up in the U.K. there is little scope for collecting comprehensive long-term data on outcomes.

Attitude of Health Personnel↗

PubMed2001

Phenolic ablation of the nail matrix.

Therapeutic ablation of nail is necessary in a variety of settings. The challenge is to achieve destruction of nail matrix with minimal pain and to ensure that there is no re-growth of nail. There are many different methods of nail ablation, with excisional surgery and phenolic ablation of matrix representing the most common. The balance of published data favours phenolic ablation as a simple procedure with low morbidity and the least chance of recurrence.

Humans↗

PubMed2001

Lateral longitudinal nail biopsy.

Lateral longitudinal nail biopsy is the gold standard of incisional nail biopsies. It can be obtained under local anaesthetic and requires normal biopsy instruments. Preoperative planning with the patient is important in order that they have realistic expectations of the therapeutic outcome and understand how to care for the wound in the postoperative period.

Bandages↗

PubMed2000

Yellow nail syndrome: the nail that grows half as fast grows twice as thick.

We report a case of a 51-year-old man with yellow nail syndrome (YNS).1 During a 23-week period of study, the dynamics of thumbnail growth were compared between one affected thumb and the normal contralateral thumb. Longitudinal nail growth was normal (0.46 mm/week) in the normal thumb and double that of the affected thumb (0.23 mm/week). Thickness of nail at the free edge in the affected thumb (0.97 mm) was twice that of the normal thumb (0.57 mm). Within the nail plate in the dorso-ventral axis there were 50% more cells in the affected thumb (358) in comparison with the contralateral control (242). This case illustrates that rate of longitudinal growth does not necessarily reflect nail plate production.

Humans↗

PubMed1998

A simplified protocol of steroid injection for psoriatic nail dystrophy.

Subjects seeking therapy for psoriatic nail dystrophy were recruited from routine clinics and involved digits were scored between 0 and 3 for severity of each of five features: subungual hyperkeratosis, pitting, onycholysis, ridging and thickening. These features were re-scored 2 months after injection of triamcinolone acetonide (0.4 mL, 10 mg/mL) into the nail bed and matrix following ring block, and then at 3-monthly intervals. A second injection was offered at 2 months if warranted by poor response. Forty-six digits were injected in 19 subjects (12 women, 7 men, mean age 48 years) receiving a mean of 1.2 doses. Follow-up ranged from 3 to 17 months (mean 9.4). Results are given for responses sustained up until the last follow-up. Onycholysis was present in 36 digits (78%) and improved in 18 (50%) of these. Pitting was present in 20 (43%), improving in nine (45%) and remaining unchanged in 11 (55%). Subungual hyperkeratosis was present in 16 (35%) and always improved after injection. Ridging was also present in 16 (35%) and improved in all but one instance. Thickening was present in 12 cases (26%), improving in 10 (83%) and remaining unchanged in the rest. Although onycholysis and pitting are the most common elements of psoriatic dystrophy we show that they are the least responsive to steroid injected in this fashion. However, subungual hyperkeratosis, ridging and thickening respond well, with benefit sustained for at least 9 months. When these are the dominant features of a nail dystrophy, treatment according to the protocol in this study appears justified.

Adult↗

PubMed1997

Comparison of psoralen-UVB and psoralen-UVA photochemotherapy in the treatment of psoriasis.

BACKGROUND: PUVA treatment of psoriasis is usually given with broad-band fluorescent UVA lamps. Narrow-band UVB exposure after oral methoxsalen has been shown to achieve a greater therapeutic response in psoriasis than identical UVB exposure given without psoralen. OBJECTIVE: The purpose of this study was to compare conventional PUVA with psoralen-UVB therapy in psoriasis. METHODS: We studied 100 patients with plaque-type psoriasis who were randomly selected to receive either conventional psoralen-UVA or psoralen-UVB treatment. RESULTS: No significant difference was found between the two treatments in the proportion of patients whose skin cleared during treatment or in the number of exposures required for clearance of psoriasis. As expected, the cumulative UV dose for clearance was smaller in the group treated with UVB compared with those receiving UVA. Side effects and disease status at 3 months after the end of treatment were similar for the two groups. CONCLUSION: Psoralen-UVB treatment of psoriasis is as effective as conventional PUVA. The mechanism of psoralen-311 nm UVB action on psoriasis requires study to predict the long-term safety of this treatment.

Adult↗

PubMed1996

Micrographic surgery for subungual squamous cell carcinoma.

Eight patients were treated for subungual squamous cell carcinoma (4 female, 4 male; mean age 61 years). History of disease ranged from 9 months to 14 years (mean 4.7 years). Outpatient surgery under local anaesthetic was performed using Mohs micrographic surgery and formalin-fixed histological specimens. Tumour clearance was achieved after 2-6 procedures (median 3) over a mean period of 6.9 days. In all cases the wounds were allowed to heal by secondary intention and the distal phalanx was preserved. During a mean follow-up period of 3.1 years (range 0.5-6), no recurrence was seen and involved digits remained functional. Mohs micrographic surgery can provide a valuable alternative to amputation for subungual squamous cell carcinoma.

Aged↗

PubMed1996

Sebaceous hyperplasia in organ transplant recipients: shared aspects of hyperplastic and dysplastic processes?

BACKGROUND: Patients receiving kidney or heart transplants are subject to a wide range of cutaneous changes attributed largely to the immunosuppression required to prevent rejection of their transplant. In addition to infection, they have an increased incidence of dysplastic lesions, some of which are malignant. OBJECTIVE: Our purpose was to determine the incidence of sebaceous hyperplasia in heart and kidney transplant recipients and its association with neoplasia. METHODS: Patients undergoing heart transplantation from a single transplant center were examined during a 30-month screening period to establish the prevalence of cutaneous abnormalities. RESULTS: Sixteen of 104 (16%) heart transplant recipients had sebaceous hyperplasia in comparison with 1% of an age- and sex-matched control group. Those with sebaceous hyperplasia did not have a significantly higher incidence of hypertrichosis than those without sebaceous hyperplasia. CONCLUSION: Sebaceous hyperplasia is seen in heart transplant recipients. It does not appear to be connected with hypertrichosis, in which it is believed that the pilosebaceous unit is the target of the direct effect of cyclosporine. We propose that the development of sebaceous hyperplasia is related to the process of dysplastic epithelial proliferation in transplant recipients.

Child↗

PubMed1996

Nail surgery: an assessment of indications and outcome.

To examine the merits of nail surgery, we studied the surgical investigation, treatment and the outcome of 78 consecutive patients with nail pathology in the context of their complaint. A diagnosis was reached in 74/78 patients. Thirty-six out of seventy-eight (46%) of patients had tumours, 17/78 (22%) had a dermatosis, 21/78 (27%) had infection or trauma and 4/78 (5%) remained undiagnosed. The presenting complaint was treated with substantial or complete resolution in 66/78 (87%) patients. Ninety-seven per cent (35/36) of those with tumours were cured, including all 5/36 with malignant and dysplastic tumours. Post-operative splitting of the nail was seen in only one patient due to secondary infection of a longitudinal nail unit biopsy. Information from this study demonstrates the diagnostic and therapeutic value of nail surgery within dermatology.

Adolescent↗

PubMed1995

Golf tee hairs in Netherton disease.

We present a case of Netherton disease, where the hairs lacked the characteristic microscopic feature of trichorrhexis invaginata. In its place were certain hairs with a golf tee morphology. These represent the proximal half of the invaginate node seen in typical Netherton disease. Scanning electron microscopy demonstrated the three-dimensional quality of this abnormality, which is subtle when assessed by light microscopy alone. We describe this sign so that it might be recognized when seen in isolation, as here, and allow the diagnosis of Netherton disease to be confirmed.

Child, Preschool↗

PubMedDate not supplied

Pili annulati coincident with alopecia areata.

Pili annulati is a rare hair shaft abnormality of unknown pathogenesis which gives a gross beading effect. An association with alopecia areata has been reported. We present a 13-year-old girl who had alopecia areata and coincidentally was found to have pili annulati. Her mother also had pili annulati which had become more noticeable as her hair had become paler with age. We discuss the possible pathogenesis of pili annulati and relate that to the microscopic banding appearance of the hair shaft. We note the relevance of the condition becoming more apparent with age. We also discuss the probable coincidental association with alopecia areata.

Adolescent↗