One hundred consecutive cases of cutaneous anthrax, occurring over an eight month period, are studied. An epizootic in livestock occurring during a period of severe drought was quickly followed by an increase in the human cases, so that no than 42 cases occurred in the fourth month of observation. Of the 100 cases, 31 occurred in children under 10 years old, and 41 in wales aged 10 to 29.The site of the lesion was usually the exposed skin of the head and neck, or upper 1imbs, these sites being more or less equally affected and accounting for over three-quarters of the recorded lesions. The upper 1imbs were more frequently affected in patients who had butchered diseased animals, but it was noted that no lesions occurred on the palmar surface of the hands, or on the soles of tbe feet. Although a history of contact with animals which died was frequently obtained, a history of skin trauma was never obtained. Intramuscular penicillin was effective in all cases, although improvement was not immediate ; there were no fatalities. Respiratory stridor was present in 2 cases, but usually the disease was relatively mild. The mode of transmission of anthrax from livestock to man, and simple but effective measures for its control in a rural community are discussed.

Literature Review: This section offers a review of the literature concerning psychodermatological assessment, that is, the assessment of the interface between the skin and its psychological correlates, and evaluates selected psychodermatological scales. Using defined criteria, fifty articles were identified, including twenty-three scales, which are reviewed in detail. Findings demonstrated that quantitative self-report scales dominated assessment. When evaluated against psychometric and theoretical criteria, the scales were found to have limited robustness and validity. These findings are discussed in relation to the relationship between disease severity and skin-related distress and subsequent theoretical and clinical implications explored. Research Report: Living with a skin condition can lead to considerable psychological distress. Understanding the mechanisms of skin-related distress is crucial in developing a psychodermatological theory and devising meaningful psychological interventions. The III present study employed Kellett's (2002) theory of "dermatological shame" to construct a psychodermatological assessment scale for use in dermatological outpatient populations, in this case, at Barnsley District General Hospital dermatology department. The scale was subjected to exploratory factor analysis and reduced from thirty to twenty-four items. Reliability and validity analyses were then carried out and the results discussed in relation to dermatological shame and cognitive models of disfigurement (Kent & Thompson, 2002; Thompson & Kent, 2001). Critical Appraisal A reflexive account is offered of the research process, through four sections: project conception, study implementation, learning and development, including methodological limitations, and process issues. This section concludes with recommendations for further research.

Many people who have urinary incontinence manage it with the use of absorbent hygiene products, such as pads. Long-term use of these products can lead to abrasion by friction between the topsheet (a nonwoven fabric) and the skin, and is exacerbated when the skin is wet. However, the nature and mechanisms of friction between skin and nonwovens are poorly understood, hindering progress to improve products. Most work on skin friction to date has involved the use of skin surrogates or real skin in the dry state only. Moreover, only a narrow range of different nonwoven fabrics have been investigated. The work described in this thesis aimed to improve understanding of friction between nonwoven fabrics and human skin, and was divided into four main blocks. In the first, friction was measured between a skin surrogate (Lorica Soft) and 13 different nonwoven fabrics, varying in structure, fibre material and manufacturing techniques. Amontons’ law was closely obeyed for all nonwovens (that is, coefficients of friction were independent of normal force) and the data were used to select a representative subset of five nonwovens for subsequent work. In the second block of work, an in vivo study of friction was conducted between the subset of (five) nonwovens and the dry volar forearm skin of 19 female volunteers (aged 20-95 years). It was found that Amontons’ law also held for all of these measurements, despite the general viscoelastic nature of human skin, the range of skin types (from smooth and firm to wrinkled and flaccid) and the difference in ages. The coefficient of friction for a given fabric varied considerably between participants (an increase of up to 101% of the lowest coefficient value), but the fabrics were generally ranked in the same order for all volunteers. The third block of work involved the measurement of wet friction between the subset of five nonwovens and volar forearm skin of five of the study participants. In general, the coefficient of friction increased with skin wetness/hydration by up to a factor of thirteen until the skin was damp/moist. The relationship for very wet skin (with surface water) – thought to be lubricated – was unclear and varied between participants and between nonwovens. However, further work would be required to locate and quantify the excess water in and on the skin, in order to more accurately evaluate the contribution of water to friction. Finally, in the fourth block of work, the fibre footprints of nonwovens against a surrogate skin surface (glass microscope slide) were examined, providing insight into how friction is mediated by the interface. Total fibre contact length was always extremely low (typically 0.3-1.6 mm · mm-2) and increased linearly with the log of pressure, usually due to an increase in the number of contacts and sometimes because of an increase in the lengths of existing fibre contacts.

This investigation included the examination of tissues for evidence of infection with the human wart virus, and the development and application of serological techniques for demonstrating response to the infection. The majority of specimens were examined by negative staining methods, and the presence of virus particles and other structures in various types of wart at different stages is reported. Two cases of molluecum oontagiosum of the sole of the foot, previously considered a site rarely if ever infected, were diagnosed. A series of twelve genital wart specimens was studied by thin sectioning and negative staining techniques. Intranuclear virus particles with the morphology of wart virus were found in cells of the stratum granulosum, and the pancity of virus particles in such tissues noted for the first time. Examination of three specimens of bladder papillomata by such methods revealed no evidence of a virus infection. Serological studies included the application of an established precipitin test for antibody to wart virus, and development of complement fixation and passive haemagglutination tests for this purpose. The specific nature of the antigen involved in these reactions was demonstrated, and the immunoglobulin class of the antibodies concerned determined. These tests were applied to sera from 265 patients with different types of wart, and to sera from 110 people not currently infected with warts. The development of a full immune response with rising titres of antibody and appearance of immunoglobulin G was demonstrated in rabbits immunised with the virus, and in some patients, particularly those with the simple type of plantar wart. The relationship of the appearance of antiviral antibodies to regression of warts, spontaneous or following therapy, was observed and considered to be a result of increased exposure to the virus antigen at that time.

Boils are considered as a minor ailment and they are usually treated by general practitioners. Dermatologists and other specialists are consulted only if any complications arise from boils. The discovery of sulphonamides, Penicillin and other antibiotics was a great help in combating this common complaint. Appearance of resistant strains of staphylococci to antibiotics has removed the umbrella of safety offered at first by these antibiotics. The present study of boils was carried out in general practice. The writer has noticed that most of the patients suffering from boils were also suffering from allergic diseases^ and he decided to investigate them closely. The patients were examined in the surgery, and the laboratory tests were carried out in the Pathological Laboratory to which every practitioner in this area has a free access.

Skin comprises an epidermis, dermis, skin appendages including hair follicles, and a fat layer. There is a growing interest in the biology of specific fat depots, and skin fat is relatively poorly studied. Importantly, most knowledge about the molecular control of adipocyte differentiation comes from in vitro studies on cell lines. This thesis aimed to provide new insights into adipogenesis in vivo by directly studying development of the skin fat layer and its relationship to the surrounding skin and hair follicles. Work, presented in Chapter 2, investigated the timing and localisation of developing fat cells in back skin of rodent embryos. Analysis of the adipogenic transcription factor C/EBPalpha and lipid accumulation revealed preadipocytes in the lower dermis of embryonic mouse skin at e17 and the start of lipid accumulation by e19. The dermal fat cells then created an adipose layer between and beneath hair follicles apparently independently of subcutaneous fat tissue. In Chapter 3, a combined laser capture microdissection and microarray approach generated gene expression profiles of cells from upper and lower dermis over three time points. Verification of the microarray data by qPCR and immunohistochemistry, and bioinformatics analysis confirmed a subdivision of the lower dermis with enriched fat-related pathways. Comparison of this microarray data with published information on adipogenesis of 3T3-cells in vitro showed important early differences with regard to transcription factor, cell cycle, cytoskeletal and extracellular matrix gene expression. Later time points revealed greater similarities between in vivo and in vitro data involving genes characteristic of mature adipocytes. In Chapter 4, the involvement of the Egfr gene (selected from generated microarray lists) in dermal fat development was investigated functionally using a skin organ culture model. In Chapter 5, a marker gene selected from the arrays (Cd36) was successfully used to develop a method of isolating dermal preadipocytes by fluorescence activated cell sorting. Specialised organ culture techniques, presented in Chapters 4 and 5, allowed the adipogenic capabilities of cells from different mouse embryonic skin compartments to be investigated. This revealed a high plasticity of dermal cells at earlier embryonic time points (e15 - 15.5) and their specialisation into either non-fatty cells (upper dermis) or adipocytes (lower dermis) later (e18.5 - 19). As summarised in Chapter 6, this thesis confirmed that the fat layer that develops from cells of the lower dermis should have a distinct nomenclature (dermal adipose tissue) from the subcutaneous fat depot and could be under different regulatory mechanisms. The work has established a new in situ model of in vivo adipogenesis and the microarray data obtained has provided novel information on molecular control of adipogenesis in general, as well as pointers as to why the lower, but not the upper compartment of the late embryonic dermis turns into fat.

Classification of the dermatophytes, a group of keratinophilic fungi, depends primarily on morphological criteria, but individual identification is often difficult. Many species have been created, based on what are often minor differences in structure or unacceptable characters such as isolation from different hosts or different clinical conditions. Biochemical techniques, used successfully in the differentiation of other micro-organisms, have had a limited application in the study of dermatophytes and were made the subject of special investigation. 22 species were grown on media containing 30 different carbon or nitrogen sources. It was found that both geophilic and zoophilic species had similar nutritional patterns, but for some, e. g. Microsporum gypseum and Tricophyton mentagrophytes, nutritional and biochemical tests are of little taxonomic value. Ability to hydrolyse urea allows differentiation of T. mentagrophytes from T. rubrum and T. erinacei, and T. soudanense from M. ferrugineum. Other nutritional differences which may be used to separate species are described. The results obtained are complementary to the classification of dermatophytes based on morphological criteria but do support the separation of certain species, e.g. M. equinum, hitherto regarded as variants of another species. Serological investigations are described and five groups have been established, based on the presence or absence of common antigens. The results show that the genus Microsporum, with the exception of M. gypseum and M. persicolor, is serologically distinct from the genus Trichophyton. M. gypseum, T. ajelloi and M. persicolor are serologically related, however, having common antigens. The genus Trichophyton was found to contain two serological sub-groups: (1) T. mentagrophytes-T. rubrum-T. schoenleinii, and (2) T. quinckeanum- T. soudanense-T. erinacei. T. tonsurans has close relationships with most other Trichophyton species. T. violaceum and Epidermophyton floccosum had few antigens in common with any other species. The two saprophytic species, T. terrestre and M. cookei, appeared to be serologically unrelated to other members of the respective genera.

The diagnosis of a patient presenting with an oral keratosis is the first stage in the management of the patient. Diagnosis is based on a combination of patient history, clinical examination and laboratory investigations. The aim of this thesis was to identify factors which may be helpful in the diagnosis of oral keratoses. It is based on a prospective study of 159 patients being examined haematologially, immunologically and histopathologically. Two main groups of keratoses were identified by the presence or absence of an associated inflammatory cell infiltrate. Infiltrated keratoses comprised patients diagnosed as lichen planus, leukoplakia, discoid lupus erythematosus, candidal leukoplakia and squamous cell carcinoma. Non infiltrated keratoses also comrpised patients diagnosed as leukoplakia but also comprised frictional and smoking keratoses and hereditary keratoses. A third category, intermediate infiltrated leukoplakia was distinguished by changeable clinical and histopathological appearances during the study period. Individual patient diagnosis followed clinical examination and immunological and histopathological investigations. Cross-tabulation of the diagnostic categories with the clinical presentations of the keratoses showed that the clinical appearances may be common to different diagnostic categories. Non infiltrated leukoplakia was seen frequently to involve the floor of mouth. All categories of keratoses had a high proportion of patients currently taking medication: non steroid anti-inflammatory drugs were more frequently taken by patients with erosive lichen planus (29%) than those with non erosive lichen planus (3%). Abnormal intestinal sugar permeability was detected in 65% and 60% of lichen planus and infiltrated leukoplakia patients respectively but not in any patients with non infiltrated keratoses. Haematological deficiencies were detected in 23 patients (14.4%) of the whole study group and were related particularly to lichen planus and non infiltrated leukoplania, 22.5% and 19.2% respectively. Tobacco habits were positively associated with categories of leukoplakia and squamous cell carcinoma. Patients with lichen planus had significantly lower tobacco and alcohol use than infiltrated, non infiltrated leukoplakia and the squamous cell carcinoma categories. Histopathological assessment of the oral keratoses did not identify any singular diagnostic characteristic. Epithelial dysplasia was seen in lichen planus, leukoplania and squamous cell carcinoma. Inflammatory infiltrate phenotypes were identified using the immunoperoxidase system and quantitative differences existed between the diagnostic categories. The T4/T8 ratio was highest for the frictional and smoking keratoses and lowest for intermediate infiltrated leukoplakia. The intermediate infiltrated leukoplakia category also showed significantly lower serum immunoglobulins (IgG, IgA and IgM) than other diagnostic categories. No evidence of blood or lesional lymphocytes was found. Co-culture experiments suggest lesional cells exert suppressor effects for squamous cell carcinoma and not for the categories of leukoplakia.

No description available.

Calcipotriol is a new and effective topical treatment for chronic plaque psoriasis vulgaris. It is an analogue of calcitriol (1,25 dihydroxyvitamin D - the active metabolite of vitamin D), and so has the potential to affect systemic calcium metabolism even when used topically. Animal studies indicate that parenteral calcipotriol has a weaker effect on systemic calcium homeostasis than calcitriol. Extensive clinical trials using relatively small amounts of calcipotriol (50mg/g) ointment (on average 30-40g/wk) detected no effect on serum calcium in vivo provided that the recommended maximum weekly dose of 100g was not exceeded. Cases of hypercalcaemia from calcipotriol ointment have been reported, both after excessive use and in relation to manufacturers recommendations. Short wave ultraviolet light (UVB) is commonly used to treat psoriasis in combination with topical agents such as dithranol and tar. The use of calcipotriol in combination with UVB is becoming common practice. UVB initiates synthesis of vitamin D in the skin and therefore might enhance the calciotropic effects of calcipotriol when used in combination. The aims of this study were to detect any alteration of calcium homeostasis in patients treated with topical calcipotriol, to identify the mechanism(s) of any detected effects and to determine whether the addition of UVB would enhance those effects. In summary, we have confirmed that topical calcipotriol does have an effect on systemic calcium homeostasis. Intestinal absorption of calcium, and probably phosphate, is increased, when large doses are applied (up to 360g of the 50mg/g ointment per week). Serum calcium and phosphate rise while serum PTH and 1,25 dihydroxyvitamin D3 levels fell. Urinary excretion of calcium and phosphate are increased. The suppressive effects on PTH and endogenous 1,25 dihydroxyvitamin D3 levels may be due to direct inhibition by calcipotriol as well as indirect effects of rising serum calcium and phosphate. At the upper limit of the recommended dose (100g/wk), calcipotriol has a small but measurable effect on systemic calcium homeostasis as manifested by a small rise in 24h urine calcium and serum ionized calcium. These changes are probably not of clinical significance. The addition of short wave ultraviolet light has no additive effect on systemic calcium homeostasis at recommended doses.