The impact of ultraviolet exposure on patch testing in clinical practice: a case-control study.

BACKGROUND: Current guidelines suggest waiting a full 6 weeks between ultraviolet (UV) exposure and patch testing owing to the localized and generalized cutaneous immunosuppression it induces, yet there is a dearth of evidence as to the duration of this immunosuppression. AIM: To determine whether there are any significant differences in the rates of positive patch-test reactions between patients who had received a significant exposure to UV within the previous 6 weeks, and similar patients who had not received such an exposure. METHODS: Rates of positive patch-test reactions were compared between patients undergoing patch testing for generalized eczema who had completed a course of phototherapy within the preceding 6 weeks, and matched controls who had not. Patients were matched for sex, age and naivety to systemic therapy. RESULTS: Of the 22 patients who had received phototherapy, 7 exhibited at least 1 positive reaction, compared with 6 of the 22 controls; this result was not significant (P > 0.05). CONCLUSIONS: The cutaneous immunosuppression induced by UV exposure appears to be fully resolved within < 6 weeks. This suggests it may therefore not be necessary in all cases to wait the full 6 weeks following significant UV exposure before undertaking patch testing.

Depression and the dermatologist: a critical analysis of contemporary isotretinoin prescribing practices.

Management of patients with current or previous depression who require isotretinoin treatment for acne is a challenging area. Current opinion favours the view that isotretinoin-induced mood disturbance is a rare, idiosyncratic reaction, not reliably related to the presence of pre-existing depression. Nonetheless, in the absence of a definitive high-quality study, there remains a degree of legitimate uncertainty. With input from a psychiatrist, we created and administered a detailed survey featuring a range of low-, medium- and higher-risk clinical scenarios, designed to capture a snapshot of current dermatological practice. Respondents indicated a wide variability in their approach, with a substantial proportion referring on to Psychiatry where this was not deemed necessary. Few dermatologists appreciated the importance of behaviours suggesting impaired impulse control. We hope this study helps to refine guidance for isotretinoin prescribing, both to maximize safety and to ensure that deserving patients with acne are not excluded from appropriate treatment.

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.

Prevention is better than cure.

The vast majority of gastric cancers are sporadic. However, 1-3% arise as a result of inherited gastric cancer predisposition syndromes, generally referred to as hereditary diffuse gastric cancer (HDGC). Of those families that fulfill the clinical criteria for HGDC only 25% have a CDH1 germline mutation. No reliable surveillance technique exists for individuals with HDGC. Difficult decisions have therefore to be made by mutation carriers to proceed with prophylactic total gastrectomy, or undergo lifelong annual surveillance. We present a case of the management of a patient with a documented CDH1 mutation and briefly review the available literature.