1
|
Frewen J, Lepping P, Goulding JMR, Walker S, Bewley A. Delusional infestation in healthcare professionals: Outcomes from a multi‐centre case series. Skin Health and Disease 2022; 2:e122. [DOI: 10.1002/ski2.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- John Frewen
- Department of Dermatology Royal Devon and Exeter NHS Foundation Trust Exeter Devon UK
| | - Peter Lepping
- Department of Psychiatry Betsi Cadwaladr University Health Board Wrexham UK
- Centre for Mental Health and Society Bangor University Wrexham UK
| | - Jonathan M. R. Goulding
- Department of Dermatology University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - Stephen Walker
- London School of Hygiene and Tropical Medicine London UK
- Hospital for Tropical Diseases and Department of Dermatology University College London Hospitals NHS Foundation Trust London UK
| | - Anthony Bewley
- Department of Dermatology Barts Health NHS Trust London UK
| |
Collapse
|
2
|
Douroudis K, Ramessur R, Barbosa IA, Baudry D, Duckworth M, Angit C, Capon F, Chung R, Curtis CJ, Di Meglio P, Goulding JMR, Griffiths CEM, Lee SH, Mahil SK, Parslew R, Reynolds NJ, Shipman AR, Warren RB, Yiu ZZN, Simpson MA, Barker JN, Dand N, Smith CH. Differences in Clinical Features and Comorbid Burden between HLA-C∗06:02 Carrier Groups in >9,000 People with Psoriasis. J Invest Dermatol 2022; 142:1617-1628.e10. [PMID: 34767815 DOI: 10.1016/j.jid.2021.08.446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
The identification of robust endotypes-disease subgroups of clinical relevance-is fundamental to stratified medicine. We hypothesized that HLA-C∗06:02 status, the major genetic determinant of psoriasis, defines a psoriasis endotype of clinical relevance. Using two United Kingdom-based cross-sectional datasets-an observational severe-psoriasis study (Biomarkers of Systemic Treatment Outcomes in Psoriasis; n = 3,767) and a large population-based bioresource (UK Biobank, including n = 5,519 individuals with psoriasis)-we compared demographic, environmental, and clinical variables of interest in HLA-C∗06:02-positive (one or two copies of the HLA-C∗06:02 allele) with those in HLA-C∗06:02‒negative (no copies) individuals of European ancestry. We used multivariable regression analyses to account for mediation effects established a priori. We confirm previous observations that HLA-C∗06:02-positive status is associated with earlier age of psoriasis onset and extend findings to reveal an association with disease expressivity in females (Biomarkers of Systemic Treatment Outcomes in Psoriasis: P = 2.7 × 10-14, UK Biobank: P = 1.0 × 10-8). We also show HLA-C∗06:02-negative status to be associated with characteristic clinical features (large plaque disease, OR for HLA-C∗06:02 = 0.73, P = 7.4 × 10-4; nail involvement, OR = 0.70, P = 2.4 × 10-6); higher central adiposity (Biomarkers of Systemic Treatment Outcomes in Psoriasis: waist circumference difference of 2.0 cm, P = 8.4 × 10-4; UK Biobank: waist circumference difference of 1.4 cm, P = 1.5 × 10-4), especially in women; and a higher prevalence of other cardiometabolic comorbidities. These findings extend the clinical phenotype delineated by HLA-C∗06:02 and highlight its potential as an important biomarker to consider in future multimarker stratified medicine approaches.
Collapse
Affiliation(s)
- Konstantinos Douroudis
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Ravi Ramessur
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Ines A Barbosa
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - David Baudry
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Michael Duckworth
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Caroline Angit
- Department of Dermatology, Lincoln County Hospital, United Lincolnshire Hospitals National Health Service (NHS) Trust, Lincoln, United Kingdom
| | - Francesca Capon
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Raymond Chung
- National Institute for Health Research (NIHR) BioResource Centre Maudsley, National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London and Maudsley National Health Service (NHS) Foundation Trust (SLaM), Lincoln, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Lincoln, United Kingdom; Social, Genetic & Developmental Psychiatry Centre, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Lincoln, United Kingdom
| | - Charles J Curtis
- National Institute for Health Research (NIHR) BioResource Centre Maudsley, National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London and Maudsley National Health Service (NHS) Foundation Trust (SLaM), Lincoln, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Lincoln, United Kingdom; Social, Genetic & Developmental Psychiatry Centre, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Lincoln, United Kingdom
| | - Paola Di Meglio
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Jonathan M R Goulding
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom
| | - Sang Hyuck Lee
- National Institute for Health Research (NIHR) BioResource Centre Maudsley, National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC) at South London and Maudsley National Health Service (NHS) Foundation Trust (SLaM), Lincoln, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Lincoln, United Kingdom; Social, Genetic & Developmental Psychiatry Centre, School of Mental Health & Psychological Sciences, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, Lincoln, United Kingdom
| | - Satveer K Mahil
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom; St. John's Institute of Dermatology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Richard Parslew
- Department of Dermatology, Liverpool University Hospitals National Health Service (NHS) Foundation Trust, Liverpool, United Kingdom
| | - Nick J Reynolds
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; Department of Dermatology, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Alexa R Shipman
- Department of Dermatology, Queen Alexandra Hospital, Portsmouth Hospital NHS Trust, Portsmouth, United Kingdom
| | - Richard B Warren
- Dermatology Centre, Salford Royal National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom
| | - Zenas Z N Yiu
- Dermatology Centre, Salford Royal National Health Service (NHS) Foundation Trust, Manchester Academic Health Science Centre, National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, The University of Manchester, Manchester, United Kingdom
| | - Michael A Simpson
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - Jonathan N Barker
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom; St. John's Institute of Dermatology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Nick Dand
- Department of Medical & Molecular Genetics, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom; Health Data Research UK, London, United Kingdom
| | - Catherine H Smith
- St John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom; St. John's Institute of Dermatology, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, United Kingdom.
| |
Collapse
|
3
|
Ahmed A, Affleck AG, Angus J, Assalman I, Baron SE, Bewley A, Goulding JMR, Jerrom R, Lepping P, Mortimer H, Shah R, Taylor RE, Thompson AR, Mohd Mustapa MF, Manounah L. British Association of Dermatologists guidelines for the management of adults with delusional infestation 2022. Br J Dermatol 2022; 187:472-480. [PMID: 35582951 DOI: 10.1111/bjd.21668] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Alia Ahmed
- Frimley Health Foundation Trust, Windsor, SL4 3DP, UK.,Barts Health NHS Trust, London, E1 2ES, UK
| | | | - Janet Angus
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Avon, BS1 3NU, UK
| | - Iyas Assalman
- East London NHS Foundation Trust, London, E1 8DE, UK
| | - Susannah E Baron
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Anthony Bewley
- Barts Health NHS Trust, London, E1 2ES, UK.,Queen Mary University of London, London, E1 4NS, UK
| | | | - Richard Jerrom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Peter Lepping
- Wrexham Maelor Hospital Liaison Psychiatry, Betsi Cadwaladr University Health Board, Wrexham, LL13 7TD, UK
| | - Helen Mortimer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Reena Shah
- Central and North West London NHS Foundation Trust, London, NW1 3AX, UK
| | | | - Andrew R Thompson
- Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK.,Cardiff University, Cardiff, Wales, CF10 3AT, UK.,British Psychological Society, London, EC2A 4UE, UK
| | | | - Lina Manounah
- Willan House, British Association of Dermatologists, London, W1T 5HQ, UK
| |
Collapse
|
4
|
Cox D, Fellows JL, Goulding JMR. Patient's perspective on a novel psychological therapy approach (flash technique) for neurofibromatosis. Clin Exp Dermatol 2021; 47:789-790. [PMID: 34905253 DOI: 10.1111/ced.15064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Deborah Cox
- Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jodie L Fellows
- Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan M R Goulding
- Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
5
|
Carter C, Martin K, Gordon C, Goulding JMR. Exploring the lived experience of women with rosacea: visible difference and psychological impact. Br J Dermatol 2021; 186:366-367. [PMID: 34582568 DOI: 10.1111/bjd.20768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
- C Carter
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, UK
| | - K Martin
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Gordon
- Department of Psychology and Behavioural Sciences, Coventry University, Coventry, UK
| | - J M R Goulding
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
6
|
Goulding JMR. Athena Speciality Certificate Examination case for male genital dermatology. Clin Exp Dermatol 2021; 47:1395-1396. [PMID: 34582582 DOI: 10.1111/ced.14947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- J M R Goulding
- Department of Dermatology, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
7
|
Blee I, Da Costa J, Powers N, Omanyondo S, Charles A, Goulding JMR. Psychodermatology in psychiatry: awareness and education among psychiatry trainees. Clin Exp Dermatol 2021; 47:145-147. [PMID: 34260104 DOI: 10.1111/ced.14850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/28/2022]
Affiliation(s)
- I Blee
- Jephson Dermatology Centre, Warwick Hospital, South Warwickshire NHS Foundation Trust, Warwick, UK
| | - J Da Costa
- General Adult Psychiatry Department, Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK
| | - N Powers
- St Luke's Hospice, Palliative Care, London North West University Healthcare NHS Trust, Harrow, London, UK
| | - S Omanyondo
- Eating Disorders Psychiatry Department, The Priory Hospital Woodbourne, Birmingham, UK
| | - A Charles
- General Adult Psychiatry, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - J M R Goulding
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
8
|
Thomas KS, Batchelor JM, Akram P, Chalmers JR, Haines RH, Meakin GD, Duley L, Ravenscroft JC, Rogers A, Sach TH, Santer M, Tan W, White J, Whitton ME, Williams HC, Cheung ST, Hamad H, Wright A, Ingram JR, Levell NJ, Goulding JMR, Makrygeorgou A, Bewley A, Ogboli M, Stainforth J, Ferguson A, Laguda B, Wahie S, Ellis R, Azad J, Rajasekaran A, Eleftheriadou V, Montgomery AA. Randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo: results of the HI-Light Vitiligo Trial. Br J Dermatol 2020; 184:828-839. [PMID: 33006767 DOI: 10.1111/bjd.19592] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidence for the effectiveness of vitiligo treatments is limited. OBJECTIVES To determine the effectiveness of (i) handheld narrowband UVB (NB-UVB) and (ii) a combination of potent topical corticosteroid (TCS) and NB-UVB, compared with TCS alone, for localized vitiligo. METHODS A pragmatic, three-arm, placebo-controlled randomized controlled trial (9-month treatment, 12-month follow-up). Adults and children, recruited from secondary care and the community, aged ≥ 5 years and with active vitiligo affecting < 10% of skin, were randomized 1 : 1 : 1 to receive TCS (mometasone furoate 0·1% ointment + dummy NB-UVB), NB-UVB (NB-UVB + placebo TCS) or a combination (TCS + NB-UVB). TCS was applied once daily on alternating weeks; NB-UVB was administered on alternate days in escalating doses, adjusted for erythema. The primary outcome was treatment success at 9 months at a target patch assessed using the participant-reported Vitiligo Noticeability Scale, with multiple imputation for missing data. The trial was registered with number ISRCTN17160087 on 8 January 2015. RESULTS In total 517 participants were randomized to TCS (n = 173), NB-UVB (n = 169) and combination (n = 175). Primary outcome data were available for 370 (72%) participants. The proportions with target patch treatment success were 17% (TCS), 22% (NB-UVB) and 27% (combination). Combination treatment was superior to TCS: adjusted between-group difference 10·9% (95% confidence interval 1·0%-20·9%; P = 0·032; number needed to treat = 10). NB-UVB alone was not superior to TCS: adjusted between-group difference 5·2% (95% CI - 4·4% to 14·9%; P = 0·29; number needed to treat = 19). Participants using interventions with ≥ 75% expected adherence were more likely to achieve treatment success, but the effects were lost once treatment stopped. Localized grade 3 or 4 erythema was reported in 62 (12%) participants (including three with dummy light). Skin thinning was reported in 13 (2·5%) participants (including one with placebo ointment). CONCLUSIONS Combination treatment with home-based handheld NB-UVB plus TCS is likely to be superior to TCS alone for treatment of localized vitiligo. Combination treatment was relatively safe and well tolerated but was successful in only around one-quarter of participants.
Collapse
Affiliation(s)
- K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - J M Batchelor
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - P Akram
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - R H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - G D Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - L Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J C Ravenscroft
- Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - W Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J White
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - M E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - S T Cheung
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - H Hamad
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Wright
- St Luke's Hospital, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - J R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - N J Levell
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - J M R Goulding
- Solihull Hospital, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Makrygeorgou
- West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Bewley
- Barts Health NHS Trust and Queen Mary University London, London, UK
| | - M Ogboli
- Birmingham Children's Hospital, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Stainforth
- York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - A Ferguson
- Royal Derby Hospital and the London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - B Laguda
- Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Wahie
- University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - R Ellis
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - J Azad
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - A Rajasekaran
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - A A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
9
|
Sach TH, Thomas KS, Batchelor JM, Perways A, Chalmers JR, Haines RH, Meakin GD, Duley L, Ravenscroft JC, Rogers A, Santer M, Tan W, White J, Whitton ME, Williams HC, Cheung ST, Hamad H, Wright A, Ingram JR, Levell N, Goulding JMR, Makrygeorgou A, Bewley A, Ogboli M, Stainforth J, Ferguson A, Laguda B, Wahie S, Ellis R, Azad J, Rajasekaran A, Eleftheriadou V, Montgomery AA. An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial). Br J Dermatol 2020; 184:840-848. [PMID: 32920824 DOI: 10.1111/bjd.19554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Economic evidence for vitiligo treatments is absent. OBJECTIVES To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo. METHODS Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months' treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015. RESULTS The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188-235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151-196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment. CONCLUSIONS Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.
Collapse
Affiliation(s)
- T H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - J M Batchelor
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - A Perways
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - R H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - G D Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - L Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J C Ravenscroft
- Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Santer
- Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, UK
| | - W Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J White
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - M E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - S T Cheung
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - H Hamad
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Wright
- St Luke's Hospital, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - J R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - N Levell
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - J M R Goulding
- Solihull Hospital, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Makrygeorgou
- West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Bewley
- Whipps Cross Hospital and The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Ogboli
- Birmingham Children's Hospital, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Stainforth
- York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - A Ferguson
- Royal Derby Hospital and the London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - B Laguda
- Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Wahie
- University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - R Ellis
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - J Azad
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - A Rajasekaran
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - A A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | | |
Collapse
|
10
|
Jerrom R, Mortimer H, Martin K, Siddiquee R, Bagchi D, Goulding JMR. A case series of shared delusional infestation: folie à deux revisited. Clin Exp Dermatol 2020; 45:414-416. [PMID: 31729765 DOI: 10.1111/ced.14138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2019] [Indexed: 11/28/2022]
Abstract
Delusional infestation describes the unshakeable belief that one's skin is infected or infested with an external organism or inanimate material, in the absence of supportive medical evidence. It is one of the most challenging psychodermatological conditions to manage, given the rigidity of patients' physically focused health beliefs, and the competing need to introduce antipsychotic therapy to bring about resolution. This is rendered exponentially more complex when partners or family members are similarly afflicted. This situation is known as shared delusional infestation, shared psychotic disorder (SPD), or folie à deux. We present a series of three couples with SPD who were referred to our tertiary psychodermatology service during the same year. On examining the literature we were intrigued to discover that subtly different subtypes of SPD have been recognized since the late 1800s. These include folie simultanée, imposée, communiquée and induite. Our cases neatly demonstrate three of these variants, and highlight the difficulties in facilitating effective treatment.
Collapse
Affiliation(s)
- R Jerrom
- Dermatology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Mortimer
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - K Martin
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Siddiquee
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D Bagchi
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J M R Goulding
- Dermatology Department, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
11
|
Muralidharan V, Zahedi D, Kaur B, Goulding JMR. Diagnosis and management of psychodermatological problems: confidence levels among dermatologists and psychiatrists. Clin Exp Dermatol 2020; 45:482-483. [PMID: 31849087 DOI: 10.1111/ced.14157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 11/26/2022]
Affiliation(s)
- V Muralidharan
- Department of Medicine, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - D Zahedi
- Department of Dermatology, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - B Kaur
- Department of Dermatology, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - J M R Goulding
- Department of Dermatology, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
12
|
Affiliation(s)
- L J Scrivens
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, U.K
| | - J M R Goulding
- Department of Dermatology, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - K J Allen
- Health Services Management Centre, University of Birmingham, Birmingham, U.K
| |
Collapse
|
13
|
Daunton A, Goulding JMR. Comment on: "When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council". J Am Acad Dermatol 2018; 79:e23-e24. [PMID: 30012283 DOI: 10.1016/j.jaad.2018.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/15/2017] [Accepted: 01/07/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Adam Daunton
- Department of Dermatology, Salford Royal Hospital National Health Service Foundation Trust, Salford, Greater Manchester, United Kingdom.
| | - Jonathan M R Goulding
- Department of Dermatology, Solihull Hospital, Heart of England National Health Service Foundation Trust, Solihull, United Kingdom
| |
Collapse
|
14
|
Affiliation(s)
- Jonathan M R Goulding
- Department of Dermatology, Heart of England NHS Foundation Trust, Solihull Hospital, Lode Lane, Solihull, B91 2JL, United Kingdom
| | | | | | | |
Collapse
|
15
|
Anyasodor MC, Taylor RE, Bewley A, Goulding JMR. Dysaesthetic penoscrotodynia may be a somatoform disorder: results from a two-centre retrospective case series. Clin Exp Dermatol 2016; 41:474-9. [PMID: 26932754 DOI: 10.1111/ced.12824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dysaesthetic penoscrotodynia (DPSD) is a poorly understood disorder, in which men experience distressing symptoms such as burning pain in their genital skin. Drugs for neuropathic pain are often used, but with little success. AIM To review a series of patients with DPSD to highlight common themes and response to treatment. METHODS Ten consecutive patients with DPSD were identified from specialist male genital dermatology and psychodermatology clinics at two centres. Clinical details, including psychiatric history, were reviewed retrospectively. Patients with no previously diagnosed psychiatric illness completed either the Generalized Anxiety Disorder (GAD)-7 scale and the Patient Health Questionnaire (PHQ)-9 depression scale, or the Hospital Anxiety and Depression Scale (HADS) and the Dermatology Life Quality Index (DLQI). RESULTS Of the 10 patients, 9 had known or newly diagnosed psychopathology. All patients were offered psychodermatological treatment, of which 7 of 10 accepted. All of those who accepted psychodermatological treatment experienced an improvement in their genital symptoms. When post-treatment scores were collected, improvement in psychiatric symptoms accompanied improvement in genital symptoms. CONCLUSIONS Psychopathology is almost invariably present in individuals with DPSD, yet these patients rarely volunteer such information. DPSD is most likely to constitute a functional somatic symptom disorder, hence psychodermatological treatment is indicated for its management. This concept reflects a significant change in the approach to this condition.
Collapse
Affiliation(s)
- M C Anyasodor
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - R E Taylor
- Barts and The London School of Medicine and Dentistry Centre for Psychiatry, London, UK
| | - A Bewley
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - J M R Goulding
- Department of Dermatology, Heart of England NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
16
|
Affiliation(s)
- Adam Daunton
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
| | - Gerald Langman
- Solihull Hospital, Heart of England NHS Foundation Trust
| | - J M R Goulding
- Solihull Hospital, Heart of England NHS Foundation Trust
| |
Collapse
|
17
|
Affiliation(s)
- J M R Goulding
- Dermatology Department, Solihull Hospital, Lode Lane, Solihull, B91 2JL, U.K
| |
Collapse
|
18
|
Sharma A, Orpin S, Goulding JMR, Goulding J, Kaur MR, Kaur M. Two cases of nicorandil-induced ulceration mimicking skin malignancy. Br J Dermatol 2014; 171:662-3. [PMID: 24836355 DOI: 10.1111/bjd.12978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Sharma
- Department of Dermatology, Heart of England NHS Trust, Solihull Hospital Lode Lane, Solihull, B92 2JL, U.K
| | | | | | | | | | | |
Collapse
|
19
|
Sharma A, Goulding JMR. Papules on the hands and feet. Clin Exp Dermatol 2013; 38:949-51. [PMID: 23668374 DOI: 10.1111/ced.12142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2013] [Indexed: 11/29/2022]
Affiliation(s)
- A Sharma
- Department of Dermatology, Solihull Hospital, Lode Lane, Solihull, Birmingham, UK
| | | |
Collapse
|
20
|
Kluk J, Goulding JMR, Finch TM. Boggy plaques on the dorsal surface of the hands. Neutrophilic dermatosis of the dorsal hands. Clin Exp Dermatol 2011; 36:688-9. [PMID: 21771017 DOI: 10.1111/j.1365-2230.2011.04021.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Kluk
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK.
| | | | | |
Collapse
|
21
|
Goulding JMR, Finch TM. Acrylates tooth and nail: coexistent allergic contact dermatitis caused by acrylates present in desensitizing dental swabs and artificial fingernails. Contact Dermatitis 2011; 65:47-8. [DOI: 10.1111/j.1600-0536.2010.01867.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Goulding JMR, Price CL, Defty CL, Hulangamuwa CS, Bader E, Ahmed I. Erectile dysfunction in patients with psoriasis: increased prevalence, an unmet need, and a chance to intervene. Br J Dermatol 2010; 164:103-9. [PMID: 20874856 DOI: 10.1111/j.1365-2133.2010.10077.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Male erectile dysfunction (ED) is common, frequently caused by pelvic arterial atherosclerosis, and is a predictor of future cardiovascular disease. There is an emerging association between psoriasis, the metabolic syndrome and atherosclerotic disease. We hypothesized that ED occurs more commonly in patients with psoriasis, at least in part due to incipient atherosclerosis, which may offer an opportunity for early intervention. OBJECTIVES To determine the prevalence of, and risk factors for, ED in patients with psoriasis in comparison with a heterogeneous dermatology outpatient control group. METHODS We conducted a pilot study with a prospective observational cross-sectional design, recruiting consecutive adult male dermatology outpatients diagnosed with psoriasis or any other skin condition. Sexually active participants completed a questionnaire, a Dermatology Life Quality Index and the validated five-item version of the International Index of Erectile Function (IIEF-5). RESULTS Fifty-three of 92 (58%) patients with psoriasis recorded an IIEF-5 score indicative of ED, compared with 64 of 130 (49%) control patients, reflecting an age-adjusted odds ratio of 2·007 (95% confidence interval 1·088-3·701; P = 0·026). A multivariable logistic regression model indicated that increasing age and hypertension, but not a diagnosis of psoriasis, were independent risk factors for ED in our study population. CONCLUSIONS We present the largest survey of ED in patients with skin disease, and the first to posit the potential link between psoriasis, ED and atherosclerosis. We suggest that an assessment of sexual function should be part of the routine holistic care provided for dermatology outpatients, and highlight the need to screen for cardiovascular risk factors in those with documented ED.
Collapse
Affiliation(s)
- J M R Goulding
- Department of Dermatology, University Hospital, Clifford Bridge Road, Walsgrave, Coventry CV2 2DX, UK.
| | | | | | | | | | | |
Collapse
|
23
|
Affiliation(s)
- Jonathan M R Goulding
- Department of Infectious Diseases and Tropical Medicine, Oxford Radcliffe Hospitals NHS Trust Oxford, UK.
| | | | | | | |
Collapse
|
24
|
Affiliation(s)
- J M R Goulding
- Department of Dermatology, Warwick Hospital, Warwick, UK.
| | | | | | | |
Collapse
|
25
|
Sherley-Dale AC, Goulding JMR, Leithead J, Loft DE, Ahmed I. Pigmentary changes in pernicious anaemia: an important but under-recognized phenomenon. Clin Exp Dermatol 2010; 36:93-5. [PMID: 20482556 DOI: 10.1111/j.1365-2230.2010.03793.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Goulding S, Goulding JMR, George T. Acknowledging learning styles: a practical approach to planning and delivering teaching sessions. Educ Prim Care 2010; 21:38-40. [PMID: 20202320 DOI: 10.1080/14739879.2010.11493874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
27
|
Goulding JMR, Knowlson LE, Carr RA, Gee BC. Asymptomatic nodules on the foot--quiz case. ACTA ACUST UNITED AC 2009; 145:1325-30. [PMID: 19917968 DOI: 10.1001/archdermatol.2009.254-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
28
|
Goulding JMR, Levine S, Blizard RA, Deroide F, Swale VJ. Dermatological surgery: a comparison of activity and outcomes in primary and secondary care. Br J Dermatol 2009; 161:110-4. [PMID: 19438854 DOI: 10.1111/j.1365-2133.2009.09228.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dermatological surgery is carried out by a variety of practitioners in primary and secondary care. OBJECTIVES To explore the activity and histopathological outcomes among different groups of dermatological surgeons dealing with skin cancers. METHODS Reports for all new skin tumour specimens processed by our histopathology department over a continuous 3-month period were reviewed retrospectively. RESULTS One thousand, one hundred and eleven new skin tumour specimens were identified. General practitioners (GPs) were least accurate in clinical diagnosis, with 42.8% (59/138) of their request forms including the eventual histological diagnosis, compared with 69.5% (328/472) for dermatologists (odds ratio, OR 0.33, 95% confidence interval, CI 0.22-0.48). Inappropriate procedures were most often performed by plastic surgeons, usually involving large excision biopsies for benign lesions in elderly patients [6.6% (20/305) of their specimens vs. 0% for dermatologists, exact P < 0.001]. Excision biopsies performed by GPs had the highest rate of margin involvement by tumour of any specialty [68% (15/22) of such specimens vs. 8% (9/116) for dermatologists; OR 25.47, 95% CI 8.26-78.53]. As per National Institute for Health and Clinical Excellence guidance, 13.8% (19/138) of tumours operated on by GPs should instead have been referred to secondary care for initial surgical management. CONCLUSIONS This study presents a strong case for dermatologists to continue to provide the lead in diagnosis of skin lesions, and in selection and execution of dermatological surgical procedures.
Collapse
Affiliation(s)
- J M R Goulding
- Department of Dermatology, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
| | | | | | | | | |
Collapse
|
29
|
Goulding JMR, Caplin ME, Rustin MHA. A progressive eruption in a 57-year-old woman. Clin Exp Dermatol 2009; 34:439-41. [PMID: 19309383 DOI: 10.1111/j.1365-2230.2008.02696.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J M R Goulding
- Department of Dermatology, Royal Free Hospital, London, UK
| | | | | |
Collapse
|
30
|
Goulding JMR, Purohit G, Borg A, Rose P, Gee BC. Porphyria cutanea tarda complicating transfusion-dependent myelodysplastic syndrome. Br J Haematol 2007; 136:2. [PMID: 17222194 DOI: 10.1111/j.1365-2141.2006.06307.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J M R Goulding
- Department of Dermatology, Warwick Hospital, Warwick, UK
| | | | | | | | | |
Collapse
|
31
|
Moule SP, Heron J, Goldstone AH, Ardeshna KM, Goulding JMR, Phillips E, Johnson N. Minerva: October 2002. Assoc Med J 2002. [DOI: 10.1136/sbmj.0210396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|