The Dermatology Center

Manchester, United Kingdom

The Dermatology Center

Manchester, United Kingdom
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Wang H.,Missouri University of Science and Technology | Chen X.,Apple Inc | Moss R.H.,Missouri University of Science and Technology | Stanley R.J.,Missouri University of Science and Technology | And 8 more authors.
Skin Research and Technology | Year: 2010

Background/purpose: Automatic lesion segmentation is an important part of computer-based image analysis of pigmented skin lesions. In this research, a watershed algorithm is developed and investigated for adequacy of skin lesion segmentation in dermoscopy images. Methods: Hair, black border and vignette removal methods are introduced as preprocessing steps. The flooding variant of the watershed segmentation algorithm was implemented with novel features adapted to this domain. An outer bounding box, determined by a difference function derived from horizontal and vertical projection functions, is added to estimate the lesion area, and the lesion area error is reduced by a linear estimation function. As a post-processing step, a second-order B-Spline smoothing method is introduced to smooth the watershed border. Results: Using the average of three sets of dermatologist-drawn borders as the ground truth, an overall error of 15.98% was obtained using the watershed technique. Conclusion: The implementation of the flooding variant of the watershed algorithm presented here allows satisfactory automatic segmentation of pigmented skin lesions. © 2010 John Wiley & Sons A/S.


Wang H.,Missouri University of Science and Technology | Moss R.H.,Missouri University of Science and Technology | Chen X.,Apple Inc | Stanley R.J.,Missouri University of Science and Technology | And 8 more authors.
Computerized Medical Imaging and Graphics | Year: 2011

In previous research, a watershed-based algorithm was shown to be useful for automatic lesion segmentation in dermoscopy images, and was tested on a set of 100 benign and malignant melanoma images with the average of three sets of dermatologist-drawn borders used as the ground truth, resulting in an overall error of 15.98%. In this study, to reduce the border detection errors, a neural network classifier was utilized to improve the first-pass watershed segmentation; a novel "edge object value (EOV) threshold" method was used to remove large light blobs near the lesion boundary; and a noise removal procedure was applied to reduce the peninsula-shaped false-positive areas. As a result, an overall error of 11.09% was achieved. © 2010 Elsevier Ltd.


Weidmann A.,The Dermatology Center | Foulkes A.C.,The Dermatology Center | Kirkham N.,Royal Free London NHS Foundation Trust | Reynolds N.J.,Newcastle University
Dermatology and Therapy | Year: 2014

Methotrexate continues to be one of the most widely used systemic immunosuppressive agents in dermatology. In addition to the important, well-characterized adverse effects such as hepatotoxicity and myelosuppression, methotrexate may induce a number of rare cutaneous adverse events including methotrexate-induced ulceration. We present a case of methotrexate-induced cutaneous ulceration in a patient with chronic plaque psoriasis occurring during long-standing methotrexate therapy. Withdrawal of the drug and appropriate skin care led to rapid healing of the ulceration and the agent was later safely reintroduced for the ongoing management of the patient’s chronic plaque psoriasis. Review of the literature demonstrates cases of this important rare adverse event, primarily occurring in patients with chronic plaque psoriasis, induced by triggers such as accidental overdose or introduction of an interacting agent. Cutaneous ulceration typically precedes other markers of toxicity. Active treatment with folinic acid (calcium leucovorin) may be required. Early recognition, prompt cessation of methotrexate, and appropriate treatment minimizes morbidity. Dermatologists need to be alert to the possibility of cutaneous adverse events associated with methotrexate therapy, aware of potential drug interactions, and confident in the management of methotrexate toxicity. © 2014, The Author(s).


Weidmann A.K.,The Dermatology Center | Al-Niaimi F.,St Johns Institute Of Dermatology | Lyon C.C.,York Teaching Hospital NHS Foundation Trust
Dermatology and Therapy | Year: 2014

Background: Stomal leaks can be associated with significant social, psychological and physical morbidity for ostomy patients. Poor fitting of the stoma appliance due to irregularities of skin contours is one cause of stoma leaks which commonly result in secondary irritant dermatitis prompting presentation to a dermatologist. In addition to skin-directed topical therapy and review of stoma appliances, correction of contour defects with intradermal injections of filler materials is one possible treatment to improve adhesion and reduce leaks.Cases: We report eight cases of ostomy patients, who presented with stoma leaks and associated dermatitis, who were treated with intradermal injections of the porcine collagen (Permacol™) or subcutaneous injections of polyacrylamide hydrogel (Aquamid Reconstruction™) for correction of skin contour defects. Resolution or improvement of symptoms was achieved for five patients, and no complications were noted as a result of treatment.Conclusions: This report represents the largest series of ostomy patients treated for correction of peristomal skin contour defects with injection therapy. Treatment was well tolerated and performed in the outpatient setting under local anesthetic. Attempted correction of peristomal skin contour defects using injection of filler materials represents a potential alternative to surgical intervention and can result in significant benefits for the patient. © 2014, The Author(s).


PubMed | Allergan, Inc., Saint Louis University, University of Nottingham, University of California at Los Angeles and 2 more.
Type: Journal Article | Journal: The British journal of dermatology | Year: 2015

Bimatoprost ophthalmic solution 003% is approved in several countries for the treatment of eyelash hypotrichosis. Previous trials were limited to 4 months of treatment and primarily idiopathic hypotrichosis.To evaluate the long-term safety and efficacy of bimatoprost in patients with idiopathic or chemotherapy-induced hypotrichosis.This multicentre, double-masked, randomized, parallel-group study included two 6-month treatment periods [treatment period 1 (TP1) and treatment period 2 (TP2)]. Patients with idiopathic hypotrichosis were randomized to three treatment groups: (i) bimatoprost (TP1 and TP2); (ii) bimatoprost (TP1) and vehicle (TP2); and (iii) vehicle (TP1) and bimatoprost (TP2). Patients with chemotherapy-induced hypotrichosis were randomized to two treatment groups: (i) bimatoprost or vehicle (TP1) and (ii) bimatoprost (TP2). Primary end point was a composite of at least a one-grade improvement in investigator-assessed Global Eyelash Assessment and at least a three-point improvement in patient-reported Eyelash Satisfaction Questionnaire Domain 2 at month 4. Secondary measures included digitally assessed eyelash characteristics.The primary efficacy end point was met in both populations (idiopathic responder rate was 402% for bimatoprost vs. 68% for vehicle; postchemotherapy responder rate was 375% for bimatoprost vs. 182% for vehicle). Efficacy by month 6 was maintained (idiopathic) or enhanced (postchemotherapy) at 12 months. Treatment effects were maintained for approximately 2 months but markedly diminished 4-6 months following treatment cessation in patients with idiopathic hypotrichosis. No drug-related serious adverse events were reported.Daily treatment with bimatoprost ophthalmic solution 003% for 1 year was effective and well tolerated in patients with idiopathic and chemotherapy-induced hypotrichosis.


Laws P.M.,The Dermatology Center | Baker P.,The Dermatology Center | Singh M.,The Dermatology Center
Clinical Teacher | Year: 2012

Background: UK medical graduates are required to reach standards defined by the General Medical Council (in Tomorrows Doctors) in all specialties, including dermatology. Aims: We assessed the self-reported competence of Foundation Year 1 (FY1) doctors in the diagnosis and management of skin disease correlated against their undergraduate dermatology experience. Methods: The FY1 doctors attending a teaching programme were surveyed at six hospital sites throughout the North Western Deanery. Questionnaires were completed on self-reported competence in learning outcomes defined by the British Association of Dermatologists (BAD). Information recorded previous undergraduate teaching (duration and delivery), and whether they felt sufficiently prepared to diagnose and manage patients with skin disease in their clinical practice. Results: Of 174 FY1 doctors, 118 attended the teaching sessions. All of the attendees completed a questionnaire. Trainees who undertook longitudinal placements in dermatology (defined as 10 or more half days of clinical experience) regarded themselves significantly more prepared to practise for their stage of training: 61percent compared with 8.9percent (χ 2=32.8, df=1, p<0.05). Furthermore, these trainees rated their abilities in basic history taking, clinical examination, management of dermatological emergencies and diagnosis of skin malignancy as being greater than those who had not experienced longitudinal placements in the specialty. Conclusions: Longitudinal placements in dermatology offer undergraduates experience in the diagnosis and management of skin disease that develops confidence for foundation practice. © Blackwell Publishing Ltd 2012.


Felton S.J.,The Dermatology Center | Al-Niaimi F.,The Dermatology Center | Ferguson J.E.,The Dermatology Center | Madan V.,The Dermatology Center
Lasers in Medical Science | Year: 2013

Naevus of Ota (NO) is a disfiguring pigmentary disorder affecting the face. Q-switched neodymium-doped yttrium aluminium garnet (QS Nd:YAG)-1,064 nm is a standard laser treatment because it causes highly selective destruction of melanin within the aberrant dermal melanocytes. However, not all lesions respond. This study aims to evaluate the efficacy/safety of QS Nd:YAG-1,064 nm and the shorter wavelength QS Alexandrite-755 nm and QS Nd:YAG-532 nm lasers in treating NO. Data were evaluated from 21 patients treated in our laser centre from 2004 to 2012. Lesional skin was irradiated with QS-532 nm/QS-755 nm/QS-1,064 nm, with settings titrated according to responses. All received initial test patches to direct initial wavelength choice, with subsequent treatments at 3-monthly intervals until clearance/lack of further response. Laser modality was switched following repeated test patches if there was no or no sustained improvement. Two thirds of patients had ≥90 % improvement compared to baseline photographs. In 20 % of patients, QS-1,064 nm was most efficacious with 97 % mean improvement. The mean improvement was 80 % for those in whom QS-755 nm was superior, and 90 % for QS-532 nm. Median number of overall laser treatments was 8 (range 4-13). Number of treatments required varied significantly according to lesional colour and site: grey lesions and those on the forehead/temple were most resistant. We confirm successful treatment of NO with QS Nd:YAG-1,064 nm and the shorter wavelength QS-755 nm/QS-532 nm lasers without serious or irreversible side effects. We recommend judicious test patch analysis before treatment and a modality switch if complete clearance is not obtained © 2013 Springer-Verlag London.


PubMed | The Dermatology Center
Type: Journal Article | Journal: Dermatology and therapy | Year: 2014

Methotrexate continues to be one of the most widely used systemic immunosuppressive agents in dermatology. In addition to the important, well-characterized adverse effects such as hepatotoxicity and myelosuppression, methotrexate may induce a number of rare cutaneous adverse events including methotrexate-induced ulceration. We present a case of methotrexate-induced cutaneous ulceration in a patient with chronic plaque psoriasis occurring during long-standing methotrexate therapy. Withdrawal of the drug and appropriate skin care led to rapid healing of the ulceration and the agent was later safely reintroduced for the ongoing management of the patients chronic plaque psoriasis. Review of the literature demonstrates cases of this important rare adverse event, primarily occurring in patients with chronic plaque psoriasis, induced by triggers such as accidental overdose or introduction of an interacting agent. Cutaneous ulceration typically precedes other markers of toxicity. Active treatment with folinic acid (calcium leucovorin) may be required. Early recognition, prompt cessation of methotrexate, and appropriate treatment minimizes morbidity. Dermatologists need to be alert to the possibility of cutaneous adverse events associated with methotrexate therapy, aware of potential drug interactions, and confident in the management of methotrexate toxicity.


PubMed | International Psoriasis Council, St Vincents Hospital, Kaiser Permanente, Innovaderm Research and 4 more.
Type: Journal Article | Journal: Journal of the European Academy of Dermatology and Venereology : JEADV | Year: 2016

In this age of expanding choices of therapy for psoriasis, topical therapies still play an important part in the management of patients. There are many knowledge gaps in topical therapy for psoriasis with regard to efficacy and safety as well as various combinations including topical therapy with phototherapy or with systemic agents. Councillors of the International Psoriasis Council comprised a topical therapy working group to describe these gaps in order to help direct future research endeavours. Herein, we present the results of this analysis, discuss topical agents in clinical development and the attributes of the ideal topical treatment for psoriasis.


PubMed | The Dermatology Center
Type: Journal Article | Journal: Dermatology and therapy | Year: 2014

Stomal leaks can be associated with significant social, psychological and physical morbidity for ostomy patients. Poor fitting of the stoma appliance due to irregularities of skin contours is one cause of stoma leaks which commonly result in secondary irritant dermatitis prompting presentation to a dermatologist. In addition to skin-directed topical therapy and review of stoma appliances, correction of contour defects with intradermal injections of filler materials is one possible treatment to improve adhesion and reduce leaks.We report eight cases of ostomy patients, who presented with stoma leaks and associated dermatitis, who were treated with intradermal injections of the porcine collagen (Permacol) or subcutaneous injections of polyacrylamide hydrogel (Aquamid Reconstruction) for correction of skin contour defects. Resolution or improvement of symptoms was achieved for five patients, and no complications were noted as a result of treatment.This report represents the largest series of ostomy patients treated for correction of peristomal skin contour defects with injection therapy. Treatment was well tolerated and performed in the outpatient setting under local anesthetic. Attempted correction of peristomal skin contour defects using injection of filler materials represents a potential alternative to surgical intervention and can result in significant benefits for the patient.

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