Psychotherapeutic interventions for burns patients and the potential use with Stevens-Johnson syndrome and toxic epidermal necrolysis patients: A systematic integrative review.

BACKGROUND: The existing evidence demonstrates that survivors of SJS/TEN have reported long-lasting psychological effects of their condition. Burns patients experience similar psychological effects. It is important to look at ways to help allay the psychological complications of SJS/TEN. As there is an absence of evidence on SJS/TEN psychotherapeutic interventions, it was judged to be beneficial to determine the evidence underpinning psychotherapeutic interventions used with burns patients. AIMS AND OBJECTIVES: The aim of this systematic integrative review was to synthesize the evidence relating to psychotherapeutic interventions used with adult burns patients and patients with SJS/TEN. METHOD: The systematic review was guided by Whittemore and Knafl's integrative review process and the PRISMA guidelines. Nine databases were searched for English and French language papers published January 2008 to January 2021. The protocol for the review was registered with PROSPERO. RESULTS: Following a screening process, 17 studies were included in the review. Two themes were identified using content analysis, (i) Empirically supported psychotherapeutic treatments, (ii) Alternative psychotherapeutic treatments. This review revealed no evidence on specific psychotherapeutic interventions for patients with SJS/TEN. Some of the interventions used with burns patients, viz. relaxation therapy, hypnosis and cognitive behavioral therapy showed some significant benefits. However, the evidence for burns patients is mainly focused on pain and pain anxiety as outcomes. CONCLUSION: Following further research, some of the interventions deployed in burns patients may be applicable to SJS/TEN patients, particularly stress reduction techniques. In addition, the caring behaviours such as compassion, respect, and getting to know the patient as a person are important components to psychological care.

Metastatic melanoma in the Mid-West of Ireland: a retrospective review.

BACKGROUND: Melanoma is the fifth most common invasive cancer in Ireland, and incidence is increasing. Metastatic melanoma has been associated with poor overall survival historically. New systemic anti-cancer treatment (SACT) options for advanced melanoma have emerged in the last decade, and outcomes are improving. AIMS: The aim of our study was to assess the incidence and clinicopathological features of metastatic melanoma in our centre, and subsequent treatment with SACT. METHODS: We analysed retrospectively patients with metastatic melanoma in the Mid-West of Ireland, over a 6-year period (2014-2019). RESULTS: In 6 years, a total of 620 patients were diagnosed with melanoma, 28 (5%) had metastatic or unresectable disease at diagnosis. Mean age at primary diagnosis was 64.5 years (range 24-90 years) and 20 (71%) were male. Median Breslow depth was 4.3 mm (mean 5.5 mm, SD ± 4.4 mm). Thirteen patients (46%) had metastases at initial presentation. Fifteen (53%) received systemic treatment in the regional cancer centre. Of 13 who did not have systemic treatment, 8 had radiological and clinical surveillance, 3 declined further treatment or surveillance and 2 were lost to follow-up. Eleven patients died from the disease with median overall survival of 1.5 years (SD ± 1.3 years). CONCLUSION: Patients with metastatic melanoma commonly had metastases at the time of first presentation. Just over half of patients with metastatic melanoma received SACT. Early detection of melanoma is key. Further research on factors involved in late presentation, and those precluding systemic treatment, may contribute to improved outcomes in advanced melanoma.

Practical experience of secukinumab in the treatment of psoriasis: experience from a single centre.

Secukinumab is a novel anti-interleukin-17A agent that has achieved a 75% decrease from baseline in Psoriasis Area and Severity Index (PASI 75) in 77-81% of patients treated in clinical trials Langley et al. (N Engl J Med 371:326-338, 2014). There is limited data on the use of secukinumab outside of clinical trials. We provide real-world data on the efficacy and safety of secukinumab in patients with severe psoriasis attending an outpatient dermatology service. In our retrospective review, we demonstrate (PASI 75) a response rate of 47% in patients previously treated with multiple systemic and biologics. Our efficacy is comparable to that seen in the Signature study who examined similar populations. Response was maintained at follow-up of almost 1 year with acceptable safety data. Patients with psoriatic arthritis were more likely to remain on secukinumab than those without at last clinic follow-up.

Pyoderma gangrenosum induced by episiotomy.

We present a patient who developed genital ulceration within hours following episiotomy procedure during a normal vaginal delivery. This was initially treated by the gynaecology and medical team as cellulitis with no improvement. A diagnosis of pyoderma gangrenosum (PG) was made by the dermatology team 12 days later. On further investigation, she was found to be hepatitis C positive. We report this case to highlight the phenomenon of pathergy and frequent misdiagnosis of PG by other medical teams. When a postsurgical wound is not healing despite relevant systemic treatment, the clinician should suspect PG as an early diagnosis and treatment is crucial.

Diagnostic error: what Muir-Torre syndrome has taught us.

A low-grade sebaceous carcinoma was excised from a 55-year-old woman's neck. At follow-up, 11 months later, a recent diagnosis of mucinous adenocarcinoma of the colon and history of clear cell endometrial carcinoma were identified. A strong family history of bowel cancer suggested Muir-Torre syndrome. Unexpectedly, hereditary non-polyposis colorectal cancer had previously been genetically confirmed; the results were found loosely filed in the paper chart. The patient had not informed us about her diagnosis; having discussed the case with other physicians she felt the diagnosis would be common knowledge. In 1999, US National Institute of Medicine estimated that preventable medical error resulted in the deaths of 44-98 000 people yearly in US hospitals. Four categories of medical error, including diagnosis, treatment, preventive and 'other' were described, while the reasoning processes that result in these errors are outlined by Reason et al. We utilise this rare case to illustrate these important concepts.

Rapid quantification of histamine in human psoriatic plaques using microdialysis and ultra high performance liquid chromatography with fluorescence detection.

Psoriasis is a chronic skin disease resulting from abnormal immune function and is characterized by the presence of scaly psoriatic plaques which are areas of inflammation and excessive skin production. The psoriatic plaques contain mast cells which are increased in number in the uppermost dermis of the psoriatic lesion and which may play a role in the initiation and maintenance of the lesion. These processes are thought to be mediated via the local release of histamine along with other mediators from the mast cells; however their precise role still remains a mystery. Our study involved the development of a rapid and ultra-sensitive liquid chromatographic method for the separation and detection of histamine. To this end a state-of-the-art ultra high pressure liquid chromatography (UHPLC) system incorporating the latest technology in fluorescence detection system was employed which allowed for the rapid and reliable trace level detection of histamine in human derived microdialysate samples. This new reverse phase method utilized a sub-two-micron packed C(18) stationary phase (50 mm × 4.6 mm, 1.8 µm particle size) and a polar mobile phase of ACN:H(2)O:acetic acid (70:30:0.05) (v/v). The column temperature was maintained at (30±2°C), the injection volume was (8 µl), with a flow rate of (1.1 ml/min). Dermal microdialysis was used to collect (20 µl) samples from healthy, peri-lesional and lesional skin regions, in the forearms of a small cohort of subjects (n=6), and the ultra sensitive liquid chromatographic method allowed for nanomolar quantitation of histamine in 6.7 min. To date this represents one of the fastest reported separations of histamine using fluorescence detection with very high chromatographic efficiency (258,000/m) and peak symmetry of (0.88). Prior to sample analysis being performed method linearity, precision and limit of detection (LOD) were investigated. The results showed that intracutaneous histamine measured at 70 min after catheter implantation was (3.44±.52 nmol) (mean±SEM) in non-lesional (control) skin and was not dissimilar to that observed in either lesional (3.10±.76 nmol) or peri-lesional skin (2.24±.20 nmol). A second fraction collected 190 min after implantation also revealed similar levels with no difference in intracutaneous histamine observed between control (2.41±.56 nmol), lesional (2.69±.54 nmol), or peri-lesional skin (2.25±.50 nmol).

Delusional parasitosis: lessons learnt.

Delusional parasitosis manifests in the patient's firm belief that they have skin symptoms due to an infestation with insects. Patients often refuse to seek psychiatric care. This study reassessed patients with delusional parasitosis in order to review and learn from them, which is important due to the significant morbidity of this condition and the therapeutic difficulties it presents to the dermatologist. Between 1995 and 2008, 13 patients with delusional parasitosis (6 men, 7 women; mean age 46 years) were included in this retrospective study. Mean duration of follow-up was 50.1 months. Nine patients were treated with pimozide, but only two had complete remission. Four were treated with sulpiride with two reported partial remissions. Risperidone was given to four patients, resulting in one partial remission. Eight patients were seen in the last 6 months and five were lost to follow-up. These findings highlight the difficulties encountered in diagnosing delusional parasitosis, the lack of response to neuroleptic medication, compliance problems and the dermatologist's dilemma of managing a psychiatric condition in a dermatological setting.