Background: Teaching dermatology is challenging because of its' highly visible and tactile nature. While images improve visual memory and are valuable teaching aids, even high-quality photographs have limitations in what they can convey. Aim: Our aim is to validate the use of silicone-based 3D skin models as simulation-based educational tools by assessing their impact on recognition of various skin conditions among nursing students. Design and settings: A quasi-experimental, two-groups study was conducted in a Higher Education Institute in Ireland. Participants: Participants were third-year undergraduate nursing students enrolled in a bachelor's programme in General Nursing or Children's and General Nursing, registered for a general module. We included 153 participants, 79 were in the control group and 74 were in the interventional group. Methods: Nursing students rotated individually among stations to observe both 3D skin models and photographs of the models. At each station, students completed an answer sheet including questions on identifying skin categories and conditions, along with a validated scale to assess satisfaction, confidence, and realism in using these models. Each station illustrated five skin conditions using either models or photographs. Both groups visited both stations; only the sequence of visits varied between them. Results: The 3D skin models significantly improved nursing students' identification of the papulosquamous skin category (47.8 % interventional group and 24.4 % control group, p = 0.003). Additionally, students exposed to the models had higher scores for categorisation (mean ranks; 85.05 interventional group and 69.46 control group, p = 0.023). Qualitative data revealed students' favourable perceptions of the 3D models as effective learning tools, particularly their realism and sensory aspects. Conclusions: Suggestions for model improvements, including skin tone and positioning on the body, are likely to enhance effectiveness. Integrating 3D skin models into nursing education curricula is highly recommended to enhance nursing students' dermatology skills and clinical skin assessment.

The study site, a major teaching hospital in Dublin, Ireland, addressed significant challenges within its dermatology service through a comprehensive improvement initiative using a person-centred Lean Six Sigma methodology. Initially, the hospital’s dermatology department faced excessive outpatient waiting times, with 3736 patients awaiting appointments, and 1615 waiting over 12 months. The person-centred Lean Six Sigma approach, which combines Lean techniques to reduce non-value add and Six Sigma methods to eliminate variation through a person-centred lens, was applied to overhaul the referral, triage, and scheduling processes. Key interventions included standardising triage categories, centralising the triage process, and redistributing referrals equitably among consultants. A new centralised triage system was established, leading to a more efficient allocation of appointments and better management of urgent cases. Post-implementation data showed a 40% reduction in the overall waiting list and a 60% reduction in the number of patients waiting over 12 months. The initiative significantly decreased the wait times across all urgency categories, with the most notable improvements in soon and urgent referrals. These changes were also the impetus for a follow-up design-led innovation phase, where the team worked with partners across the educational and healthcare system to enable disruptive change. The success of this project provides a scalable model for improvements in similar healthcare settings.

The Skin and UV Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) is a tool that can be used to decide when to first screen for skin cancer in organ transplant recipients (OTRs). The objective of this study was to assess the applicability of this tool in thoracic OTRs. Based on data from patient files, the OTRs were categorized into four risk groups according to the SUNTRAC tool. The time of the first post-transplant skin cancer in each OTR was recorded. The proportion of OTRs with post-transplant skin cancer in the low-, medium-, high- and very high-risk groups was 0%, 28.3%, 58.3% and 100%, respectively. This positive correlation suggests that SUNTRAC can be used to determine when to first screen for skin cancer in heart and lung OTRs.

Hidradenitis suppurativa (HS) is a chronic inflammatory debilitating condition that primarily affects younger people. Its exact prevalence is unknown, but it is estimated to affect at least 1% of the Irish and UK population. Onset is late adolescence and the early 20s in the majority. The impact of early-onset HS (< 18 years) is increasingly recognized, but awareness and knowledge of disease prevalence and severity in Ireland remain sparse. Studies in adults highlight association with a raised body mass index (BMI) and smoking, in addition to an increased prevalence in young females with African American or mixed ancestry. Presently, there is an absence of specific guidelines for management in those aged < 18 years. With rising obesity levels, combined with decreasing pubertal age, we may encounter early-onset HS more often in future. We present a snapshot of patients with HS attending a single paediatric hospital who were considered for systemic therapy. Ten patients were included (eight females). Mean (SD) age of symptom onset was 12.4 (1.9) years, mean (SD) age of presentation was 14 (2.1) and mean duration of symptoms prior to presentation was 1.5 years. Nine received systemic therapy (nine antibiotics and four biologics). Disease severity, defined by Hurley stage, was mild in one, moderate in five and severe in four. All patients had achieved puberty, one was defined as early-onset (age 10 years) and another as precocious (age 9 years). The BMIs varied: one was normal, two were above a healthy weight, five were very overweight and three were severely overweight according to UK centiles. Most patients experienced comorbidities, including, but not limited to, Crohn disease (n = 1), hepatic steatosis (n = 2), pilonidal sinus (n = 3) and acne (n = 5). One had diabetes, two impaired fasting glucose and one hypercholesterolaemia. No patient reported smoking. Passive smoking and blood pressure were not documented. Four patients had positive family histories. Six patients identified as Black Irish (one Irish Caribbean and five Irish Nigerian), two were White Irish, one patient was from India and one was from Poland. We describe a group of individuals aged ≤ 16 years, the majority of whom had moderate–severe HS. They had similar comorbidities to internationally reported literature in early-onset HS. More skin of colour ethnicities are represented than seen in the general Irish population, which probably reflects both the catchment area and severity of the skin conditions experienced. The limitations of our study include under-representation of milder disease due to an inability to perform a full cross-sectional study at present. Further prospective studies are required to capture the prevalence and characteristics of HS fully in our population of children and young adults. Considering the lifetime impact of this condition, guidelines for the management of HS under the age of 18 years should be considered.

We surveyed Irish dermatologists' confidence in caring for people who identify as transgender patients. The majority of respondents had not previously received education around the care of transgender people in dermatology, and most agreed they would benefit from this.

This clinical case describes a patient with a cutaneous dental sinus initially misdiagnosed as a primary dermatological issue and treated unsuccessfully with prolonged antimicrobial therapy. It highlights the importance of considering odontogenic cutaneous fistula as a possible differential diagnosis for chronic suppurative cutaneous lesions on the face or neck.

This clinical case describes a patient with a cutaneous dental sinus initially misdiagnosed as a primary dermatological issue and treated unsuccessfully with prolonged antimicrobial therapy. It highlights the importance of considering odontogenic cutaneous fistula as a possible differential diagnosis for chronic suppurative cutaneous lesions on the face or neck.

New order: redesigning referral pathways to improve access for patients from dermatology outpatient waiting lists Orla McFeely, Aileen Igoe, Emily Pender, Liana Victory, Michelle McGuirk, Heather Coetzee and Patsy Lenane Mater Misericordiae University Hospital, Dublin, Ireland Waiting list times are a ubiquitous issue among dermatology departments across the Republic of Ireland. Long waiting times, combined with the quality of the referral letter, may result in the delayed diagnosis of time-dependent conditions. In September 2020, 3736 patients were awaiting dermatology outpatient appointments in our department (2000 of whom had not been given an appointment) in a model 4 teaching hospital. The dermatology team, using Lean Six Sigma methodology, undertook a full root-and-branch review of the service. A value stream analysis event enabled prioritization of the referral and triage process as key elements in addressing this issue. Desktop exercises were undertaken by members of the dermatology team, paying particular attention to triage and booking processes, analysis of waiting lists and a deep dive on referral data. It transpired that each consultant within the dermatology department would triage patient-referral letters on their subjective sense of the urgency of the referral. This was problematic as a poor-quality referral letter could result in the delayed diagnosis of a significant condition. Moreover, triage categories differed between consultants, both in number of categories and in associated waiting time. For example, the category ‘soon’ represented 6 months for one consultant and an indefinite waiting time for another. Lastly, each consultant was given a vastly differing patient waiting list, as a referral would be directed to the consultant it was addressed to. As a result of these findings, a centralized triage and booking system was co-designed by the team and implemented, alongside assessment of each referral, to eliminate duplicates or inappropriate referrals. Referral forms were also standardized for common dermatological diagnoses. Criteria set out by the Royal College of Physicians were adhered to regarding appropriate referrals to dermatology. For example, viral warts are described as for community-based intervention only. Incomplete or vague referrals were also returned to the referring general practitioner (GP). This resulted in faster triage, consistent patient waiting times, full use of capacity and increased liaison with GPs. Whole-system improvement was achieved. It has further resulted in a 40% reduction in the dermatology outpatient appointment waiting list from 3736 to 2228 patients waiting to be seen (September 2020 and June 2021, respectively). This study has demonstrated the power Lean Six Sigma methodology has to improve dermatology health systems, and more specifically waiting times for outpatient care. We feel it is worth highlighting the benefit, as these benefits may be achieved by those who use these methods in dermatology departments globally. P58 Pigment epithelia-derived factor drives invasion in NF1mutant malignant melanoma Charlotte Lovatt, Megan Williams, Alex Gibbs, Mukhtar Abdullahi, Huw Morgan, Simone Lanfredini, Carlotta Olivero, G. Spurlock, Sally Davies, Charlotte Philpott, Hannah Tovell, Peter Turnpenny, Dilair Baban, Sam Knight, Julian Sampson, Hilda Berm, Eric Legius, Meena Upadhyaya and Girish Patel European Cancer Stem Cell Research Institute Cardiff University, Cardiff, UK; Division of Cancer and Genetics Cardiff University, Cardiff, UK; Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; The Wellcome Trust Centre for Human Genetics, Oxford, UK; and Department of Genetics University of Leuven, Leuven, Belgium Inherited loss of NF1 in neurofibromatosis type 1 is associated with melanocyte proliferation and migration to form caf e au lait macules (CALMS). More recently, NF1 mutations have been identified as the third most common driver mutation in malignant melanoma (MM). Even alongside the most common MM BRAF mutation, loss-of-function NF1 mutations portend a worse prognosis due to more invasive disease. To understand the molecular basis for CALMS and invasive malignancy a comparative transcriptomic analysis was undertaken of normal vs. CALMS melanocytes from three distinct genodermatoses: classic NF1 loss (CALMS and internal malignancy, n = 3), three base-pair loss (CALMS but no internal malignancy, n = 3) and Legius syndrome (CALMS but no internal malignancy, n = 1). Based on our findings, we examined the protective effect of pigment epithelia-derived factor (PEDF) on MM cellular models as part of an international consortia, melanocyte culture, microarray, bioinformatic analysis and loss of heterozygosity single-nucleotide polymorphism analysis. Validation of findings by reverse-transcriptase polymerase chain reaction, NF1 knockdown with small interfering RNA and PEDF overexpression in normal melanocytes and characterized MM cell lines was carried out. Functional studies included cell proliferation, migrations and invasion. CALMS melanocytes uniformly demonstrated loss of heterozygosity. Bioinformatic analysis of CALM vs. within-patient normal melanocytes confirmed not only activation of the RAS–mitogen-activated protein kinase (MAPK) pathway in keeping with these RASopathies, but also identified PEDF as uniformly discordantly downregulated. NF1 knockdown in normal melanocytes and MM (including NF1 driver mutant and BRAF comutant) cells, led to increased proliferation, migration and invasion, which was reversed in PEDF co-transduced cells. The phosphoinositide 3 kinase (PI3K)–Akt–mammalian target of rapamycin (mTOR) pathway was uniquely activated in classic neurofibromatosis CALMS only, suggesting that this oncogenic pathway is associated with the tumour-generating phenotype. Melanocytes in CALMS arise from loss of heterozygosity associated with activation of the RAS–MAPK and PI3K–AKT–mTOR pathway in the case of classic neurofibromatosis. Somatic mutations in MM similarly drive these pathways leading to discordant downregulation of PEDF that in turn leads MM

To the Editor: Basal cell carcinomas (BCC) occur more frequently than cutaneous squamous cell carcinomas (cSCC) with a general population ratio of 2.5:1.1NCRI Cancer trends.https://www.ncri.ie/sites/ncri/files/pubs/Trends%20report%20skin%20cancer%20final180717.pdfDate accessed: February 23, 2021Google Scholar There is wide variation in this ratio likely due to differences in demographics, latitude, and immunosuppression. The ratio is reversed following solid organ transplantation.2Euvrard S. Kanitakis J. Pouteil-Noble C. et al.Comparative epidemiologic study of premalignant and malignant epithelial cutaneous lesions developing after kidney and heart transplantation.J Am Acad Dermatol. 1995; 33: 222-229Abstract Full Text PDF PubMed Scopus (212) Google Scholar The Irish National Cancer Registry records first cSCC and BCC, providing a robust dataset to explore patient and transplant-related factors unique to the development of cSCC compared to BCC. We matched datasets from national transplant centers with Irish National Cancer Registry data from 1994 to 2014. Eligible participants were divided into 4 groups; “cSCC only,” “BCC only,” “cSCC and BCC,” and “No cSCC or BCC” and compared using multinomial logistic regression analysis (Supplemental Appendix 1). The analysis included 3580 organ transplant recipients over a 21-year follow-up period. The total follow-up time was 28,407 person years with a median follow up of 7.1 years (interquartile range = 9.1; Supplemental Table I). Of these patients, 231 (6%) had “cSCC only,” 239 (7%) had “BCC only,” 174 (5%) had “cSCC and BCC,” and 2936 (82%) had “No cSCC or BCC” (Table I). Female sex was significantly associated with “BCC only” compared with “cSCC only” (P = .001; relative risk ratio = 1.99; 95% CI = 1.31-3.01). There was no significant effect of organ transplant type, age at the time of transplant, year of transplant, and follow-up time on “cSCC only” versus that on “BCC only” risk (P = .487, P = .066, P = .149, and P = .427, respectively; Fig 1).Table IPatient demographic details for each of the 4 outcome groupsTotalcSCC onlyBCC onlycSCC and BCCNo cSCC or BCC3580231 (6%)239 (7%)174 (5%)2936 (82%)Male2256180 (8%)155 (7%)154 (7%)1767 (78%)Female132451 (4%)84 (6%)20 (2%)1169 (88%)Follow up (person years)28,40723362546221821,306Median follow up (years)7.19.410.813.26.2 IQR9.18.18.27.48.4Mean age at the time of transplant (years)44.853.750.555.243.0 Range0.8-77.416.7-76.613.7-77.421.7-76.30.8-75.9Median age at the time of transplant (years)47.255.051.755.945.0 IQR24.515.618.213.925.4Age at the time of transplant (years) <3070210 (1%)11 (2%)4 (1%)677 (96%) 30-3956023 (4%)37 (7%)6 (1%)494 (88%) 40-4971439 (5%)56 (8%)38 (5%)581 (81%) 50-5991678 (9%)74 (8%)62 (7%)702 (77%) >6068881 (12%)61 (9%)64 (9%)482 (70%)Transplant type Renal2446166 (7%)165 (7%)130 (5%)1985 (81%) Heart21618 (8%)23 (11%)21 (10%)154 (71%) Lung19210 (5%)11 (6%)7 (4%)164 (85%) Liver72637 (5%)40 (6%)16 (2%)633 (87%)Year of transplant 1994-199641042 (10%)38 (9%)50 (12%)280 (68%) 1997-199939335 (9%)34 (9%)36 (9%)288 (93%) 2000-200248833 (7%)41 (8%)38 (8%)376 (77%) 2003-200550940 (8%)42 (8%)17 (3%)410 (81%) 2006-200858536 (6%)34 (6%)19 (3%)496 (85%) 2009-201158337 (6%)32 (5%)11 (2%)503 (86%) 2012-20146128 (1%)18 (3%)3 (1%)583 (95%)BCC, Basal cell carcinomas; cSCC, cutaneous squamous cell carcinomas; IQR, interquartile range. Open table in a new tab BCC, Basal cell carcinomas; cSCC, cutaneous squamous cell carcinomas; IQR, interquartile range. Our study showed that the ratio of “BCC only” to “cSCC only” was statistically significantly higher in women than in men. Despite this, men in our study still had overall higher rates of “BCC only” compared to women (7% vs 6%). Similar trends are observed in the non-transplant population.1NCRI Cancer trends.https://www.ncri.ie/sites/ncri/files/pubs/Trends%20report%20skin%20cancer%20final180717.pdfDate accessed: February 23, 2021Google Scholar Heart transplant recipients generally receive a higher level of immunosuppression than renal and liver transplant recipients, which has been associated with higher rates of cSCC, but not BCC, than in the general population.3Fortina A.B. Piaserico S. Caforio A.L. et al.Immunosuppressive level and other risk factors for basal cell carcinoma and squamous cell carcinoma in heart transplant recipients.Arch Dermatol. 2004; 140: 1079-1085Crossref PubMed Scopus (100) Google Scholar However, our study showed no significant effect of organ transplant type on “cSCC only” versus “BCC only” risk. The cumulative incidence of keratinocyte carcinoma increases with time after transplantation4Bavinck J.N. Hardie D.R. Green A. et al.The risk of skin cancer in renal transplant recipients in Queensland, Australia. a follow-up study.Transplantation. 1996; 61: 715-721Crossref PubMed Scopus (443) Google Scholar; however, the year of transplant and follow-up time did not impact “cSCC only” versus “BCC only” risk. The year of transplant can indirectly reflect trends in immunosuppressive protocols and impact on keratinocyte carcinoma risk. The latter supports our recent findings that rates of both cSCC and BCC reduced equally over the last 20 years, maintaining the standardized incidence ratio of cSCC to BCC.5Menzies S. O'Leary E. Callaghan G. et al.Declining incidence of keratinocyte carcinoma in organ transplant recipients.Br J Dermatol. 2019; 181: 983-991Crossref PubMed Scopus (15) Google Scholar The limitations of the study include not adjusting for non-registry variables, which may impact differently on “cSCC only” versus “BCC only” risk, such as immunosuppressive protocols, skin type, and prior UV exposure. Additionally, the outcome groups used in our study are not static, eg, in a patient in the “BCC only” group, a cSCC developed after the study period. Finally, our data relies upon histologically confirmed keratinocyte carcinoma. This study examines keratinocyte cancer risk factors in organ transplant recipients subgroups in which BCC, cSCC, or both developed exclusively. Sex was found to be an independent risk factor, with women at increased risk of “BCC only” relative to “cSCC only” when compared to men. Further studies are required to explore whether different patterns of UV exposure or different responses to immunosuppression in male and female organ transplant recipients might explain our findings. None disclosed.

Solid organ transplant recipients have an increased risk of malignancy compared with the general population. Mammalian target of rapamycin (mTOR) inhibitors have been used as immunosuppressants in transplant recipients. There remains a lack of evidence of this treatment in nonrenal solid organ transplantation. We aimed to perform a systematic review and meta‐analysis to assess the effects of mTOR inhibitors on secondary nonmelanoma skin cancer (NMSC) malignancies in nonrenal transplant recipients.

Photodermatology, Photoimmunology & PhotomedicineVolume 33, Issue 3 p. 176-179 Letter to the Editor Factors predicting pain and effect of oral analgesia in topical photodynamic therapy Roisin A. Hambly, Corresponding Author Roisin A. Hambly roisinhambly@gmail.com orcid.org/0000-0002-7050-738X Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland Correspondence: Dr Roisin A. Hambly, Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland. Tel: 01 803 2784 e-mail: roisinhambly@gmail.comSearch for more papers by this authorNazish Mansoor, Nazish Mansoor Department of Dermatology, Mater Misericordiae University Hospital, Dublin, IrelandSearch for more papers by this authorCatherine Quinlan, Catherine Quinlan Department of Dermatology, Mater Misericordiae University Hospital, Dublin, IrelandSearch for more papers by this authorZahra Shah, Zahra Shah Department of Dermatology, Mater Misericordiae University Hospital, Dublin, IrelandSearch for more papers by this authorPatsy Lenane, Patsy Lenane Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland School of Medicine, University College Dublin, Dublin, IrelandSearch for more papers by this authorNicola Ralph, Nicola Ralph Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland School of Medicine, University College Dublin, Dublin, IrelandSearch for more papers by this authorFergal J Moloney, Fergal J Moloney Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland School of Medicine, University College Dublin, Dublin, IrelandSearch for more papers by this author Roisin A. Hambly, Corresponding Author Roisin A. Hambly roisinhambly@gmail.com orcid.org/0000-0002-7050-738X Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland Correspondence: Dr Roisin A. Hambly, Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland. Tel: 01 803 2784 e-mail: roisinhambly@gmail.comSearch for more papers by this authorNazish Mansoor, Nazish Mansoor Department of Dermatology, Mater Misericordiae University Hospital, Dublin, IrelandSearch for more papers by this authorCatherine Quinlan, Catherine Quinlan Department of Dermatology, Mater Misericordiae University Hospital, Dublin, IrelandSearch for more papers by this authorZahra Shah, Zahra Shah Department of Dermatology, Mater Misericordiae University Hospital, Dublin, IrelandSearch for more papers by this authorPatsy Lenane, Patsy Lenane Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland School of Medicine, University College Dublin, Dublin, IrelandSearch for more papers by this authorNicola Ralph, Nicola Ralph Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland School of Medicine, University College Dublin, Dublin, IrelandSearch for more papers by this authorFergal J Moloney, Fergal J Moloney Department of Dermatology, Mater Misericordiae University Hospital, Dublin, Ireland School of Medicine, University College Dublin, Dublin, IrelandSearch for more papers by this author First published: 14 February 2017 https://doi.org/10.1111/phpp.12301Citations: 8 Funding source: None. Conflicts of interest: : None declared. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume33, Issue3May 2017Pages 176-179 RelatedInformation

To the Editor, Narrowband UVB or TL-01 phototherapy is an effective treatment for psoriasis (1). The emitted wavelength range (311–313 nm) is optimal for antipsoriatic activity (2). A rare side effect of TL-01 phototherapy is the development of blisters on psoriatic lesions, during a treatment course. Herein, we report four such cases which were identified in our institution over a 5-month period and review all reported cases in an effort to better understand the pathogenesis of this phenomenon.

IMPORTANCE Alopecia areata is an idiopathic cause of hair loss with limited therapeutic repertoire.OBJECTIVE To compare the efficacy and safety of a high-vs low-potency topical corticosteroid in pediatric patients.DESIGN, SETTING, AND PARTICIPANTS This single-center, randomized, blind, 2-arm, parallel-group, superiority trial was carried out over a 24-week period at a tertiary referral academic dermatology clinic at The Hospital for Sick Children in Toronto, Ontario, Canada. Forty-two children attending the outpatients clinic, 2 to 16 years of age with alopecia areata affecting at least 10% of scalp surface area, were eligible; 1 declined to participate. There were no withdrawals from the study.INTERVENTIONS FOR CLINICAL TRIALS Patients were randomly assigned to receive clobetasol propionate, 0.05% cream, or hydrocortisone, 1%, cream. Patients applied a thin layer of the assigned cream twice daily to the areas of hair loss for 2 cycles of 6 weeks on, 6 weeks off, for a total of 24 weeks.MAIN OUTCOMES AND MEASURES The primary outcome was the change in scalp surface area with hair loss over 24 weeks following enrollment.RESULTS All participants were assessed at 6, 12,18, and 24 weeks (except 1 participant who missed the 6-week visit). After adjusting for baseline hair loss, the clobetasol group had a statistically significant (P<.001) greater decrease in the surface area with hair loss, compared with the hydrocortisone group at all time points except at 6 weeks. One patient with extensive alopecia areata experienced skin atrophy that resolved spontaneously in 6 weeks. There was no difference observed in the number of patients with abnormal urinary cortisol at the beginning and the end of the study.CONCLUSIONS AND RELEVANCE Topical clobetasol propionate, 0.05%, cream is efficacious and safe as a first-line agent for limited patchy childhood alopecia areata.

A 55-year-old woman presented with an extensive warfarin-induced skin necrosis while an inpatient for treatment of a pulmonary embolism and thromboembolic stroke. She had a background of diabetes mellitus, hypertension and dyslipidaemia. Her warfarin was stopped and she was anticoagulated with low-molecular weight heparin. The wound was successfully treated with a combination of antibiotic, debridement and negative pressure wound therapy.

BACKGROUND:Mycosis fungoides is an uncommon cutaneous T-cell lymphoma characterized by malignant monoclonal proliferation of T-helper lymphocytes. Its course is variable with a potential for lymphatic and hematogenous involvement. We report the investigations, staging, treatment, follow-up, and outcome of 28 patients. This is the first such study reported from Ireland.METHODS:Twenty-eight patients with mycosis fungoides (14 women, 14 men; average age, 52.5 years) were reviewed over 12 years in the dermatology clinic which assesses an average of 4500 patients per year. All mycosis fungoides patients were referred from their family physicians. The diagnosis was made in all cases from a combination of clinical findings, histology, and immunohistochemistry. TNM staging revealed 11 patients at diagnosis stage IA (T1), 12 at stage IB (T2), four at stage IIB (T3), and one at stage III (T4).RESULTS:The usual male preponderance was not found. Eight patients needed multiple biopsies to establish the diagnosis. Detailed investigations were not useful in the early stages. Patients were followed up over a 12-year period. Thirteen patients died as a result of cutaneous lymphoma. Two patients with stage IA disease progressed rapidly and died, a feature reported in only 10% of patients at this stage. Five patients showed unusual features, including a long history prior to presentation, the development of the rarely reported bullous mycosis fungoides, and aggressive disease beginning at a young age.CONCLUSIONS:Mycosis fungoides is rare; we reviewed 28 patients over 12 years. The prognosis is poor at the later stages; 13 patients died. Two patients who died were unusual in that they rapidly progressed from stage IA disease; however, in the majority of patients with this stage, the prognosis is excellent. Detailed investigations were unhelpful in early stage disease. Close clinical follow-up is essential to identify disease progression.

Pediatric DermatologyVolume 23, Issue 1 p. 81-83 KID Syndrome Susan B. Mallory M.D., Susan B. Mallory M.D.Search for more papers by this authorBernice R. Krafchik M.B., Ch.B., F.R.C.P.C., Bernice R. Krafchik M.B., Ch.B., F.R.C.P.C.Search for more papers by this authorPatsy Lenane F.R.C.P.C., Patsy Lenane F.R.C.P.C. Departments of Dermatology and Medical Genetics, The Hospital for Sick Children, Toronto, CanadaSearch for more papers by this authorSam Cammisuli F.R.C.P.C., Sam Cammisuli F.R.C.P.C. Departments of Dermatology and Medical Genetics, The Hospital for Sick Children, Toronto, CanadaSearch for more papers by this authorDavid Chitayat F.R.C.P.C., David Chitayat F.R.C.P.C. Departments of Dermatology and Medical Genetics, The Hospital for Sick Children, Toronto, CanadaSearch for more papers by this authorBernice Krafchik M.B., Ch.B., F.R.C.P.C., Bernice Krafchik M.B., Ch.B., F.R.C.P.C. Departments of Dermatology and Medical Genetics, The Hospital for Sick Children, Toronto, CanadaSearch for more papers by this author Susan B. Mallory M.D., Susan B. Mallory M.D.Search for more papers by this authorBernice R. Krafchik M.B., Ch.B., F.R.C.P.C., Bernice R. Krafchik M.B., Ch.B., F.R.C.P.C.Search for more papers by this authorPatsy Lenane F.R.C.P.C., Patsy Lenane F.R.C.P.C. Departments of Dermatology and Medical Genetics, The Hospital for Sick Children, Toronto, CanadaSearch for more papers by this authorSam Cammisuli F.R.C.P.C., Sam Cammisuli F.R.C.P.C. Departments of Dermatology and Medical Genetics, The Hospital for Sick Children, Toronto, CanadaSearch for more papers by this authorDavid Chitayat F.R.C.P.C., David Chitayat F.R.C.P.C. Departments of Dermatology and Medical Genetics, The Hospital for Sick Children, Toronto, CanadaSearch for more papers by this authorBernice Krafchik M.B., Ch.B., F.R.C.P.C., Bernice Krafchik M.B., Ch.B., F.R.C.P.C. Departments of Dermatology and Medical Genetics, The Hospital for Sick Children, Toronto, CanadaSearch for more papers by this author First published: 24 January 2006 https://doi.org/10.1111/j.1525-1470.2006.00178.xCitations: 3 Address correspondence to Patsy Lenane, M.D., Dermatology Department, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada, or e-mail: [email protected]. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat REFERENCES 1 Burns FS. A case of generalized keratoderma with unusual involvement of the eyes, nasal and buccal mucous membranes. J Cutan Dis 1915; 33: 255–360. Google Scholar 2 Caceres-Rios H, Tamayo-Sanchez L, Ruiz-Maldonado R. Keratitis, ichthyosis and deafness (KID syndrome): review of the literature and proposal of new terminology. Pediatr Dermatol 1996; 13: 105–113. 10.1111/j.1525-1470.1996.tb01414.x PubMedWeb of Science®Google Scholar 3 Morris J, Ackerman AB, Koblenzer PJ. Generalized spiny hyperkeratosis, universal alopecia and deafness: a previously undescribed syndrome. Arch Dermatol 1969; 100: 692–697. 10.1001/archderm.100.6.692 CASPubMedWeb of Science®Google Scholar 4 Wilson GH, Squires RH, Weinberg AG. Keratitis, hepatitis, ichthyosis and deafness: report and review of KID syndrome. Am J Med Genet 1991; 40: 253–259. 10.1002/ajmg.1320400302 PubMedWeb of Science®Google Scholar 5 Harms M, Gilards S, Levy PM et al. 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Alopecia areata, the alleged autoimmune process leading to nonscarring hair loss, is not uncommon. it has been classified as an acquired cause of alopecia; however, recently it has been reported in the neonatal period. We report 4 cases of congenital alopecia areata with follow-up from 3 to 5 years. The diagnosis was made clinically in all cases. All patients had prolonged periods of quiescence of hair loss ranging from 6 to 24 months. Treatments used included minoxidil 2% and a range of topical steroids including hydrocortisone 1%, betamethasone valerate 0.05%, fluocinonide 0.05%, and clobetasol propionate 0.05%. The best regrowth observed resulted from the use of clobetasol propionate 0.05%, giving full regrowth in 50% of those treated. Alopecia areata can occur at all ages and, thus, can be classified as both an acquired and a congenital disorder resulting in hair loss.

Pediatric DermatologyVolume 22, Issue 3 p. 266-267 What syndrome is this? Susan B. Mallory M.D., Susan B. Mallory M.D. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaSearch for more papers by this authorBernice R. Krafchick M.B., Ch.B., F.R.C.P.C., Bernice R. Krafchick M.B., Ch.B., F.R.C.P.C. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaSearch for more papers by this authorS. Alexander Holme M.B., Ch.B., M.R.C.P., Corresponding Author S. Alexander Holme M.B., Ch.B., M.R.C.P. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaAddress correspondence to Dr S. A. Holme, Welsh Institute of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales, UK, or e-mail: saholme@hotmail.com.Search for more papers by this authorPatsy Lenane M.B., B.C.H., B.A.O., M.R.C.P.I., Patsy Lenane M.B., B.C.H., B.A.O., M.R.C.P.I. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaSearch for more papers by this authorBernice R. Krafchik M.B., Ch.B., F.R.C.P.C., Bernice R. Krafchik M.B., Ch.B., F.R.C.P.C. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaSearch for more papers by this author Susan B. Mallory M.D., Susan B. Mallory M.D. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaSearch for more papers by this authorBernice R. Krafchick M.B., Ch.B., F.R.C.P.C., Bernice R. Krafchick M.B., Ch.B., F.R.C.P.C. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaSearch for more papers by this authorS. Alexander Holme M.B., Ch.B., M.R.C.P., Corresponding Author S. Alexander Holme M.B., Ch.B., M.R.C.P. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaAddress correspondence to Dr S. A. Holme, Welsh Institute of Dermatology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, Wales, UK, or e-mail: saholme@hotmail.com.Search for more papers by this authorPatsy Lenane M.B., B.C.H., B.A.O., M.R.C.P.I., Patsy Lenane M.B., B.C.H., B.A.O., M.R.C.P.I. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaSearch for more papers by this authorBernice R. Krafchik M.B., Ch.B., F.R.C.P.C., Bernice R. Krafchik M.B., Ch.B., F.R.C.P.C. Dermatology Department, The Hospital for Sick Children, Toronto, Ontario, CanadaSearch for more papers by this author First published: 23 May 2005 https://doi.org/10.1111/j.1525-1470.2005.22321.xCitations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume22, Issue3May 2005Pages 266-267 RelatedInformation