Dermatology

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Prevention and management of PU and its implications to patient outcomes, length of hospitalisation and trust budget
(University Hospitals Birmingham NHS Foundation Trust, 2025-05-30) De Veyra, Alberto III Custodio; University Hospitals Birmingham NHS Foundation Trust; Ward 29 (Lower GI) and Surgical Assessment Unit; Nursing and Midwifery Registered; De Veyra, Alberto III Custodio
I. Introduction At present, the University Hospitals Birmingham NHS Foundation Trust (UHB) is not yet implementing any form of skin tone assessment which puts its patients at risk especially those with dark skin tones. In addition, a more intentional use of information, language, terminology and illustrative images on dark skin tones during staff training should be applied to equip staff in ensuring that care is tailored to the individual and their needs on all acute sites of UHB namely Queen Elizabeth Hospital Birmingham (QEHB), Birmingham Heartlands Hospital (BHH), Good Hope Hospital (GHH) and Solihull Hospital (SH). A total of 5,787 and 21,994 PU was reported in GHH and the whole of UHB, respectively between April 2023 and July 2024. In Ward 29 of GHH alone which has 24-bed capacity, a total of 85 PU was reported during the above-mentioned dates. This number could be less than the actual as only an average of 72.2% of skin assessments were completed within that span. The lack of formal training and competence on skin tone assessment may have contributed to this underreporting as the focus on identifying ‘redness’ for instance which may differ in presentation depending on skin tone, has created a bias that mean patients with dark skin tones may not receive accurate diagnosis and care. II. Problem statement: Inaccurate daily skin assessments that could lead to the development and poor management of Moisture Associated Skin Damage (MASD) and Pressure Ulcers (PU) among patients in Ward 29. III. Aims: The aim of this project is to equip Ward 29 staff with the necessary knowledge, skills and tools on PU categorisation to all patients of different skin tones to facilitate a more accurate skin assessment. The following objectives are crucial towards the fulfilment of the QI project aim: •To ensure that roles and responsibilities between Nurses/Nursing Associates and HCAs on skin assessment and recording are clearly defined, properly communicated, and reinforced. •To facilitate staff training/refresher course on PU categorisation and skin tone assessment. •To introduce a paper form skin assessment chart with PU categorisation guide and skin tone assessment tool that can be transposed on Prescribing Information and Communication System (PICS). IV. Goal: To improve Ward 29's overall performance on completed skin assessments on PICS from 72.2% to 80% and reduce the number of Trust-Acquired Pressure Ulcers (TAPU) within the Department in 12 months. V. Change Idea This QI project seeks to prioritise two change ideas such as (1) facilitating staff training/refresher course on PU categorisation and skin tone assessment and (2) introducing a paper form skin assessment chart with PU categorisation guide and skin tone assessment tool that can be transposed on Prescribing Information and Communication System (PICS) in Ward 29 of GHH. Among the different factors that lead to the inaccurate daily skin assessments in Ward 29 as shown in the fishbone diagram, the lack of staff training and paper form chart on PU categorisation and skin tone assessment contribute to most of the problem. Using the Pareto principle, there is a high probability of gaining the biggest improvement by tackling these two issues alone which are also less complicated to deal with than the other factors.
Epidermolysis bullosa.
(Nature Publishing Group, 2020-09-24) Bardhan, Ajoy; Bruckner-Tuderman, Leena; Chapple, Iain L C; Fine, Jo-David; Harper, Natasha; Has, Cristina; Magin, Thomas M; Marinkovich, M Peter; Marshall, John F; McGrath, John A; Mellerio, Jemima E; Polson, Rex; Heagerty, Adrian H; Dermatology; Medical and Dental; Bardhan, Ajoy; Harper, Natasha; Heagerty, Adrian
Epidermolysis bullosa (EB) is an inherited, heterogeneous group of rare genetic dermatoses characterized by mucocutaneous fragility and blister formation, inducible by often minimal trauma. A broad phenotypic spectrum has been described, with potentially severe extracutaneous manifestations, morbidity and mortality. Over 30 subtypes are recognized, grouped into four major categories, based predominantly on the plane of cleavage within the skin and reflecting the underlying molecular abnormality: EB simplex, junctional EB, dystrophic EB and Kindler EB. The study of EB has led to seminal advances in our understanding of cutaneous biology. To date, pathogenetic mutations in 16 distinct genes have been implicated in EB, encoding proteins influencing cellular integrity and adhesion. Precise diagnosis is reliant on correlating clinical, electron microscopic and immunohistological features with mutational analyses. In the absence of curative treatment, multidisciplinary care is targeted towards minimizing the risk of blister formation, wound care, symptom relief and specific complications, the most feared of which - and also the leading cause of mortality - is squamous cell carcinoma. Preclinical advances in cell-based, protein replacement and gene therapies are paving the way for clinical successes with gene correction, raising hopes amongst patients and clinicians worldwide.
Diagnosis and management of psychodermatological problems: confidence levels among dermatologists and psychiatrists.
(Oxford University Press, 2020-02-25) Muralidharan, V; Zahedi, D; Kaur, B; Goulding, J M R; Dermatology; Medical and Dental; Goulding, Jon
No abstract available
An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial).
(Oxford University Press, 2020-11-04) Sach, T H; Thomas, K S; Batchelor, J M; Perways, A; Chalmers, J R; Haines, R H; Meakin, G D; Duley, L; Ravenscroft, J C; Rogers, A; Santer, M; Tan, W; White, J; Whitton, M E; Williams, H C; Cheung, S T; Hamad, H; Wright, A; Ingram, J R; Levell, N; Goulding, J M R; Makrygeorgou, A; Bewley, A; Ogboli, M; Stainforth, J; Ferguson, A; Laguda, B; Wahie, S; Ellis, R; Azad, J; Rajasekaran, A; Eleftheriadou, V; Montgomery, A A; Dermatology; Medical and Dental; Goulding, Jon
Background: Economic evidence for vitiligo treatments is absent. Objectives: To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo. Methods: Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months' treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015. Results: The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188-235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151-196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment. Conclusions: Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.
Algorithm based smartphone apps to assess risk of skin cancer in adults: systematic review of diagnostic accuracy studies.
(British Medical Association, 2020-02-10) Freeman, Karoline; Dinnes, Jacqueline; Chuchu, Naomi; Takwoingi, Yemisi; Bayliss, Sue E; Matin, Rubeta N; Jain, Abhilash; Walter, Fiona M; Williams, Hywel C; Deeks, Jonathan J
Objective: To examine the validity and findings of studies that examine the accuracy of algorithm based smartphone applications ("apps") to assess risk of skin cancer in suspicious skin lesions. Design: Systematic review of diagnostic accuracy studies. Data sources: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, CPCI, Zetoc, Science Citation Index, and online trial registers (from database inception to 10 April 2019). Eligibility criteria for selecting studies: Studies of any design that evaluated algorithm based smartphone apps to assess images of skin lesions suspicious for skin cancer. Reference standards included histological diagnosis or follow-up, and expert recommendation for further investigation or intervention. Two authors independently extracted data and assessed validity using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2 tool). Estimates of sensitivity and specificity were reported for each app. Results: Nine studies that evaluated six different identifiable smartphone apps were included. Six verified results by using histology or follow-up (n=725 lesions), and three verified results by using expert recommendations (n=407 lesions). Studies were small and of poor methodological quality, with selective recruitment, high rates of unevaluable images, and differential verification. Lesion selection and image acquisition were performed by clinicians rather than smartphone users. Two CE (Conformit Europenne) marked apps are available for download. SkinScan was evaluated in a single study (n=15, five melanomas) with 0% sensitivity and 100% specificity for the detection of melanoma. SkinVision was evaluated in two studies (n=252, 61 malignant or premalignant lesions) and achieved a sensitivity of 80% (95% confidence interval 63% to 92%) and a specificity of 78% (67% to 87%) for the detection of malignant or premalignant lesions. Accuracy of the SkinVision app verified against expert recommendations was poor (three studies). Conclusions: Current algorithm based smartphone apps cannot be relied on to detect all cases of melanoma or other skin cancers. Test performance is likely to be poorer than reported here when used in clinically relevant populations and by the intended users of the apps. The current regulatory process for awarding the CE marking for algorithm based apps does not provide adequate protection to the public. Systematic review registration: PROSPERO CRD42016033595.
AI-based smartphone apps for risk assessment of skin cancer need more evaluation and better regulation.
(Nature Publishing Group, 2021-03-19) Matin, Rubeta N; Dinnes, Jacqueline
Smartphone applications ("apps") with artificial intelligence (AI) algorithms are increasingly used in healthcare. Widespread adoption of these apps must be supported by a robust evidence-base and app manufacturers' claims appropriately regulated. Current CE marking assessment processes inadequately protect the public against the risks created by using smartphone diagnostic apps.
A heterozygous mutation in GJB2 (Cx26F142L) associated with deafness and recurrent skin rashes results in connexin assembly deficiencies.
(Munksgaard, 2020-09-22) Albuloushi, Ahmad; Lovgren, Marie-Louise; Steel, Ainsley; Yeoh, Yeelon; Waters, Alex; Zamiri, Mozheh; Martin, Patricia E; Dermatology; Medical and Dental; Lovgren, Marie-Louise
Mutations in GJB2 encoding Connexin 26 (CX26) are associated with hearing loss and hyperproliferative skin disorders of differing severity including keratitis-ichthyosis-deafness (KID) and Vohwinkel syndrome. A 6-year-old Caucasian girl who presented with recurrent skin rashes and sensorineural hearing loss harboured a heterozygous point mutation in GJB2 (c.424T > C; p.F142L). To characterize the impact of CX26F142L on cellular events. Plasmids CX26WT, CX26F142L, CX26G12R (KID) or CX26D66H (Vohwinkel) were transfected into HeLa cells expressing Cx26 or Cx43 or into HaCaT cells, a model keratinocyte cell line. Confocal microscopy determined protein localization. MTT assays assessed cell viability in the presence or absence of carbenoxolone, a connexin-channel blocker. Co-immunoprecipitation/Western blot analysis determined Cx43:Cx26 interactions. Quantitative real-time polymerase chain reaction assessed changes in gene expression of ER stress markers. Dye uptake assays determined Connexin-channel functionality. F142L and G12R were restricted to perinuclear areas. Collapse of the microtubule network, rescued by co-treatment with paclitaxel, occurred. ER stress was not involved. Cell viability was reduced in cells expressing F142L and G12R but not D66H. Unlike G12R that forms "leaky" hemichannels, F142L had restricted permeability. Cell viability of F142L and G12R transfected cells was greater in HeLa cells expressing Cx43 than in native Cx-free HeLa cells. Co-immunoprecipitation suggested a possible interaction between Cx43 and the three mutations. Expression of CX26F142L and G12R results in microtubule collapse, rescued by interaction with Cx43. The GJB2 mutations interacted with Cx43 suggesting that unique Cx43:Cx26 channels are central to the diverse phenotype of CX26 skin-related channelopathies.
A case report on the use of topical cysteamine 5% cream in the management of refractory postinflammatory hyperpigmentation (PIH) resistant to triple combination cream (hydroquinone, topical corticosteroids, and retinoids).
(Blackwell Science, 2020-10-31) Mathe, Nomathamsanqa; Balogun, Mariam; Yoo, Jinah
Background: Postinflammatory hyperpigmentation (PIH) occurs as a result of different inflammatory dermatoses and exogenous factors in individuals with darker skin types. With current skin lightening treatments, there are concerns about irritation leading to worsening of their underlying inflammatory skin condition or worsening of PIH. Case: A 20-year-old woman with Fitzpatrick skin type (FST) V presented with facial hyperpigmented patches since childhood following an intermittent erythematous, pruritic facial rash. Skin biopsy confirmed PIH secondary to possible burnt-out morphea. Treatment with topical adapalene 0.1% gel and triple combination cream (containing hydroquinone, topical corticosteroids, and retinoids) proved unsuccessful. Treatment with cysteamine 5% cream over 4 months resulted in significant improvement with a reduction in the melanin index. Discussion: The current recommendation for first-line treatment in PIH is hydroquinone or triple combination cream containing hydroquinone, which can be associated with significant short- and long-term side effects. Cysteamine 5% cream is one of the latest cosmetic skin lightening products. It is hypothesized that cysteamine reduces melanin production by inhibiting key melanogenic enzymes required in melanogenesis. Its efficacy and tolerability have been demonstrated in two randomized controlled trials against placebo in patients with melasma. This report demonstrates a successful use of cysteamine 5% cream in a patient with chronic severe PIH.
A 10-year review of surgical management of dermatofibrosarcoma protuberans.
(Oxford University Press, 2020-09-16) Durack, A; Gran, S; Gardiner, M D; Jain, A; Craythorne, E; Proby, C M; Marsden, J; Harwood, C A; Matin, R N
Background: Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer. Standard treatment in the UK is either wide local excision (WLE) or Mohs micrographic surgery (MMS). It is unclear which approach has the lower recurrence rate. Objectives: We undertook a retrospective comparative review of surgical management of DFSP in the UK National Health Service in order to define (i) current surgical practice for primary and recurrent DFSP, (ii) local recurrence rates for primary DFSP and (iii) survival outcomes for DFSP. Methods: A retrospective clinical case-note review of patients with histologically confirmed DFSP (January 2004 to December 2013) who have undergone surgical treatment. Results: The surgical management of 483 primary and 64 recurrent DFSP in 11 plastic surgery and 15 dermatology departments was analysed. Almost 75% of primary DFSP (n = 362) were treated with WLE and 20% (n = 97) with MMS. For recurrent DFSP, 69% (n = 44) and 23% (n = 15) of patients underwent WLE and MMS, respectively. Recurrent primary DFSP occurred in six patients after WLE and none after MMS. The median follow-up time was 25·5 months (interquartile range 6·8-45·1) for new and 19·8 (IQR 4·5-44·5) for recurrent DFSP [Correction added on 1 Feb 2021, after first online publication: 4.8 years (interquartile range 3.5-5.8) was incorrect], with eight reported deaths during the follow-up analysis period (one confirmed to be DFSP related). Conclusions: WLE was the most common surgical modality used to treat DFSP across the UK. The local recurrence rate was very low, occurring only after WLE. Although a prospective randomized controlled trial may provide more definitive outcomes, in the absence of a clearly superior surgical modality, treatment decisions should be based on patient preference, clinical expertise and cost.
Comment on 'Augmenting secondary intention healing in dermatologic surgery through low-cost interventions'
(Oxford University Press, 2025-03-29) Potluru, Aparna; Barlow, Richard; Wernham, Aaron; Leicester Royal Infirmary; University Hospital Birmingham NHS Foundation Trust; Walsall Healthcare NHS Trust; Dermatology; Medical and Dental; Wernham, Aaron
No abstract available
A case series of shared delusional infestation: folie à deux revisited.
(Oxford University Press, 2019-12-20) Jerrom, R; Mortimer, H; Martin, K; Siddiquee, R; Bagchi, D; Goulding, J M R; Nursing; Dermatology; Medical and Dental; Nursing and Midwifery Registered; Bagchi, Dhruba; Goulding, Jon
Delusional infestation describes the unshakeable belief that one's skin is infected or infested with an external organism or inanimate material, in the absence of supportive medical evidence. It is one of the most challenging psychodermatological conditions to manage, given the rigidity of patients' physically focused health beliefs, and the competing need to introduce antipsychotic therapy to bring about resolution. This is rendered exponentially more complex when partners or family members are similarly afflicted. This situation is known as shared delusional infestation, shared psychotic disorder (SPD), or folie à deux. We present a series of three couples with SPD who were referred to our tertiary psychodermatology service during the same year. On examining the literature we were intrigued to discover that subtly different subtypes of SPD have been recognized since the late 1800s. These include folie simultanée, imposée, communiquée and induite. Our cases neatly demonstrate three of these variants, and highlight the difficulties in facilitating effective treatment.
A characteristic rash caused by Shiitake mushrooms - An emerging concern?
(John Wiley & Sons, 2021-05-05) Maruthappu, Thiviyani; Hader, Zahra
Shiitake mushroom dermatitis is a striking rash that can present as an emergency. Despite the dramatic appearance, the rash is an idiosyncratic reaction which resolves spontaneously and does not progress to anaphylaxis.
Approach to Mycosis Fungoides in children: Consensus-based recommendations
(Mosby, 2024-08-23) Zvulunov, Alex; Neale, Holly; Stern, Jonah; Santaguida, Pasqualina; Stein, Amy Buros; Koh, Mark; Eichenfield, Lawrence F; Guitart, Joan; Goebeler, Matthias; Scarisbrick, Julia; Willemze, Rein; Coughlin, Carrie C; George, Renu; Brazzelli, Valeria; Marschalkó, Márta; Belousova, Irena; Querfeld, Christiane; Bagot, Martine; Szepietowski, Jacek C; Papadavid, Evangelina; Quaglino, Pietro; Hoeger, Peter; Ortiz-Romero, Pablo L; Nikolaou, Vasiliki; Dummer, Reinhard; Aung, Phyu P; Lawley, Leslie; Morel, Kimberly D; Ngan, Bo; Wain, Mary; Gameiro, Ana; Lacy-Niebla, Rosa María; Pope, Elena; Dermatology; Medical and Dental; Scarisbrick, Julia
Background: Pediatric Mycosis fungoides (MF) management extrapolates from adult guidelines, despite differing clinical aspects. Recommendations are essential to address unique challenges in this distinct patient group. Objective: This project aims to derive consensus recommendations for pediatric MF management. Methods: Experts from pediatric dermatology, general dermatology, dermatopathology, and pediatric hematology-oncology (N = 83) were invited to contribute to consensus recommendations. The process involved 3 electronic Delphi rounds, concluding with a final consensus meeting using a modified Nominal Group Technique for unresolved items. Results: Consensus included more clinical severity measures than tumor-node-metastasis-blood staging: pruritus, functional or esthetic impairment (eg, palms, soles, genitalia), quality of life impact, and psychological aspects (eg, embarrassment, anxiety, depression), plus parental anxiety. Ten recommendations were made for managing early and advanced pediatric MF. Disagreement emerged in choosing therapies beyond stage I of the disease. Discussion: This multinational initiative aimed to standardize optimal pediatric MF management and successfully generated consensus recommendations. Additional work is needed for structured, prospective protocols in advanced-stage pediatric MF. Limitations: Lack of pediatric hematologists-oncologists and patients' representatives. Conclusion: Documentation of extended clinical severity and outcome measures is recommended. Addressing the need for structured protocols in advanced-stage pediatric MF and implementing systematic, prospective data collection is crucial.
Comparative analysis of cellulite treatment modalities: a systematic review.
(Springer-Verlag, 2024-11-15) Lim, Su Kwan; Gultekin, Gozde; Suresan, Srutti; Jacob, Anu; Zou, Yutong; Liyanage, Dinithi D; Parekh, Jvalant N; Mavilakandy, Akash K; Vyas, Krishna; Khajuria, Ankur; Respiratory; Surgery; Medical and Dental; Liyanage, Dinithi D; Parekh, Jvalant N
Background: Cellulite is a highly prevalent and aesthetically distressing skin condition. Whilst there are a variety of treatment modalities, none are definitively established. Objective: This systematic review aims to assess invasive and noninvasive treatment modalities for cellulite management. Methods: The review protocol was published and registered a priori (PROSPERO CRD42022359334). A comprehensive electronic search for relevant randomised controlled trials, (RCTs) was performed in CENTRAL, MEDLINE, Embase and Web of Science databases. Study quality and risk of bias were assessed using Cochrane's risk of bias tool, respectively. Results: Overall, 753 studies were initially identified, of which 24 randomised controlled trials (RCTs) satisfied the eligibility criteria with a total of 2084 patients with a mean follow-up of 3.33 ± 13.4 weeks. Evaluated interventions included mechanical stimulation, topical therapy, shock wave therapy (SWT), laser and light-based devices, radiofrequency therapy, subcutaneous injectables, and ultrasound. SWT emerged as a standout intervention, demonstrating a consistent cellulite reduction score of 2.07 ± 0.39 across four studies. Radiofrequency therapy exhibited a statistically significant reduction of thigh circumference (- 2.09 cm, p < 0.001) and subcutaneous tissue thickness (- 2.23 cm, p < 0.001). Subcutaneous injectables, specifically collagenase Clostridium histolyticum-aaes, demonstrated a statistically significant improvement in the clinician-reported photonumeric cellulite severity scale (17.0%) and patient-reported photonumeric cellulite severity scale (25.7%) (p < 0.001). The overall quality of the studies using the grading of recommendations, assessment, development and evaluation approach was moderate. Conclusion: This is the first methodologically robust systematic review evaluating interventions for cellulite. SWT, radiofrequency therapy, and subcutaneous injectables have shown promising findings in cellulite treatment. Level of evidence i: The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .
Bilateral lower limb ulceration in a patient with a malignancy
(Oxford University Press, 2024-12-13) Riley, Callum; Butt, Sanaa; Mathe, Nomathamsanqa; Cain, Owen; Kaushal, Ghazia; University Hospitals Birmingham NHS Foundation Trust; Internal Medicine; Cellular Pathology; Dermatology; Medical and Dental; Riley, Callum; Cain, Owen; Kaushal, Ghazia
No abstract available
Reducing the risk of seating acquired pressure ulcers: An update on the society of tissue viability clinical guide.
(Tissue Viability Society, 2024-10-04) Worsley, Peter R; Stephens, Melanie; Bartley, Carol; Neill, Sharon; Marshall, Ayesha; Greenwood, Clare; Chester Bessell, Deborah; Rose, Samantha; Scattergood, Sharon; Rooney, Samantha; Physiotherapist; Allied Health Professional; Rooney, Samantha
No abstract available
Cutaneous metastasis: A rare presentation of prostate cancer.
(Oxford University Press, 2024-10-08) Passby, Lauren; Colloby, Peter; Roberts, Claudia; Preston, Philip; University Hospitals Birmingham NHS Foundation Trust.; Pathology; Dermatology; Histopathology; Medical and Dental; Passby, Lauren; Colloby, Peter; Roberts, Claudia; Preston, Philip
No abstract available
Findings of the british association of dermatologists career survey of dermatologists in training and new consultant dermatologists 2023.
(Oxford University Press, 2024-10-25) Passby, Lauren; Bardhan, Ajoy; Griffiths, Tamara; Chowdhury, Mahbub M; Dermatology; Medical and Dental; Passby, Lauren; Bardhan, Ajoy
Previous surveys of UK dermatology trainees have identified key patterns regarding future career intentions that can help to inform workforce planning as consultant vacancies continue to grow. We invited all doctors training in dermatology, as well as all dermatology doctors who have completed training between 2018-2023 to complete separate surveys over a six-week period. These surveys explored: career locations, working patterns, pull factors towards particular posts, and push factors away from NHS consultant posts. The findings of these surveys confirm persisting trends towards less than full time working, ongoing limited geographical mobility of trainees, and a reducing appetite for academic work all identified in previous surveys. This survey offers the first insight into the working lives and factors influencing these career choices of consultants who completed their dermatology training between 2018-2023.
Raising the bar for randomized trials involving artificial intelligence: the SPIRIT-artificial intelligence and CONSORT-artificial intelligence guidelines
(Elsevier, 2021-03-22) Taylor, Matthew; Liu, Xiaoxuan; Denniston, Alastair; Esteva, Andre; Ko, Justin; Daneshjou, Roxana; Chan, An-Wen; University of Birmingham; Health Data Research UK; University Hospitals Birmingham NHS Foundation Trust; Moorfields Eye Hospital NHS Foundation Trust; UCL Institute of Ophthalmology; Salesforce AI Research; Stanford University School of Medicine; University of Toronto; Ophthalmology; Medical and Dental; Denniston, Alastair
Artificial intelligence (AI)-based applications have the potential to improve the quality and efficiency of patient care in dermatology. Unique challenges in the development and validation of these technologies may limit their generalizability and real-world applicability. Before the widespread adoption of AI interventions, randomized trials should be conducted to evaluate their efficacy, safety, and cost effectiveness in clinical settings. The recent Standard Protocol Items: Recommendations for Interventional Trials-AI extension and Consolidated Standards of Reporting Trials-AI extension guidelines provide recommendations for reporting the methods and results of trials involving AI interventions. High-quality trials will provide gold standard evidence to support the adoption of AI for the benefit of patient care.
The epidemiology of epidermolysis bullosa in England and Wales: data from the national epidermolysis bullosa database
(Oxford University Press, 2022-03-31) Petrof, Gabriela; Papanikolaou, Maria; Martinez, Anna E; Mellerio, Jemima E; McGrath, John A; Bardhan, Ajoy; Harper, Natasha; Heagerty, Adrian; Ogboli, Malobi; Chiswell, Christopher; Moss, Celia; Dermatology; Medical and Dental; Bardhan, Ajoy; Harper, Natasha; Heagerty, Adrian
Background: The National Health Service (NHS) epidermolysis bullosa (EB) service, established in 2002, offers comprehensive, free care to all patients in England and Wales. Objectives: To quantify prevalence, incidence and mortality of EB in England and Wales. Methods: Demographic data for patients in England and Wales were collected on a secure electronic database, prospectively from January 2002 to April 2021 and retrospectively for cases prior to 2002. Vital status was verified using central NHS data. Results: By March 2021, 2594 individuals were registered, of whom 2361 were living, which yielded a prevalence of 34·8 per million of the population for all EB types [EB simplex (EBS) 17 per million, dystrophic EB (DEB) 10·7 per million, junctional EB (JEB) 1 per million and Kindler EB 0·3 per million]. We recorded 1200 babies with EB born since 2002. The average incidence per million live births for EBS, DEB, JEB and Kindler EB was 32·5, 26·1, 8·9 and 0·9, respectively (total incidence for all types of EB was 67·8 per million). Birth rates fell progressively over the 19-year period for JEB-severe (JEB-S) (r = -0·56) and recessive DEB-severe (r = -0·44) and also for milder types of EB. We observed longer survival in JEB-S over the 19-year period (r2 = 0·18) with a median survival of 12·7 months over the past 5 years. Conclusions: In this study, we provide the first accurate epidemiological data for EB in England and Wales. We believe the observed reduction in birth incidence of severe types of EB reflects an uptake of genetic counselling advice, whereas the reduction in milder types may be due to delayed presentation. A potential small trend towards longer survival of babies with JEB-S may reflect improved multidisciplinary care.

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