The prevalence of human leucocyte antigen and human papillomavirus DNA in penile intraepithelial neoplasia in England 2011-2012.

BACKGROUND: The pathogenesis of penile intraepithelial neoplasia (PeIN) is unclear but human papillomavirus (HPV) infection and polymorphisms in human leucocyte antigen (HLA). OBJECTIVES: To examine the prevalence of HPV DNA and HLA in PeIN. METHODS: Adult Caucasian men with a clinical and histological diagnosis of PeIN, that is, Bowenoid papulosis (BP), Bowen's disease of penis (BDP) and erythroplasia of Queyrat (EQ) were selected and phenotyped from the clinical records. DNA was extracted from blood and paraffin-embedded sections for HLA and HPV typing, respectively. Human leucocyte antigen allele frequencies were compared with those derived from the UK-based Caucasian population. RESULTS: Seventy-two cases of PeIN (20 BP, 34 BDP and 18 EQ) were studied. Human papillomavirus DNA was identified in 65/72 (90.2%) PeIN; Alphapapillomavirus types were detected in 62/72 (85%) followed by Betapapillomavirus types in 9/72 (12.5%) and cutaneous types in 7/72 (9.7%); HPV16 was the most prevalent genotype at 35/72 (48.6%) followed by HPV33 at 7/72 (9.7%); multiple infections were seen in 18/72 (25%) PeIN. HLA-C*15 (Bonferroni corrected p = 0.049) confers susceptibility to PeIN, whereas HLA-DQA1*01 (corrected p = 0.02) protects against PeIN. HPV16-associated PeIN cases showed no statistically significant association with HLA genotype after multiple corrections. CONCLUSION: Human papillomavirus is involved in the pathogenesis of PeIN. Immunogenotype may play a role in the pathogenesis of PeIN.

Immunogenetics and human papillomavirus (HPV) in male genital lichen sclerosus (MGLSc).

BackgroundThe pathogenesis of male genital lichen sclerosus (MGLSc) is controversial. Incriminated factors include infection with human papillomavirus (HPV) and autoimmunity (e.g. Human Leukocyte Antigen [HLA]). To address the roles of HLA and HPV in MGLSc we studied adult Caucasian males with a clinical and histological diagnosis of MGLSc. The men in the study attended two specialised Male Genital Dermatoses Clinics between July 2011 and September 2012 and were selected and phenotyped from the clinical records. DNA was extracted from blood and paraffin-embedded biopsy sections, for HLA and HPV typing, respectively. HLA allele frequencies were compared with those derived from the UK-based Caucasian population. Eighty-eight cases of MGLSc were identified. HPV DNA was detected in 33/88 (37.5%) cases of MGLSc. HPV16 was the most prevalent type found: 11/88 (12.5%) MGLSc. No statistically significant HLA associations were established but HLA-B*35, -B*51, -C*15, -DRB1*04, -DRB1*10 (predisposition) and -DQA1*01 (protection) were revealed as alleles of interest. HPV16-associated MGLSc cases showed no statistically significant association with HLA genotype. The relationship between HPV and MGLSc suggests a passenger effect rather than a pathogenic role. HLA is not associated with MGLSc nor co-existent HPV16.

Rapidly enlarging lipoma.

Lipoma is a common subcutaneous tumour composed of fat tissue. It may occur as a sporadic solitary lesion or as multiple lesions. They often grow very slowly. They vary between 2 and 10 cm in size. There are rarely any subjective symptoms. Lipomas do not usually require treatment unless they are big enough to be symptomatic. We reported a 75-year-old man with a rapidly enlarging and ulcerated mass on his right upper thigh.

Survey of Dermatologists and Venereologists Shows Varying Approach to Penile Biopsies.

OBJECTIVE: To determine frequency of use and safety of epinephrine containing local anesthesia among dermatologists in the United Kingdom and venereologists undertaking penile biopsy. DESIGN: A survey was distributed nationally to members of the British Association of Dermatologists and the British Association for Sexual Health and Human Immunodeficiency Virus in December 2016. RESULTS: Sixty-six responses were received: 36.4 percent of respondents used epinephrine routinely, 16.7 percent sometimes used it, and 47 percent did not use it at all. Epinephrine use was more commonly by dermatologists in either some or all cases (56.8%) compared with venereologists (40%). Only two complications were reported to epinephrine use. Both were temporary without report of necrosis. CONCLUSION: Use of epinephrine-containing local anesthesia is common among physicians in the United Kingdom undertaking penile biopsies. Despite this, no episodes of necrosis were observed. While further investigation is still required, it is likely that use of epinephrine-containing local anesthesia is safe for local penile injection.

Treatment Satisfaction Among Patients with Moderate-to-severe Psoriasis.

OBJECTIVE: Various treatment options are available for the management of psoriasis; however, there remains a scarcity of literature regarding satisfaction levels among these patients. Given that treatment dissatisfaction is associated with lower levels of adherence, the objective of the present study was to establish satisfaction levels among patients with psoriasis. DESIGN: A modified version of a previously validated satisfaction questionnaire was completed by patients. SETTING: Dermatology outpatient department (Solihull, United Kingdom). PARTICIPANTS: Thirty-eight patients with psoriasis (median age 43). MEASUREMENTS: The questionnaire addressed various domains of satisfaction including satisfaction with safety, convenience, information provision, and finally global satisfaction with 1) topical treatments, 2) phototherapy, and 3) systemic treatments. RESULTS: Mean global satisfaction with phototherapy and systemic treatments was significantly higher than with topical treatments. The authors' findings also showed that 20 percent of patients receiving topical treatment were dissatisfied with the convenience of the treatment. Interestingly, the only domain causing dissatisfaction among patients receiving systemic therapies (largely biologies) was safety. Despite this, satisfaction with both systemic treatment and phototherapy was higher than has been previously reported. CONCLUSION: The findings of this study indicate that levels of satisfaction with phototherapy and systemic treatments are high, which is encouraging for both clinicians and patients. However, there are undoubtedly higher levels of dissatisfaction with topical treatments. Given that topical treatments have the greatest safety profile, they will continue to be the first-line treatment for psoriasis. Advances that focus on patient concerns should become a priority in order to improve compliance and reduce the need for more costly intervention.

Male genital lichen sclerosus.

Male genital lichen sclerosus (MGLSc) is a chronic inflammatory skin disease responsible for male sexual dyspareunia and urological morbidity. An afeared complication is squamous cell carcinoma (SCC) of the penis. The precise etiopathogenesis of MGLSc remains controversial although genetic, autoimmune and infective (such as human papillomavirus (HPV) hepatitis C (HCV), Epstein-Barr virus (EBV) and Borrelia) factors have been implicated: Consideration of all the evidence suggests that chronic exposure of susceptible epithelium to urinary occlusion by the foreskin seems the most likely pathomechanism. The mainstay of treatment is topical ultrapotent corticosteroid therapy. Surgery is indicated for cases unresponsive to topical corticosteroid therapy, phimosis, meatal stenosis, urethral stricture, carcinoma in situ (CIS) and squamous cell carcinoma.

The effect of pulsed dye laser on the dermatology life quality index in erythematotelangiectatic rosacea patients: an assessment.

BACKGROUND: Erythematotelangiectatic rosacea is a common cutaneous disorder. It has a major psychosocial impact on a patient's life. OBJECTIVE: This study aims to investigate the impact of pulsed dye laser on the quality of life of affected patients as measured by the Dermatology Life Quality Index. METHODS: The authors report a prospective study of 20 patients (in a wide range of skin phototypes) attending a laser clinic. All patients completed the Dermatology Life Quality Index questionnaires before and after three sessions of laser treatment. RESULTS: The mean Dermatology Life Quality Index scores pre- and post-laser treatment were 17.3 and 4.3, respectively. All patients experienced a statistically significant improvement in their quality of life (p<0.0001, paired t test). CONCLUSION: The Dermatology Life Quality Index questionnaire (pre- and post-laser treatment) is an important tool for monitoring the efficacy of therapy and patient satisfaction.

Cutaneous telangiectasia and cauda equina syndrome: a presentation of diffuse large B-cell lymphoma.

We describe a 72-year-old woman with striking cutaneous telangiectatic lesions that chronologically preceded presentation with cauda equina syndrome. Diffuse large B-cell lymphoma (DLBCL) was confirmed on skin biopsies from plaques on the abdominal wall and left ankle, the possibilities including primary cutaneous DLBCL leg-type or systemic DLBCL. We speculate that this clinical appearance may arise due to lymphatic or vascular congestion resulting from the dense lymphoid infiltrate in this case.

Hairy intraoral flap--an unusual indication for laser epilation: a series of 5 cases and review of the literature.

A variety of the flaps used to reconstruct defects of the head and neck region following surgery for malignant disease contain hair follicles that may result in unwanted hair growth. This can cause significant distress to the patients in a variety of ways. We report 5 cases of significant intraoral hair growth of which 4 cases were successfully managed with long-pulsed alexandrite laser. One patient was not treated due to technical difficulties. We review the literature on the management of hair growth on intraoral flaps.