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Burden-Teh E, Murphy R, Gran S, Nijsten T, Hughes C, Abdul-Wahab A, Bewley A, Burrows N, Darne S, Gach JE, Katugampola R, Jury CS, Kuet K, Llewellyn J, McPherson T, Ravenscroft JC, Taibjee S, Wilkinson C, Thomas KS. Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case-control diagnostic accuracy study (DIPSOC study). Br J Dermatol 2021; 186:341-351. [PMID: 34477218 PMCID: PMC9298773 DOI: 10.1111/bjd.20689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND In children, psoriasis can be challenging to diagnose. Difficulties arise from differences in the clinical presentation compared with adults. OBJECTIVES To test the diagnostic accuracy of previously agreed consensus criteria and to develop a shortlist of the best predictive diagnostic criteria for childhood psoriasis. METHODS A case-control diagnostic accuracy study in 12 UK dermatology departments (2017-2019) assessed 18 clinical criteria using blinded trained investigators. Children (< 18 years) with dermatologist-diagnosed psoriasis (cases, N = 170) or a different scaly inflammatory rash (controls, N = 160) were recruited. The best predictive criteria were identified using backward logistic regression, and internal validation was conducted using bootstrapping. RESULTS The sensitivity of the consensus-agreed criteria and consensus scoring algorithm was 84·6%, the specificity was 65·1% and the area under the curve (AUC) was 0·75. The seven diagnostic criteria that performed best were: (i) scale and erythema in the scalp involving the hairline, (ii) scaly erythema inside the external auditory meatus, (iii) persistent well-demarcated erythematous rash anywhere on the body, (iv) persistent erythema in the umbilicus, (v) scaly erythematous plaques on the extensor surfaces of the elbows and/or knees, (vi) well-demarcated erythematous rash in the napkin area involving the crural fold and (vii) family history of psoriasis. The sensitivity of the best predictive model was 76·8%, with specificity 72·7% and AUC 0·84. The c-statistic optimism-adjusted shrinkage factor was 0·012. CONCLUSIONS This study provides examination- and history-based data on the clinical features of psoriasis in children and proposes seven diagnostic criteria with good discriminatory ability in secondary-care patients. External validation is now needed.
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Affiliation(s)
- E Burden-Teh
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R Murphy
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - S Gran
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - T Nijsten
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - C Hughes
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - A Abdul-Wahab
- Department of Dermatology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - A Bewley
- Department of Dermatology, Barts Health NHS Trust, London, UK
| | - N Burrows
- Department of Dermatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Darne
- Department of Dermatology, The James Cook University Hospital, Middlesbrough, UK
| | - J E Gach
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - R Katugampola
- Department of Dermatology, Cardiff and Vale University Health Board, Cardiff, UK
| | - C S Jury
- Department of Dermatology, Royal Hospital for Children, Glasgow, UK
| | - K Kuet
- Department of Dermatology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - J Llewellyn
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T McPherson
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J C Ravenscroft
- Department of Paediatric Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Taibjee
- Department of Dermatology, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - C Wilkinson
- Department of Dermatology, University Hospital Plymouth NHS Trust, Plymouth, UK
| | - K S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Seccombe EL, Ardern‐Jones M, Walker W, Austin S, Taibjee S, Williams S, Hossain P, Shenoy D, Fityan A. Bronchiolitis obliterans as a long‐term sequela of Stevens–Johnson syndrome and toxic epidermal necrolysis in children. Clin Exp Dermatol 2019; 44:897-902. [DOI: 10.1111/ced.13969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2019] [Indexed: 01/10/2023]
Affiliation(s)
- E. L. Seccombe
- Department of Dermatology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - M. Ardern‐Jones
- Department of Dermatology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - W. Walker
- Paediatric Respiratory Department University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - S. Austin
- Department of Dermatology Dorset County Hospital NHS Foundation Trust Dorchester Dorset UK
| | - S. Taibjee
- Department of Dermatology Dorset County Hospital NHS Foundation Trust Dorchester Dorset UK
| | - S. Williams
- Department of Paediatrics University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - P. Hossain
- Department of Ophthalmology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - D. Shenoy
- Department of Paediatrics University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
| | - A. Fityan
- Department of Dermatology University Hospital Southampton NHS Foundation Trust Southampton Hampshire UK
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Powell JB, Dokal I, Carr R, Taibjee S, Cave B, Moss C. X-linked dyskeratosis congenita presenting in adulthood with photodamaged skin and epiphora. Clin Exp Dermatol 2015; 39:310-4. [PMID: 24635067 DOI: 10.1111/ced.12272] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2013] [Indexed: 11/27/2022]
Abstract
Dyskeratosis congenita (DC) is a clinically and genetically heterogeneous multisystem bone marrow failure disorder of telomere maintenance, which may present with dermatological features. The main cause of mortality is bone marrow failure, often developing in the second decade of life, although pulmonary disease and malignancies such as squamous cell carcinomas (SCCs) may also prove fatal. We report the case of a 28-year-old man with X-linked DC and confirmed DKC1 gene mutation. In addition to the classic triad of nail dystrophy, hyperpigmentation and oral leucoplakia, the patient had actinic keratosis (AK) and photodamaged skin, hitherto under-recognized features of this condition. Awareness of the clinical presentation of DC is important, as accurate clinical and molecular diagnosis affords patients and their families genetic counselling, cancer prevention and screening measures, and planning for complications such as bone marrow failure.
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Affiliation(s)
- J B Powell
- Department of Dermatology, Worcestershire Royal Hospital, Worcester, UK
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