130 results on '"Wahie S"'
Search Results
2. 10-MINUTE CONSULTATION: A scaly rash on the hands
- Author
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Reddy, H, De Vittoris, A, and Wahie, S
- Published
- 2012
3. An economic evaluation of the randomised controlled trial of topical corticosteroid and home‐based narrowband UVB for active and limited vitiligo (The HI‐Light Trial)
- Author
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Sach, T.H., Thomas, K.S., Batchelor, J.M., Akram, P., Chalmers, J.R., Haines, R.H., Meakin, G.D., Duley, L., Ravenscroft, J.C., Rogers, A., Santer, M., Tan, W., White, J., Whitton, M.E., Williams, H.C., Cheung, S.T., Hamad, H., Wright, A., Ingram, J.R., Levell, N., Goulding, J.M.R., Makrygeorgou, A., Bewley, A., Ogboli, M., Stainforth, J., Ferguson, A., Laguda, B., Wahie, S., Ellis, R., Azad, J., Rajasekaran, A., Eleftheriadou, V., and Montgomery, A.A.
- Subjects
integumentary system - Abstract
Background\ud Economic evidence for vitiligo treatments is absent.\ud \ud Objectives\ud To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo.\ud \ud Methods\ud Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months’ treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost–utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015.\ud \ud Results\ud The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188–235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151–196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment.\ud \ud Conclusions\ud Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.
- Published
- 2021
4. An observer-blinded randomized controlled pilot study comparing localised psoralen-ultraviolet A with localized narrowband ultraviolet B for the treatment of hand eczema: RF04
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Brass, D., Farr, P., Reynolds, N., Stocken, D., Macdonald, C., Wahie, S., Weatherhead, S., Wilkinson, J., Lloyd, J., Hill, S., Fouweather, T., and Hampton, P.
- Published
- 2015
5. Severity of polymorphic light eruption in pre- and post-menopausal women: a comparative study
- Author
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Reddy, H., Carmichael, A. J., and Wahie, S.
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- 2015
- Full Text
- View/download PDF
6. Subacute cutaneous lupus erythematosus occurring postradiotherapy: CPC12
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Tang, D. Y.L., Whitaker, S., and Wahie, S.
- Published
- 2014
7. Severity of polymorphic light eruption in pre-and postmenopausal women: a comparative study: RF01
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Reddy, H., Wahie, S., and Carmichael, A. J.
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- 2014
8. Using Real-World Data to Guide Ustekinumab Dosing Strategies for Psoriasis: A Prospective Pharmacokinetic-Pharmacodynamic Study
- Author
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Pan, S., Tsakok, T., Dand, N., Lonsdale, D.O., Loeff, F.C., Bloem, K., de Vries, A., Baudry, D., Duckworth, M., Mahil, S., Pushpa-Rajah, A., Russell, A., Alsharqi, A., Becher, G., Murphy, R., Wahie, S., Wright, A., Griffiths, C.E.M., Reynolds, N.J., Barker, J., Warren, R.B., David Burden, A., Rispens, T., Standing, J.F., Smith, C.H., Benham, M., Evans, I., Hussain, S., Kirby, B., Lawson, L., Mason, K., McElhone, K., Ormerod, A., Owen, C., Barnes, M.R., Di Meglio, P., Emsley, R., Evans, A., Payne, K., Landsteiner Laboratory, and AII - Inflammatory diseases
- Subjects
Oncology ,Male ,030226 pharmacology & pharmacy ,Severity of Illness Index ,030207 dermatology & venereal diseases ,0302 clinical medicine ,Drug Dosage Calculations ,Prospective Studies ,General Pharmacology, Toxicology and Pharmaceutics ,Prospective cohort study ,media_common ,medicine.diagnostic_test ,General Neuroscience ,lcsh:Public aspects of medicine ,R735 ,General Medicine ,Articles ,Middle Aged ,3. Good health ,Treatment Outcome ,Female ,Ustekinumab ,Drug Monitoring ,medicine.drug ,Drug ,Adult ,medicine.medical_specialty ,RM ,Adolescent ,media_common.quotation_subject ,Injections, Subcutaneous ,RL ,Models, Biological ,General Biochemistry, Genetics and Molecular Biology ,Article ,03 medical and health sciences ,Young Adult ,Pharmacokinetics ,Psoriasis ,Internal medicine ,medicine ,Humans ,Dosing ,Aged ,business.industry ,Research ,lcsh:RM1-950 ,Bayes Theorem ,lcsh:RA1-1270 ,medicine.disease ,R1 ,lcsh:Therapeutics. Pharmacology ,Therapeutic drug monitoring ,Pharmacodynamics ,Dermatologic Agents ,business - Abstract
Variation in response to biologic therapy for inflammatory diseases, such as psoriasis, is partly driven by variation in drug exposure. Real-world psoriasis data were used to develop a pharmacokinetic/pharmacodynamic (PK/PD) model for the first-line therapeutic antibody ustekinumab. The impact of differing dosing strategies on response was explored. Data were collected from a UK prospective multicenter observational cohort (491 patients on ustekinumab monotherapy, drug levels, and anti-drug antibody measurements on 797 serum samples, 1,590 measurements of Psoriasis Area Severity Index (PASI)). Ustekinumab PKs were described with a linear one-compartment model. A maximum effect (E max) model inhibited progression of psoriatic skin lesions in the turnover PD mechanism describing PASI evolution while on treatment. A mixture model on half-maximal effective concentration identified a potential nonresponder group, with simulations suggesting that, in future, the model could be incorporated into a Bayesian therapeutic drug monitoring “dashboard” to individualize dosing and improve treatment outcomes.
- Published
- 2020
9. Association of clinical and demographic factors with the severity of Palmoplantar Pustulosis
- Author
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Benzian-Olsson, N., Dand, N., Chaloner, C., Bata-Csorgo, Z., Borroni, R., Burden, A.D., Cooper, H.L., Cornelius, V., Cro, S., Dasandi, T., Griffiths, C.E.M., Kingo, K., Kõks, S., Lachmann, H., McAteer, H., Meynell, F., Mrowietz, U., Parslew, R., Patel, P., Pink, A.E., Reynolds, N.J., Tanew, A., Torz, K., Trattner, H., Wahie, S., Warren, R.B., Wright, A., Barker, J.N., Navarini, A.A., Smith, C.H., Capon, F., Benzian-Olsson, N., Dand, N., Chaloner, C., Bata-Csorgo, Z., Borroni, R., Burden, A.D., Cooper, H.L., Cornelius, V., Cro, S., Dasandi, T., Griffiths, C.E.M., Kingo, K., Kõks, S., Lachmann, H., McAteer, H., Meynell, F., Mrowietz, U., Parslew, R., Patel, P., Pink, A.E., Reynolds, N.J., Tanew, A., Torz, K., Trattner, H., Wahie, S., Warren, R.B., Wright, A., Barker, J.N., Navarini, A.A., Smith, C.H., and Capon, F.
- Abstract
Importance Although palmoplantar pustulosis (PPP) can significantly impact quality of life, the factors underlying disease severity have not been studied. Objective To examine the factors associated with PPP severity. Design, Setting, and Participants An observational, cross-sectional study of 2 cohorts was conducted. A UK data set including 203 patients was obtained through the Anakinra in Pustular Psoriasis, Response in a Controlled Trial (2016-2019) and its sister research study Pustular Psoriasis, Elucidating Underlying Mechanisms (2016-2020). A Northern European cohort including 193 patients was independently ascertained by the European Rare and Severe Psoriasis Expert Network (2014-2017). Patients had been recruited in secondary or tertiary dermatology referral centers. All patients were of European descent. The PPP diagnosis was established by dermatologists, based on clinical examination and/or published consensus criteria. The present study was conducted from October 1, 2014, to March 15, 2020. Main Outcomes and Measures Demographic characteristics, comorbidities, smoking status, Palmoplantar Pustulosis Psoriasis Area Severity Index (PPPASI), measuring severity from 0 (no sign of disease) to 72 (very severe disease), or Physician Global Assessment (PGA), measuring severity as 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), and 4 (severe). Results Among the 203 UK patients (43 men [21%], 160 women [79%]; median age at onset, 48 [interquartile range (IQR), 38-59] years), the PPPASI was inversely correlated with age of onset (r = −0.18, P = .01). Similarly, in the 159 Northern European patients who were eligible for inclusion in this analysis (25 men [16%], 134 women [84%]; median age at onset, 45 [IQR, 34-53.3] years), the median age at onset was lower in individuals with a moderate to severe PGA score (41 years [IQR, 30.5-52 years]) compared with those with a clear to mild PGA score (46.5 years [IQR, 35-55 years]) (P = .04). In the UK sample, the median
- Published
- 2020
10. Frontal fibrosing alopecia: a descriptive cross-sectional study of 711 cases in female patients from the UK
- Author
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McSweeney, SM, Christou, EAA, Dand, N, Boalch, A, Holmes, S, Harries, M, Palamaras, I, Cunningham, F, Parkins, G, Kaur, M, Farrant, P, McDonagh, A, Messenger, A, Jones, J, Jolliffe, V, Ali, I, Ardern-Jones, M, Mitchell, C, Burrows, N, Atkar, R, Banfield, C, Alexandroff, A, Champagne, C, Cooper, HL, Patel, GK, Macbeth, A, Page, M, Bryden, A, Mowbray, M, Wahie, S, Armstrong, K, Cooke, N, Goodfield, M, Man, I, de Berker, D, Dunnil, G, Takwale, A, Rao, A, Siah, T-W, Sinclair, R, Wade, MS, Bhargava, K, Fenton, DA, McGrath, JA, Tziotzios, C, McSweeney, SM, Christou, EAA, Dand, N, Boalch, A, Holmes, S, Harries, M, Palamaras, I, Cunningham, F, Parkins, G, Kaur, M, Farrant, P, McDonagh, A, Messenger, A, Jones, J, Jolliffe, V, Ali, I, Ardern-Jones, M, Mitchell, C, Burrows, N, Atkar, R, Banfield, C, Alexandroff, A, Champagne, C, Cooper, HL, Patel, GK, Macbeth, A, Page, M, Bryden, A, Mowbray, M, Wahie, S, Armstrong, K, Cooke, N, Goodfield, M, Man, I, de Berker, D, Dunnil, G, Takwale, A, Rao, A, Siah, T-W, Sinclair, R, Wade, MS, Bhargava, K, Fenton, DA, McGrath, JA, and Tziotzios, C
- Published
- 2020
11. Association of Serum Ustekinumab Levels With Clinical Response in Psoriasis
- Author
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Tsakok, T, Wilson, N, Dand, N, Loeff, FC, Bloem, K, Baudry, D, Duckworth, M, Pan, S, Pushpa-Rajah, A, Standing, JF, de Vries, A, Alsharqi, A, Becher, G, Murphy, R, Wahie, S, Wright, A, Griffiths, CEM, Reynolds, NJ, Barker, J, Warren, RB, Burden, AD, Rispens, T, Stocken, D, Smith, C, British Association of Dermatologists Biologic and Immunomodulat, and Psoriasis Stratification to Optimise Relevant Therapy (PSORT) Co
- Abstract
Importance: High-cost biologic therapies have transformed the management of immune-mediated inflammatory diseases. To optimize outcomes and reduce costs, dose adjustment informed by measurement of circulating drug levels has been shown to be effective in various settings. However, limited evidence exists for this approach with the interleukin 12 and interleukin 23 inhibitor ustekinumab. Objective: To evaluate clinical utility of therapeutic drug monitoring for ustekinumab in patients with psoriasis. Design, Setting, and Participants: A prospective observational cohort of 491 adults with psoriasis was recruited to the multicenter Biomarkers of Systemic Treatment Outcomes in Psoriasis study within the British Association of Dermatologists Biologic and Immunomodulators Register from June 2009 to December 2017; samples from some patients were taken between 2009 and 2011 as part of a pilot study with the same inclusion criteria. Exposure: Serum ustekinumab level measured at any point during the dosing cycle using an enzyme-linked immunosorbent assay. Main Outcomes and Measures@ Disease activity measured using the Psoriasis Area and Severity Index (PASI) score. Treatment response outcomes were PASI75 (75% reduction in PASI score from baseline [primary outcome]), PASI90 (90% reduction of PASI score from baseline), and absolute PASI score of 1.5 or less. Results: A total of 491 patients (171 women and 320 men; mean [SD] age, 45.7 [12.8] years) had 1 or more serum samples (total, 853 samples obtained 0-56 weeks from start of treatment) and 1 or more PASI scores within the first year of treatment. Antidrug antibodies were detected in only 17 of 490 patients (3.5%). Early measured drug levels (1-12 weeks after starting treatment) were associated with PASI75 response 6 months after starting treatment (odds ratio, 1.38; 95% CI, 1.11-1.71) when adjusted for baseline PASI score, age, and ustekinumab dose. However, this finding was not consistent across the other PASI outcomes (PASI90 and PASI score of ≤1.5). Conclusions and Relevance: This real-world study provides evidence that measurement of early serum ustekinumab levels could be useful to direct the treatment strategy for psoriasis. Adequate drug exposure early in the treatment cycle may be particularly important in determining clinical outcome.
- Published
- 2019
12. Long-term response to hydroxychloroquine in patients with discoid lupus erythematosus
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Wahie, S. and Meggitt, S. J.
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- 2013
- Full Text
- View/download PDF
13. A scaly rash on the hands
- Author
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Reddy, H, De Vittoris, A, and Wahie, S
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- 2012
- Full Text
- View/download PDF
14. Cutaneous features of intravascular lymphoma
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Wahie, S., Dayala, S., Husain, A., Summerfield, G., Hervey, V., and Langtry, J. A. A.
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- 2011
- Full Text
- View/download PDF
15. Measuring disease activity and damage in cutaneous lupus erythematosus
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Wahie, S., Mc Coll, E., Reynolds, N. J., and Meggitt, S. J.
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- 2011
- Full Text
- View/download PDF
16. Frontal fibrosing alopecia: a descriptive cross‐sectional study of 711 cases in female patients from the UK
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McSweeney, S.M., primary, Christou, E.A.A., additional, Dand, N., additional, Boalch, A., additional, Holmes, S., additional, Harries, M., additional, Palamaras, I., additional, Cunningham, F., additional, Parkins, G., additional, Kaur, M., additional, Farrant, P., additional, McDonagh, A., additional, Messenger, A., additional, Jones, J., additional, Jolliffe, V., additional, Ali, I., additional, Ardern‐Jones, M., additional, Mitchell, C., additional, Burrows, N., additional, Atkar, R., additional, Banfield, C., additional, Alexandroff, A., additional, Champagne, C., additional, Cooper, H.L., additional, Patel, G.K., additional, Macbeth, A., additional, Page, M., additional, Bryden, A., additional, Mowbray, M., additional, Wahie, S., additional, Armstrong, K., additional, Cooke, N., additional, Goodfield, M., additional, Man, I., additional, Berker, D., additional, Dunnil, G., additional, Takwale, A., additional, Rao, A., additional, Siah, T.‐W., additional, Sinclair, R., additional, Wade, M.S., additional, Bhargava, K., additional, Fenton, D.A., additional, McGrath, J.A., additional, and Tziotzios, C., additional
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- 2020
- Full Text
- View/download PDF
17. Chronic urticaria in the real‐life clinical practice setting in the UK: results from the noninterventional multicentre AWARE study
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Savic, S., primary, Leeman, L., additional, El‐Shanawany, T., additional, Ellis, R., additional, Gach, J.E., additional, Marinho, S., additional, Wahie, S., additional, Sargur, R., additional, Bewley, A.P., additional, Nakonechna, A., additional, Randall, R., additional, Fragkas, N., additional, Somenzi, O., additional, and Marsland, A., additional
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- 2020
- Full Text
- View/download PDF
18. Response to hydroxychloroquine in patients with discoid lupus erythematosus: RF-3
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Wahie, S., Goodfield, M. J.D., Carmichael, A. J., Carr, M. M., Drummond, A., Jones, S. K., Lovell, C. R., Reynolds, N. J., and Meggitt, S. J.
- Published
- 2010
19. Measuring disease activity and damage in discoid lupus erythematosus
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Wahie, S., McColl, E., Reynolds, N. J., and Meggitt, S. J.
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- 2010
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- View/download PDF
20. British Association of Dermatologists guidelines for the management of people with cutaneous lupus erythematosus 2021.
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O'Kane, D., McCourt, C., Meggitt, S., D'Cruz, D.P., Orteu, C.H., Benton, E., Wahie, S., Utton, S., Hashme, M., Mohd Mustapa, M.F., and Exton, L.S.
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LUPUS erythematosus ,DERMATOLOGISTS - Abstract
Linked Comment: B.F. Chong. Br J Dermatol 2021; 185:1084. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
21. Genome-wide association study in frontal fibrosing alopecia identifies four susceptibility loci including HLA-B*07:02
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Tziotzios, C., Petridis, C., Dand, N., Ainali, C., Saklatvala, J.R., Pullabhatla, V., Onoufriadis, A., Pramanik, R., Baudry, D., Lee, S.H., Wood, K., Liu, L., Seegobin, S., Michelotti, G.A., Lwin, S.M., Christou, E.A.A., Curtis, C.J.., de Rinaldis, E., Saxena, A., Holmes, S., Harries, M., Palamaras, I., Cunningham, F., Parkins, G., Kaur, M., Farrant, P., McDonagh, A., Messenger, A., Jones, J., Jolliffe, V., Ali, I., Ardern-Jones, M., Mitchell, C., Burrows, N., Atkar, R., Banfield, C., Alexandroff, A., Champagne, C., Cooper, H.L., Vano-Galvan, S., Maria Molina-Ruiz, A., Ormaechea Perez, N., Patel, G.K., Macbeth, A., Page, M., Bryden, A., Mowbray, M., Wahie, S., Armstrong, K., Cooke, N., Goodfield, M., Man, I., de Berker, D., Dunnill, G., Takwale, A., Rao, A., Siah, T.-W., Sinclair, R., Wade, M.S., Dlova, N.C., Setterfield, J., Lewis, F., Bhargava, K., Kirkpatrick, N., Estivill, X., Stefanato, C.M., Flohr, C., Spector, T., Watt, F.M., Smith, C.H., Barker, J.N., Fenton, D.A., Simpson, M.A., and McGrath, J.A.
- Abstract
Frontal fibrosing alopecia (FFA) is a recently described inflammatory and scarring type of hair loss affecting almost exclusively women. Despite a dramatic recent increase in incidence the aetiopathogenesis of FFA remains unknown. We undertake genome-wide association studies in females from a UK cohort, comprising 844 cases and 3,760 controls, a Spanish cohort of 172 cases and 385 controls, and perform statistical meta-analysis. We observe genome-wide significant association with FFA at four genomic loci: 2p22.2, 6p21.1, 8q24.22 and 15q2.1. Within the 6p21.1 locus, fine-mapping indicates that the association is driven by the HLA-B*07:02 allele. At 2p22.1, we implicate a putative causal missense variant in CYP1B1, encoding the homonymous xenobiotic- and hormone-processing enzyme. Transcriptomic analysis of affected scalp tissue highlights overrepresentation of transcripts encoding components of innate and adaptive immune response pathways. These findings provide insight into disease pathogenesis and characterise FFA as a genetically predisposed immuno-inflammatory disorder driven by HLA-B*07:02.
- Published
- 2019
22. Pityriasis lichenoides: the differences between children and adults
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Wahie, S., Hiscutt, E., Natarajan, S., and Taylor, A.
- Published
- 2007
23. Sunscreen ingredients and labelling: a survey of products available in the UK
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Wahie, S., Lloyd, J. J., and Farr, P. M.
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- 2007
24. Pityriasis lichenoides: the young and the old: PA-4
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Wahie, S., Hiscutt, E., Natarajan, S., and Taylor, A.
- Published
- 2007
25. An open-label, dose-ranging study of methotrexate for moderate-to-severe adult atopic eczema
- Author
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Weatherhead, S. C., Wahie, S., Reynolds, N. J., and Meggitt, S. J.
- Published
- 2007
26. Facial cellulitis as the presenting manifestation of a painless dental abscess
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Wahie, S, Vadhera, S, and Meggitt, S J
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- 2006
27. Oropharyngeal mycosis fungoides
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Wahie, S., Lucraft, H. H., Hartley, C., Milne, D. S., Prabhu, V., and Farr, P. M.
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- 2006
28. Sunscreens: composition and labelling of currently available products: PD-2
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Wahie, S., Lloyd, J. J., and Farr, P. M.
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- 2006
29. Cutaneous signs as a presenting manifestation of alcohol excess
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Wahie, S. and Lawrence, C. M.
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- 2006
30. Hepatitis: a rare, but important, complication of infliximab therapy for psoriasis
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Wahie, S., Alexandroff, A., and Reynolds, N. J.
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- 2006
31. Psoriasis occurring after myeloablative therapy and autologous stem cell transplantation
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WAHIE, S., ALEXANDROFF, A., REYNOLDS, N. J., and MEGGITT, S. J.
- Published
- 2006
32. Myotoxicity occurring with ciclosporin in a patient with atopic dermatitis
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WAHIE, S. and MEGGITT, S. J.
- Published
- 2005
33. Severe dermal binding mucous membrane pemphigoid in a 14-year-old boy treated with mycophenolate mofetil, prednisolone and dapsone: PA-13
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WAHIE, S. and TAYLOR, A. E.M.
- Published
- 2005
34. Genome-wide association study in frontal fibrosing alopecia identifies four susceptibility loci including HLA-B*07:02
- Author
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Tziotzios, C, Petridis, C, Dand, N, Ainali, C, Saklatvala, JR, Pullabhatla, V, Onoufriadis, A, Pramanik, R, Baudry, D, Lee, SH, Wood, K, Liu, L, Seegobin, S, Michelotti, GA, Lwin, SM, Christou, EAA, Curtis, CJ, de Rinaldis, E, Saxena, A, Holmes, S, Harries, M, Palamaras, I, Cunningham, F, Parkins, G, Kaur, M, Farrant, P, McDonagh, A, Messenger, A, Jones, J, Jolliffe, V, Ali, I, Ardern-Jones, M, Mitchell, C, Burrows, N, Atkar, R, Banfield, C, Alexandroff, A, Champagne, C, Cooper, HL, Vano-Galvan, S, Maria Molina-Ruiz, A, Ormaechea Perez, N, Patel, GK, Macbeth, A, Page, M, Bryden, A, Mowbray, M, Wahie, S, Armstrong, K, Cooke, N, Goodfield, M, Man, I, de Berker, D, Dunnill, G, Takwale, A, Rao, A, Siah, T-W, Sinclair, R, Wade, MS, Dlova, NC, Setterfield, J, Lewis, F, Bhargava, K, Kirkpatrick, N, Estivill, X, Stefanato, CM, Flohr, C, Spector, T, Watt, FM, Smith, CH, Barker, JN, Fenton, DA, Simpson, MA, McGrath, JA, Tziotzios, C, Petridis, C, Dand, N, Ainali, C, Saklatvala, JR, Pullabhatla, V, Onoufriadis, A, Pramanik, R, Baudry, D, Lee, SH, Wood, K, Liu, L, Seegobin, S, Michelotti, GA, Lwin, SM, Christou, EAA, Curtis, CJ, de Rinaldis, E, Saxena, A, Holmes, S, Harries, M, Palamaras, I, Cunningham, F, Parkins, G, Kaur, M, Farrant, P, McDonagh, A, Messenger, A, Jones, J, Jolliffe, V, Ali, I, Ardern-Jones, M, Mitchell, C, Burrows, N, Atkar, R, Banfield, C, Alexandroff, A, Champagne, C, Cooper, HL, Vano-Galvan, S, Maria Molina-Ruiz, A, Ormaechea Perez, N, Patel, GK, Macbeth, A, Page, M, Bryden, A, Mowbray, M, Wahie, S, Armstrong, K, Cooke, N, Goodfield, M, Man, I, de Berker, D, Dunnill, G, Takwale, A, Rao, A, Siah, T-W, Sinclair, R, Wade, MS, Dlova, NC, Setterfield, J, Lewis, F, Bhargava, K, Kirkpatrick, N, Estivill, X, Stefanato, CM, Flohr, C, Spector, T, Watt, FM, Smith, CH, Barker, JN, Fenton, DA, Simpson, MA, and McGrath, JA
- Abstract
Frontal fibrosing alopecia (FFA) is a recently described inflammatory and scarring type of hair loss affecting almost exclusively women. Despite a dramatic recent increase in incidence the aetiopathogenesis of FFA remains unknown. We undertake genome-wide association studies in females from a UK cohort, comprising 844 cases and 3,760 controls, a Spanish cohort of 172 cases and 385 controls, and perform statistical meta-analysis. We observe genome-wide significant association with FFA at four genomic loci: 2p22.2, 6p21.1, 8q24.22 and 15q2.1. Within the 6p21.1 locus, fine-mapping indicates that the association is driven by the HLA-B*07:02 allele. At 2p22.1, we implicate a putative causal missense variant in CYP1B1, encoding the homonymous xenobiotic- and hormone-processing enzyme. Transcriptomic analysis of affected scalp tissue highlights overrepresentation of transcripts encoding components of innate and adaptive immune response pathways. These findings provide insight into disease pathogenesis and characterise FFA as a genetically predisposed immuno-inflammatory disorder driven by HLA-B*07:02.
- Published
- 2019
35. Clinical and genetic differences between pustular psoriasis subtypes
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Twelves, S, Mostafa, A, Dand, N, Burri, E, Farkas, K, Wilson, R, Cooper, HL, Irvine, AD, Oon, HH, Kingo, K, Koks, S, Mrowietz, U, Puig, L, Reynolds, N, Tan, EST, Tanew, A, Torz, K, Trattner, H, Valentine, M, Wahie, S, Warren, RB, Wright, A, Bata-Csorgo, Z, Szell, M, Griffiths, CEM, Burden, AD, Choon, SE, Smith, CH, Barker, JN, Navarini, AA, and Capon, F
- Subjects
palmoplantar pustulosis ,Generalized pustular psoriasis ,Generalised pustular psoriasis ,ACH, Acrodermatitis continua of Hallopeau ,GPP, Generalized pustular psoriasis ,PPP, Palmoplantar pustulosis ,IL36RN ,genotype-phenotype correlation ,ERASPEN, European Rare and Severe Psoriasis Expert Network ,PV, Psoriasis vulgaris ,acrodermatitis continua of Hallopeau ,Article ,AP1S3 - Abstract
Background The term pustular psoriasis indicates a group of severe skin disorders characterized by eruptions of neutrophil-filled pustules. The disease, which often manifests with concurrent psoriasis vulgaris, can have an acute systemic (generalized pustular psoriasis [GPP]) or chronic localized (palmoplantar pustulosis [PPP] and acrodermatitis continua of Hallopeau [ACH]) presentation. Although mutations have been uncovered in IL36RN and AP1S3, the rarity of the disease has hindered the study of genotype-phenotype correlations. Objective We sought to characterize the clinical and genetic features of pustular psoriasis through the analysis of an extended patient cohort. Methods We ascertained a data set of unprecedented size, including 863 unrelated patients (251 with GPP, 560 with PPP, 28 with ACH, and 24 with multiple diagnoses). We undertook mutation screening in 473 cases. Results Psoriasis vulgaris concurrence was lowest in PPP (15.8% vs 54.4% in GPP and 46.2% in ACH, P, Graphical abstract
- Published
- 2018
36. Steady-state pharmacokinetics of hydroxychloroquine in patients with cutaneous lupus erythematosus
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Al-Rawi, H, primary, Meggitt, S J, additional, Williams, F M, additional, and Wahie, S, additional
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- 2017
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37. Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial
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Williams, Hywel C, primary, Wojnarowska, Fenella, additional, Kirtschig, Gudula, additional, Mason, James, additional, Godec, Thomas R, additional, Schmidt, Enno, additional, Chalmers, Joanne R, additional, Childs, Margaret, additional, Walton, Shernaz, additional, Harman, Karen, additional, Chapman, Anna, additional, Whitham, Diane, additional, Nunn, Andrew J, additional, Adams, J, additional, Akhras, V, additional, Anstey, A, additional, Barnard, C, additional, Bell, H, additional, Blackford, S, additional, Bröcker, E, additional, Carmichael, A, additional, Coelho, R R, additional, Craig, F, additional, Davies, K, additional, Ellis, R, additional, English, J, additional, Gläser, R, additional, Groves, R, additional, Günthert, C, additional, Hampton, P J, additional, Hepburn, N, additional, Hügel, R, additional, Hussain, K, additional, Ingram, J, additional, Layton, A M, additional, Levell, N J, additional, Lewis, V, additional, Malhomme, H, additional, Omerod, A, additional, Patel, G, additional, Rallan, R, additional, Ravenscroft, J, additional, Santander, H, additional, Steinbrink, K, additional, Sticherling, M, additional, Thomas, C, additional, Vatve, M, additional, van Beek, N, additional, Venning, V, additional, Veysey, E, additional, Wachsmuth, R, additional, Wahie, S, additional, Walker, B, additional, Walsh, M, additional, Wee, J, additional, Westmoreland, M, additional, Wong, G, additional, Ferguson, Adam, additional, Verpetinske, Indre, additional, Duarte-Williamson, Emilia, additional, Antony, Fiona, additional, Bower, Chris, additional, Gawkrodger, David, additional, Taghipour, Kathy, additional, Dunnill, M G S, additional, Waters, Alex, additional, Bottomley, Walter, additional, Wright, Andrew, additional, Sterling, Jane, additional, Azam, Adzura, additional, Gibbs, Sam, additional, Luger, Thomas, additional, Salvary, Ingrid, additional, Lovell, Chris, additional, Ilchyshyn, Andrew, additional, Gibbon, Karen, additional, Nik, Marinella, additional, Charles-Holmes, Robert, additional, and Lavery, A Lloyd, additional
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- 2017
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38. Steady-state pharmacokinetics of hydroxychloroquine in patients with cutaneous lupus erythematosus.
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Al-Rawi, H., Meggitt, S. J., Williams, F. M., and Wahie, S.
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LUPUS erythematosus treatment ,LUPUS erythematosus ,PHARMACOKINETICS ,CHLOROQUINE ,SKIN diseases ,DIAGNOSIS - Abstract
Background: Hydroxychloroquine (HCQ), a 4-aminoquinolone antimalarial, is regarded as the oral therapy of choice for cutaneous and systemic lupus erythematosus (SLE). It is also licensed for rheumatoid arthritis (RA). Studies of HCQ-treated patients with SLE or RA have demonstrated a positive correlation between whole-blood HCQ levels and clinical response. Such studies have involved measuring whole-blood concentrations at any given time point after HCQ ingestion assuming that steady-state concentrations would undergo limited fluctuation over a daily interval because HCQ has a long half-life. This approach might not sufficiently take into account the potential intra-patient variation in HCQ blood levels that can occur over a 24-hour period. Such variation, if significant, could affect the credibility of any concentration-response relationship provided from these previous studies. Objectives: The objectives of this report are to: (a) investigate the intra-patient variation in HCQ whole-blood levels and (b) suggest an optimum time for sampling patients for future studies. Methods: Six patients were recruited with cutaneous lupus erythematosus who had each been on HCQ 200 mg twice daily for at least six months, so that they were at steady-state. Each patient was fasted overnight and had standardized meals and dosing schedule. Whole blood was sampled at seven time points over 24 hours. Whole-blood HCQ levels were measured with high-performance liquid chromatography using gradient elution, fluorimetric detection and chloroquine as an internal standard. The assay had a mean inter- and intra-day coefficient of variation of 10% and 5% respectively and a limit of detection of 5ng/ml. Results: HCQ levels appeared to follow a biphasic pattern over the sampling period. Maximum levels were noted a median of four hours (range 2-6) after ingestion. Median intra-patient variation between trough and peak levels, 'Cmax' ((peak - trough)/trough x 100%), was 27% (range 8-150%). Conclusions: This study demonstrated that whole-blood HCQ levels vary 27% (median, range 8-150%) within an individual over a 12-hour period. Drug levels might differ between individuals because of multiple factors, including variable adherence to medication. Measuring HCQ levels for assessment of drug adherence could be valuable in the 'real-world' clinical setting. This could be assessed by taking a blood sample at any time following HCQ ingestion. If patients were found to have very low or undetectable levels of HCQ, non-adherence to HCQ should be suspected. [ABSTRACT FROM AUTHOR]
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- 2018
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39. Severity of polymorphic light eruption in pre- and post-menopausal women: a comparative study
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Reddy, H., primary, Carmichael, A.J., additional, and Wahie, S., additional
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- 2014
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40. Measuring disease activity and damage in cutaneous lupus erythematosus
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Wahie, S., primary, Mc Coll, E., additional, Reynolds, N.J., additional, and Meggitt, S.J., additional
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- 2010
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41. Cutaneous features of intravascular lymphoma
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Wahie, S., primary, Dayala, S., additional, Husain, A., additional, Summerfield, G., additional, Hervey, V., additional, and Langtry, J. A. A., additional
- Published
- 2010
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42. Severity of polymorphic light eruption in pre- and postmenopausal women: a comparative study.
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Reddy, H., Carmichael, A.J., and Wahie, S.
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POSTMENOPAUSE ,ALLERGIES ,IMMUNOSUPPRESSION ,WOMEN'S health ,COMPARATIVE studies ,APPROXIMATION theory - Abstract
Background Polymorphic light eruption (PLE) is approximately four times more common in women than in men and often begins in young adult life. It is hypothesized that patients with PLE have an inherent resistance to UVL-induced immunosuppression, which is a physiological phenomenon in normal healthy individuals. Consequently, in PLE there is a delayed-type hypersensitivity reaction to a UVL-modified skin antigen, which results in an inflammatory reaction and a variable rash. The female hormone, 17β-oestradiol, has been shown to inhibit UVL-induced physiological suppression of contact hypersensitivity responses. This has been postulated to account for the female preponderance of PLE. If 17β-oestradiol plays a significant part in the disease, one might hypothesize that the severity of PLE might reduce in women after menopause. Objectives To compare the severity of PLE in pre-menopausal women with that in post-menopausal women. Methods Eighteen pre-menopausal and 18 post-menopausal women with PLE had their Polymorphic Light Eruption Severity Index (PLESI) scored by a single investigator. Results Pre-menopausal women (mean age 40 years; range 25-50) had a mean PLESI of 54.8 (range 0-86, SD 20.2). Post-menopausal women (mean age 63 years; range 53-78) had a mean PLESI of 36.8 (range 0-74, SD 18.2). A significant difference in mean PLESI values between pre- and post-menopausal women was noted (18.0; 95% CI 4.9-31.0; P = 0.008). At the time of the study, three subjects in the pre-menopausal group and one subject in the post-menopausal group were on oestrogen preparations. Even after excluding the four patients on oral oestrogens, there remained a statistically significant difference in the mean PLESI scores between the pre-menopausal and post-menopausal groups (55.10 vs. 36.64; difference of 18.46, 95% CI: 4.0-32.91; P = 0.014). Conclusions The severity of PLE was significantly less in post-menopausal women as compared with pre-menopausal women. [ABSTRACT FROM AUTHOR]
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- 2015
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43. Psoriasis occurring after myeloablative therapy and autologous stem cell transplantation
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Wahie, S., primary, Alexandroff, A., additional, Reynolds, N.J., additional, and Meggitt, S.J., additional
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- 2005
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44. A genome-wide meta-analysis of palmoplantar pustulosis implicates T H 2 responses and cigarette smoking in disease pathogenesis.
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Hernandez-Cordero A, Thomas L, Smail A, Lim ZQ, Saklatvala JR, Chung R, Curtis CJ, Baum P, Visvanathan S, Burden AD, Cooper HL, Dunnill G, Griffiths CEM, Levell NJ, Parslew R, Reynolds NJ, Wahie S, Warren RB, Wright A, Simpson M, Hveem K, Barker JN, Dand N, Løset M, Smith CH, and Capon F
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- Humans, Genetic Predisposition to Disease, Polymorphism, Single Nucleotide, Psoriasis genetics, Psoriasis immunology, Genome-Wide Association Study, Cigarette Smoking adverse effects, Th2 Cells immunology
- Abstract
Background: Palmoplantar pustulosis (PPP) is an inflammatory skin disorder that mostly affects smokers and manifests with painful pustular eruptions on the palms and soles. Although the disease can present with concurrent plaque psoriasis, TNF and IL-17/IL-23 inhibitors show limited efficacy. There is therefore a pressing need to uncover PPP disease drivers and therapeutic targets., Objectives: We sought to identify genetic determinants of PPP and investigate whether cigarette smoking contributes to disease pathogenesis., Methods: We performed a genome-wide association meta-analysis of 3 North-European cohorts (n = 1,456 PPP cases and 402,050 controls). We then used the scGWAS program to investigate the cell-type specificity of the association signals. We also undertook genetic correlation analyses to examine the similarities between PPP and other immune-mediated diseases. Finally, we applied Mendelian randomization to analyze the causal relationship between cigarette smoking and PPP., Results: We found that PPP is not associated with the main genetic determinants of plaque psoriasis. Conversely, we identified genome-wide significant associations with the FCGR3A/FCGR3B and CCHCR1 loci. We also observed 13 suggestive (P < 5 × 10
-6 ) susceptibility regions, including the IL4/IL13 interval. Accordingly, we demonstrated a significant genetic correlation between PPP and TH 2-mediated diseases such as atopic dermatitis and ulcerative colitis. We also found that genes mapping to PPP-associated intervals were preferentially expressed in dendritic cells and often implicated in T-cell activation pathways. Finally, we undertook a Mendelian randomization analysis, which supported a causal role of cigarette smoking in PPP., Conclusions: The first genome-wide association study of PPP points to a pathogenic role for deregulated TH 2 responses and cigarette smoking., Competing Interests: Disclosure statement This work was supported by NIHR BioResource Centre Maudsley, National Institute for Health Research Maudsley Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London. We gratefully acknowledge capital equipment funding from the Maudsley Charity (grant no. 980) and Guy’s and St Thomas’s Charity (grant no. STR130505). The work was also supported by the NIHR Manchester Biomedical Research Centre (grant no. NIHR203308). The Trøndelag Health Study (HUNT) is a collaboration between HUNT Research Centre (Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology), Trøndelag County Council, Central Norway Regional Health Authority, and the Norwegian Institute of Public Health. The genotyping in HUNT was financed by the National Institutes of Health; University of Michigan; the Research Council of Norway; the Liaison Committee for Education, Research and Innovation in Central Norway; and the Joint Research Committee between St Olavs Hospital and the Faculty of Medicine and Health Sciences, NTNU. The APRICOT trial was funded by the Efficacy and Mechanism Evaluation (EME) Programme, an MRC and NIHR partnership (grant no. EME 13/50/17). This study was supported by Boehringer-Ingelheim and by the Psoriasis Association (grant nos. BSTOP50/5 and PhD studentship ST3/20 to A.H.C.). Z.Q.L. was supported by the Talent Development Fund of KK Women’s and Children’s Hospital, Singapore. N.J.R. is an NIHR Senior Investigator and is also supported by NIHR Newcastle Biomedical Research Centre, NIHR Newcastle In Vitro Diagnostics Co-operative, and NIHR Newcastle Patient Safety Research Collaboration. The views expressed are those of the author(s) and not necessarily those of the NHS, Department of Health, or King’s College London. None of the funders was involved in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Disclosure of potential conflict of interest: F. Capon has received grants and consultancy fees from Boehringer-Ingelheim. A. D. Burden has received consultancy fees from Boehringer-Ingelheim. C. E. M. Griffiths has received research grants and/or honoraria from AbbVie, Almirall, Anaptysbio, Boehringer-Ingelheim, Bristol Meyers Squibb, Evelo, GlaxoSmithKline, Inmagene, Janssen, Lilly, ONO Pharmaceuticals, Novartis, Pfizer, and UCB. P. Baum and S. Visvanathan are Boehringer-Ingelheim employees. S. Wahie has had nonfinancial support (sponsorship to attend dermatology conferences) from Janssen, AbbVie, Novartis, Almirall, and UCB. J. N. Barker declares paid activities as an advisor and speaker for AbbVie, Amgen, Boehringer-Ingelheim, Bristol Myers Squibb, Johnson & Johnson, Lilly, and Novartis. The rest of the authors declare that they have no relevant conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2024
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45. Damaging Alleles Affecting Multiple CARD14 Domains Are Associated with Palmoplantar Pustulosis.
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Niaouris A, Hernández-Cordero A, Haddad S, Hassi NK, Benzian-Olsson N, Bugarin Diz C, Burden AD, Cooper HL, Griffiths CEM, Parslew R, Pink AE, Reynolds NJ, Wahie S, Warren RB, Wright A, Simpson M, Baum P, Visvanathan S, Barker JN, Smith CH, and Capon F
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- Humans, Alleles, Guanylate Cyclase, Membrane Proteins, CARD Signaling Adaptor Proteins, Psoriasis genetics, Exanthema
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- 2023
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46. An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial).
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Sach TH, Thomas KS, Batchelor JM, Perways A, Chalmers JR, Haines RH, Meakin GD, Duley L, Ravenscroft JC, Rogers A, Santer M, Tan W, White J, Whitton ME, Williams HC, Cheung ST, Hamad H, Wright A, Ingram JR, Levell N, Goulding JMR, Makrygeorgou A, Bewley A, Ogboli M, Stainforth J, Ferguson A, Laguda B, Wahie S, Ellis R, Azad J, Rajasekaran A, Eleftheriadou V, and Montgomery AA
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- Adrenal Cortex Hormones, Adult, Child, Combined Modality Therapy, Cost-Benefit Analysis, Humans, Treatment Outcome, Ultraviolet Therapy, Vitiligo drug therapy
- Abstract
Background: Economic evidence for vitiligo treatments is absent., Objectives: To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo., Methods: Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months' treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015., Results: The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188-235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151-196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment., Conclusions: Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success., (© 2020 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)
- Published
- 2021
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47. Randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo: results of the HI-Light Vitiligo Trial.
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Thomas KS, Batchelor JM, Akram P, Chalmers JR, Haines RH, Meakin GD, Duley L, Ravenscroft JC, Rogers A, Sach TH, Santer M, Tan W, White J, Whitton ME, Williams HC, Cheung ST, Hamad H, Wright A, Ingram JR, Levell NJ, Goulding JMR, Makrygeorgou A, Bewley A, Ogboli M, Stainforth J, Ferguson A, Laguda B, Wahie S, Ellis R, Azad J, Rajasekaran A, Eleftheriadou V, and Montgomery AA
- Subjects
- Adrenal Cortex Hormones, Adult, Child, Combined Modality Therapy, Humans, Mometasone Furoate, Ointments, Treatment Outcome, Ultraviolet Therapy, Vitiligo drug therapy
- Abstract
Background: Evidence for the effectiveness of vitiligo treatments is limited., Objectives: To determine the effectiveness of (i) handheld narrowband UVB (NB-UVB) and (ii) a combination of potent topical corticosteroid (TCS) and NB-UVB, compared with TCS alone, for localized vitiligo., Methods: A pragmatic, three-arm, placebo-controlled randomized controlled trial (9-month treatment, 12-month follow-up). Adults and children, recruited from secondary care and the community, aged ≥ 5 years and with active vitiligo affecting < 10% of skin, were randomized 1 : 1 : 1 to receive TCS (mometasone furoate 0·1% ointment + dummy NB-UVB), NB-UVB (NB-UVB + placebo TCS) or a combination (TCS + NB-UVB). TCS was applied once daily on alternating weeks; NB-UVB was administered on alternate days in escalating doses, adjusted for erythema. The primary outcome was treatment success at 9 months at a target patch assessed using the participant-reported Vitiligo Noticeability Scale, with multiple imputation for missing data. The trial was registered with number ISRCTN17160087 on 8 January 2015., Results: In total 517 participants were randomized to TCS (n = 173), NB-UVB (n = 169) and combination (n = 175). Primary outcome data were available for 370 (72%) participants. The proportions with target patch treatment success were 17% (TCS), 22% (NB-UVB) and 27% (combination). Combination treatment was superior to TCS: adjusted between-group difference 10·9% (95% confidence interval 1·0%-20·9%; P = 0·032; number needed to treat = 10). NB-UVB alone was not superior to TCS: adjusted between-group difference 5·2% (95% CI - 4·4% to 14·9%; P = 0·29; number needed to treat = 19). Participants using interventions with ≥ 75% expected adherence were more likely to achieve treatment success, but the effects were lost once treatment stopped. Localized grade 3 or 4 erythema was reported in 62 (12%) participants (including three with dummy light). Skin thinning was reported in 13 (2·5%) participants (including one with placebo ointment)., Conclusions: Combination treatment with home-based handheld NB-UVB plus TCS is likely to be superior to TCS alone for treatment of localized vitiligo. Combination treatment was relatively safe and well tolerated but was successful in only around one-quarter of participants., (© 2020 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)
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- 2021
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48. Loss-of-function myeloperoxidase mutations are associated with increased neutrophil counts and pustular skin disease.
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Vergnano M, Mockenhaupt M, Benzian-Olsson N, Paulmann M, Grys K, Mahil SK, Chaloner C, Barbosa IA, August S, Burden AD, Choon SE, Cooper H, Navarini AA, Reynolds NJ, Wahie S, Warren RB, Wright A, Huffmeier U, Baum P, Visvanathan S, Barker JN, Smith CH, and Capon F
- Published
- 2021
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49. Association of Clinical and Demographic Factors With the Severity of Palmoplantar Pustulosis.
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Benzian-Olsson N, Dand N, Chaloner C, Bata-Csorgo Z, Borroni R, Burden AD, Cooper HL, Cornelius V, Cro S, Dasandi T, Griffiths CEM, Kingo K, Koks S, Lachmann H, McAteer H, Meynell F, Mrowietz U, Parslew R, Patel P, Pink AE, Reynolds NJ, Tanew A, Torz K, Trattner H, Wahie S, Warren RB, Wright A, Barker JN, Navarini AA, Smith CH, and Capon F
- Subjects
- Adult, Age of Onset, Comorbidity, Cross-Sectional Studies, Ex-Smokers statistics & numerical data, Female, Humans, Male, Middle Aged, Non-Smokers statistics & numerical data, Prevalence, Psoriasis epidemiology, Psoriasis prevention & control, Quality of Life, Risk Factors, Sex Factors, Smokers statistics & numerical data, Smoking Prevention, Psoriasis diagnosis, Severity of Illness Index, Smoking epidemiology
- Abstract
Importance: Although palmoplantar pustulosis (PPP) can significantly impact quality of life, the factors underlying disease severity have not been studied., Objective: To examine the factors associated with PPP severity., Design, Setting, and Participants: An observational, cross-sectional study of 2 cohorts was conducted. A UK data set including 203 patients was obtained through the Anakinra in Pustular Psoriasis, Response in a Controlled Trial (2016-2019) and its sister research study Pustular Psoriasis, Elucidating Underlying Mechanisms (2016-2020). A Northern European cohort including 193 patients was independently ascertained by the European Rare and Severe Psoriasis Expert Network (2014-2017). Patients had been recruited in secondary or tertiary dermatology referral centers. All patients were of European descent. The PPP diagnosis was established by dermatologists, based on clinical examination and/or published consensus criteria. The present study was conducted from October 1, 2014, to March 15, 2020., Main Outcomes and Measures: Demographic characteristics, comorbidities, smoking status, Palmoplantar Pustulosis Psoriasis Area Severity Index (PPPASI), measuring severity from 0 (no sign of disease) to 72 (very severe disease), or Physician Global Assessment (PGA), measuring severity as 0 (clear), 1 (almost clear), 2 (mild), 3 (moderate), and 4 (severe)., Results: Among the 203 UK patients (43 men [21%], 160 women [79%]; median age at onset, 48 [interquartile range (IQR), 38-59] years), the PPPASI was inversely correlated with age of onset (r = -0.18, P = .01). Similarly, in the 159 Northern European patients who were eligible for inclusion in this analysis (25 men [16%], 134 women [84%]; median age at onset, 45 [IQR, 34-53.3] years), the median age at onset was lower in individuals with a moderate to severe PGA score (41 years [IQR, 30.5-52 years]) compared with those with a clear to mild PGA score (46.5 years [IQR, 35-55 years]) (P = .04). In the UK sample, the median PPPASI score was higher in women (9.6 [IQR, 3.0-16.2]) vs men (4.0 [IQR, 1.0-11.7]) (P = .01). Likewise, moderate to severe PPP was more prevalent among Northern European women (57 of 134 [43%]) compared with men (5 of 25 [20%]) (P = .03). In the UK cohort, the median PPPASI score was increased in current smokers (10.7 [IQR, 4.2-17.5]) compared with former smokers (7 [IQR, 2.0-14.4]) and nonsmokers (2.2 [IQR, 1-6]) (P = .003). Comparable differences were observed in the Northern European data set, as the prevalence of moderate to severe PPP was higher in former and current smokers (51 of 130 [39%]) compared with nonsmokers (6 of 24 [25%]) (P = .14)., Conclusions and Relevance: The findings of this study suggest that PPP severity is associated with early-onset disease, female sex, and smoking status. Thus, smoking cessation intervention might be beneficial.
- Published
- 2020
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50. Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: HI-Light Vitiligo three-arm RCT.
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Batchelor JM, Thomas KS, Akram P, Azad J, Bewley A, Chalmers JR, Cheung ST, Duley L, Eleftheriadou V, Ellis R, Ferguson A, Goulding JM, Haines RH, Hamad H, Ingram JR, Laguda B, Leighton P, Levell N, Makrygeorgou A, Meakin GD, Millington A, Ogboli M, Rajasekaran A, Ravenscroft JC, Rogers A, Sach TH, Santer M, Stainforth J, Tan W, Wahie S, White J, Whitton ME, Williams HC, Wright A, and Montgomery AA
- Subjects
- Administration, Cutaneous, Adolescent, Child, Child, Preschool, Combined Modality Therapy, Cost-Benefit Analysis, Dermatologic Agents administration & dosage, Dermatologic Agents economics, Female, Humans, Male, Models, Economic, Mometasone Furoate administration & dosage, Mometasone Furoate adverse effects, Mometasone Furoate economics, Quality of Life, Single-Blind Method, Technology Assessment, Biomedical, Ultraviolet Therapy adverse effects, Ultraviolet Therapy economics, United Kingdom, Dermatologic Agents therapeutic use, Mometasone Furoate therapeutic use, Ultraviolet Therapy methods, Vitiligo therapy
- Abstract
Background: Systematic reviews suggest that narrowband ultraviolet B light combined with treatments such as topical corticosteroids may be more effective than monotherapy for vitiligo., Objective: To explore the clinical effectiveness and cost-effectiveness of topical corticosteroid monotherapy compared with (1) hand-held narrowband ultraviolet B light monotherapy and (2) hand-held narrowband ultraviolet B light/topical corticosteroid combination treatment for localised vitiligo., Design: Pragmatic, three-arm, randomised controlled trial with 9 months of treatment and a 12-month follow-up., Setting: Sixteen UK hospitals - participants were recruited from primary and secondary care and the community., Participants: Adults and children (aged ≥ 5 years) with active non-segmental vitiligo affecting ≤ 10% of their body area., Interventions: Topical corticosteroids [mometasone furoate 0.1% (Elocon
® , Merck Sharp & Dohme Corp., Merck & Co., Inc., Whitehouse Station, NJ, USA) plus dummy narrowband ultraviolet B light]; narrowband ultraviolet B light (narrowband ultraviolet B light plus placebo topical corticosteroids); or combination (topical corticosteroids plus narrowband ultraviolet B light). Topical corticosteroids were applied once daily on alternate weeks and narrowband ultraviolet B light was administered every other day in escalating doses, with a dose adjustment for erythema. All treatments were home based., Main Outcome Measures: The primary outcome was self-assessed treatment success for a chosen target patch after 9 months of treatment ('a lot less noticeable' or 'no longer noticeable' on the Vitiligo Noticeability Scale). Secondary outcomes included blinded assessment of primary outcome and percentage repigmentation, onset and maintenance of treatment response, quality of life, side effects, treatment burden and cost-effectiveness (cost per additional successful treatment)., Results: In total, 517 participants were randomised (adults, n = 398; and children, n = 119; 52% male; 57% paler skin types I-III, 43% darker skin types IV-VI). At the end of 9 months of treatment, 370 (72%) participants provided primary outcome data. The median percentage of narrowband ultraviolet B light treatment-days (actual/allocated) was 81% for topical corticosteroids, 77% for narrowband ultraviolet B light and 74% for combination groups; and for ointment was 79% for topical corticosteroids, 83% for narrowband ultraviolet B light and 77% for combination. Target patch location was head and neck (31%), hands and feet (32%), and rest of the body (37%). Target patch treatment 'success' was 20 out of 119 (17%) for topical corticosteroids, 27 out of 123 (22%) for narrowband ultraviolet B light and 34 out of 128 (27%) for combination. Combination treatment was superior to topical corticosteroids (adjusted risk difference 10.9%, 95% confidence interval 1.0% to 20.9%; p = 0.032; number needed to treat = 10). Narrowband ultraviolet B light was not superior to topical corticosteroids (adjusted risk difference 5.2%, 95% confidence interval -4.4% to 14.9%; p = 0.290; number needed to treat = 19). The secondary outcomes supported the primary analysis. Quality of life did not differ between the groups. Participants who adhered to the interventions for > 75% of the expected treatment protocol were more likely to achieve treatment success. Over 40% of participants had lost treatment response after 1 year with no treatment. Grade 3 or 4 erythema was experienced by 62 participants (12%) (three of whom were using the dummy) and transient skin thinning by 13 participants (2.5%) (two of whom were using the placebo). We observed no serious adverse treatment effects. For combination treatment compared with topical corticosteroids, the unadjusted incremental cost-effectiveness ratio was £2328.56 (adjusted £1932) per additional successful treatment (from an NHS perspective)., Limitations: Relatively high loss to follow-up limits the interpretation of the trial findings, especially during the post-intervention follow-up phase., Conclusion: Hand-held narrowband ultraviolet B light plus topical corticosteroid combination treatment is superior to topical corticosteroids alone for treatment of localised vitiligo. Combination treatment was relatively safe and well tolerated, but was effective in around one-quarter of participants only. Whether or not combination treatment is cost-effective depends on how much decision-makers are willing to pay for the benefits observed., Future Work: Development and testing of new vitiligo treatments with a greater treatment response and longer-lasting effects are needed., Trial Registration: Current Controlled Trials ISRCTN17160087., Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 24, No. 64. See the NIHR Journals Library website for further project information.- Published
- 2020
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