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Yesudian RI, Yesudian PD. Case reports and narrative fallacies: the enigma of black swans in dermatology. Clin Exp Dermatol 2020; 46:641-645. [PMID: 33245798 DOI: 10.1111/ced.14504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 01/06/2023]
Abstract
Narrative fallacy is a problematic heuristic that leads us to make inaccurate cause-effect relationships. They are a particular issue in case reports because of the limited scope of these papers, the perpetuated biases they proffer and the misperception of 'black swan' events. This article highlights the negative effects of these fallacies in dermatological practice through three case studies: the use of epinephrine with lignocaine at distal sites, the difference between once-daily and twice-daily application of topical steroids, and the effect of sterile gloves for skin surgery on infection rates. Awareness of the biases in case reports and the employment of metacognition may help us to avoid falling victim to narrative fallacies. Given the potential problems with this heuristic, Clinical and Experimental Dermatology (CED) utilizes case reports to further medical education and offer different clinical perspectives, rather than as a driver of medical knowledge.
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Affiliation(s)
- R I Yesudian
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - P D Yesudian
- Department of Dermatology, Wrexham Maelor Hospital, Wrexham, UK
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2
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Yesudian PD, Yesudian P. Verrucous pemphigus or postpemphigus acanthomata? Clin Exp Dermatol 2020; 46:188-189. [PMID: 32986865 DOI: 10.1111/ced.14462] [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] [Received: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 12/01/2022]
Affiliation(s)
- P D Yesudian
- Department of Dermatology, Wrexham Maelor Hospital, Wrexham, UK
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Yesudian R, Yesudian PD, Yesudian P. Oral treatment of ringworm with griseofulvin. Clin Exp Dermatol 2020; 46:993-994. [PMID: 32862439 DOI: 10.1111/ced.14415] [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: 07/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
- R Yesudian
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - P D Yesudian
- Department of Dermatology, Wrexham Maelor Hospital, Wrexham, Clywd, UK
| | - P Yesudian
- Department of Dermatology, Chennai Skin Foundation, Chennai, India
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Yesudian PD, de Berker DAR. Inflammatory nail conditions. Part 2: nail changes in lichen planus and alopecia areata. Clin Exp Dermatol 2020; 46:16-20. [PMID: 32799372 DOI: 10.1111/ced.14352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 02/03/2023]
Abstract
Nail changes are frequently seen in patients with cutaneous lichen planus and alopecia areata. This manuscript provides an updated overview on the clinical features, management and prognosis of both conditions. Searches of electronic databases PubMed and EMBASE were conducted and eligible articles were accessed. Practical management principles relevant to these two conditions are also included.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Wrexham Maelor Hospital, Wrexham, UK
| | - D A R de Berker
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
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Yesudian PD. Treating cystic and conglobate acne with 13-cis-retinoic acid. Clin Exp Dermatol 2020; 45:1109-1110. [PMID: 32789894 DOI: 10.1111/ced.14347] [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: 05/03/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- P D Yesudian
- Department of Dermatology, Wrexham Maelor Hospital, Wrexham, UK
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Yesudian PD, de Berker DAR. Inflammatory nail conditions. Part 1: nail changes in psoriasis. Clin Exp Dermatol 2020; 46:9-15. [PMID: 33220008 DOI: 10.1111/ced.14351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 01/15/2023]
Abstract
Nail changes are visible in a variety of inflammatory dermatoses. The commonest dermatological condition with nail manifestations is chronic plaque psoriasis. This two-part article reviews the nail signs in psoriasis in Part 1, and the nail changes in cutaneous lichen planus and alopecia areata in Part 2. It provides a brief summary of the salient points in the clinical features, management and prognosis of these entities, with practical recommendations that may be beneficial to all dermatologists.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Wrexham Maelor Hospital, Wrexham, UK
| | - D A R de Berker
- Department of Dermatology, Bristol Royal Infirmary, Bristol, UK
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Keragala BSDP, Gunasekera CN, Yesudian PD, Guruge C, Dissanayaka BS, Liyanagama DP, Jinadasa GIM, Constantine SR, Herath HMMTB. Disseminated Mycobacterium simiae infection in a patient with adult-onset immunodeficiency due to anti-interferon-gamma antibodies - a case report. BMC Infect Dis 2020; 20:258. [PMID: 32234012 PMCID: PMC7110743 DOI: 10.1186/s12879-020-04984-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Mycobacterial species other than Mycobacterium tuberculosis and Mycobacterium leprae are generally free-living organisms and Mycobacterium simiae is one of the slowest growing Non-tuberculous mycobacteria. This is the first case report of Mycobacterium simiae infection in Sri Lanka and only very few cases with extrapulmonary manifestation reported in the literature. Case presentation A 24-year-old, previously healthy Sri Lankan male presented with generalized lymphadenopathy with discharging sinuses, evening pyrexia, weight loss, poor appetite and splenomegaly. Lymph node biopsies showed sheets of macrophages packed with organisms in the absence of granulomata. Ziehl Neelsen, Wade Fite and Giemsa stains revealed numerous red coloured acid-fast bacilli within foamy histiocytes. Slit skin smear for leprosy was negative and tuberculosis, fungal and bacterial cultures of the lymph node and bone marrow did not reveal any growth. Later he developed watery diarrhea and colonoscopy revealed multiple small polyps and ulcers throughout the colon extending up to the ileum, Which was confirmed to be due to cytomegalovirus confirmed by PCR and successfully treated with ganciclovir. Positron emission tomography scan guided biopsies of the gut and lymph nodes confirmed presence of mycobacterial spindle cell pseudo-tumours and PCR assays revealed positive HSP65. The culture grew Mycobacterium Simiae. Flow cytometry analysis on patient’s blood showed extremely low T and B cell counts and immunofixation revealed low immunoglobulin levels. His condition was later diagnosed as adult onset immunodeficiency due to anti- interferon – gamma autoantibodies. He was initially commenced on empirical anti-TB treatment with atypical mycobacterial coverage. He is currently on a combination of daily clarithromycin, ciprofloxacin, linezolid with monthly 2 g/kg/intravenous immunoglobulin to which, he had a remarkable clinical response with complete resolution of lymphadenopathy and healing of sinuses. Conclusions This infection is considered to be restricted to certain geographic areas such as mainly Iran, Cuba, Israel and Arizona and this is the first case report from Sri lanka. Even though the infection is mostly seen in the elderly patients, our patient was only 24 years old. In the literature pulmonary involvement was common presentation, but in this case the patient had generalized lymphadenopathy and colonic involvement without pulmonary involvement.
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Finn DJ, Graham C, Holt DJ, Kelly R, Rajlawat BP, Yesudian PD. Management of mucous membrane pemphigoid in a joint oral medicine-dermatology clinic. Clin Exp Dermatol 2020; 45:685-690. [PMID: 32003042 DOI: 10.1111/ced.14188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/28/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Mucous membrane pemphigoid (MMP) comprises a group of immunobullous diseases involving the mucosa and skin. Potential sequelae include painful mucosal erosions, vision loss and laryngeal stenosis. AIM To characterize the features of patients with MMP seen within an Oral Medicine setting, including clinical features, immunofluorescence results and response to treatment. METHODS A retrospective case note analysis was undertaken. Treatment effect was divided into response and nonresponse using predetermined adjective terms. RESULTS In total, 42 cases of MMP were identified (18 men, 24 women), mean age 65 years (range 36-85 years). Oral involvement was most common on the gingivae (n = 38; 90.5%) while the most common extraoral sites involved were ocular (n = 13; 31.0%) and skin (n = 12; 28.6%). Features of MMP were found in 21 of 34 (61.8%) of routine biopsies, 31 of 34 (91.2%) direct immunofluorescence samples and 8 of 25 (32.0%) indirect immunofluorescence samples. Topical corticosteroids provided effective symptom control in 9 of 42 cases (21.4%), while systemic therapy was used in 31 of 42 patients (73.8%). Dapsone was prescribed for 25 patients, of whom 18 (72.0%) responded. Mycophenolate mofetil was used in 13 cases and had a response rate of 46.2%. Overall, 27 of 42 patients (64.3%) achieved a response using a tolerable topical or systemic treatment. CONCLUSION This series demonstrates that MMP has a female predominance and is a disease of older age, with a predilection for specific oral sites. Direct immunofluorescence has a high sensitivity in detecting features of MMP. Although some patients achieve adequate symptom control with topical corticosteroids, many require systemic therapy.
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Affiliation(s)
- D J Finn
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, UK
| | - C Graham
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, UK
| | - D J Holt
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, UK
| | - R Kelly
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, UK
| | - B P Rajlawat
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, UK
| | - P D Yesudian
- Department of Oral Medicine, Liverpool University Dental Hospital, Liverpool, UK
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Popli U, Rawleiy E, Yesudian PD. Tender cutaneous nodules in a patient with cardiac sarcoidosis. Clin Exp Dermatol 2019; 45:357-359. [PMID: 31313845 DOI: 10.1111/ced.14027] [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] [Accepted: 06/05/2019] [Indexed: 11/27/2022]
Affiliation(s)
- U Popli
- Department of Dermatology, Ysbyty Gwynedd, Bangor, UK
| | - E Rawleiy
- Wrexham Maelor Hospital, Wrexham, UK
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Berth-Jones J, Exton LS, Ladoyanni E, Mohd Mustapa MF, Tebbs VM, Yesudian PD, Levell NJ. British Association of Dermatologists guidelines for the safe and effective prescribing of oral ciclosporin in dermatology 2018. Br J Dermatol 2019; 180:1312-1338. [PMID: 30653672 DOI: 10.1111/bjd.17587] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 02/06/2023]
Affiliation(s)
- J Berth-Jones
- Department of Dermatology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, London, W1T 5HQ, U.K
| | - E Ladoyanni
- Department of Dermatology, Dudley Group NHS Foundation Trust, Dudley, DY1 2HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, London, W1T 5HQ, U.K
| | - V M Tebbs
- formerly of George Eliot Hospital, College Street, Nuneaton, CV10 7DJ, U.K
| | - P D Yesudian
- Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, LL13 7TD, U.K
| | - N J Levell
- Dermatology Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, U.K
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Shipman AR, Yesudian PD, Humphreys F, Levell NJ. History of Clinical and Experimental Dermatology. Clin Exp Dermatol 2019; 44:e55-e57. [DOI: 10.1111/ced.13911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2018] [Indexed: 11/26/2022]
Affiliation(s)
- A. R. Shipman
- Dermatology Department; Portsmouth Hospital; Portsmouth Hampshire UK
| | - P. D. Yesudian
- Dermatology Department; Betsi Cadwaladr University Health Board; Wrexham Gwynedd UK
| | - F. Humphreys
- Dermatology Department; Warwick Hospital; Warwick UK
| | - N. J. Levell
- Dermatology Department; Norfolk and Norwich University Hospital; Norwich UK
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Warren RB, Weatherhead SC, Smith CH, Exton LS, Mohd Mustapa MF, Kirby B, Yesudian PD. British Association of Dermatologists' guidelines for the safe and effective prescribing of methotrexate for skin disease 2016. Br J Dermatol 2017; 175:23-44. [PMID: 27484275 DOI: 10.1111/bjd.14816] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
Affiliation(s)
- R B Warren
- The Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, Manchester, M6 8HD, U.K
| | - S C Weatherhead
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, U.K
| | - C H Smith
- St John's Institute of Dermatology, Guy's and St Thomas NHS Foundation Trust, London, SE1 9RT, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - B Kirby
- St Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - P D Yesudian
- Glan Clwyd Hospital, Sarn Lane, Rhyl, LL18 5UJ, U.K
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Chen KS, Tan TH, Yesudian PD. Clinical, demographic and laboratory characteristics of methotrexate-responsive eczema. J Eur Acad Dermatol Venereol 2016; 30:e158-e159. [PMID: 26558602 DOI: 10.1111/jdv.13465] [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] [Indexed: 11/30/2022]
Affiliation(s)
- K S Chen
- Department of Dermatology, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
| | - T H Tan
- Department of Dermatology, Betsi Cadwaladr University Health Board, Bodelwyddan, UK
| | - P D Yesudian
- Department of Dermatology, Betsi Cadwaladr University Health Board, Bodelwyddan, UK.
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Abstract
Lichen sclerosus (LS) is a chronic inflammatory disorder of the skin and mucosa, presenting to genitourinary physicians and dermatologists. It affects both sexes and all age groups. Although the exact aetiology is uncertain, genetic predisposition, infections and autoimmune factors have been implicated in its pathogenesis. Symptoms include pruritis and soreness, but asymptomatic presentations are not uncommon. The classical clinical picture is of atrophic white plaques in the anogenital region. Histopathology is specific with basal cell degeneration, upper dermal oedema, homogenization of collagen and a chronic inflammatory infiltrate. Short courses of potent topical corticosteroids form the mainstay of treatment. The condition tends to be remitting and relapsing, with spontaneous regressions reported in a few. In men, the term balanitis xerotica obliterans is sometimes used to describe late and severe LS of the penis. Scarring and progression to squamous cell carcinomas can occur in chronic LS, resulting in significant morbidity. A multi-disciplinary approach to care and the need for long-term monitoring cannot be over-emphasized.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Countess of Chester Hospital, Liverpool Road, Chester CH2 1UL, UK.
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Abstract
Behçet's disease (BD) is a chronic, relapsing multisystem vasculitis with predominant involvement of the oral and genital mucosa. It has a worldwide distribution, but the prevalence is highest in Central Asia and the Far East (along the ancient 'Silk Route'). Genetic, environmental, immunological and haemostatic factors play a role in the aetiopathogenesis. The International Study Group for BD proposed criteria for the diagnosis of this condition, the essential feature being recurrent oral ulceration. Genital ulcers and skin manifestations are common, while ocular changes are the most important cause of morbidity. Almost any organ in the body can be involved, and systemic involvement may portend a poorer prognosis. There is no pathognomonic test for BD and the diagnosis is made on clinical findings. Treatment of BD would require multidisciplinary cooperation, and early referral to an ophthalmologist is advisable to prevent ocular morbidity. Topical and systemic agents (colchicine, dapsone and thalidomide) are useful in controlling exacerbation of the oral and genital ulcers. Severe disease may require immunosuppressive agents and, more recently, biological agents have been used successfully. It tends to follow an unpredictable course, and the eventual prognosis depends on the systemic involvement.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Countess of Chester Hospital, Chester, UK.
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Yesudian PD, Cabral RM, Ladusans E, Spinty S, Gibbs J, Fryer A, Christiano AM, Mendelsohn SS. Novel compound heterozygous mutations in thedesmoplakingene cause hair shaft abnormalities and culminate in lethal cardiomyopathy. Clin Exp Dermatol 2014; 39:506-8. [DOI: 10.1111/ced.12329] [Citation(s) in RCA: 3] [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: 12/08/2013] [Indexed: 11/30/2022]
Affiliation(s)
- P. D. Yesudian
- Department of Dermatology; Glan Clwyd Hospital; Bodelwyddan UK
| | - R. M. Cabral
- Department of Dermatology; Columbia University; Russ Berrie Medical Science Pavilion; New York NY USA
| | - E. Ladusans
- Department of Paediatric Cardiology; Alder Hey Children's Hospital; Liverpool UK
| | - S. Spinty
- Department of Neurosciences; Alder Hey Children's Hospital; Liverpool UK
| | - J. Gibbs
- Departments of Paediatrics; Countess of Chester Hospital; Chester UK
| | - A. Fryer
- Department of Genetics; Alder Hey Children's Hospital; Liverpool UK
| | - A. M. Christiano
- Department of Dermatology; Columbia University; Russ Berrie Medical Science Pavilion; New York NY USA
| | - S. S. Mendelsohn
- Department of Dermatology; Countess of Chester Hospital; Chester UK
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Abstract
Even though psoriasis is a common skin disorder, reports of it involving the oral cavity are exceedingly rare, with less than 100 publications in the literature. Biopsy-proven oral psoriasis has been reported in the oral medical literature, but the commonest oral mucosal findings in most studies are associated non-specific features including fissured and geographic tongue. Case series on this entity have not provided any definitive data to support its existence. From the evidence available to date, it is still unclear if oral psoriasis is a distinct entity or if, indeed, it exists.
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Affiliation(s)
- P D Yesudian
- Betsi Cadwaladr University Health Board, Bodelwyddan, UK.
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Abstract
Imiquimod has immune-stimulant properties that can precipitate autoimmune conditions like eczema, psoriasis and lichenoid conditions. We report two cases here where imiquimod induced florid lichen sclerosus in one patient and lichen planus in another. In both patients the condition was so aggressive and unresponsive to steroid treatment that circumcision was necessary.
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Affiliation(s)
- C O'Mahony
- Countess of Chester Hospital NHS Foundation Trust, Chester CH21UL, UK.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Thomas Drive, Liverpool LI4 3LB, England
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Yesudian PD, Armstrong S, Cawood JI, Allan RB, Mendelsohn SS, Kaye SB. Mucous membrane pemphigoid: management of advanced ocular disease with intravenous cyclophosphamide and amniotic membrane transplantation. Br J Dermatol 2005; 153:692-4. [PMID: 16120180 DOI: 10.1111/j.1365-2133.2005.06826.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Yesudian PD, Dobson CM, Wilson NJ. alpha1-Antitrypsin deficiency panniculitis (phenotype PiZZ) precipitated postpartum and successfully treated with dapsone. Br J Dermatol 2004; 150:1222-3. [PMID: 15214923 DOI: 10.1111/j.1365-2133.2004.05991.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Royal Liverpool University Hospital, Liverpool, UK.
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27
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Abstract
Myrmecia are viral warts that result from the coalescence of plantar or palmar warts into large plaques. Treatment of these warts involves physical or chemical destruction of the verrucae, potent keratolytics or immunotherapy. Imiquimod 5% cream is a novel topical immunomodulator that has been used successfully in the treatment of genital and common warts. We report its successful use in a 35-year-old immunocompetent man who had had resistant plantar warts for 15 years.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Royal Liverpool University Hospital, Liverpool, UK
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Royal Liverpool University Hospital, Prescott Street, Liverpool L7 8XP, UK
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Royal Liverpool University Hospital, Liverpool L7 8XP, UK.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
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Yesudian PD, Krishnan SG, Jayaraman M, Janaki VR, Yesudian P. Tufted angioma in a case of neurofibromatosis type I. Indian J Dermatol Venereol Leprol 2001; 67:44-5. [PMID: 17664704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Tufted angiomas are rare benign tumours with a characteristic histopathological appearance. Their occurrence in neurofibromatosis type 1, a genodermatosis in which vascular malformations are not uncommon, has hitherto not been reported. Some of the characteristic features of tufted angiomas are discussed.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Madras Medical College and Government General Hospital, Chennai, India
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Yesudian PD, Krishnan S, Jayaraman M, Janaki VR, Boopal Raj JM. Interface dermatitis in a patient with AIDS. Indian J Dermatol Venereol Leprol 2000; 66:308-309. [PMID: 20877111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Interface dermatitis is a histological reaction pattern which is seen in a number of conditions. One of the recent associations of the histology is in Acquired Immune Deficiency Syndrome. There are differentiating factors between interface dermatitis occurring in AIDS and those occurring in other conditions. These are discussed in detail.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Madras Medical College and Government General Hospital, Chennai, India
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Krishnan SS, Yesudian PD, Jayaraman M, Janaki VR, Boopalraj JM. Poikilodermatous mycosis fungoides. Indian J Dermatol Venereol Leprol 1998; 64:199-200. [PMID: 20921766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- S S Krishnan
- From the Department of Dermatology, Madras Medical College and Government General Hospital, Madras, India,
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Abstract
BACKGROUND Pemphigus is a group of vesiculobullous disorders in which the blisters usually heal with hyper or hypopigmentation. The appearance of acanthomata at sites of previous blisters has been noted in some cases. METHODS All cases of pemphigus admitted to the Madras Medical College hospitals during a 2-year period from March 1993 to March 1995 were taken into the study and screened for the presence of acanthomata. RESULTS Fifty-two cases of pemphigus were identified, 47 of pemphigus vulgaris and five of pemphigus foliaceus; and of these 13 developed acanthomata when the blisters healed. Ten of these cases were of pemphigus vulgaris and three were of pemphigus foliaceus; biopsy of these lesions showed hyperkeratosis, acanthosis, papillomatosis, and intraepidermal clefting. Immunofluorescence carried out in two of these acanthomata also showed intercellular fluorescence. CONCLUSIONS The occurrence of acanthomata in healed lesions of pemphigus is not uncommon; because histopathologic and immunofluorescence evidence of disease activity is present, cases of this sort require careful follow-up.
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Affiliation(s)
- P D Yesudian
- Department of Dermatology, Madras Medical College, Madras, India
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Krishnan SS, Yesudian PD, Jayaraman M, Janaki VR, Raj JB. Atypical dyskeratosis congenita. Indian J Dermatol Venereol Leprol 1997; 63:47-49. [PMID: 20944261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Dyskeratosis congenita is a syndrome characterised mainly by pigmentation and atrophy of skin, nail dystrophy and oral leucoplakia. We report a patient who had features consistent with this syndrome including skin atrophy and pigmentation, oral leucoplakia, oesophageal stricture, but with normal finger and toe nails. Even though many variants have been described in the literature sparing of the nails as in our patient is extremely uncommon.
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Affiliation(s)
- S S Krishnan
- Department of Dermatology, Madras Medical College and Government General Hospital, Madras, India
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