Issues surrounding consumer-bought food-allergy testing.

BACKGROUND: Allergy is increasingly reported by patients and members of the public, and there is evidence that the prevalence is increasing. Not all diagnoses have been made by clinicians, as direct-to-consumer (DTC) allergy tests are widely available online. AIM: To determine if DTC allergy tests are processed in accredited laboratories and utilize validated methods, while providing an overview of the DTC allergy tests available. METHODS: Internet searches using 'allergy test kit' and 'intolerance test' were performed to identify DTC food-allergy tests. Each company was contacted to enquire if they had ISO15189 accreditation, what methods of testing they used and what was the extent of individual clinical input used to guide the test requested or result interpretation. RESULTS: In total, 24 online companies providing DTC food-allergy testing were identified, of which 22 were contactable. One laboratory had ISO15189 accreditation, which was also the only laboratory using clinically recognized specific IgE testing and had a clinician involved in the process. Other laboratories used bioresonance or IgG and involved a nutritionist at most. CONCLUSION: Online DTC food-allergy tests are largely misleading to the consumer and provided by unaccredited laboratories using controversial methodology. The dermatologist must politely discount these results and assess the role of food allergy in a patient's skin disease on the merit of clinical history, supported by specific IgE testing as appropriate.

Anakinra for palmoplantar pustulosis: results from a randomized, double-blind, multicentre, two-staged, adaptive placebo-controlled trial (APRICOT).

BACKGROUND: Palmoplantar pustulosis (PPP) is a rare, debilitating, chronic inflammatory skin disease that affects the hands and feet. Clinical, immunological and genetic findings suggest a pathogenic role for interleukin (IL)-1. OBJECTIVES: To determine whether anakinra (an IL-1 receptor antagonist) delivers therapeutic benefit in PPP. METHODS: This was a randomized (1 : 1), double-blind, two-staged, adaptive, UK multicentre, placebo-controlled trial [ISCRTN13127147 (registered 1 August 2016); EudraCT number: 2015-003600-23 (registered 1 April 2016)]. Participants had a diagnosis of PPP (> 6 months) requiring systemic therapy. Treatment was 8 weeks of anakinra or placebo via daily, self-administered subcutaneous injections. Primary outcome was the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at 8 weeks. RESULTS: A total of 374 patients were screened; 64 were enrolled (31 in the anakinra arm and 33 in the placebo arm) with a mean (SD) baseline PPPASI of 17·8 (10·5) and a PPP investigator's global assessment of severe (50%) or moderate (50%). The baseline adjusted mean difference in PPPASI favoured anakinra but did not demonstrate superiority in the intention-to-treat analysis [-1·65, 95% confidence interval (CI) -4·77 to 1·47; P = 0·30]. Similarly, secondary objective measures, including fresh pustule count (2·94, 95% CI -26·44 to 32·33; favouring anakinra), total pustule count (-30·08, 95% CI -83·20 to 23·05; favouring placebo) and patient-reported outcomes, did not show superiority of anakinra. When modelling the impact of adherence, the PPPASI complier average causal effect for an individual who received ≥ 90% of the total treatment (48% in the anakinra group) was -3·80 (95% CI -10·76 to 3·16; P = 0·285). No serious adverse events occurred. CONCLUSIONS: No evidence for the superiority of anakinra was found. IL-1 blockade is not a useful intervention for the treatment of PPP.

Neuroimaging in infants and children in select neurocutaneous disorders.

The role of neuroimaging in neurocutaneous disorders is an evolving field. Research can be inconsistent and inconclusive, leading to divergent practice for some disorders. This study provides an overview of the current role of magnetic resonance imaging (MRI) of the brain in select neurocutaneous disorders, namely Sturge-Weber syndrome, congenital melanocytic naevus syndrome, neurofibromatosis type 1, tuberous sclerosis complex, incontinentia pigmenti and basal cell naevus syndrome. Future research assessing new targeted treatments and novel MRI techniques may change current practice.

Faecal calprotectin in dermatology practice.

Inflammatory bowel disease (IBD) is a chronic relapsing inflammatory condition of the bowel with two primary subtypes: Crohn disease and ulcerative colitis. Extraintestinal manifestations are common in IBD and, after musculoskeletal involvement, dermatological lesions are the most common. Currently, colonoscopy and biopsy are the most definitive tests for a diagnosis of IBD. However, in the past decade, faecal markers have emerged as new diagnostic tools to detect and monitor intestinal inflammation, and faecal calprotectin (FCP) in particular has gained popularity owing to its high sensitivity and specificity for detection of organic bowel disease. This review aims to explore whether there is a role for FCP measurement when encountering cutaneous manifestations associated with IBD.

Lactate dehydrogenase in dermatology practice.

Lactate dehydrogenase (LDH) is used in dermatology practice, particularly as a prognostic marker for cutaneous lymphoma. LDH is an intracellular enzyme involved in anaerobic glycolysis, and is found at low concentrations in the blood. LDH is produced in every tissue, thus cell damage releases LDH into the circulation, so the causes of elevated LDH levels are multiple. The utility of LDH in dermatology practice is reviewed, alongside current diagnostic and staging guidelines.

A study of the number of female editors-in-chief of dermatology journals.

INTRODUCTION: Over the past 50 years the proportion of women entering medical school has vastly increased, however there still exists a gender gap in top leadership positions, including within academic medicine. It is important to investigate the influence of women in this area, and assess change over time. The aim of the study was to assess the number of women who have acted as editors-in-chief of prominent dermatology journals over the 20th and 21st centuries. METHODS: A list of 25 journals was collated based on their impact factors and prominence. Information regarding previous and current editors was obtained, compiled and analysed. RESULTS: Overall there have been 26 female editors and at least 128 male editors in the 25 dermatology journals, which means that less than 19% of editors-in-chief have been female. 45.8% of journals have not yet had a female editor. The percentage of female editors ranged from 0% to 100%, with only one journal having had all female editors (International Journal of Women's Dermatology). On average, the journals had female editorship for 27.2% of the total number of years in publication. Of the 13 journals that have had a female editor, 61.5% had their first female editor after the year 2000. DISCUSSION AND CONCLUSION: There are various factors that influence these numbers including age of the journals and length of each editorship. It is clear that over time there has been an increase in the number of women holding these prestigious positions however gender equity has not yet been reached.

Follicular porokeratosis: four new cases.

Porokeratosis, a disorder of keratinisation, is clinically characterized by the presence of annular plaques with a surrounding keratotic ridge. Clinical variants include linear, disseminated superficial actinic, verrucous/hypertrophic, disseminated eruptive, palmoplantar and porokeratosis of Mibelli (one or two typical plaques with atrophic centre and guttered keratotic rim). All of these subtypes share the histological feature of a cornoid lamella, characterized by a column of 'stacked' parakeratosis with focal absence of the granular layer, and dysmaturation (prematurely keratinised cells in the upper spinous layer). In recent years, a proposed new subtype, follicular porokeratosis (FP_, has been described, in which the cornoid lamella are exclusively located in the follicular ostia. We present four new cases that showed typical histological features of FP.

The age-old problem of acne.

Acne vulgaris is one of the top three most commonly encountered dermatological problems worldwide in both primary and secondary care. Acne diagnosis and treatment date back to ancient Greek and Egyptian times. This article explores acne through the ages and discusses past theories on etiology and treatment with particular focus on the discovery of retinoids and their impact on women's health.

Establishing and prioritizing research questions for the treatment of alopecia areata: the Alopecia Areata Priority Setting Partnership.

BACKGROUND: Alopecia areata (AA) is a common hair loss disorder that results in patchy to complete hair loss. Many uncertainties exist around the most effective treatments for this condition. OBJECTIVES: To identify uncertainties in AA management and treatment that are important to both service users (people with hair loss, carers and relatives) and healthcare professionals. METHODS: An AA priority setting partnership was established between patients, their carers and relatives, and healthcare professionals to identify the most important uncertainties in AA. The methodology of the James Lind Alliance was followed to ensure a balanced, inclusive and transparent process. RESULTS: In total, 2747 treatment uncertainties were submitted by 912 participants, of which 1012 uncertainties relating to AA (and variants) were analysed. Questions were combined into 'indicative uncertainties' following a structured format. A series of ranking exercises further reduced this list to a top 25 that were taken to a final prioritization workshop where the top 10 priorities were agreed. CONCLUSIONS: We present the top 10 research priorities for AA to guide researchers and funding bodies to support studies important to both patients and clinicians.

A dermatological questionnaire for general practitioners in England with a focus on melanoma; misdiagnosis in black patients compared to white patients.

BACKGROUND: Malignant melanoma presents a significant health burden in the UK in terms of mortality and financial cost. This aggressive and often fatal disease is under-diagnosed among patients with darker skin tones (type 5 and 6) such as Afro-Caribbean patients. A lack of both patient and practitioner awareness leads to a later diagnosis in patients with black compared to white skin. There is currently a paucity of literature looking at the diagnosis rates of melanoma between patients of different ethnicities in the UK and the reasons behind these differences. OBJECTIVE: The primary aim was to obtain data on the diagnosis rate of melanoma in the primary care setting, with particular attention to white vs. black skin types. METHODS: An online questionnaire was sent to 2975 general practitioner (GP) practices in England and 287 responses were received. The questionnaire contained 20 high-quality picture questions of differing common skin conditions. The participants were asked to choose their diagnosis from 20 potential diagnoses. Only 4/20 questions were melanomas, two on white and two on black skin. No accompanying histories were provided. RESULTS: The mean score for the questionnaire was 11.6/20 (58%) with a range from 5% to 100%. Of the two black skin melanoma pictures, 177/287 (62%) and 90/287 (31%) responses were incorrectly identified, compared to 37/287 (13%) and 19/287 (7%) in the white skin melanoma pictures. CONCLUSION: The questionnaire results show a clear increased misdiagnosis of melanoma in black patients in primary care vs. white. The results suggest that vigilance is needed when diagnosing possible melanoma in black patients and better quality melanoma teaching is required in GP training concentrating on pigmented skin. This pilot study should encourage more research into ethnic skin inequalities in the UK.

Professor Claudine Blanchet-Bardon: French dermatologist and leading authority on inherited ichthyoses.

This article recounts the early life and professional achievements through 2016 of Professor Claudine Blanchet-Bardon, a French dermatologist who is known for her work in dermatogenetics, genetic counseling, and the care of patients with ichthyoses among other important work.