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Lavery MJ, Nawimana S, Parslew R, Stewart L. A flare of pre-existing erythema multiforme following BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. Clin Exp Dermatol 2021; 46:1325-1327. [PMID: 33914926 PMCID: PMC9213915 DOI: 10.1111/ced.14714] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | | | - R. Parslew
- Department of Dermatology Liverpool University Hospitals NHS Foundation Trust Liverpool UK,Department of Dermatology Alder Hey Children’s Hospital NHS Foundation Trust Liverpool UK
| | - L. Stewart
- Department of Dermatology Liverpool University Hospitals NHS Foundation Trust Liverpool UK
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Cro S, Cornelius V, Pink A, Wilson R, Pushpa‐Rajah A, Patel P, Abdul‐Wahab A, August S, Azad J, Becher G, Chapman A, Dunnill G, Ferguson A, Fogo A, Ghaffar S, Ingram J, Kavakleiva S, Ladoyanni E, Leman J, Macbeth A, Makrygeorgou A, Parslew R, Ryan A, Sharma A, Shipman A, Sinclair C, Wachsmuth R, Woolf R, Wright A, McAteer H, Barker J, Burden A, Griffiths C, Reynolds N, Warren R, Lachmann H, Capon F, Smith C. Anakinra for palmoplantar pustulosis: results from a randomized, double-blind, multicentre, two-staged, adaptive placebo-controlled trial (APRICOT). Br J Dermatol 2021; 186:245-256. [PMID: 34411292 PMCID: PMC9255857 DOI: 10.1111/bjd.20653] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Palmoplantar pustulosis (PPP) is a rare, debilitating, chronic inflammatory skin disease that affects the hands and feet. Clinical, immunological and genetic findings suggest a pathogenic role for interleukin (IL)-1. OBJECTIVES To determine whether anakinra (an IL-1 receptor antagonist) delivers therapeutic benefit in PPP. METHODS This was a randomized (1 : 1), double-blind, two-staged, adaptive, UK multicentre, placebo-controlled trial [ISCRTN13127147 (registered 1 August 2016); EudraCT number: 2015-003600-23 (registered 1 April 2016)]. Participants had a diagnosis of PPP (> 6 months) requiring systemic therapy. Treatment was 8 weeks of anakinra or placebo via daily, self-administered subcutaneous injections. Primary outcome was the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at 8 weeks. RESULTS A total of 374 patients were screened; 64 were enrolled (31 in the anakinra arm and 33 in the placebo arm) with a mean (SD) baseline PPPASI of 17·8 (10·5) and a PPP investigator's global assessment of severe (50%) or moderate (50%). The baseline adjusted mean difference in PPPASI favoured anakinra but did not demonstrate superiority in the intention-to-treat analysis [-1·65, 95% confidence interval (CI) -4·77 to 1·47; P = 0·30]. Similarly, secondary objective measures, including fresh pustule count (2·94, 95% CI -26·44 to 32·33; favouring anakinra), total pustule count (-30·08, 95% CI -83·20 to 23·05; favouring placebo) and patient-reported outcomes, did not show superiority of anakinra. When modelling the impact of adherence, the PPPASI complier average causal effect for an individual who received ≥ 90% of the total treatment (48% in the anakinra group) was -3·80 (95% CI -10·76 to 3·16; P = 0·285). No serious adverse events occurred. CONCLUSIONS No evidence for the superiority of anakinra was found. IL-1 blockade is not a useful intervention for the treatment of PPP.
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Affiliation(s)
- S. Cro
- Imperial Clinical Trials UnitImperial College LondonLondonW12 7RHUK
| | - V.R. Cornelius
- Imperial Clinical Trials UnitImperial College LondonLondonW12 7RHUK
| | - A.E. Pink
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - R. Wilson
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - A. Pushpa‐Rajah
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - P. Patel
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - A. Abdul‐Wahab
- St George’s University Hospitals NHS Foundation TrustLondonSW17 0QTUK
| | - S. August
- Poole Hospital NHS Foundation Trust University Hospitals DorsetPooleBH15 2JBUK
| | - J. Azad
- South Tees Hospitals NHS Foundation TrustMiddlesbroughTS4 3BWUK
| | - G. Becher
- West Glasgow Ambulatory Care HospitalGlasgowG3 8SJUK
| | - A. Chapman
- Homerton University HospitalLondonE9 6SRUK
| | | | - A.D. Ferguson
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyDE22 3NEUK
| | - A. Fogo
- Kingston HospitalKingston upon ThamesKT2 7QBUK
| | - S.A. Ghaffar
- Ninewells Hospital and Medical SchoolDundeeDD1 9SYUK
| | - J.R. Ingram
- Division of Infection and ImmunitySchool of MedicineCardiff UniversityUniversity Hospital of WalesCardiffCF14 4XNUK
| | | | | | | | - A.E. Macbeth
- Norfolk and Norwich University Hospitals NHS Foundation TrustNorwichNR4 7UYUK
| | | | - R. Parslew
- Liverpool University Hospitals NHS Foundation TrustLiverpoolL9 7ALUK
| | - A.J. Ryan
- King’s College HospitalLondonSE5 9RSUK
| | - A. Sharma
- Nottingham University Hospitals NHS TrustNottinghamNG7 2UHUK
| | - A.R. Shipman
- Portsmouth Hospitals Universities NHS TrustSt Mary’s Community Health CampusPortsmouthPO3 6ADUK
| | | | - R. Wachsmuth
- Royal Devon and Exeter NHS Foundation TrustExeterEX2 5DWUK
| | - R.T. Woolf
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
| | - A. Wright
- Bradford Teaching Hospitals NHS Foundation TrustBradfordBD9 6RJUK
| | - H. McAteer
- The Psoriasis AssociationNorthamptonNN4 7BFUK
| | - J.N.W.N. Barker
- St John’s Institute of DermatologySchool of Basic and Medical BiosciencesFaculty of Life Sciences and MedicineKing’s College LondonLondonSE1 9RTUK
| | - A.D. Burden
- Institute of Infection, Immunity and InflammationUniversity of GlasgowGlasgowG12 8TAUK
| | - C.E.M. Griffiths
- Dermatology CentreSalford Royal NHS Foundation TrustUniversity of ManchesterNIHR Manchester Biomedical Research CentreManchesterM6 8HDUK
| | - N.J. Reynolds
- Institute of Translational and Clinical MedicineMedical SchoolUniversity of NewcastleDepartment of DermatologyRoyal Victoria Infirmary and NIHR Newcastle Biomedical Research CentreNewcastle Hospitals NHS Foundation TrustNewcastle upon TyneNE2 4HHUK
| | - R.B. Warren
- National Amyloidosis CentreUniversity College LondonLondonNW3 2PFUK
| | - H.J. Lachmann
- National Amyloidosis CentreUniversity College LondonLondonNW3 2PFUK
| | - F. Capon
- Department of Medical and Molecular GeneticsKing’s College LondonLondonSE1 9RTUK
| | - C.H. Smith
- St John’s Institute of DermatologyGuy’s HospitalGuy’s and St Thomas’ NHS Foundation TrustLondonSE1 9RTUK
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Mahil SK, Ezejimofor MC, Exton LS, Manounah L, Burden AD, Coates LC, de Brito M, McGuire A, Murphy R, Owen CM, Parslew R, Woolf RT, Yiu ZZN, Uthman OA, Mohd Mustapa MF, Smith CH. Comparing the efficacy and tolerability of biologic therapies in psoriasis: an updated network meta-analysis. Br J Dermatol 2020; 183:638-649. [PMID: 32562551 DOI: 10.1111/bjd.19325] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The rapid expansion of psoriasis biologics has led to an urgent need to understand their relative efficacy and tolerability to inform treatment decisions better and, specifically, to inform guideline development. OBJECTIVES To update a 2017 meta-analysis on the comparative efficacy and tolerability of biologic treatments for psoriasis. METHODS We searched the MEDLINE, PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs), published up to 7 September 2018, of 11 licensed, NICE-approved biologics targeting tumour necrosis factor (adalimumab, etanercept, infliximab, certolizumab pegol), interleukin (IL)-12/IL-23p40 (ustekinumab), IL-17A (secukinumab, ixekizumab), IL-17RA (brodalumab) and IL-23p19 (guselkumab, tildrakizumab, risankizumab). A frequentist network meta-analysis ascertained direct or indirect evidence comparing biologics with one another, methotrexate or placebo. This was combined with hierarchical cluster analyses to consider efficacy (≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) or Physician's Global Assessment 0 or 1; PASI 75; Dermatology Life Quality Index improvement) and tolerability (drug withdrawal due to adverse events) outcomes at 10-16 weeks, followed by assessments of study quality, heterogeneity and inconsistency. RESULTS We identified 62 RCTs presenting data on direct comparisons (31 899 participants). All biologics were efficacious compared with placebo or methotrexate at 10-16 weeks. Hierarchical cluster analyses revealed that adalimumab, brodalumab, certolizumab pegol, guselkumab, risankizumab, secukinumab, tildrakizumab and ustekinumab were comparable with respect to high short-term efficacy and tolerability. Infliximab and ixekizumab clustered together, with high short-term efficacy but relatively lower tolerability than the other agents, although the number of drug withdrawal events across the network was low, so these findings should be treated with caution. CONCLUSIONS Using our methodology we found that most biologics cluster together with respect to short-term efficacy and tolerability, and we did not identify any single agent as 'best'. These data need to be interpreted in the context of longer-term efficacy, effectiveness data, safety, posology and drug acquisition costs when making treatment decisions.
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Affiliation(s)
- S K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - M C Ezejimofor
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - L Manounah
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8QQ, UK
| | - L C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - M de Brito
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - A McGuire
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK.,Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, S10 3FL, UK.,University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - C M Owen
- Department of Dermatology, East Lancashire Hospitals NHS Trust, Burnley, BB10 2PQ, UK
| | - R Parslew
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - R T Woolf
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, M13 9PT, UK
| | - O A Uthman
- Warwick Centre for Applied Health Research and Delivery, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | | | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
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4
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Smith CH, Yiu ZZN, Bale T, Burden AD, Coates LC, Edwards W, MacMahon E, Mahil SK, McGuire A, Murphy R, Nelson-Piercy C, Owen CM, Parslew R, Uthman OA, Woolf RT, Manounah L, Ezejimofor MC, Exton LS, Mohd Mustapa MF. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2020: a rapid update. Br J Dermatol 2020; 183:628-637. [PMID: 32189327 DOI: 10.1111/bjd.19039] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Z Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, M13 9PT, UK
| | - T Bale
- British Dermatology Nursing Group representative, Aneurin Bevan Health Board, Wales, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, G12 8QQ, UK
| | - L C Coates
- British Society for Rheumatology, London, EC4Y 8EE, UK.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - W Edwards
- Patient representative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - E MacMahon
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - S K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - A McGuire
- Pharmacy Department , Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK.,Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, S10 3FL, UK.,University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - C Nelson-Piercy
- Women's Health Academic Centre, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - C M Owen
- Department of Dermatology, East Lancashire Hospitals NHS Trust, Burnley, BB10 2PQ, UK
| | - R Parslew
- Department of Dermatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8XP, UK
| | - O A Uthman
- Warwick Centre for Applied Health Research and Delivery, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - R T Woolf
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - L Manounah
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - M C Ezejimofor
- British Association of Dermatologists, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, London, W1T 5HQ, UK
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5
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Smith CH, Jabbar-Lopez ZK, Yiu ZZ, Bale T, Burden AD, Coates LC, Cruickshank M, Hadoke T, MacMahon E, Murphy R, Nelson-Piercy C, Owen CM, Parslew R, Peleva E, Pottinger E, Samarasekera EJ, Stoddart J, Strudwicke C, Venning VA, Warren RB, Exton LS, Mohd Mustapa MF. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017. Br J Dermatol 2018; 177:628-636. [PMID: 28513835 DOI: 10.1111/bjd.15665] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2017] [Indexed: 01/17/2023]
Affiliation(s)
- C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - Z K Jabbar-Lopez
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - Z Z Yiu
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9NT, U.K
| | - T Bale
- British Dermatology Nursing Group representative, Aneurin Bevan Health Board, Wales, U.K
| | - A D Burden
- Department of Dermatology, Royal Infirmary of Edinburgh, Edinburgh, EH3 9HA, U.K
| | - L C Coates
- British Society for Rheumatology, Chapel Allerton Hospital, Leeds, LS7 4SA, U.K.,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, U.K
| | - M Cruickshank
- National Guideline Centre, Royal College of Physicians, London, NW1 4LE, U.K
| | | | - E MacMahon
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - R Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, U.K
| | - C Nelson-Piercy
- Women's Health Academic Centre, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - C M Owen
- Department of Dermatology, East Lancashire Hospitals NHS Trust, Burnley, BB10 2PQ, U.K
| | - R Parslew
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, L7 8XP, U.K
| | - E Peleva
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, U.K
| | - E Pottinger
- National Guideline Centre, Royal College of Physicians, London, NW1 4LE, U.K
| | - E J Samarasekera
- National Guideline Centre, Royal College of Physicians, London, NW1 4LE, U.K
| | - J Stoddart
- Independent chair, Healthcare Quality Improvement Partnership, London, EC2Y 9AE, U.K
| | | | - V A Venning
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7LE, U.K
| | - R B Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9NT, U.K
| | - L S Exton
- British Association of Dermatologists, London, W1T 5HQ, U.K
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6
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Wong JLC, Khirwadkar N, Parslew R. Localized cluster of nodules in childhood. Clin Exp Dermatol 2017; 43:88-90. [PMID: 29058336 DOI: 10.1111/ced.13251] [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: 02/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- J L C Wong
- Dermatology Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Broadgreen Hopsital, Liverpool, UK
| | - N Khirwadkar
- Histopathology Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Broadgreen Hopsital, Liverpool, UK
| | - R Parslew
- Dermatology Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Broadgreen Hopsital, Liverpool, UK
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7
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Affiliation(s)
- P Trehan
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Broadgreen Hospital, Liverpool, UK
| | - E Pang
- Department of Dermatology, St Helens and Knowsley Hospitals NHS Trust, Whiston Hospital, Prescot, Lancashire, UK
| | - N Khirwadkar
- Department of Histopathology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Broadgreen Hospital, Liverpool, UK
| | - A Alsharqi
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Broadgreen Hospital, Liverpool, UK
| | - R Parslew
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Broadgreen Hospital, Liverpool, UK
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8
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Hébert HL, Bowes J, Smith RL, Flynn E, Parslew R, Alsharqi A, McHugh NJ, Barker JNWN, Griffiths CEM, Barton A, Warren RB. Identification of loci associated with late-onset psoriasis using dense genotyping of immune-related regions. Br J Dermatol 2015; 172:933-9. [PMID: 25124732 DOI: 10.1111/bjd.13340] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic plaque psoriasis can be subdivided into two groups according to the age of onset: type 1 (early onset, before 40 years) and type 2 (late onset, at or beyond 40 years). So far, 36 genetic loci have been associated with early-onset psoriasis in genome-wide association studies of white populations, while few studies have investigated genetic susceptibility to late-onset psoriasis. OBJECTIVES To characterize the genetics underpinning late-onset psoriasis. METHODS We genotyped 543 cases of late-onset psoriasis and 4373 healthy controls using the Immunochip array, a dense genotyping chip containing single-nucleotide polymorphisms previously associated with autoimmune diseases. Imputation using SNP2HLA and stepwise logistic regression analysis was performed for markers spanning the human leucocyte antigen gene region. RESULTS Two loci (HLA-C and IL12B) previously associated with early-onset psoriasis showed significant association at a genome-wide threshold in the current study (P < 5 × 10(-8)). Six more loci (TRAF3IP2, IL23R, RNF114, IFIH1, IL23A and HLA-A) showed study-wide significant association (P < 2·3 × 10(-5); calculated using Genetic type 1 error calculator). Additionally, we identified an association at IL1R1 on chromosome 2q13, which is not associated with early-onset disease. CONCLUSIONS This is the largest study to date of genetic loci in late-onset psoriasis, and demonstrates the overlap that exists with early-onset psoriasis. It also suggests that some loci are associated exclusively with late-onset psoriasis.
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Affiliation(s)
- H L Hébert
- The Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, M6 8HD, U.K; Arthritis Research U.K. Centre for Genetics and Genomics, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PT, U.K
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Jayasekera P, Parslew R, Al-Sharqi A. A case of tumour necrosis factor-α inhibitor- and rituximab-induced plantar pustular psoriasis that completely resolved with tocilizumab. Br J Dermatol 2014; 171:1546-9. [PMID: 24890762 DOI: 10.1111/bjd.13146] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 11/28/2022]
Abstract
Rituximab, a chimeric B-cell-depleting monoclonal antibody, is a well-established therapy for rheumatoid arthritis. It is emerging that classical psoriatic lesions and plantar pustular psoriasis (PPP) are cutaneous side-effects of this drug. Antitumour necrosis factor (anti-TNF) therapies have multiple documented side-effects including PPP and psoriasis. We report a patient who has rheumatoid arthritis, who failed on anti-TNF therapies and then was commenced on rituximab. Subsequently she developed localized PPP. Due to deterioration of her joint disease she was switched to the interleukin-6 blocker tocilizumab, and the PPP resolved.
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Affiliation(s)
- P Jayasekera
- Department of Dermatology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, U.K
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10
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Laws P, Downs A, Parslew R, Dever B, Smith C, Barker J, Moriarty B, Murphy R, Kirby B, Burden A, McBride S, Anstey A, O’Shea S, Ralph N, Buckley C, Griffiths C, Warren R. Practical experience of ustekinumab in the treatment of psoriasis: experience from a multicentre, retrospective case cohort study across the U.K. and Ireland. Br J Dermatol 2011; 166:189-95. [DOI: 10.1111/j.1365-2133.2011.10638.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Arun B, Coupland S, Parslew R. Cysts and erythematous plaques on the face and scalp. Clin Exp Dermatol 2009; 34:547-8. [PMID: 19522988 DOI: 10.1111/j.1365-2230.2008.02778.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)
- B Arun
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
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12
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Yesudian PD, Klafkowski J, Parslew R, Gould D, Lloyd D, Pizer B. Tufted Angioma???Associated Kasabach-Merritt Syndrome Treated with Embolization and Vincristine. Plast Reconstr Surg 2007; 119:1392-1393. [PMID: 17496631 DOI: 10.1097/01.prs.0000255189.06739.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Paul D Yesudian
- Department of Dermatology (Yesudian, Parslew) Department of Radiology (Klafkowski, Gould) Department of Surgery (Lloyd) Department of Paediatric Oncology, Royal Liverpool Children's Hospital, Liverpool, United Kingdom (Pizer)
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13
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Parslew R, Lewis-Jones M, Friedmann P. Sinus histiocytosis with massive lymphadenopathy: response of cutaneous lesions to PUVA. J Eur Acad Dermatol Venereol 2006. [DOI: 10.1111/j.1468-3083.1997.tb00269.x] [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: 11/29/2022]
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17
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McArdle F, Rhodes LE, Parslew R, Jack CIA, Friedmann PS, Jackson MJ. UVR-induced oxidative stress in human skin in vivo: effects of oral vitamin C supplementation. Free Radic Biol Med 2002; 33:1355-62. [PMID: 12419467 DOI: 10.1016/s0891-5849(02)01042-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Previous studies of cultured skin cells and murine skin in vivo have indicated that UVR-induced damage involves the generation of reactive oxygen species and depletion of endogenous antioxidant systems. In order to explore the relevance of this to UVR-induced damage to human skin, we have undertaken a detailed examination of the time-course of changes in markers of oxidative stress in human skin following exposure to physiological amounts of UVR in vivo. In addition, we have examined the skin bioavailability of a common nutritional antioxidant, vitamin C, and have assessed the effects of supplementation on markers of oxidative stress. Our hypothesis was that acute exposure of human skin to UVR in vivo would lead to oxidation of cellular biomolecules that could be prevented by prior vitamin C treatment. A UVR-challenge of 120 mJ/cm2 of broadband UVB (peak 310 nm, range 270-400 nm) was applied to buttock skin of 8 healthy volunteers. This caused a rapid and significant rise in activity of skin catalase at 1 h and an increase in the oxidized/total glutathione ratio at 6 h post-UVR. AP-1 DNA binding also peaked at 1-6 h post-UVR, then declined rapidly to baseline levels. No significant changes were seen in skin malonaldehyde content. Oral vitamin C supplements (500 mg/day) were taken by 12 volunteers for 8 weeks resulting in significant rises in plasma and skin vitamin C content. Supplementation had no effect on the UVR-induced erythemal response. The skin malonaldehyde content was reduced by vitamin C supplementation, but surprisingly, reductions in the skin content of total glutathione and protein thiols were also seen. We speculate that this apparently paradoxical effect could be due to regulation of total reductant capacity by skin cells, such that vitamin C may have been replacing other reductants in these cells. No evidence was obtained for an effect of the supplementary vitamin C on the mild oxidative stress seen in human skin following UVR exposure.
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Affiliation(s)
- F McArdle
- Department of Medicine, University of Liverpool, Liverpool, UK
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Rhodes LE, Belgi G, Parslew R, McLoughlin L, Clough GF, Friedmann PS. Ultraviolet-B-induced erythema is mediated by nitric oxide and prostaglandin E2 in combination. J Invest Dermatol 2001; 117:880-5. [PMID: 11676827 DOI: 10.1046/j.0022-202x.2001.01514.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Ultraviolet-B-induced erythema (one, two, or four times the minimal erythema dose) was reduced but not abolished by application of 1% indomethacin gel immediately after irradiation of human skin. Continuous synthesis of prostaglandins is reflected by similar levels of indomethacin-mediated inhibition of erythema at any time within 48 h after irradiation. Repeated applications of indomethacin did not increase the inhibition. Twenty-four hours after irradiation with four minimal erythema doses, mean prostaglandin E2 levels in suction blisters were 27.2 ng per ml (SEM 11) compared with 8.6 ng per ml in unirradiated skin (n = 25; p < 0.01). Prosta glandin E2 levels in dermal tissues, sampled by microdialysis (depth 0.6 +/- 0.1 mm), were 310 pg per ml (SEM 123) and 237 pg per ml (SEM 88) in irradiated and unirradiated skin, respectively (n = 7, n.s.). Nitric oxide also made a significant contribution to ultraviolet-B-induced erythema. Ultraviolet erythema was inhibited by L-NAME in a dose-related fashion with 2 mM L-NAME causing total abolition of the response. L-NAME was effective at all time points up to 48 h suggesting that NO was produced continuously. NO was undetectable in suction blister fluid but in dermal microdialysate NO was present at 44.3 ng per ml (SEM 6.2) following ultraviolet B compared with 26.0 ng per ml (SEM 8.0) in unirradiated skin (p < 0.05), approximately 1000 times the molar concentration of prostaglandin E2. These findings confirm prostaglandin E2 and NO to be mediators of ultraviolet-induced erythema. They also show that there is prolonged synthesis of both mediators within the erythemal response and that synthesis of NO is induced by lower doses of ultraviolet B compared with that of prostaglandin E2.
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Affiliation(s)
- L E Rhodes
- Photobiology Unit, Dermatology Center, Hope Hospital, Manchester, UK
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Abstract
BACKGROUND Chronic idiopathic urticaria is a disabling condition that does not always respond to antihistamine drugs and other agents are sometimes needed to control disease activity. Warfarin has demonstrated efficacy in single unblinded case studies [1] but has been dismissed by others [2]. OBJECTIVE We investigated the effect of warfarin treatment in eight patients with chronic idiopathic urticaria unresponsive to antihistamines in an open study. Six of the eight patients responded to treatment and three had a dramatic response. These three were included in a double-blind placebo-controlled trial of warfarin therapy to confirm significant benefit from treatment. METHODS The three warfarin responders had their stable warfarin dose encapsulated and placebo capsules were provided. A double-blind placebo-controlled crossover trial was performed on each patient. Visual analogue scores recorded disease activity. RESULTS Comparison of visual analogue scores showed a significant benefit while on warfarin with a reduction in pruritus and angio-oedema. CONCLUSION This is the first double-blind placebo-controlled study to show a response of chronic idiopathic urticaria to warfarin. The mechanisms of action are unclear and require further study.
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Affiliation(s)
- R Parslew
- Royal Liverpool University Hospital, Department of Dermatology, Prescot Street, Liverpool, UK
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Azurdia RM, Graham RM, Weismann K, Guerin DM, Parslew R. Acne keloidalis in caucasian patients on cyclosporin following organ transplantation. Br J Dermatol 2000; 143:465-7. [PMID: 10951177 DOI: 10.1046/j.1365-2133.2000.03694.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Sweet's syndrome is associated with haematological malignancy, particularly acute myelogenous leukaemia, but there are few reports of its association with polycythaemia rubra vera. We describe an 85-year-old man with polycythaemia rubra vera who developed Sweet's syndrome and review the literature of this association.
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Affiliation(s)
- G A Wong
- Departments of Dermatology and Pathology, Royal Liverpool University Hospitals NHS Trust, Liverpool, UK.
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Abstract
The role of inflammatory mediators in the pathogenesis and pathophysiology of skin diseases is now widely accepted. We analysed the profiles of inflammatory mediators in normal, sensitive (past history of eczema, but currently patch test negative) and diseased (psoriasis and eczema) skin types to identify the patterns associated with various degrees of inflammatory dermatoses. Compared with normal skin, prostaglandin E2 was increased approximately 3.8-fold (p<0.0002) and 4.7-fold (p<0.0001) in suction blister fluids from sensitive and diseased skin types, respectively. Leukotriene B4 and interleukin-1alpha showed no differences between normal and sensitive skin types. However, in lesional skin from psoriasis and eczema patients, leukotriene B4 was increased approximately 6.6-fold (p<0.0001), whereas interleukin-1alpha was decreased approximately 3.1-fold (p<0.001). Interleukin 6 and tumour necrosis factor-alpha could not discriminate between skin types. We conclude that only prostaglandin E2 showed a significant stepwise increase on progression from normal through sensitive and inflammatory skin diseases. Levels of leukotriene B4 and interleukin-1alpha were also indicative of disease state and may be important in the pathophysiology of these conditions.
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Affiliation(s)
- D M Reilly
- Biosciences Division, Unilever Research, Colworth Laboratory, Sharnbrook, Bedford, UK
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Abstract
Anthralin is a safe, effective treatment for psoriasis, but its efficacy is hampered by the side-effects of irritation and staining of the uninvolved skin. To avoid burning, it is customary to start at low concentrations and increase every 48-72 h until the therapeutically effective concentration is reached, which takes time and appears to prolong treatment. We felt that if the minimal erythema concentration (MEC) of anthralin could be determined initially in an individual, this ought to be near or at the final achievable therapeutic concentration. Hence, by analogy with ultraviolet therapy, treatment could start just below this concentration and thus avoid delay. A series of concentrations of anthralin in Lassar's paste was applied to the back for 3 h, and erythemal responses assessed at 24 and 48 h. MECs (0.015-0.03%) were far below those usually reached during normal therapy. To test the possibility that the skin was adapting to anthralin, we pretreated areas of skin with a subirritant concentration of anthralin (0.007%) for 3 h on 2 consecutive days prior to application of the full dose series. On the pretreated areas, the MEC increased fourfold from 0. 015% to 0.06% (P < 0.01); the concentration of anthralin required to produce the mid-point on the dose-response curve increased from 0. 06% to 0.25% (P = 0.01), demonstrating a clear adaptive response. One pretreatment produced a 52% reduction in erythema compared with control challenge, and maximal 61% inhibition was seen after three applications. Pretreatment with a subirritant concentration of a control irritant, croton oil, had no effect on the response to anthralin and vice versa. Pretreatment of skin with danthron, the non-irritant oxidation product of anthralin, had no effect, suggesting that the attenuation effect is specific to native anthralin. To see whether the attenuation might be due to modulation of xenobiotic metabolizing enzymes, skin was pretreated with inducers and inhibitors of the cytochrome P450 and NADPH-dependent quinone reductase (NDQR) enzyme systems. However, no effect was seen. In conclusion, we have shown that the irritant response to anthralin is attenuated by repeated applications of a subirritant concentration of anthralin; this is not a non-specific response to all irritants, but a specific property of native anthralin, and the enzymes P450 and NDQR are apparently not responsible for this effect.
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Affiliation(s)
- R Parslew
- Department of Dermatology, Royal Liverpool Hospital, Liverpool L7 8XP, U.K
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Parslew R, Jones KT, Rhodes JM, Sharpe GR. The antiproliferative effect of lectin from the edible mushroom (Agaricus bisporus) on human keratinocytes: preliminary studies on its use in psoriasis. Br J Dermatol 1999; 140:56-60. [PMID: 10215768 DOI: 10.1046/j.1365-2133.1999.02607.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lectins or agglutinins are proteins with affinity for specific sugar residues. Peanut agglutinin (PNA) and the lectin from the edible mushroom (Agaricus bisporus, ABL) both bind to the disaccharide galactosyl beta-1,3-N-acetyl galactosamine alpha-. This is expressed in keratinocytes as an O-linked chain on CD44, a polymorphic membrane glycoprotein. Many lectins are mitogens and PNA is a mitogen for colonic epithelial cells. However, ABL reversibly inhibits proliferation of colonic cancer cell lines without cytotoxicity and thus has therapeutic potential in situations such as psoriasis where proliferation is increased. We have therefore investigated the effect of ABL on the growth of normal human cultured keratinocytes and a human papilloma virus (HPV)-transformed cell line. In a 5-day dose-response study, keratinocyte growth was greatly reduced by 1.0 microg/mL ABL and completely inhibited by 3.0 microg/mL ABL (ANOVA, P < 0.0001). Exposure to 1.0 microg/mL ABL for only 8 h gave the same growth inhibition as did continued exposure for 3 days. No cytotoxic or morphological changes were observed. An HPV-immortalized cell line was relatively resistant to ABL: in a 5-day dose-response study, exposure to 30 microg/mL was required to inhibit cell growth completely. Topical application of ABL 0.01% or 0.1% to normal human skin caused no change in skin erythema, blood flow or thickness compared with vehicle or baseline (n = 6). ABL 0. 1% in white soft paraffin was compared with vehicle in 11 psoriatic patients, using comparative contralateral plaques. Twice daily application for 2 weeks showed no significant difference from vehicle-treated sites, although the skin thickness of plaques fell from 5.3 +/- 0.4 (n = 11, mean +/- SEM) to 4.1 +/- 0.3 mm. In view of the in vitro results further studies are warranted, particularly if means can be found to improve the epidermal penetration of the relatively large ABL molecule (60 kDa).
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Affiliation(s)
- R Parslew
- University Department of Dermatology, University of Liverpool, UK
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Parslew R, Rhodes L. Is histological examination of tissue removed by GP's always necessary. Clinically important skin lesions would have been missed with a selective histological approach. BMJ 1998; 316:778; author reply 779. [PMID: 9529429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Parslew R, Lewis-Jones MS. Localized unilateral hyperhidrosis secondary to an eccrine naevus. Clin Exp Dermatol 1997; 22:246-7. [PMID: 9536550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We describe a patient with intermittent unilateral hyperhidrosis localized to the left hand only. Histology confirmed the presence of an eccrine naevus.
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Affiliation(s)
- R Parslew
- Department of Dermatology, Royal Liverpool Hospital Trust, UK
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Parslew R. Sinus histiocytosis with massive lymphadenopathy: response of cutaneous lesions to PUVA. J Eur Acad Dermatol Venereol 1997. [DOI: 10.1016/s0926-9959(97)00108-6] [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: 11/29/2022]
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Parslew R. Accuracy of diagnosis of benign skin lesions in hospital practice: a comparison of clinical and histological findings. J Eur Acad Dermatol Venereol 1997. [DOI: 10.1016/s0926-9959(97)00116-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Halpern SM, Parslew R, Cerio R, Kirby JT, Sharpe GR. Kaposi's sarcoma associated with immunosuppression for bullous pemphigoid. Br J Dermatol 1997; 137:140-3. [PMID: 9274643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Kaposi's sarcoma may occur in transplant recipients on immunosuppressive regimens, but is not well recognized in association with treatment for dermatological disease. We report two cases where multifocal Kaposi's sarcoma developed following iatrogenic immunosuppression with prednisolone and azathioprine for bullous pemphigoid. Both patients were HIV negative and, in one case, lesions regressed both clinically and histologically when immunosuppressive therapy was withdrawn.
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Affiliation(s)
- S M Halpern
- Department of Dermatology, Royal Liverpool University Hospital, London, U.K
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Parslew R, Braithwaite I, Klenerman L, Friedmann P. An investigation into the effect of ischaemia and pressure on irritant inflammation. Br J Dermatol 1997; 136:734-6. [PMID: 9205508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Reports of chemical burns beneath tourniquets during orthopaedic procedures led us to explore the irritant effects produced by the skin antiseptics used during such procedures. A sphygmomanometer and tourniquet, at a pressure of 200 mmHg for 30 min, was used to created pressure and ischaemia which were then examined separately for their respective effects on irritant inflammation in normal subjects and those with atopic eczema. As no inflammation could be demonstrated with the antiseptics, we subsequently used the known irritant chemical anthralin to examine the effect of ischaemia with and without pressure. Site-related variation in anthralin-induced inflammation was observed but there was no demonstrable effect of either pressure or ischaemia on the inflammatory response. Therefore, as we are unable to show a relationship between ischaemia with or without pressure and irritant inflammation, we conclude that burns under tourniquets are likely to be idiosyncratic reactions and their further investigation requires examination of the individuals affected.
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Affiliation(s)
- R Parslew
- Department of Dermatology, Royal Liverpool University Hospital, UK
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Affiliation(s)
- R Parslew
- Department of Dermatology, Royal Liverpool University Hospital Trust, UK
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Abstract
A 14-year-old girl with partial unilateral lentiginosis affecting the left side of the neck, left shoulder and left upper arm is described. She also had a further patch of multiple lentigines over the right side of the face.
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Affiliation(s)
- R Parslew
- Department of Dermatology, Royal Liverpool University Hospital, UK
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Abstract
A young woman with Darier's disease treated with acitretin developed Kaposi's varicelliform eruption, from which herpes simplex virus was isolated. Herpes simplex infection complicating Darier's disease is well recognized but uncommon. A young woman of 19 years is described who presented with fever and general malaise.
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Affiliation(s)
- R Parslew
- Department of Dermatology, Royal Liverpool University Hospital NHS Trust, UK
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