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Ibbotson SH, Allan D, Dawe RS, Eadie E, Farr PM, Fassihi H, Fedele F, Ferguson J, Fityan A, Freeman P, Fullerton L, Goulden V, Haque S, Ling TC, Mackay A, McKenna K, Ralph N, Rhodes LE, Sarkany R, Turner D, Ungureanu S, Weatherhead S. Photodiagnostic services in the UK and Republic of Ireland: a British Photodermatology Group Workshop Report. J Eur Acad Dermatol Venereol 2021; 35:2448-2455. [PMID: 34459043 DOI: 10.1111/jdv.17632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice. OBJECTIVES The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research. METHODS An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland. RESULTS/CONCLUSIONS We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology.
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Affiliation(s)
- S H Ibbotson
- Photobiology Unit, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK.,Photobiology Unit, University of Dundee School of Medicine, Ninewells Hospital & Medical School, Dundee, UK
| | - D Allan
- Medical Physics Department, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Salford, UK
| | - R S Dawe
- Photobiology Unit, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - E Eadie
- Photobiology Unit, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - P M Farr
- Department of Dermatology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - H Fassihi
- Photodermatology Unit, St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - F Fedele
- Photodermatology Unit, St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - J Ferguson
- Photodermatology Unit, St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - A Fityan
- Department of Dermatology, University Hospital Southampton NHS Foundation Trust, Hampshire, UK
| | - P Freeman
- Department of Medical Physics, St Thomas' Hospital, London, UK
| | - L Fullerton
- Photobiology Unit, NHS Tayside, Ninewells Hospital & Medical School, Dundee, UK
| | - V Goulden
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - S Haque
- Department of Dermatology, Cambridge University Hospital, Cambridge, UK
| | - T C Ling
- Photobiology Unit, Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - A Mackay
- Photobiology Unit, Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - K McKenna
- Department of Dermatology, Belfast City Hospital, Belfast, UK
| | - N Ralph
- Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - L E Rhodes
- Photobiology Unit, Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - R Sarkany
- Photodermatology Unit, St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - D Turner
- Photodermatology Unit, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | - S Ungureanu
- Department of Dermatology, Solihull Hospital, Solihull, Birmingham, UK
| | - S Weatherhead
- Department of Dermatology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
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Oxidative Stress and Treg and Th17 Dysfunction in Systemic Lupus Erythematosus. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:2526174. [PMID: 27597882 PMCID: PMC4997077 DOI: 10.1155/2016/2526174] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/15/2016] [Accepted: 05/23/2016] [Indexed: 12/19/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organ systems. The pathogenic mechanisms that cause SLE remain unclear; however, it is well recognized that the immune balance is disturbed and that this imbalance contributes to the autoimmune symptoms of SLE. Oxidative stress represents an imbalance between the production and manifestation of reactive oxygen species and the ability of the biological system to readily detoxify the reactive intermediates or to repair the resulting damage. In humans, oxidative stress is involved in many diseases, including atherosclerosis, myocardial infarction, and autoimmune diseases. Numerous studies have confirmed that oxidative stress plays an important role in the pathogenesis of SLE. This review mainly focuses on the recent research advances with respect to oxidative stress and regulatory T (Treg)/helper T 17 (Th17) cell dysfunction in the pathogenesis of SLE.
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Chang J, Werth VP. Therapeutic options for cutaneous lupus erythematosus: recent advances and future prospects. Expert Rev Clin Immunol 2016; 12:1109-21. [PMID: 27249209 DOI: 10.1080/1744666x.2016.1188006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Treatment and prevention are of critical importance in patients with cutaneous lupus erythematosus (CLE), as the disease can have a devastating effect on patient well-being and quality of life. AREAS COVERED We conducted a selective search of the PubMed database for articles published between December 2010 and November 2015. This review encompasses both non-pharmaceutical (photoprotection, smoking cessation, drug withdrawal, and vitamin D replacement) and pharmaceutical (topicals, antimalarials, immunosuppressives, biologics, etc.) interventions used in the treatment of CLE. Expert Commentary: Recent work has expanded our understanding of established therapies as well as introduced new treatments for consideration, though existing medications still prove inadequate for a subset of patients. Changes in trial design may help to alleviate this issue.
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Affiliation(s)
- Joshua Chang
- a Dermatology Section, Corporal Michael J. Crescenz Philadelphia VA Medical Center , Philadelphia , PA , USA.,b Department of Dermatology , Perelman School of Medicine at the University of Pennsylvania , Philadelphia , PA , USA
| | - Victoria P Werth
- a Dermatology Section, Corporal Michael J. Crescenz Philadelphia VA Medical Center , Philadelphia , PA , USA.,b Department of Dermatology , Perelman School of Medicine at the University of Pennsylvania , Philadelphia , PA , USA
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Hejazi EZ, Werth VP. Cutaneous Lupus Erythematosus: An Update on Pathogenesis, Diagnosis and Treatment. Am J Clin Dermatol 2016; 17:135-46. [PMID: 26872954 DOI: 10.1007/s40257-016-0173-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Cutaneous lupus erythematosus (CLE) includes a broad range of dermatologic manifestations, which may or may not be associated with systemic disease. Recent studies in this area continue to shape our understanding of this disease and treatment options. Epidemiologic studies have found an incidence of CLE of 4.30 per 100,000, which approaches similar analysis for systemic lupus erythematosus (SLE). Although there have been extensive efforts to define SLE, the classification of CLE and its subgroups remains a challenge. Currently, diagnosis relies on clinical and laboratory findings as well as skin histology. The Cutaneous Lupus Area and Severity Index™ (CLASI™) is a validated measure of disease activity and damage. CLE pathogenesis is multifactorial and includes genetic contributions as well as effects of ultraviolet (UV) light. Immune dysregulation and aberrant cell signaling pathways through cytokine cascades are also implicated. Patient education and avoidance of triggers are key to disease prevention. Antimalarials and topical steroids continue to be the standard of care; however, immunosuppressants, thalidomide analogs and monoclonal antibodies are possible systemic therapies for the treatment of recalcitrant disease.
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Miller S, Bergman R, Duffy M, Gross D, Jackson A, James R, Kotrebai M, Lamontagne A, Lyon T, Yandek E, Sliney D. Interlaboratory Evaluation of Ultraviolet Radiation Emissions from Compact Fluorescent Lamps. Photochem Photobiol 2016; 92:348-354. [DOI: 10.1111/php.12573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Sharon Miller
- Center for Devices and Radiological Health; US Food and Drug Administration; Silver Spring MD
| | | | | | | | | | - Robert James
- Center for Devices and Radiological Health; US Food and Drug Administration; Silver Spring MD
| | | | - Andre Lamontagne
- Winchester Engineering and Analytical Center; US Food and Drug Administration; Winchester MA
| | | | | | - David Sliney
- Division of Environmental Health Engineering; Bloomberg School of Public Health; Johns Hopkins University; Baltimore MD
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Tiao J, Werth VP. Cutaneous lupus erythematosus flare following exposure to surgical light during a dental procedure. BMJ Case Rep 2015; 2015:bcr2015212864. [PMID: 26661286 PMCID: PMC4680308 DOI: 10.1136/bcr-2015-212864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/04/2022] Open
Abstract
A patient in her 60s with systemic lupus erythematosus presented to an outpatient dermatology clinic on multiple occasions, with exacerbations of cutaneous lupus after exposure to surgical lighting during dental procedures. Her photosensitivity to surgical lighting suggests that artificial light sources pose potential triggers of lupus erythematosus in extra photosensitive individuals. This case report summarises those potential triggers and some options to decrease exposure from surgical lighting.
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Affiliation(s)
- Janice Tiao
- Corporal Michael J. Crescenz VA Medical Center Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz VA Medical Center Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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