Psoriasis: Cox NH

Ibbotson SH, Bilsland D, Cox NH, Dawe RS, Diffey B, Edwards C, Farr PM, Ferguson J, Hart G, Hawk J, Lloyd J, Martin C, Moseley H, McKenna K, Rhodes LE, Taylor DK, Anonymous00115. · Pathobiology Unit, Ninewells Hospital and Medical School, Dundee, UK. · Br J Dermatol. · Pubmed #15327535 No free full text.

Abstract: Summary These guidelines for use of narrowband (TL-01) ultraviolet B have been prepared for dermatologists by the British Photodermatology Group on behalf of the British Association of Dermatologists. They present evidence-based guidance for treatment of patients with a variety of dermatoses and photodermatoses, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of background photobiology.

Cox NH. · Department of Dermatology, Cumberland Infirmary, Carlisle, United Kingdom. · J Am Acad Dermatol. · Pubmed #17368637 No free full text.

Abstract: BACKGROUND: As an adjunct to visual inspection, dermatologists routinely palpate the skin during clinical examination. The value of palpation in isolation is unproven. METHODS: To determine whether palpation alone could distinguish between two common dermatoses, atopic dermatitis and plaque psoriasis, a cohort of 16 patients were examined by a dermatologist using touch alone, with screens to prevent visualisation of the lesions. RESULTS: The diagnosis was correctly made in 14 of 16 cases (P = .012). LIMITATIONS: Patients were not consecutive as availability of the dermatologist and nursing staff was required, and several exclusion criteria applied. There was no formal power calculation. The study aimed to prove a concept about dissociating sensory modalities and does not prove that palpation would necessarily have provided "added value" to a visual diagnosis in the cases selected. CONCLUSION: This study demonstrates that dissociation between sensory inputs that are usually concurrent (in this case, visual and tactile) is a feasible experiment in dermatology, and that such dissociation did not remove the diagnostic input of the sole sensory modality that was permitted-in this case, confirming that palpation alone does have some importance in dermatologic diagnosis. It may explain some of the reservations about accuracy of teledermatology diagnoses of dermatoses, where palpation is not possible.

Cox NH, Paterson WD. · Department of Dermatology, Cumberland Infirmary, Carlisle CA2 7HY, UK. · Br J Dermatol. · Pubmed #12534615 No free full text.

This publication has no abstract.

Cox NH, Gordon PM, Dodd H. · Department of Dermatology, Cumberland Infirmary, Carlisle CA2 7HY, UK. · Br J Dermatol. · Pubmed #12072078 No free full text.

Abstract: Severe drug eruptions may cause diagnostic and therapeutic difficulty when they mimic or provoke endogenous patterns of dermatosis. We report three patients with known psoriasis in whom use of bupropion (Zyban), prescribed to assist with cessation of smoking, led to severe pustular or erythrodermic exacerbation of psoriasis within 3-5 weeks. All patients were systemically unwell and required hospitalization to control the disease flare.

Cox NH, Bowman J. · Department of Dermatology, Cumberland Infirmary, Carlisle, UK. · Clin Exp Dermatol. · Pubmed #10671962 No free full text.

Abstract: In a questionnaire to community nurses treating dermatological patients, 14 out of 69 (20%) either treated children or gave advice to parents regarding childhood eczema, 35 (51%) treated adult eczema, 11 (16%) treated psoriasis, 55 (80%) treated leg ulcers, and 30 (43%) treated other dermatological problems. Specific questions regarding confidence to treat or educate were analysed in relation to the tasks being performed. All but 15% (8/55) treating leg ulcers were confident about their ability to apply four-layer bandaging. However, 8 out of 11 (72%) respondents treating psoriasis were not confident about their ability to treat scalp scaling, 11 out of 14 (79%) of those treating childhood eczema were not confident about applying body suiting, and 26 out of 36 (72%) of those treating eczema (any age), were not confident about ability to recognize infection as a cause or complication of dermatoses. The favoured educational modalities were visits to the local dermatology department (60/69, 87%), availability of a dermatology Nurse Practitioner or Liaison Nurse, or access to a hospital nurse-run dermatology clinic (both 44/69, 63%), or attendance at courses (36/69, 52%). Community nurses have an important role in treating and educating patients who may not require or be able to attend hospitals for treatment; they will achieve this best by provision of relevant locally based education, with allocation of adequate study time.