• Issue

    British Journal of Dermatology: Volume 171, Issue 3

    i, 441-678, e9-e89
    September 2014

Editor's Choice

Free Access

Editor's Choice

  • Pages: i
  • First Published: 19 September 2014

Editorials

Free Access

Editorials in the British Journal of Dermatology

  • Pages: 441-442
  • First Published: 19 September 2014
Free Access

Progress in skin cancer: the U.K. experience

  • Pages: 443-445
  • First Published: 19 September 2014

Scholarly reviews

Vascular tumours in infants. Part II: vascular tumours of intermediate dignity and malignant tumours

  • Pages: 474-484
  • First Published: 25 June 2014

What's already known about this topic?

  • Malignant vascular tumours can mimic infantile haemangiomas, but need to be differentiated as soon as possible.

What does this study add?

  • This is a comprehensive review of vascular tumours of intermediate dignity and malignant vascular tumours presenting during infancy and early childhood.
  • We present clinical and histological criteria for differential diagnosis and discuss treatment options.

Review Article

Safety of biological therapies for psoriasis: effects on reproductive potential and outcomes in male and female patients

  • Pages: 485-491
  • First Published: 19 April 2014

What's already known about this topic?

  • Biologics are novel, effective therapies for psoriasis.
  • Evidence on the safety of biological therapies during pregnancy and lactation and for male fertility and mutagenicity is limited.
  • An adverse event registry has raised questions regarding the teratogenic property of biological therapies.

What does this study add?

  • This article reviews the current evidence for the effects of biological therapies on pregnancy outcome and lactation and on male mutagenicity and fertility.
  • It provides guidance for the clinician to counsel both male and female patients with psoriasis who wish to conceive while on biological therapies.

Original articles

Cutaneous biology

Cathelicidin antimicrobial peptide LL-37 augments interferon-β expression and antiviral activity induced by double-stranded RNA in keratinocytes

  • Pages: 492-498
  • First Published: 06 March 2014

What's already known about this topic?

  • LL-37 enhances DNA uptake into intracellular compartments, which leads to Toll-like receptor (TLR)9- and TLR7-dependent overproduction of interferons (IFNs) in dendritic cells.
  • In keratinocytes, LL-37 enhances the responsiveness of TLR9.
  • LL-37 modulates poly (I:C)-induced proinflammatory responses in keratinocytes.

What does this study add?

  • In keratinocytes, LL-37 enhances the expression of IFN-β and antiviral activity induced by poly (I:C).

Expression of programmed death-1 in skin biopsies of benign inflammatory vs. lymphomatous erythroderma

  • Pages: 499-504
  • First Published: 06 March 2014

What's already known about this topic?

  • Histological differentiation between Sézary syndrome (SS) and erythrodermic inflammatory dermatoses (EID) is often difficult.
  • Programmed death-1 (PD-1) is strongly expressed by the neoplastic cells in skin biopsies of SS suggesting diagnostic potential, but similar studies in EID are lacking.

What does this study add?

  • PD-1 is expressed not only by CD4+ neoplastic T cells in SS, but also by activated (epi)dermal CD8+ T cells in EID.
  • Expression of PD-1 by > 50% of CD4+ T cells and expression of CD7 by ≤ 20% of the infiltrating T cells strongly support a diagnosis of SS.

Open Access

Elevations in vascular markers and eosinophils in chronic spontaneous urticarial weals with low-level persistence in uninvolved skin

  • Pages: 505-511
  • First Published: 26 March 2014

What's already known about this topic?

  • Earlier studies, mainly using conventional histology, showed increases in eosinophils and neutrophils in chronic urticaria weals.
  • There are conflicting reports on mast cell numbers.

What does this study add?

  • Increases in vascularity, as well as eosinophil, neutrophil and basophil infiltration are features of lesional skin in chronic spontaneous urticaria.
  • Uninvolved skin may be primed as there were persisting vascular markers and eosinophils, as well as increases in mast cells.

Clinical and laboratory investigations

Quercetagetin inhibits macrophage-derived chemokine in HaCaT human keratinocytes via the regulation of signal transducer and activator of transcription 1, suppressor of cytokine signalling 1 and transforming growth factor-β1

  • Pages: 512-523
  • First Published: 06 March 2014

What's already known about this topic?

  • Inflammatory chemokines are related to the presence of atopic dermatitis.
  • Quercetagetin inhibits inflammatory chemokines via regulation of the signal transducer and activator of transcription 1 (STAT1) signal.

What does this study add?

  • Quercetagetin increases the expression of suppressor of cytokine signalling 1, and it decreases the phosphorylation of STAT1 through the disruption of docking between STAT1 and interferon (IFN)-γR1.
  • Quercetagetin also increases the expression of the anti-inflammatory cytokine transforming growth factor-β1.

Incidence of IgA vasculitis in the adult Slovenian population

  • Pages: 524-527
  • First Published: 06 March 2014

What's already known about this topic?

  • IgA vasculitis (IgAV) is considered to be common in children and rare in adults, with annual incidence rates (AIR) of 3·5–26·7 and 0·8–1·8 per 100 000, respectively.

What does this study add?

  • The AIR of adult IgAV in Slovenia was 5·1 per 100 000 persons (95% confidence interval 3·4–7·4).
  • Persons over the age of 60 years appear to be at increased risk of IgAV, which implies bimodal distribution of this disease.

Genotyping of Borrelia from formalin-fixed paraffin-embedded skin biopsies of cutaneous borreliosis and tick bite reactions by assays targeting the intergenic spacer region, ospA and ospC genes

  • Pages: 528-543
  • First Published: 28 January 2014

What's already known about this topic?

  • Different Borrelia genospecies are considered to be responsible for the protean manifestations of Lyme borreliosis.
  • Polymerase chain reaction (PCR)-based genotyping requires fresh tissue or culture, and culture is technically difficult and time consuming.

What does this study add?

  • Conventional PCR assays for the intergenic spacer, ospA and ospC successfully identified Borrelia genospecies in paraffin-embedded biopsies from a routine dermatopathology laboratory.
  • This approach may serve as rapid confirmation of early borreliosis and enable identification of invasive ospC strains with possible therapeutic implications.

Clinical and immunological profiles in 17 Japanese patients with drug-induced pemphigus studied at Kurume University

  • Pages: 544-553
  • First Published: 03 March 2014

What's already known about this topic?

  • Drug-induced pemphigus (DIP) is a rare type of drug eruption. Most patients with DIP show pemphigus foliaceus-like clinical and histopathological features.
  • To date, approximately 200 cases of DIP have been described.
  • It has been reported that thiol-containing drugs cause pemphigus foliaceus, while nonthiol drugs cause pemphigus vulgaris.

What does this study add?

  • We report characteristics of 17 patients with DIP for their background, clinical and histopathological manifestations, causative drugs and the results of immunofluorescence, enzyme-linked immunosorbent assays and immunoblotting.
  • The present study indicated that the majority of the patients with DIP studied showed a pemphigus foliaceus-type phenotype with antidesmoglein 1 autoantibodies, caused by thiol-containing drugs.

Herpes simplex virus reactivation as a trigger of mucous lesions in pemphigus vulgaris

  • Pages: 554-560
  • First Published: 24 March 2014

What's already known about this topic?

  • Although infectious agents have long been implicated in the induction or exacerbation of pemphigus vulgaris (PV), a convincing role for the agent in the aetiology of PV has not been established.

What does this study add?

  • We successfully detected high levels of herpes simplex virus (HSV) DNA in the saliva samples from six of 16 patients with PV at the earliest stage, who had no episodes of herpes simplex.
  • These patients with PV have run a more complex, intractable course refractory to conventional therapy.
  • Detection of HSV DNA in saliva will alert physicians to the possibility of greater risk of subsequently developing refractory PV.

Dermatological surgery and lasers

Evaluating ex vivo fluorescence confocal microscopy images of basal cell carcinomas in Mohs excised tissue

  • Pages: 561-570
  • First Published: 21 April 2014

What's already known about this topic?

  • Fluorescence confocal microscopy (FCM) permits the analysis of freshly excised skin tissue to detect residual tumours during Mohs surgery.
  • However, few studies have been performed to describe the major morphological features of basal cell carcinoma (BCC) as seen on FCM.

What does this study add?

  • FCM allowed obtaining an excellent correlation of BCC findings with the corresponding histopathology.
  • Additionally, it was possible to distinguish distinct BCC and to highlight possible confounders.

Epidemiology and health services research

Influence of smoking on disease severity and antimalarial therapy in cutaneous lupus erythematosus: analysis of 1002 patients from the EUSCLE database

  • Pages: 571-579
  • First Published: 26 March 2014

What's already known about this topic?

  • The influence of smoking on disease severity in patients with cutaneous lupus erythematosus (CLE) and the efficacy of antimalarial treatment is still being controversially discussed in literature.

What does this study add?

  • The present analysis of a study population of 838 patients with CLE suggests that smoking is a risk factor for the disease, in particular for intermittent CLE.
  • The results confirm that there is a negative influence of smoking on disease severity and that the efficacy of the antimalarials hydroxychloroquine and chloroquine is affected by smoking.

Increased prevalence of psoriasis in patients with coronary artery disease: results from a case–control study

  • Pages: 580-587
  • First Published: 05 June 2014

What's already known about this topic?

  • The risk of acute systemic heart disease is increased in patients with psoriasis.
  • Psoriasis as an independent risk factor for coronary artery disease (CAD) is debated.

What does this study add?

  • The prevalence of psoriasis is twofold higher in patients with CAD than in control patients without CAD.
  • In patients with CAD, psoriasis is associated with a more severe coronary artery involvement.

Risk factors for facial melasma in women: a case–control study

  • Pages: 588-594
  • First Published: 19 April 2014

What's already known about this topic?

  • Melasma is chronic hypermelanosis; the physiopathology is not fully understood, although some trigger elements are known, such as sun exposure, pregnancy, sexual hormones, cosmetics, inflammatory skin processes, photosensitive medications and genetic predisposition

What does this study add?

  • This work confirmed that sun exposure, sexual hormones, darker skin phototypes and familial history are risk factors for melasma and moreover disclosed psychological stress and Amerindian ancestry as new elements.

Comparison of anatomical locations of cutaneous melanoma in men and women: a population-based study in France

  • Pages: 595-601
  • First Published: 11 April 2014

What's already known about this topic?

  • The predominance of melanomas on the trunk in men and on the lower limbs in women has been reported for a long time, and was recently found to decrease in some developed countries.
  • Few population-based studies have compared the precise location and side between the sexes.

What does this study add?

  • Women had more frequent melanomas on the lower limb, the hand and foot, and the central area and right side of the head and neck.
  • Melanomas of the trunk, the peripheral area, and left side of the head and neck were more frequent in men.
  • The distribution of foot melanoma differed between the sexes.
  • Different patterns of ultraviolet and sun exposure suggest the usefulness of sex-specific advice for melanoma prevention.

Providing lifestyle behaviour change support for patients with psoriasis: an assessment of the existing training competencies across medical and nursing health professionals

  • Pages: 602-608
  • First Published: 21 April 2014

What's already known about this topic?

  • Psoriasis is associated with unhealthy lifestyle behaviours linked to poorer psoriasis outcomes.
  • Health professionals are well placed to support lifestyle behaviour change (LBC) but lack confidence to conduct LBC interventions.

What does this study add?

  • Lifestyle as a health risk in patients with psoriasis is not well recognized and should be included in specialist dermatology training.
  • Health promotion skills/competencies are poorly specified in the curricula, with little or no reference to evidence-based approaches to LBC.

Prevalence and incidence of hand eczema in adolescence: report from BAMSE – a population-based birth cohort

  • Pages: 609-614
  • First Published: 17 June 2014

What's already known about this topic?

  • The occurrence and extent of hand eczema in adults is well known.
  • The prevalence of hand eczema in adolescents has been reported in a few studies, but the incidence rate and age at onset has not previously been studied.
  • It is not known which are the more reliable reporters of the occurrence of hand eczema in adolescents, parents or adolescents.

What does this study add?

  • Incidence rate of hand eczema in adolescents is of the same magnitude as in adults; 1-year period prevalence is somewhat lower.
  • The extent of hand eczema is comparable to findings in adults.
  • The onset of hand eczema is evenly distributed during childhood.
  • Female predominance seems to start in adolescence.
  • Self-reports of hand eczema by 16 year olds are suggested to be preferable.

Genetics

Keloids in Rubinstein–Taybi syndrome: a clinical study

  • Pages: 615-621
  • First Published: 16 August 2014

What's already known about this topic?

  • Individuals with Rubinstein–Taybi syndrome (RSTS) have an increased likelihood of developing keloid scars.
  • RSTS is caused by mutations in the histone acetyltransferase genes, CREBBP or EP300.
  • Keloids are proliferative fibrous growths and can cause extensive itching.

What does this study add?

  • This study found that 24% of individuals with RSTS from a single country develop keloids.
  • We describe age of onset, site, natural clinical course and reaction to various medical treatment schedules.
  • RSTS is the most common Mendelian disorder in which keloids occur with a high frequency.

Photobiology

Actinic damage on the back is significantly determined by MC1R variants and previous sun exposure compared with other body sites in a multivariate analysis

  • Pages: 622-630
  • First Published: 26 March 2014

What's already known about this topic?

  • Signs of actinic skin damage such as solar lentigines and wrinkling are associated with sun exposure in the past.
  • MC1R variants are associated with increased sun sensitivity and impaired tanning ability.
  • The association of MC1R variants with signs of actinic skin damage has been rarely investigated, providing diverging results.

What does this study add?

  • Actinic damage on the back is a better marker of previous harmful sun exposure compared with other body sites.
  • Actinic damage on the back is more closely related to MC1R variants in contrast to other sites.
  • Actinic damage on commonly uncovered areas such as the face is not helpful for assessing previous sun exposure.

Therapeutics

Long-term efficacy and safety of infliximab maintenance therapy in patients with plaque-type psoriasis in real-world practice

  • Pages: 631-641
  • First Published: 26 March 2014

What's already known about this topic?

  • Tumour necrosis factor-α inhibitors have been shown to improve moderate-to-severe plaque psoriasis in controlled clinical trials.

What does this study add?

  • The long-term safety and efficacy of infliximab in patients with plaque-type psoriasis in real-world practice were evaluated.
  • At the end of the treatment phase, 56·8% of patients achieved 75% Psoriasis Area and Severity Index improvement (PASI 75) at week 50. Among patients who received treatment in year two of the study, 66·3% achieved PASI 75 at week 98.
  • Safety results were consistent with previous reports of long-term biological treatment.

Concise communications

Predictors of local adverse effects caused by topical tretinoin cream 0·1% in the Veterans Affairs Topical Tretinoin Chemoprevention trial

  • Pages: 642-645
  • First Published: 26 March 2014

What's already known about this topic?

  • Topical tretinoin commonly causes cutaneous irritation and may result in noncompliance.

What does this study add?

  • This study identifies patient characteristics associated with increasing and decreasing risks of skin irritation from topical tretinoin use.
  • This information will help clinicians tailor topical tretinoin treatment for individual patients and educate them before treatment.

Partial clinical response to anakinra in severe palmoplantar pustular psoriasis

  • Pages: 646-649
  • First Published: 28 March 2014

What's already known about this topic?

  • Palmoplantar pustular psoriasis (PPPP) is a chronic inflammatory skin disease known to be refractory to currently available therapeutics.
  • Anakinra is a recombinant form of interleukin-1 receptor antagonist (IL-1Ra) labelled for the treatment of rheumatoid arthritis and commonly used in DIRA syndrome (deficiency in IL-1Ra).

What does this study add?

  • We report two cases of PPPP managed with anakinra.
  • Anakinra may provide transient alleviation of skin inflammation in PPPP, without complete remission.

Case report

The expanding spectrum of IgA pemphigus: a case report and review of the literature

  • Pages: 650-656
  • First Published: 06 March 2014

What's already known about this topic?

  • IgA pemphigus (IGAP) is a rare variant of pemphigus.
  • Pemphigus is traditionally subdivided into subcorneal pustular dermatosis and intraepidermal neutrophilic IgA dermatosis.

What does this study add?

  • A case report and a review of previous reports pointing to the need to revise the current classification of IGAP.
  • The possibility of the existence of a spectrum of IGAP-like diseases.

Correspondence

Two cases of nicorandil-induced ulceration mimicking skin malignancy

  • Pages: 662-663
  • First Published: 16 May 2014

News and Notices

News and Notices

  • Pages: 678
  • First Published: 19 September 2014

Plain language summaries

Free Access

Plain Language Summaries

  • Pages: e9-e12
  • First Published: 19 September 2014

Abstracts

Abstracts

  • Pages: e13-e89
  • First Published: 19 September 2014