Smoking related COPD and facial wrinkling: is there a common susceptibility?

BACKGROUND: Cigarette smoking causes accelerated facial wrinkling and predisposes to chronic obstructive pulmonary disease (COPD). However, it has long been recognised that there is a subgroup of susceptible smokers who are at increased risk of developing airflow obstruction. We have tested the hypothesis that there is a common susceptibility for the development of COPD and facial wrinkling in cigarette smokers. METHODS: One hundred and forty nine current and ex-smokers were recruited from a family based study of COPD genetics, 68 (45.6%) of whom fulfilled the definition of COPD. 124 (83.2%) had no or minor facial wrinkling (Daniell /=IV). Generalised estimating equations were used to adjust for familial correlations between related individuals and the potential confounding effects of age and pack years smoked. RESULTS: Forced expiratory volume in 1 second (FEV(1)) was significantly lower in those with wrinkles than in those without (mean difference in FEV(1) % predicted -13.7%, 95% CI -27.5 to 0.0, p = 0.05) and facial wrinkling was associated with a substantially increased risk of COPD (adjusted OR 5.0, 95% CI 1.3 to 18.5, p<0.02). The Daniell score correlated with the extent of emphysema on the CT scan (p<0.05) and facial wrinkling was also associated with a greater risk of more extensive emphysema (adjusted OR 3.0, 95% CI 1.0 to 9.3, p = 0.05). CONCLUSION: Facial wrinkling is associated with COPD in smokers, and both disease processes may share a common susceptibility. Facial wrinkling in smokers may therefore be a biomarker of susceptibility to COPD.

Hidradenitis suppurativa, Dowling-Degos and multiple epidermal cysts: a new follicular occlusion triad.

This case illustrates the rare association between hidradenitis suppurativa (HS) and Dowling-Degos disease (DDD). Furthermore the association of HS, DDD and multiple epidermal cysts has not to our knowledge been described before, but their coexistence in the same patient is likely to reflect the same follicular anomaly. It is possible that a single underlying defect of follicular proliferation may account for the coexistence of these conditions.

Elastophagocytosis: a feature of resolving Sweet's syndrome.

We report the case of a patient with atypical Sweet's syndrome characterized by an annular erythema that showed consumption of elastic fibres by giant cells and histiocytes. Although the lesions were found on sun-exposed sites and the first biopsy demonstrated extensive elastophagocytosis, our patient did not have photodamaged skin clinically. A repeat biopsy 5 weeks later demonstrated an abundant collection of neutrophils supporting the diagnosis of Sweet's syndrome. To our knowledge, an elastolytic granulomatous reaction pattern has not been previously reported in Sweet's syndrome.

Dermatology Life Quality Index: influence of an illustrated version.

BACKGROUND: An illustrated version of the Dermatology Life Quality Index (DLQI) was developed in order to improve the ease with which this standard questionnaire is answered. OBJECTIVES: To compare the illustrated version with the text-only version of the DLQI. METHODS: The two versions were administered to 206 patients attending Dermatology outpatient clinics. The time taken to complete either the illustrated or the text-only version was noted in 52 additional patients. RESULTS: One hundred and ninety-one of 206 patients completed both questionnaires satisfactorily. Their mean DLQI scores were 6.4 (median 4.0, lower quartile 1.0, upper quartile 11.0) for the illustrated version and 6.3 (median 4.0, lower quartile 1.0, upper quartile 10.0) for the text-only version. For the 98 patients who answered the illustrated version first, the mean DLQI scores were 6.9 (median 4.0, lower quartile 1.9, upper quartile 11.9) for the illustrated version and 6.4 (median 4.0, lower quartile 1.8, upper quartile 11.0) for the text-only version. For the 93 patients who answered the text-only version first, the mean DLQI scores were 5.9 (median 4.0, lower quartile 1.7, upper quartile 10.2) for the illustrated version and 6.2 (median 5.0, lower quartile 0.5, upper quartile 9.5) for the text-only version. The median time taken to complete the text-only version was 124 s (mean +/- SD 126 +/- 65, n = 27) and 88 s (mean +/- SD 101 +/- 52, n = 25) for the illustrated version (P = 0.08). There was a very close correlation (r = 0.98) between the scores of the text-only and the illustrated versions; 82.2% of patients either scored the same or had a DLQI score difference of only 1. One hundred and seven (59.8%) patients preferred using the illustrated version and 66 (36.9%) preferred the text-only version. One hundred and four (57.5%) found the illustrated version easier to use. CONCLUSIONS: The illustrated version was superior to the text-only version in terms of patient preference and ease of use, but it was not possible to demonstrate exact equivalence between the two versions.

Laser treatment improves quality of life of hirsute females.

Hirsutism has a significant impact on the quality of life of affected patients. We report a prospective study of 45 hirsute females attending a laser clinic. Of these, 15 patients completed a pair of modified dermatology life quality index (DLQI) questionnaires, immediately before and at varying intervals (up to 6 months) after laser treatment. The mean DLQI score before treatment was 12.8 (median = 9.0, SD = 8.5). The mean DLQI score at 1-2 months was 7.0 (median = 2.5, SD = 10.0, P = 0.06), at 2-4 months it was 9.2 (median = 10.0, SD = 10.0, P = 0.48) and at 4-6 months it was 11.5 (median = 10.5, SD = 8.0, P = 0.88). There was a major improvement in DLQI score at 1-2 months but longer-term benefit was not observed. In a separate questionnaire, hirsute females (n = 45) reported a high level of patient satisfaction (71.1%) and willingness to have further treatment (77.8%) despite the fact that 97.1% had unwanted hair back at pretreatment levels at 6 months.

Keratosis pilaris atrophicans in mother and daughter.

We report two cases of keratosis follicularis spinulosa decalvans in a Caucasian family involving a 28-year-old woman and her mother. This is an unusual family in that no male relatives are similarly affected. Secondly, both patients have no significant eye changes but quite extensive scarring alopecia. To the best of our knowledge this is the second reported family in the UK.

Recent advances in laser therapy for the treatment of cutaneous vascular disorders.

The use of lasers for the treatment of cutaneous vascular disorders has expanded rapidly since its inception in the early 1960s. The flashlamp-pumped pulsed tunable dye laser (PDL), which is the best laser system for the treatment of port-wine stains (PWS), is based on the premise of selective photothermolysis. Recent literature demonstrates enhanced selective photothermolysis by modifying the PDL to include a longer pulse width, a longer wavelength and higher energy fluences through the use of dynamic cooling. Multiple pulse laser irradiation, a new innovative method, shows promising preliminary results in eradicating hypertrophic PWS. In the treatment of capillary haemangiomas, previous uncontrolled studies suggest benefit with early PDL therapy but a recent randomised controlled trial does not support this claim. Mixed haemangiomas respond poorly to PDL treatment, uncomplicated tumours are best left to involute spontaneously whilst life/organ-threatening lesions require early active intervention. The efficacy of lasers in the treatment of telangiectatic leg veins (TLV) remains controversial. The literature revealed many conflicting claims. Larger and properly controlled studies are necessary to better define the role of lasers in the treatment of TLV.

Minocycline as a therapeutic option in bullous pemphigoid.

We present a retrospective analysis of patients with bullous pemphigoid (BP) treated with minocycline in the Department of Dermatology, Churchill Hospital, Oxford between July 1986 and May 2000. More than 200 patients with BP were seen in clinic during the review period. Of these, 22 patients were treated with minocycline, mostly as adjuvant therapy. The response to treatment was assessed by clinical improvement and whether the dose of concurrent immunosuppressive drugs was subsequently reduced. A major response was seen in six patients, a minor response in 11 and no response was seen in five patients. Minocycline was discontinued in four patients because of the occurrence of side-effects. Overall analysis revealed marked clinical benefits of minocycline in BP. However, this is a non-placebo controlled study and should now be followed by a prospective double-blind controlled clinical trial.