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Cummins DM, Marshall C, Asfour L, Bryden A, Champagne C, Chiang YZ, Fairhurst D, Farrant P, Heal C, Holmes S, Joliffe V, Jones J, Kaur MR, Meah N, Messenger A, Mowbray M, Takwale A, Tziotzios C, Wade M, Wong S, Zaheri S, Harries M. Frontal Fibrosing Alopecia survey of severity assessment methods in routine clinical practice and validation of the IFFACG measurement guidance. Clin Exp Dermatol 2021; 47:903-909. [PMID: 34826169 DOI: 10.1111/ced.15035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/05/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lack of validated and responsive outcome measures in the management of Frontal Fibrosing Alopecia (FFA) significantly limits our ability to assess disease progression and treatment response over time. OBJECTIVES The aim of this study was to understand how FFA extent and progression is currently assessed in UK specialist centres, validate components of the International FFA Cooperative Group (IFFACG) statement on FFA assessment, and identify pragmatic advice to improve FFA management in clinic. METHODS Consultant Dermatologists with a specialist interest in hair loss (n=17) were invited to take part. Preferred FFA assessment methods were explored using questionnaires and clinical scenarios. Participants were asked to identify and mark the current hairline in 10 frontal and 10 temporal hairline images, with assessment repeated 3 months later (to assess intra-individual variability) and 12 months later (to test whether inter-individual accuracy could be improved with simple instruction). RESULTS All 17 clinicians (100%) completed the questionnaire at each time interval. We identified a wide variation in assessment techniques between our experts. Measurements were perceived as the most accurate method of assessing frontal recession whereas photography was preferred for temporal recession. Inter-rater reliability between clinicians measuring the frontal hairline scenarios indicated a moderate strength of agreement (ICC 0.613; 95% CI: 0.398 to 0.848), yet intra-rater reliability was found to be poor with wide limits of agreement (-8.71mm to 9.92mm) on follow-up. Importantly, when clear guidance was provided on how the hairline should be identified (questionnaire 3), inter-rater reliability improved significantly, with an ICC 0.702 suggesting moderate agreement (95% CI: 0.508 to 0.890; p<0.001). A similar pattern was seen with temporal hairline measurements, which again improved in accuracy with instruction. CONCLUSION We show that accuracy of measurements in FFA can be improved with simple instruction and validate components of the IFFACG measurement recommendations.
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Affiliation(s)
- D M Cummins
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - C Marshall
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - L Asfour
- Sinclair Dermatology, Melbourne, Australia
| | - A Bryden
- Department of Dermatology, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - C Champagne
- Department of Dermatology, Watford General Hospital, West Hertfordshire Hospitals, Vicarage Rd, Watford, WD18 0HB, UK
| | - Y Z Chiang
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - D Fairhurst
- Department of Dermatology, Pontefract General Infirmary, Friarwood Lane, Pontefract, West Yorkshire, WF8 1PL, UK
| | - P Farrant
- Department of Dermatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, BN2 3EW, UK
| | - C Heal
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - S Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK
| | - V Joliffe
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - J Jones
- Department of Dermatology, Royal Free Hospital, London, NW3 2QG, UK and The Hospital of St. John and St. Elizabeth, St. John's Wood, London, NW8 9NH, UK
| | - M R Kaur
- Department of Dermatology, University Hospitals Birmingham NHS Foundation Trust, Solihull, B91 2JL, UK
| | - N Meah
- Department of Dermatology, St Helens and Knowsley Teaching Hospitals NHS Trust, St Helens, UK
| | - A Messenger
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - M Mowbray
- Department of Dermatology, Queen Margaret Hospital, Dunfermline, KY12 0SU, UK
| | - A Takwale
- Department of Dermatology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, GL1 3NN, UK
| | - C Tziotzios
- St John's Institute of Dermatology, Guy's and St Thomas' Hospitals NHS Foundation Trust & King's College London, SE1 9RT, UK
| | - M Wade
- The London Skin and Hair Clinic, London, WC1V 7DN, UK
| | - S Wong
- HCA, The Shard, St. Thomas Street, London, SE1 9BS
| | - S Zaheri
- Department of Dermatology, Imperial College NHS Healthcare Trust, London, UK
| | - M Harries
- The Dermatology Centre, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK.,Centre for Dermatology Research, University of Manchester, MAHSC and NIHR Manchester Biomedical Research Centre, Manchester, UK
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Affiliation(s)
- S Karanovic
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Lode Lane, Solihull, B91 2JL, U.K
| | - M Harries
- Dermatology Centre, The University of Manchester, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, U.K
| | - M R Kaur
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Lode Lane, Solihull, B91 2JL, U.K
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Fremlin GA, Orpin S, Kaur MR. Clarithromycin, rifampicin and fusidic acid triple combination therapy for chronic folliculocentric pustulosis of the scalp. Clin Exp Dermatol 2017; 42:913-914. [PMID: 28691163 DOI: 10.1111/ced.13199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- G A Fremlin
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Lode Lane, Solihull, West Midlands, B91 2JL, UK
| | - S Orpin
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Lode Lane, Solihull, West Midlands, B91 2JL, UK
| | - M R Kaur
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Lode Lane, Solihull, West Midlands, B91 2JL, UK
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Harper N, Saigal H, Kaur MR, Orpin S. The ‘golden goddess’ of spices: a potentially effective topical therapy for Bowen disease? Clin Exp Dermatol 2017; 42:545-547. [DOI: 10.1111/ced.13099] [Citation(s) in RCA: 2] [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: 08/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- N. Harper
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull Hospital, Lode Lane; Solihull B91 2JL UK
| | - H. Saigal
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull Hospital, Lode Lane; Solihull B91 2JL UK
| | - M. R. Kaur
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull Hospital, Lode Lane; Solihull B91 2JL UK
| | - S. Orpin
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull Hospital, Lode Lane; Solihull B91 2JL UK
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Mansouri Y, Martin-Clavijo A, Newsome P, Kaur MR. Dissecting cellulitis of the scalp treated with tumour necrosis factor-α inhibitors: experience with two agents. Br J Dermatol 2016; 174:916-8. [PMID: 26527324 DOI: 10.1111/bjd.14269] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Y. Mansouri
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull West Midlands U.K
| | - A. Martin-Clavijo
- Department of Dermatology; University Hospitals Birmingham NHS Foundation Trust; Birmingham West Midlands U.K
| | - P. Newsome
- University of Birmingham; NIHR Liver BRU and Centre for Liver Research; Birmingham West Midlands U.K
| | - M. R. Kaur
- Department of Dermatology; Heart of England NHS Foundation Trust; Solihull West Midlands U.K
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Chan SA, Hejmadi R, Webster K, Kaur MR. A unexpected growth arising within nevus sebaceous of Jadassohn. Dermatol Online J 2016; 22:13030/qt03s2g1c8. [PMID: 26990478] [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] [Received: 01/15/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023] Open
Abstract
The predisposition to epithelial neoplasms in nevus sebaceous is well established; most tumors occur in adults and are benign. Hidradenoma is a relatively rare benign tumor of sweat gland origin that can rarely arise within a nevus sebaceous. We present an interesting case of a hidradenoma and sebaceoma arising within a nevus sebaceous and present a literature review of the 2 conditions. Even though hidradenoma is a benign tumor, we would advocate complete excision given the potential for malignant transformation.
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Chan SA, Hejmadi R, Webster K, Kaur MR. A unexpected growth arising within nevus sebaceous of Jadassohn. Dermatol Online J 2016. [DOI: 10.5070/d3221029796] [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: 11/08/2022] Open
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Cuell A, Bansal N, Cole T, Kaur MR, Lee J, Loffeld A, Moss C, O'Donnell M, Takeichi T, Thind CK, McGrath JA. Familial progressive hyper- and hypopigmentation and malignancy in two families with new mutations in KITLG. Clin Exp Dermatol 2015; 40:860-4. [PMID: 26179221 DOI: 10.1111/ced.12702] [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: 01/20/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Familial progressive hyper- and hypopigmentation (FPHH) is an autosomal dominant skin condition presenting in childhood with generalized macular dyspigmentation, usually reported in patients of East Asian origin. It overlaps phenotypically with other dyschromatoses, but can now be distinguished by mutations in the KIT ligand gene (KITLG). AIM We report two unrelated white families with similar phenotypic presentations of FPHH developing in early childhood in several generations. METHODS Sanger sequencing of the exons and flanking introns of KITLG was performed. RESULTS This identified a new heterozygous missense mutation in each family (p.Thr34Asn and p.Val37Gly, respectively). Of the six affected individuals examined by us, two had cancer: a 62-year-old man in family 1 had developed two primary melanomas and a pharyngeal carcinoma, and a 42-year-old woman in family 2 had developed thyroid carcinoma. All had unusually sparse lateral eyebrows, a finding not previously reported in this condition. CONCLUSIONS We summarize the genetic spectrum of the dyschromatoses and discuss a possible increased risk of malignancy in FPHH.
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Affiliation(s)
- A Cuell
- Department of Dermatology, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - N Bansal
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
| | - T Cole
- Department of Clinical Genetics, Birmingham Women's Hospital, NHS Foundation Trust, Birmingham, UK
| | - M R Kaur
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
| | - J Lee
- Genetic Skin Disease Group, St John's Institute of Dermatology, King's College London, London, UK
| | - A Loffeld
- Department of Dermatology, Solihull Hospital, Heart of England NHS Foundation Trust, Solihull, UK
| | - C Moss
- Department of Dermatology, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - M O'Donnell
- Department of Clinical Genetics, Birmingham Women's Hospital, NHS Foundation Trust, Birmingham, UK
| | - T Takeichi
- Genetic Skin Disease Group, St John's Institute of Dermatology, King's College London, London, UK
| | - C K Thind
- Department of Dermatology, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, UK
| | - J A McGrath
- Genetic Skin Disease Group, St John's Institute of Dermatology, King's College London, London, UK
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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
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Powell JB, Kaur MR. 2011-2012 survey and audit of phototherapy services in the West Midlands, UK. Clin Exp Dermatol 2014; 39:65-6. [PMID: 23855732 DOI: 10.1111/ced.12199] [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: 04/07/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J B Powell
- Dermatology Department, Solihull Hospital, Heart of England NHS Trust, Birmingham, West Midlands, UK.
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Raghavendran RR, Humphreys F, Kaur MR. Successful use of mycophenolate mofetil to treat severe chronic urticaria in a patient intolerant to ciclosporin. Clin Exp Dermatol 2013; 39:68-9. [DOI: 10.1111/ced.12156] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 11/26/2022]
Affiliation(s)
- R. R. Raghavendran
- Department of Dermatology; Heart of England NHS Foundation Trust; Birmingham UK
| | - F. Humphreys
- Department of Dermatology; South Warwickshire NHS Foundation Trust; Warwick UK
| | - M. R. Kaur
- Department of Dermatology; Heart of England NHS Foundation Trust; Birmingham UK
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Lew TT, Kaur MR, Hague JS. Oral terbinafine as an alternative treatment for Hailey-Hailey disease. Clin Exp Dermatol 2013; 38:929-30. [PMID: 23659757 DOI: 10.1111/ced.12144] [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] [Accepted: 01/25/2013] [Indexed: 11/29/2022]
Affiliation(s)
- T. T. Lew
- Solihull Hospital; Heart of England Hospitals NHS Foundation Trust; West Midland
| | - M. R. Kaur
- Solihull Hospital; Heart of England Hospitals NHS Foundation Trust; West Midland
| | - J. S. Hague
- Solihull Hospital; Heart of England Hospitals NHS Foundation Trust; West Midland
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Affiliation(s)
- M R Kaur
- Department of Dermatology, Walsgrave Hospital, University Hospitals Coventry and Warwickshire NHS Trust, Warwickshire, UK.
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Abstract
Toxic epidermal necrolysis (TEN) is a life-threatening, immune-mediated reaction, characterized by severe cutaneous and mucosal blisters and erosions. It often presents with flu-like symptoms, followed by a maculopapular, urticarial, purpuric or erythema multiforme-like eruption, which then evolves into blisters and sheet-like erosions. Presentation with pustules, however, is not well described in the English literature, and may lead to delayed diagnosis. We present two unusual cases of TEN that initially presented with pustular lesions.
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Affiliation(s)
- J S Hague
- South Warwickshire General Hospitals NHS Trust, Warwick Hospital, Warwick, UK.
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Kaur MR, Sethi B, Roberts C, Titley G, Lim SPR. A longstanding nail abnormality in a young man. Clin Exp Dermatol 2009; 34:273-4. [PMID: 19187315 DOI: 10.1111/j.1365-2230.2007.02544.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: 11/29/2022]
Affiliation(s)
- M R Kaur
- Department of Plastic Surgery, University Hospital Birmingham Foundation Trust, Birmingham, UK.
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Kaur MR, Brundler MA, Stevenson O, Moss C. Disseminated clustered juvenile xanthogranuloma: an unusual morphological variant of a common condition. Clin Exp Dermatol 2008; 33:575-7. [DOI: 10.1111/j.1365-2230.2008.02705.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kaur MR, Grindulis K, Maheshwari M, Ellis CJ, Bhat J, Tan CY. Delayed diagnosis of leprosy due to presentation with a rheumatoid-like polyarthropathy. Clin Exp Dermatol 2008; 32:784-5. [PMID: 17953648 DOI: 10.1111/j.1365-2230.2007.02525.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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)
- M R Kaur
- Department of Dermatology, City Hospital, Birmingham, UK.
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Abstract
Desmoplastic trichoepithelioma (DT) is a rare benign adnexal neoplasm considered to have follicular differentiation. It usually presents as an asymptomatic, firm, annular plaque with a raised border. The most common site of occurrence is the face, usually on the cheek. Females are more often affected than males and the age range of patients previously reported is 8-79 years. We present a case of congenital desmoplastic trichoepithelioma. A girl was born at term to a healthy mother after an uneventful pregnancy and was noted to have widespread erythematous plaques with milia-like lesions over the right scalp, face and neck, with some areas of atrophic scarring. Histology and immunohistochemistry of incisional biopsies of the lesions were consistent with a diagnosis of DT. To our knowledge, this is the first reported case of congenital DT.
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Affiliation(s)
- J J Carter
- Department of Dermatology, City Hospital, Birmingham, UK.
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Affiliation(s)
- M R Kaur
- Department of Dermatology, University Hospital Birmingham, Birmingham, UK.
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