Photodiagnostic services in the UK and Republic of Ireland: a British Photodermatology Group Workshop Report.

BACKGROUND: Photodiagnostic investigations are essential for the accurate diagnosis of abnormal cutaneous photosensitivity and provide important information for the management of patients with photodermatoses (cutaneous photosensitivity disorders). Although photodiagnosis has been undertaken since the early 1970s, specialist services in the United Kingdom (UK) and Republic of Ireland are limited and there is no formal guidance on diagnostic approach. Indeed, there is a limited literature in this area of methodology and diagnostic practice. OBJECTIVES: The primary objective was to undertake a British Photodermatology Group Workshop to review the role and activities of specialist centres in the UK and Republic of Ireland in order to ascertain whether there were consensus practices. Secondary objectives were to identify key priorities for service, training and research. METHODS: An initial detailed survey review of current activities was undertaken prior to the Workshop and data from this survey were used to inform discussion at the Workshop, which was attended by key photodermatology experts from the UK and Republic of Ireland. RESULTS/CONCLUSIONS: We have undertaken a detailed review of current Photodiagnostic Services in the UK and Republic of Ireland and report on our findings from the 12 centres and we have identified key areas of consensus practice. This is an important step in the process of standardising and optimising procedures and protocols and defining minimum clinical standards for photodiagnostic investigations, which are of such diagnostic importance in Dermatology.

Minimizing thermal stress for data center servers through thermal-aware relocation.

A rise in inlet air temperature may lower the rate of heat dissipation from air cooled computing servers. This introduces a thermal stress to these servers. As a result, the poorly cooled active servers will start conducting heat to the neighboring servers and giving rise to hotspot regions of thermal stress, inside the data center. As a result, the physical hardware of these servers may fail, thus causing performance loss, monetary loss, and higher energy consumption for cooling mechanism. In order to minimize these situations, this paper performs the profiling of inlet temperature sensitivity (ITS) and defines the optimum location for each server to minimize the chances of creating a thermal hotspot and thermal stress. Based upon novel ITS analysis, a thermal state monitoring and server relocation algorithm for data centers is being proposed. The contribution of this paper is bringing the peak outlet temperatures of the relocated servers closer to average outlet temperature by over 5 times, lowering the average peak outlet temperature by 3.5% and minimizing the thermal stress.

The removal of metallic single-walled carbon nanotubes using an aqueous two-phase system.

Here we report our findings on the removal of metallic single-walled carbon nanotubes using an aqueous two-phase system. The aqueous two-phase system contained as received carbon nanotubes, polyethylene glycol, dextran, N-methylpyrrolidone, cetyltrimethylammonium bromide, and water which phase separated into top and bottom phases. The top phase was dominated by polyethylene glycol whereas the bottom phase was dominated by dextran. The dextran-rich phase contained more semiconducting species while metallic species was more abundant in the polyethylene glycol rich-phase. It was found via Fourier-Transform Infrared Spectroscopy that cetyltrimethylammonium bromide only present in the dextran-rich phase. A selectivity mechanism is tentatively proposed and discussed.

Sunscreen photopatch testing: a series of 157 children.

BACKGROUND: Photoprotection including sunscreen use in children is encouraged by health campaigns. While sunscreen chemicals are common causes of photoallergic (PA) contact reactions in adults, limited data are available in children. OBJECTIVES: To assess the frequency of PA and contact allergy (CA) to sunscreens in children aged < 18 years undergoing investigation for suspected photosensitivity. METHODS: Retrospective analysis of data on children who underwent photopatch testing to a standard series of nine ultraviolet (UV) filters and to sunscreen products in a single photoinvestigation centre (2000-11). Duplicate series of UV filters and the children's own sunscreen products were applied to the back, with readings taken at sample removal, and at 24 and 48 h after 5 J cm(-2) UVA exposure of one series. RESULTS: The analysis comprised 157 children (aged 3-17 years, 69 male and 88 female). In total 10 children (6·4%) showed positive photopatch responses to UV filters and/or their sunscreen products (4·5% to UV filters, 5·7% to their sunscreen products). The responsible UV filters most often identified were benzophenone-3 and octyl methoxycinnamate. Additionally, CA reactions were observed in nine children (5·7%), with 16 children (10·2%) showing PA and/or CA to UV filters and/or sunscreen products. CONCLUSIONS: This is the largest series of photopatch testing reported in children, and shows that both sunscreen PA and CA are quite frequent in those undergoing photoinvestigation. Photopatch testing should be considered in children presenting with features of photosensitivity.

Evidence of high levels of anxiety and depression in polymorphic light eruption and their association with clinical and demographic variables.

BACKGROUND: Polymorphic light eruption (PLE) is a prevalent photosensitivity condition associated with psychological distress. Objective To examine patients with PLE for evidence of anxiety and depression, the influence of demographic and clinical variables, and the coping strategies used. METHODS: In a cross-sectional design, patients with PLE (n = 145) who had attended a hospital dermatology department completed validated questionnaires assessing anxiety, depression, social anxiety, and coping strategies. Clinical variables examined were: (i) number of months of the year affected by PLE; (ii) facial involvement; (iii) time taken for the rash to resolve; and (iv) whether the patient ever used steroids for their condition. RESULTS: Participants ranged in age from 16-78 (mean 44 years, SD 11.9), 81% female, with a mean age at onset of PLE of 28 years. Evidence of high levels of anxiety and depression was found in PLE, with 22% and 8% of patients scoring as probable cases for anxiety and depression, respectively. Higher levels of anxiety were associated with younger age of onset of PLE (r = -0.25, P < 0.01) and facial involvement (t = 2.84, P < 0.01), and depression was also associated with facial involvement (t = 3.60, P < 0.01). Furthermore, higher levels of depression and anxiety were associated with the use of maladaptive coping strategies, and depression was found to be the principal predictor of quality of life. CONCLUSIONS: High levels of anxiety and depression occur in PLE. Clinicians should be alert to the potential need for psychological management, particularly in patients with facial involvement and a younger age of onset of PLE.

Retrospective survey of serum lipids in patients receiving more than three courses of isotretinoin.

Isotretinoin is well recognised to cause hyperlipidaemia. This is most obvious during the second month of a 4-month course. Since there are no long-term data on lipid profiles, we have identified 30 subjects who have received 3 or more courses of isotretinoin. They had been exposed to a median of 24.5 months (range 12-103) isotretinoin therapy with a median total cumulative dose of 350 mg/kg (range 152-1221). The median serum cholesterol pre-treatment was 4.6 mmol/L (range 3-6.4). This compared to a median of 4.5 mmol/L (range 3-6.4) just prior to starting the final course. The median triglyceride levels before treatment and pre-final course were 0.8 mmol/L (range 0.3-1.7) and 0.92 mmol/L (range 0.4-2.6) respectively, indicating no significant change in cholesterol or triglyceride concentrations when measured prior to the first and last courses. In addition there was no correlation between cholesterol or triglyceride concentration before the final course of isotretinoin and the total cumulative dose of isotretinoin. We conclude that there appears to be little risk of causing hyperlipidaemia by prolonged therapy with isotretinoin in patients with acne.

A questionnaire survey of attitudes to and usage of sunscreens in northwest England.

BACKGROUND/PURPOSE: Sunscreens are employed with the aim of reducing the deleterious effects of ultraviolet radiation (UVR), but little is known about their use in the UK. METHODS: This questionnaire survey assessed attitudes to and usage of sunscreens in northwest England in 2000. Subjects (186 females and 102 males) were recruited from the waiting rooms of four general practices, with a high response rate of 97%. RESULTS: Females were more frequent users of sunscreens than males, but only 35% females and 8% males reported their regular use. Twenty-two per cent of the study population did not use sunscreens at all, whereas 66% of subjects bought a sunscreen product once a year or less. Thirty-four per cent subjects reported experiencing sunburn in the last 2 years. Interestingly, more (60%) sunburns were found to occur at home in the UK than on holidays abroad, and these frequently occurred during outdoor activities other than deliberate sunbathing. CONCLUSION: There remains much scope for sunscreen education in the British public.

Keloidal scleroderma.

A 53-year-old woman with systemic sclerosis developed numerous cutaneous nodules, resembling keloids, on her anterior chest wall. The nodules failed to respond to therapy with topical steroid, calcipotriol, or extended photochemotherapy. This is a rare, disfiguring variant of scleroderma, unresponsive to treatment, and poorly understood.

What do trainee hairdressers know about hand dermatitis?

Hand dermatitis is an important cause of morbidity in hairdressers. We conducted a questionnaire survey of 121 trainee hairdressers from 2 hairdressing colleges in Burnley (UK). The questionnaire concerned the number and types of hairdressing procedures performed, previous and current medical history, awareness of risks to the skin from hairdressing, and knowledge of hand dermatitis prevention. 17% of the trainees suffered currently from hand dermatitis. This is likely to be due to the large amount of wet work done by apprentice hairdressers, particularly those who worked in salons. 2/3 of trainees were not aware that atopic eczema predisposed to hand dermatitis. Formal pre-school and pre-employment counselling was limited. Knowledge on hand care among trainees was not often translated into practice, with gloves being worn by only 9% when shampooing and 58% when perming. Prevention of hand dermatitis by education and pre-employment counselling is of fundamental importance.

Epstein-Barr virus-positive blastoid nasal T/natural killer-cell lymphoma in a caucasian.

T/natural killer (NK)-cell lymphoma is a subtype of non-Hodgkin's lymphoma, with frequent cutaneous involvement; it follows an aggressive course. Most cases are reported in Asia, and typically present with nasopharyngeal involvement. There is a distinct variant known as blastoid T/NK-cell lymphoma, which affects elderly, non-Asian patients, with absence of nasal involvement. We report a middle-aged caucasian man who had blastoid T/NK-cell lymphoma with nasal involvement.

PUVA therapy in lichen aureus.

Lichen aureus is one of the subtypes of a rare group of diseases, pigmented purpuric dermatoses. The natural course of the disease is slow evolution and slow resolution. Treatment is generally limited. We report a case of lichen aureus that responded dramatically to photochemotherapy (PUVA).

Esophageal investigations in connective tissue disease: which tests are most appropriate?

Our aim was to review the use of esophageal investigations in patients with suspected connective tissue disease (CTD). Forty-seven patients (39 women and 8 men) with suspected CTD were referred for esophageal manometry at the gastrointestinal physiology unit in the Royal Victoria Hospital, Belfast, U.K., over a 10-year period (1987-1997). The mean age was 51.7 years (range = 21-79 years). Chart review was conducted 1 to 10 years after manometry to confirm the final diagnoses: scleroderma was found in 11; CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia), 8; mixed connective tissue disease, 14; Raynaud's alone, 5; and other CTDs, 9. All 47 successfully underwent esophageal manometry. In addition to manometry, 24 underwent gastroscopy; 27, barium meal; and 3, esophageal pH studies. Clinically significant esophageal abnormalities were noted in 8 (33%) on gastroscopy, in 15 (56%) on barium meal, and in 31 (66%) on manometry. Gastroscopy had a significantly lower positivity rate than the others (p < 0.05). Only three patients had pH testing, yet all three pH tests were abnormal. During manometry, abnormal findings were significantly more common in scleroderma-CREST when compared with other diagnoses (89% vs. 50%; p < 0.02). Thirty-three patients reported dysphagia. Abnormal manometry was more likely in these cases (82% vs. 33%; p < 0.02). A high percentage of patients with CTD have significant esophageal motility disorders. Investigations were more likely to be positive with scleroderma-CREST than other CTDs, even if dysphagia was present. Barium meal and manometry are more useful than OGD. pH studies were under-used. There is need for a standardized approach to esophageal investigations in patients with CTDs.