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Background:\ud Pyoderma gangrenosum (PG) is an uncommon dermatosis with a limited evidence base for treatment.\ud \ud Objective:\ud We sought to estimate the effectiveness of topical therapies in the treatment of patients with PG.\ud \ud Methods:\ud This was a retrospective cohort study of UK secondary care patients with a clinical diagnosis of PG that was suitable for topical treatment (recruited between July 2009 and June 2012). Participants received topical therapy after normal clinical practice (primarily topical corticosteroids [classes I-III] and tacrolimus 0.03% or 0.1%). The primary outcome was speed of healing at 6 weeks. Secondary outcomes included the following: proportion healed by 6 months; time to healing; global assessment; inflammation; pain; quality of life; treatment failure; and recurrence.\ud \ud Results:\ud Sixty-six patients (22-85 years of age) were enrolled. Clobetasol propionate 0.05% was the most commonly prescribed therapy. Overall, 28 of 66 (43.8%) ulcers healed by 6 months. The median time to healing was 145 days (95% confidence interval, 96 days to ∞). Initial ulcer size was a significant predictor of time to healing (hazard ratio, 0.94 [95% confidence interval, 0.88-1.00); P = .043). Four patients (15%) had a recurrence.\ud \ud Limitations:\ud Our study did not include a randomized comparator.\ud \ud Conclusion:\ud Topical therapy is potentially an effective first-line treatment for PG that avoids the possible side effects associated with systemic therapy. It remains unclear whether more severe disease will respond adequately to topical therapy alone.

Editor – We read the article by Silver1 with great interest, and agree that as healthcare providers, we need to be involved in developing robust self-management strategies for our patients. In dermatology, we see patients with several chronic skin conditions, which often require years of secondary care follow-up. One such example is psoriasis, a common inflammatory skin condition, in which inadequate patient support and information can result …

Editorial commentDr Lawrence Khoo and Dr Charles Taylor have reviewed the literature concerning ultraviolet light therapy for atopic dermatitis including conventional broad-band UVB, UVA, UVA-1 and narrow-band UVB. They have also examined the evidence for treatment of eczema with PUVA and ambient sunlight. This detailed review serves to bring residents and trainees up-to-date with the various phototherapies used to treat atopic eczema and in particular places narrow-band UVB firmly within this repertoire of therapies. Narrow-band UVB phototherapy has moved from being a research based phototherapy offered in a small number of specialized photodermatology units in Europe to being widely available in phototherapy units throughout the world. This rapid development is a reflection of the obvious efficacy of narrow-band UVB in the treatment of psoriasis and has close parallels with the development of PUVA. As with PUVA there is now accumulating evidence that narrow-band UVB phototherapy has a role in the treatm...

Editoral commentOver the past 10 years narrowband UVB has become established as a standard treatment for recalcitrant chronic plaque psoriasis. Dr Pravit Asawanonda and Dr Charles Taylor of the Mas...

The gold standard for investigation of patients with suspected photosensitivity involves phototesting on non-exposed skin with an irradiation monochromator (IM). However, this device is bulky, expensive and only available at a small number of specialised photodermatology units. We have developed a small handheld high output monochromatic light source for phototesting to UVA at 365 nm using light-emitting diodes (LEDs).A UNO light engine (Enfis, Swansea, UK) at 365 nm was used to develop a handheld intense source. Seventy-seven normal healthy volunteers were phototested on the lower back with the LED source and with an IM at 365 nm. Minimal erythema dose (MED) at 24 h was assessed visually and by a diffuse reflectance erythemameter.In 77 volunteers, MED levels for the two sources agreed in 66 out of 77 cases (85.7%). In a further 10 out of 77 patients, the measured MED elicited by the LED source was 1 dose level higher than the monochromator MED.A high-intensity portable and low cost LED phototesting device was developed. The results confirm that phototesting to UVA at 365 nm using this LED light source compares favourably to monochromator light testing at this wavelength.

A 53-year-old woman with chronic plaque psoriasis treated with adalimumab (antitumour necrosis factor (anti TNF) α therapy) for 10 months presented with an 8 week history of hyperesthesia in a 'glove and stocking' distribution and clumsiness on walking. Nerve conduction studies confirmed the clinical diagnosis of a chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). She was admitted and treated with intravenous immunoglobulin and oral steroids and made an excellent recovery. To our knowledge, this is the first published report of CIDP associated with anti TNF α therapy given to treat psoriasis.

The identification of robust endotypes—disease subgroups of clinical relevance—is fundamental to stratified medicine. We hypothesized that HLA-C∗06:02 status, the major genetic determinant of psoriasis, defines a psoriasis endotype of clinical relevance. Using two United Kingdom–based cross-sectional datasets—an observational severe-psoriasis study (Biomarkers of Systemic Treatment Outcomes in Psoriasis; n = 3,767) and a large population-based bioresource (UK Biobank, including n = 5,519 individuals with psoriasis)—we compared demographic, environmental, and clinical variables of interest in HLA-C∗06:02–positive (one or two copies of the HLA-C∗06:02 allele) with those in HLA-C∗06:02‒negative (no copies) individuals of European ancestry. We used multivariable regression analyses to account for mediation effects established a priori. We confirm previous observations that HLA-C∗06:02–positive status is associated with earlier age of psoriasis onset and extend findings to reveal an association with disease expressivity in females (Biomarkers of Systemic Treatment Outcomes in Psoriasis: P = 2.7 × 10 –14, UK Biobank: P = 1.0 × 10 –8). We also show HLA-C∗06:02–negative status to be associated with characteristic clinical features (large plaque disease, OR for HLA-C∗06:02 = 0.73, P = 7.4 × 10 –4; nail involvement, OR = 0.70, P = 2.4 × 10 –6); higher central adiposity (Biomarkers of Systemic Treatment Outcomes in Psoriasis: waist circumference difference of 2.0 cm, P = 8.4 × 10 –4; UK Biobank: waist circumference difference of 1.4 cm, P = 1.5 × 10 –4), especially in women; and a higher prevalence of other cardiometabolic comorbidities. These findings extend the clinical phenotype delineated by HLA-C∗06:02 and highlight its potential as an important biomarker to consider in future multimarker stratified medicine approaches.