Clinical Service Line 04 - Opthalmology, Dermatology, Plastics, Outpatients, ENT/Audiology, OMFT/Dental

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    Dermatitis artefacta in the orofacial region: a case report with literature review
    (2023) Patel, Mumta; Mumtaz, Shadaab; Deroide, Florence; Amini, Ali
    In spite of wide prevalence, deliberate self-injury in the oro-facial region is rarely reported in literature. It is also associated with misinterpretation related to ‘attention seeking’ or ‘mental health crises’ leading to deficient understanding of this phenomenon. A literature review was performed using online search databases looking at dermatitis artefacta in the head and neck region. A case of a patient who was seen in our unit is also presented to give important insights into this condition. In total, 54 cases from 15 publications were included in this observational study. Female gender predilection was notable (4:1) with an average presenting age of 30 years. The face itself was more frequently injured, along with the neck and scalp. Only one-third (34%) of the patients were known to have psychiatric conditions, such as depressive and personality disorders. Dermatitis artefacta is a well-known skin condition caused by deliberate self-injury. It is a complex entity that is frequently unrecognized and underdiagnosed.
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    Atopic Polygenic Risk Score Is Associated with Paradoxical Eczema Developing in Patients with Psoriasis Treated with Biologics.
    (2023) Al-Janabi, Ali; Eyre, Steve; Foulkes, Amy; Khan, Adnan R.; Dand, Nick; Burova, Ekaterina; Makrygeorgou, Areti; Davies, Emily; Smith, Catherine H.; Griffiths, Christopher E. M.; Morris, Andrew P.; Warren, Richard B.
    Biologic therapies for psoriasis can cause paradoxical eczema. The role of genetic factors in its pathogenesis is unknown. To identify risk variants, we conducted a GWAS of 3,212 patients with psoriasis, of whom 88 developed paradoxical eczema. Two lead SNPs reached genome-wide significance (P ≤ 5 × 10-8) for association with paradoxical eczema: rs192705221 (near UNC5B, P = 9.52 × 10-10) and rs72925168 (within SLC1A2, P = 1.66 × 10-9). Genome-wide significant SNPs from published GWAS were used to generate polygenic risk scores (PRSs) for atopic eczema, general atopic disease, or a combination, which were tested for association with paradoxical eczema. Improvement over a clinical risk model was assessed by the area under the curve. All three atopy polygenic risk scores were associated with paradoxical eczema (P < 0.05); polygenic risk score for a combination of atopic eczema and general atopic disease had the strongest association (OR = 1.83, 95% CI = 1.17-2.84, P = 0.0078). Including atopic polygenic risk scores in the multivariable model, which included age, sex, atopic background, and psoriatic arthritis history, increased the area under the curve from 0.671 to 0.681-0.686. Atopic genetic burden is associated with paradoxical eczema occurring in biologic-treated patients with psoriasis, indicating shared underlying mechanisms. Incorporating genetic risk may improve treatment outcome prediction models for psoriasis.
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    Dimple piercings: a concerning trend
    (2023) Boyd, M.; Khobaragade, B.; Mumtaz, S.