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Background/purpose: Low vitamin D levels have been associated with adverse effects on health. The primary source of vitamin D is cutaneous production during sunlight exposure. Sun avoidance can restrict vitamin D photosynthesis and is common practice amongst patients with photosensitivity. Few studies have examined vitamin D status in this population, particularly those in northern latitudes. The purpose of this study was therefore to investigate the prevalence and possible predictors of low vitamin D status in patients referred to a tertiary photodiagnostic service., Methods: A case note review of 165 patients who attended the National Photodiagnostic Service for assessment at the Photobiology Unit in Dundee, Scotland (latitude 56 °N) over 1 year was conducted. Clinical information and serum 25-hydroxyvitamin D (25(OH)D) concentration were documented. Multivariate analyses were used to identify predictors of vitamin D status., Results: Mean 25(OH)D concentration was 41.9 nmol/L [standard deviation (SD) 22.0]. Forty percent of patients had insufficient vitamin D levels [25(OH)D 25-49 nmol/L] and 25% were vitamin D deficient [25(OH)D<25 nmol/L]. Blood collection in winter was the strongest predictor of low 25(OH)D status (P<0.001); strict photoprotection (P=0.04), onset of symptoms within an hour of sunlight exposure (P=0.01) and abnormal monochromator phototesting responses (P=0.009) also predicted low vitamin D levels. Supplement use was associated with higher vitamin D levels (P<0.001), even amongst patients who strictly avoided sunlight (P=0.03)., Conclusions: Patients with photosensitivity who live in northern latitudes are at high risk of low vitamin D levels, particularly in winter and spring. Increased awareness of this risk is crucial to ensure preventative strategies, such as supplementation, are implemented., (© 2012 John Wiley & Sons A/S.)

Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the indication for tonsillectomy in the management of sore throat were published in January 1999. To determine adherence to these guidelines in our unit, clinical records were examined on admission for tonsillectomy. Three cohorts were analysed. The first listed prior to SIGN, the second after SIGN and the third after presentation of the results of cohorts 1 and 2. The records were examined for documentation of the number of attacks of tonsillitis in the preceding year. The first cohort revealed poor documentation of attacks of tonsillitis (30 per cent). The subsequent cohorts showed progressive improvement in record keeping (74 per cent and 96 per cent). The adherence to SIGN guidelines for those with adequate documentation also improved (75 per cent, 80 per cent, 93.5 per cent). The importance of adequate record keeping to enable audit of practice and the impact of national guidelines on practice are discussed.