Biomedical subjects
J A Cotterill
Publications and source records attributed to J A Cotterill.
The use of calcipotriol in HIV-related psoriasis.
We report the case of a 28-year-old homosexual man with advanced HIV disease (CDC classification group IV A) who developed erythrodermic psoriasis which responded to calcipotriol, a topical vitamin D analogue. We believe this to be the first reported case of HIV-related psoriasis responsive to this form of treatment. Systemic therapy for HIV-related psoriasis is limited because of immunosuppressive effects. We suggest that calcipotriol may prove to be a useful therapeutic option in these patients.
Notalgia paraesthetica--report of three cases and their treatment.
Notalgia paraesthetica is a rare entity which involves the posterior primary rami of thoracic nerves T2-T6. Patients present with a localized discomfort or pruritus on the back. The condition runs a benign course and usually resolves spontaneously. However, whilst present the symptoms can be relentless and disturbing to patients. We report three patients with notalgia paraesthetica, all of whom were helped symptomatically by the topical application of the local anaesthetic cream, EMLA (2.5% lignocaine and 2.5% prilocaine).
Dermatological non-disease.
Patients with dermatological non-disease present with a rich symptomatology. These symptoms, as well as body image, psychiatric considerations, and management of these patients are discussed.
Erosive pustular dermatosis of the leg--a definition.
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The treatment of port wine stains with the carbon dioxide laser.
The carbon dioxide (CO2) laser was used to treat 51 patients with port wine stains (PWS). Twenty-nine patients were adults who had failed to respond to argon or continuous wave dye laser therapy and 22 patients were children with pink PWS. Follow-up assessment of 40 patients 12 months after treatment revealed an excellent or good result in 74% of adults and 53% of children. The results in adult 'therapeutic failures' was encouraging and CO2 laser therapy can be advised for this group. Two children had a poor result, one with a hypertrophic scar, and treatment in this age group with the CO2 laser should be considered with caution.
Anxiety and depression in patients with chronic urticaria and generalized pruritus.
Thirty-four dermatology out-patients with chronic idiopathic urticaria and 34 with idiopathic generalized pruritus were investigated using standardized self-assessment psychological questionnaires to determine the incidence of significant symptoms of depression and anxiety. These patients were compared with age- and sex-matched but otherwise unselected general dermatology out-patients. Using the Beck depression inventory, significantly more patients with generalized pruritus (32.4%) had depressive symptomatology (score greater than 14) than controls (13.2%, P less than 0.05). Although more patients with chronic urticaria had depressive symptomatology (14.7%) than controls (4.4%), the difference was not statistically significant. Using the Speilberger state-trait anxiety inventory there were no significant differences between the patients with pruritus or urticaria and their controls with respect to state or trait anxiety scores above the upper 90% probability limit for the general population. Thus, significant depression may be expected in a substantial proportion of patients with idiopathic generalized pruritus but in a relatively small proportion of those with chronic urticaria.
Reduced vasoactive responses in port wine stains.
Changes in skin blood flow and haemoglobin content of port wine stains and clinically normal contralateral skin were determined by laser-Doppler flowmetry and reflectance spectrophotometry in 14 patients after application of a vasodilating cream containing methyl nicotinate 1.0%, glycol salicylate 10.0% and capsaicin BPC 0.1% (Algipan cream) and in 16 patients after application of a corticosteroid tape containing flurandrenolone (Haelan tape). Changes in blood flow measured after application of vasodilator cream were significantly reduced in port wine stains compared with contralateral skin (P less than 0.01). After application of the vasoconstrictor steroid tape changes in blood flow were significantly reduced in the port wine stains (P less than 0.05) and changes in haemoglobin content were also significantly reduced in the port wine stains compared with normal skin (P less than 0.05). These results support the concept of reduced autonomic innervation of cutaneous vasculature in port wine stains.
Ulceration of the palms and soles. An unusual feature of cutaneous T-cell lymphoma.
Two patients, one with Sézary syndrome and one with mycosis fungoides are described, in whom lesions on the palms and soles were associated with extensive ulceration and gave rise to diagnostic difficulty. Extensive ulceration of the palms and soles is uncommon; its presence should alert clinicians to the possibility of cutaneous T-cell lymphoma.
Psychophysiological aspects of eczema.
Anxiety is a personality trait of adult patients with eczema and hyperkinesis commonly found in childhood. Eczema may be precipitated and exacerbated by stress in vulnerable individuals. Eczema, appearing on important body image areas or visible skin areas such as the face, may produce marked reactive depression. Biofeedback techniques, including habit reversal, are useful in management. Chronic intractable eczema may be a sign of impaired parent/child relationships.
Widespread crusted plaques and a history of blisters. Bullous ichthyosiform erythroderma.
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The treatment of decorative tattoos with the carbon dioxide laser.
The carbon dioxide laser was used in the treatment of 51 patients with decorative tattoos. Sixty-eight treatments were performed under local anaesthesia. Morbidity from treatment was low. Results 6 months after treatment in 44 patients revealed excellent or good results in 24 patients and hypertrophic scarring in three patients. These results confirm the value of this laser in the treatment of tattoos and demonstrate the advantages of this therapy over other treatments currently employed.
Continuous wave dye laser therapy of port wine stains.
A continuous wave dye laser emitting light at 577 nm has been used in the treatment of 100 patients with port wine stains. Subjective assessments in 92 patients revealed an excellent or good result in 63% and a fair result in 17%. There was a 5% incidence of hypertrophic scarring and a 5% incidence of post-inflammatory hyperpigmentation. Overall, 12% of patients experienced a poor result. The best results were obtained in older patients with purple port wine stains.
Psychological disabilities amongst patients with port wine stains.
In a questionnaire study to assess psychological disabilities in 110 patients with port wine stains, 71 completed questionnaires were analysed. The questionnaire revealed a high level of psychological morbidity resulting from a feeling of stigmatization amongst these patients that was not apparent in casual social intercourse. In contrast, standard psychological screening tests for psychiatric illness, depression or anxiety revealed that these patients had similar or less evidence of morbidity than controls or other patient groups. It would appear that patients with port wine stains suffer a considerable degree of psychological morbidity which they suppress. This may be related to a need to hide their port wine stain.
Hydroxyurea in the management of therapy resistant psoriasis.
Eighty-five patients with extensive chronic plaque psoriasis, unresponsive to conventional topical therapy, were treated with long-term hydroxyurea in a dose of 0.5-1.5 g daily. Fifty-two (61%) had a satisfactory remission during treatment without significant adverse effects. Treatment was discontinued in 33 patients (39%), due to an inadequate response or significant relapse during treatment and because of adverse reactions (19%). Four (4.7%) patients on hydroxyurea developed actinic psoriasis. Significant haematological abnormalities occurred in 30 patients (35%), but these became normal following a reduction in the dose of hydroxyurea or temporarily stopping the drug. In only six was it considered necessary to discontinue treatment because of bone marrow suppression. Our experience suggests that hydroxyurea is an effective long-term treatment for psoriasis that is refractory to conventional topical therapy and that the incidence of serious adverse effects compares favourably with other cytotoxic drugs.
Vitiligo following diphencyprone dermatitis.
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Transformation of myelodysplasia to acute myeloid leukaemia during psoralen photochemotherapy (PUVA) treatment of psoriasis.
A patient with stable chronic myelomonocytic leukaemia was treated with 8-methoxypsoralen photochemotherapy (PUVA) for erythrodermic psoriasis. After 4 months, transformation to acute myeloid leukaemia (AML) occurred. We would suggest caution when considering PUVA therapy in patients with pre-leukaemic disorders.