Low referral rate of overweight/obese patients with hidradenitis suppurativa to weight-management services: a missed opportunity?

Hidradenitis suppurativa (HS) is associated with obesity and other cardiovascular risk factors. Referral of overweight/obese patients with HS to weight-management (WM) services is advised as this may help reduce HS disease severity and cardiovascular risk. A retrospective observational study of 50 patients with HS attending a specialist HS clinic was conducted to assess general practitioner referral patterns of overweight/obese patients with HS for WM. Forty-two patients (84%) were classified as overweight or obese. None of 6 overweight patients and none of 18 obese class 1 patients had been referred to WM prior to dermatology referral, while only 2 of 10 (20%) obese class 2 and 3 of 8 (38%) obese class 3 patients had been referred. The overall WM referral rate for overweight/obese patients was only 12% (n = 5/42). The low referral rate suggests that further efforts are required to diagnose overweight/obesity in primary care, improve the provision of WM services and educate medical professionals that HS is a weight-related comorbidity.

Opportunities for implementing a patient-initiated follow-up pathway for patients with psoriasis completing phototherapy.

We performed a retrospective case analysis to identify opportunities to introduce a patient-initiated follow-up (PIFU) pathway for patients with psoriasis completing narrowband ultraviolet B phototherapy at our centre. In total, 42 patients completed phototherapy between January 2016 and August 2018 and outcomes were observed for 36 months after phototherapy cessation. Had a PIFU pathway been in place, 24 routine follow-up appointments could have been saved and 8 nonattendances could have been avoided. Seven patients who were discharged or did not attend follow-up after phototherapy flared within 12 months and could have benefited from PIFU to re-access dermatology care. In total 21 patients (50.0%) experienced a relapse within 36 months of completion of phototherapy, and 18 of these (85.7%) relapsed at 0-12 months. The median time to relapse was 6 months. We conclude a post-phototherapy PIFU pathway could help eliminate unnecessary appointments for patients in remission and improve access for patients who relapse. A 12-month PIFU duration prior to discharge would be sufficient to capture the majority of relapses.

Ancillary techniques to improve dermoscopy specificity for skin cancer detection.

Although the use of dermoscopy has markedly improved both the sensitivity and specificity for skin cancer detection, there is still opportunity for improvement. Ancillary techniques provide additional ways to assess a lesion with the aim of improving our diagnostic ability with little extra cost. Usage of these techniques can strengthen diagnosis and help reduce unnecessary biopsies of benign lesions.

Anogenital dermatology: caseload analysis of new outpatient referrals at a single dermatology centre.

Little is known about the volume of outpatient referrals for anogenital dermatoses received by NHS dermatology departments. We undertook a caseload analysis at our centre and found 6.0% of GP referrals to Dermatology were for anogenital dermatoses. This has important implications for training in this field of dermatology as well as for service provision.

Impact of Zostavax Vaccination on T-Cell Accumulation and Cutaneous Gene Expression in the Skin of Older Humans After Varicella Zoster Virus Antigen-Specific Challenge.

Background: The live attenuated vaccine Zostavax was developed to prevent varicella zoster virus (VZV) reactivation that causes herpes zoster (shingles) in older humans. However, the impact of vaccination on the cutaneous response to VZV is not known. Methods: We investigated the response to intradermal VZV antigen challenge before and after Zostavax vaccination in participants >70 years of age by immunohistological and transcriptomic analyses of skin biopsy specimens collected from the challenge site. Results: Vaccination increased the proportion of VZV-specific CD4+ T cells in the blood and promoted the accumulation of both CD4+ and CD8+ T cells in the skin after VZV antigen challenge. However, Zostavax did not alter the proportion of resident memory T cells (CD4+ and CD8+) or CD4+Foxp3+ regulatory T cells in unchallenged skin. After vaccination, there was increased cutaneous T-cell proliferation at the challenge site and also increased recruitment of T cells from the blood, as indicated by an elevated T-cell migratory gene signature. CD8+ T-cell-associated functional genes were also highly induced in the skin after vaccination. Conclusion: Zostavax vaccination does not alter the abundance of cutaneous resident memory T cells but instead increases the recruitment of VZV-specific T cells from the blood and enhances T-cell activation, particularly cells of the CD8+ subset, in the skin after VZV antigen challenge.