ABSTRACT
BACKGROUND: Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice. OBJECTIVES: The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research. METHODS: An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland. RESULTS/CONCLUSIONS: We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology.
Subject(s)
Skin Diseases , Humans , Ireland , Surveys and Questionnaires , United KingdomSubject(s)
Cowpox virus , Cowpox , Adult , Animals , Cats , Cowpox/diagnosis , Cowpox virus/genetics , Humans , Male , United Kingdom/epidemiology , ZoonosesSubject(s)
Acute Generalized Exanthematous Pustulosis/etiology , Acute Generalized Exanthematous Pustulosis/pathology , Cholecystitis, Acute/diagnostic imaging , Contrast Media/adverse effects , Iopamidol/adverse effects , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Acute Generalized Exanthematous Pustulosis/therapy , Administration, Intravenous , Administration, Oral , Aged, 80 and over , Cholecystitis, Acute/pathology , Cholecystitis, Acute/surgery , Contrast Media/administration & dosage , Female , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Hypersensitivity/diagnosis , Hypersensitivity/etiology , Iopamidol/administration & dosage , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are characterized by widespread skin and mucosal blistering and necrosis. The triggers and long-term sequelae in children may differ from those reported for adults. Bronchiolitis obliterans (BO) is an uncommon complication, with only 15 previously reported cases, but can lead to significant long-term morbidity, requiring lung transplantation in some cases. We report three children with nondrug-related SJS (n = 1) and TEN (n = 2) who developed BO. Two were treated with intravenous immunoglobulin therapy (2-2.4 g/kg) and all three survived. We highlight salient learning points from our cases and potential pitfalls in diagnosis of BO, including delayed onset, and we also review the literature.
Subject(s)
Bronchiolitis Obliterans/etiology , Stevens-Johnson Syndrome/complications , Adolescent , Bronchiolitis Obliterans/diagnosis , Bronchiolitis Obliterans/diagnostic imaging , Bronchiolitis Obliterans/therapy , Child , Child, Preschool , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Lung/diagnostic imaging , Male , Respiratory Function Tests , Tomography, X-Ray ComputedABSTRACT
Vitamin D can be synthesized following exposure to ultraviolet radiation (UVR), ingested in the diet or provided through oral supplementation. The medical literature frequently states that humans obtain most of their vitamin D from sunshine and that UVR exposure is essential to maintain vitamin D levels. A systematic review was conducted to determine the requirement for UVR in maintaining adequate (> 50 nmol L(-1) ) serum 25-hydroxyvitamin D [25(OH)D] levels. Studies reporting serum 25(OH)D during situations of negligible UVR exposure were sought. Forty-one studies (from a search yielding 42 698 articles) with a total of 4211 healthy adults met the inclusion criteria, providing 56 datasets from different population groups. Over 50% of subjects had > 50 nmol L(-1) 25(OH)D in 10 of 19 datasets reporting winter levels in areas with limited UVR. In addition, > 50% of subjects had adequate 25(OH)D levels in four of 12 datasets from polar regions during periods of negligible UVR, one of nine datasets documenting clothing-related minimal UVR and two of eight datasets detailing employment-related minimal UVR. The data demonstrate that many adults maintain adequate serum vitamin D levels despite negligible UVR exposure for several months. However, we acknowledge that preceding UVR exposure leading to vitamin D storage and delayed release may account for this maintenance of adequate serum vitamin D levels. There remains a need for further research on whether UVR exposure is required for longer-term maintenance of adequate vitamin D levels.
