E.M. Higgins

Guidelines for the management of tinea capitis

These guidelines for the management of tinea capitis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence‐based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.

Psychiatric illness in patients referred to a dermatology-psychiatry clinic

There is a recognized psychiatric morbidity among those who attend dermatology clinics. We aimed to determine the pattern of psychological and social problems among patients referred to a liaison psychiatrist within a dermatology clinic. Notes from 149 patients were reviewed and more detailed assessments performed in a subgroup of 32 consecutive referrals. All but 5% merited a psychiatric diagnosis. Of these, depressive illness accounted for 44% and anxiety disorders, 35%. Less common general psychiatric disorders included social phobia, somatization disorder, alcohol dependence syndrome, obsessive-convulsive disorder, posttraumatic stress disorder, anorexia nervosa, and schizophrenia. Classical disorders such as dermatitis artefacta and delusional hypochondriasis were uncommon. Commonly, patients presented with longstanding psychological problems in the context of ongoing social difficulties rather than following discrete precipitants. Psychiatric intervention resulted in clinical improvement in most of those followed up. Of the dermatological categories 1) exacerbation of preexisting chronic skin disease; 2) symptoms out of proportion to the skin lesion; 3) dermatological nondisease; 4) scratching without physical signs, the commonest were dermatological nondisease and exacerbation of chronic skin disease. Anxiety was common in those from all dermatological categories. Patients with dermatological nondisease had the highest prevalence of depression. Skin patients with significant psychopathology may go untreated unless referred to a psychiatrist. The presence of dermatological nondisease or symptoms out of proportion to the skin disease should particularly alert the physician to the possibility of underlying psychological problems.

Serum S‐100 protein: a potentially useful prognostic marker in cutaneous melanoma

S‐100, an acidic calcium‐binding protein, is present within cells of neuroendocrine origin. Its value in the immunohistochemical diagnosis of tumours of melanocytic origin is well established. More recently, a potential role has been proposed for the serum concentration of this protein as a marker of metastatic melanoma disease activity. In the present study, the concentration of serum S‐100 protein was measured in 97 patients with histologically proven malignant melanoma who were attending a dermatology and/or oncology department for the follow‐up of their disease. Serum S‐100 was also measured in 48 control subjects without malignant melanoma. The clinical stage of the patients was classified according to the criteria of the American Joint Committee on Cancer into stages I‐IV. The median (range) serum S‐100 protein concentration was significantly higher in stage I (0·11 (0·1–0·21) μg/L, P<0·001), stage II (0·11 (0·05–0·22) μg/L, P<0·001), stage III (0·24 (0·07–0·41)μg/L, P<0·0001) and stage IV (0·39 (0·06–15·0)μg/L, P<0·0001) compared with the control group (0·1 (0·05–0·15)μg/L). At a threshold value of 0·2μg/L, the sensitivity and specificity for detection of advanced disease were 82% and 91%. respectively. Thus serum S‐100 protein may be a valuable prognostic marker for malignant melanoma and for monitoring therapy. Serum S‐100 protein concentration was also compared with the Breslow thickness of the tumours. There was a significant correlation between these variables (n=72. rs=0·32, P<0·01). Combining a serum S‐100 threshold value of >0·22μg/L and a Breslow thickness of >4mm improved the sensitivity and specificity for the presence of secondary spread to 91% and 95%, respectively. Therefore, a combination of both baseline serum S‐100 protein and Breslow thickness may provide a better indication of the prognosis at diagnosis.

A randomized comparison of 4 weeks of terbinafine vs. 8 weeks of griseofulvin for the treatment of tinea capitis

Background Tinea capitis is a common childhood infection that has recently become more frequent in urban areas in Europe and the U.S.A. The current licensed treatment in children is griseofulvin 10 mg kg−1 daily, which is usually given for 6–8 weeks.

Cutaneous Rosai–Dorfman disease

We report a patient with purely cutaneous Rosai–Dorfman disease (RDD) who presented with a solitary, asymptomatic plaque on the back of her left thigh, with characteristic, large histiocytoid cells exhibiting emperipolesis histologically. Cutaneous lesions occur in 27% of patients with lymph node involvement in RDD however purely cutaneous disease has only been reported on 18 previous occasions. The aetiology is unknown, although it is thought to be a reactive disorder rather than neoplastic, possibly an immunological response to an infectious agent.

Scalp ringworm in south‐east London and an analysis of a cohort of patients from a paediatric dermatology department

Summary Background Scalp ringworm or tinea capitis has become an increasingly important public health issue in the past decade in Great Britain. Recently, certain dermatology departments in London have seen a large increase in tinea capitis in all its forms.

Skin lesions in adult liver transplant recipients: a study of 100 consecutive patients

Background The surgical advances made in the area of organ transplantation along with the use of more efficacious immunosuppression have meant an increase in patient survival. This longer‐living transplant population has started to exhibit cutaneous problems, some of which lead to an increased mortality while others lead to a decline in the quality of life.

Drug reaction with eosinophilia and systemic symptoms: is cutaneous phenotype a prognostic marker for outcome? A review of clinicopathological features of 27 cases

Background  Drug reaction with eosinophilia and systemic symptoms (DRESS) describes a heterogeneous group of severe adverse reactions to medications. The cutaneous phenotype has a number of guises, accompanied by a variety of systemic features including fever, haematological abnormalities and visceral involvement, most commonly the liver. Clinical markers of prognosis have not been identified.

Double-blind, randomized, placebo-controlled trial of the use of topical 10% potassium hydroxide solution in the treatment of molluscum contagiosum.

Abstract:  Molluscum contagiosum is a common viral infection of the skin that frequently affects children. Lesions take between 6 and 18 months to resolve spontaneously and are a source of great embarrassment to both caretakers and children, often affecting attendance at school and limiting social activity. Treatment options to date have been poorly tolerated by children but recent studies have suggested that potassium hydroxide may be beneficial. This double‐blind, randomized, placebo‐controlled study compared 10% potassium hydroxide with placebo (normal saline). Twenty patients, aged 2 to 12 years, were recruited. Parents applied a solution twice daily to lesional skin until signs of inflammation appeared. Children were examined by the same observer on days 0, 15, 30, 60, and 90. Seventy percent of children receiving topical potassium hydroxide cleared, compared with 20% in the placebo group. Further dosing studies are required to identify whether weaker concentrations of potassium hydroxide are as efficacious, with less irritancy.

British Association of Dermatologists' guidelines for the management of tinea capitis 2014

British Association of Dermatologists’ guidelines for the management of tinea capitis 2014 L.C. Fuller, R.C. Barton, M.F. Mohd Mustapa, L.E. Proudfoot, S.P. Punjabi and E.M. Higgins Department of Dermatology, Chelsea & Westminster Hospital, Fulham Road, London SW10 9NH, U.K. Department of Microbiology, Leeds General Infirmary, Leeds LS1 3EX, U.K. British Association of Dermatologists, Willan House, 4 Fitzroy Square, London W1T 5HQ, U.K. St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, U.K. Department of Dermatology, Hammersmith Hospital, 150 Du Cane Road, London W12 0HS, U.K. Department of Dermatology, King’s College Hospital, Denmark Hill, London SE5 9RS, U.K.