Skin Disease With Chronic Itch Linked to Depression, Suicidal Thoughts

Itchy skin in patients with chronic skin disease is significantly linked to clinical depression, suicidal ideation and stress, according to a new study published in the Journal of Investigative Dermatology. Click here to read PsychCentral article
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New Technology appraisal guidance [TA521] Guselkumab for treating moderate to severe plaque psoriasis

New Technology appraisal guidance [TA521] Guselkumab for treating moderate to severe plaque psoriasis
Published date: 13 June 2018                   Next review: June 2021
For full guidance https://www.nice.org.uk/guidance/ta521

New NICE Technology appraisal guidance TA511: Brodalumab for treating moderate to severe plaque psoriasis

Brodalumab for treating moderate to severe plaque psoriasis.


Brodalumab is recommended as an option for treating plaque psoriasis in adults, only if:

the disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10 and

the disease has not responded to other systemic therapies, including ciclosporin, methotrexate and PUVA (psoralen and long-wave ultraviolet A radiation), or these options are contraindicated or not tolerated and

the company provides the drug with the discount agreed in the patient access scheme.

Published March 2018

Full guidance available at https://www.nice.org.uk/guidance/TA511/chapter/1-Recommendations

UHCW publication: Gin, tonic water and the sun

Image Gallery: Gin, tonic water and the sun.
Chan SA, Shim TN
British journal of dermatology Vol. 177, Iss. 6, (December 2017): e349
Full text available at http://onlinelibrary.wiley.com/doi/10.1111/bjd.15891/epdf (UHCW Athens login required)

UHCW publication: Clarithromycin as a steroid sparing agent for the management of infantile bullous pemphigoid

Clarithromycin as a steroid sparing agent for the management of infantile bullous pemphigoid Simon Tso, Gabriela Petrof, Simon Unter, Frances Humphreys
BMJ Case Reports 2018; doi:10.1136/bcr-2017-223507
http://casereports.bmj.com/content/2018/bcr-2017-223507.full



You can publish in BMJ Case Reports with the UHCW Fellowship Code. Ask in the CSB Library for more details.

EpiFix for chronic wounds [MIB 139]

New:  EpiFix for chronic wounds


EpiFix (MiMedx) amniotic membrane allograft is made of dehydrated human amnion/chorion membrane tissue (dHACM). The tissue is derived from amniotic membranes donated with informed consent in the US. EpiFix is terminally sterilised to reduce virus transmission. It is promoted to enhance wound healing, reduce scar tissue formation and modulate inflammation.
EpiFix is indicated for a wide range of wounds; the scope of this briefing is chronic difficult-to-heal wounds including diabetic foot ulcers, venous leg ulcers, arterial ulcers and pressure ulcers.
The company's instructions for use recommend weekly administration. After wound cleaning and debridement in a non-infected wound, EpiFix is removed from the packaging and cut to fit the size of the wound. After EpiFix is applied, a non-adherent contact layer should be placed on top and the wound dressed as usual. EpiFix can be used alongside compression, offloading, negative pressure and hyperbaric oxygen therapy.


The innovative aspect of EpiFix is that it is an allograft of human amniotic membrane that has been processed and purified for use (using the MiMedx proprietary PURION process). This is designed to preserve bioactive components and deliver non-viable cells, multiple extracellular matrix (ECM) proteins, active growth factors, cytokines, chemokines and other specialty proteins present in amniotic tissue with the aim of helping to regenerate soft tissue.

NIHR Signal Biological therapies for psoriasis do not increase serious infection risk

People with psoriasis who take an immune-modulating treatment are no more likely to get serious infections than people taking standard therapies.inf




There are fears that these biological therapies raise the risk of serious infections and this has discouraged their use. They are recommended by NICE for moderate to severe psoriasis. Previous studies have reached conflicting conclusions, making it hard to advise on the true risk.




This study used a large database of people with psoriasis from the UK and Ireland. It compared serious infection risk of the biological therapies (etanercept, adalimumab or ustekinumab) with non-biological therapies, after accounting for factors such as other illnesses. It found none of the biological therapies studied had a higher risk of infection compared to non-biological therapies or compared to each other.




From the NIHR Dissemination Centre

Are patients satisfied with the head and neck skin cancer service? An evaluation of outpatient services with a review of published reports

British Journal of Oral and Maxillofacial Surgery December 2017 Volume 55, Issue 10, Pages 1018–1023 

Scientific publications place much emphasis on postoperative outcomes such as recurrence, but little attention to patients’ satisfaction. The purpose of this evaluation was to find out patients’ reported outcomes after their initial consultation, treatment, and follow-up appointments for non-melanoma skin cancer of the head and neck.

UHCW Research: V. Petrosyan

Transcutaneous microwave ablation for severe primary axillary hyperhidrosis [IPG601]

New interventional procedures guidance from NICE: Evidence based recommendations on transcutaneous microwave ablation for severe primary axillary hyperhidrosis in adults. Current evidence on the safety and efficacy of transcutaneous microwave ablation for severe primary axillary hyperhidrosis is inadequate in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.

Clinicians wishing to do transcutaneous microwave ablation for severe primary axillary hyperhidrosis should:

• Inform the clinical governance leads in their NHS trusts.
• Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In particular, during the consent process patients should be informed about the possibility of nerve damage. In addition, the use of NICE's information for the public is recommended.
• Audit and review clinical outcomes of all patients having transcutaneous microwave ablation for severe primary axillary hyperhidrosis (see section 7.3).

NHS England announces new specialised treatments for patients

NHS England has announced the results of the first of two prioritisation rounds to decide which new specialised commissioning treatments and services will be made available for patients for the 2018/19 financial year.

An initial three new treatments and services were approved for funding including a treatment for HIV, a new specialised service for adults with primary ciliary dyskinesia, a genetic disorder affecting the respiratory system, and a new specialised service for Stevens-Johnson syndrome, a serious disorder of the skin.

Funding for the new treatments and services will begin from April.

Risankizumab (by Subcutaneous Injection) for Moderate to Severe Chronic Plaque Psoriasis

Risankizumab is a drug which is injected into the skin. It works in a unique way by blocking a specific process which allows the body’s immune cells (specifically T-cells) from attacking and damaging the skin. Risankizumab is currently being trialled in a range of diseases involving the immune system including Crohn’s disease, and psoriatic arthritis.

From the NIHR Innovation Observatory

PO191 Diffuse psoriatic exacerbation following immunoglobulin administration

Association of British Neurologists (ABN) Annual Meeting 20172,3–5th May 2017 ACC, Liverpool

We report the first case of a widespread, exfoliative and erythematous psoriatic exacerbation following immunoglobulin administration. Serious dermatological complications should be considered in patients with pre-existing psoriasis prior to immunoglobulin administration.

UHCW Research: Fizzah Ali, Akram A Hosseini and Antony Thomas

Survey of Dermatologists and Venereologists Shows Varying Approach to Penile Biopsies

J Clin Aesthet Dermatol. 2017;10(10):26–27

Objective. To determine frequency of use and safety of epinephrine containing local anesthesia among dermatologists in the United Kingdom and venereologists undertaking penile biopsy.

Conclusion. Use of epinephrine-containing local anesthesia is common among physicians in the United Kingdom undertaking penile biopsies. Despite this, no episodes of necrosis were observed. While further investigation is still required, it is likely that use of epinephrine-containing local anesthesia is safe for local penile injection.

UHCW Research: Aaron Wernham and Tang Ngee Shim

Do perioperative antibiotics reduce the risk of surgical site infections following excision of ulcerated skin cancers? a critically appraised topic

Br J Dermatol. 2017 Nov 28. doi: 10.1111/bjd.16157. [Epub ahead of print]

Aim was to To review the efficacy of perioperative antibiotics in reducing the risk of surgical site infections (SSI) following excision of ulcerated skin cancers.

The heterogeneity of the RCTs included in this study makes it difficult to make a direct comparison of the outcomes measured. High quality evidence demonstrating a beneficial effect of the use of peri-operative antibiotics to prevent SSI following excision of ulcerated skin cancers is lacking. In the absence of an evidence-base, we propose that a well-designed multi-centred RCT could evaluate the effect of peri-operative antibiotics following excision of ulcerated tumours, and potentially reduce inappropriate antibiotic prescribing. This article is protected by copyright. All rights reserved.

UHCW Research: Wernham, A. G. H.

Vismodegib for treating basal cell carcinoma [TA489]

New technology appraisal guidance from NICE:

Evidence-based recommendations on vismodegib (Erivedge) for treating basal cell carcinoma in adults.

Vismodegib is not recommended within its marketing authorisation for treating symptomatic metastatic basal cell carcinoma, or locally advanced basal cell carcinoma that is inappropriate for surgery or radiotherapy, in adults.

1.2 This recommendation is not intended to affect treatment with vismodegib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

A regressing spindle cell tumour of Reed

BMJ Case Reports 2017; doi:10.1136/bcr-2017-222002

Spindle cell tumour of Reed is a benign melanocytic naevus which usually presents as a deeply pigmented mole. It is more commonly found on the lower extremities of young girls. It is an uncommon naevus but its incidence and prevalence are not known. A Reed naevus typically goes through a rapid initial growth phrase before stabilising in size and then regresses over time. Awareness of Reed naevus has been demonstrated to be low, even among dermatology doctors.

UHCW Research: Simon Tso, William Hunt and Joanna E Gach

Follicular porokeratosis: four new cases

Clinical and Experimental Dermatology, 42(8) 2017

Porokeratosis, a disorder of keratinisation, is clinically characterized by the presence of annular plaques with a surrounding keratotic ridge. Clinical variants include linear, disseminated superficial actinic, verrucous/hypertrophic, disseminated eruptive, palmoplantar and porokeratosis of Mibelli (one or two typical plaques with atrophic centre and guttered keratotic rim). All of these subtypes share the histological feature of a cornoid lamella, characterized by a column of 'stacked' parakeratosis with focal absence of the granular layer, and dysmaturation (prematurely keratinised cells in the upper spinous layer). In recent years, a proposed new subtype, follicular porokeratosis (FP_, has been described, in which the cornoid lamella are exclusively located in the follicular ostia. We present four new cases that showed typical histological features of FP.

UHCW Research: Odeke, M.

Cemiplimab for advanced cutaneous squamous cell

Cemiplimab is an intravenous drug under development for advanced cSCC. It acts on specific protein

on immune cells, allowing the defence system of the body to inhibit the growth of the cancer cells.

For patients who develop advanced cSCC, there are limited treatment options available. If licensed,

cemiplimab may offer a new licenced treatment option for patients with advanced cSCC.

From the NIHR Innovation Observatory

Mepilex Border dressings for preventing pressure ulcers [MIB124]

New: Medtech innovation briefing


The technology described in this briefing are Mepilex Border dressings, specifically the 2 variants designed to prevent pressure ulcers (Mepilex Border Heel and Mepilex Border Sacrum).

The innovative aspects are that the dressing is designed to reduce pressure and friction caused by patient movements. It also uses the company's proprietary Safetac technology, which is intended to minimise pain when changing dressings or inspecting the skin.

Treatment of Skin Disease E-Book: Comprehensive Therapeutic Strategies

Book.  Various chapters. eISBN 978-0-7020-6913-0. Elsevier 2018

UHCW Research: Imtiaz Ahmed, Ajoy Bardhan, John Berth-Jones, Surod Qazaz, Rabia S. Rashid, Ure Eke, Joanna E. Gach, Andrew Ilchyshyn, Murtaza Khan and Tang Ngee Shim