E M Higgins

King's College London, Londinium, England, United Kingdom

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Publications (91)388.31 Total impact

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    ABSTRACT: Coxsackievirus A6 (CV-A6) is an emerging pathogen that has in recent years been associated with atypical hand, foot and mouth disease. This manifests as a generalized papular or vesicular eruption, which may be associated with fever and systemic disturbance. We report a series of six children presenting to a single centre in the UK with disseminated CV-A6 infection on a background of atopic dermatitis (AD). Our patients exhibited a widespread papular or vesicular eruption in association with exacerbation of AD. Several of our cases mimicked eczema herpeticum, but the extent was more generalized, and individual lesions were discrete rather than clustered and were less circumscribed in character. This series highlights that CV-A6 infection may be encountered in the UK, and should be considered in the differential diagnosis of an acute exacerbation of AD, particularly in children. © 2015 British Association of Dermatologists.
    Clinical and Experimental Dermatology 02/2015; DOI:10.1111/ced.12574 · 1.23 Impact Factor
  • British Journal of Dermatology 09/2014; 171(3):454-63. DOI:10.1111/bjd.13196 · 4.10 Impact Factor
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    ABSTRACT: Generalized pustular psoriasis (GPP) is a rare and severe variant of psoriasis. We report a case of a 79-year-old woman who presented with generalized pustular psoriasis and significant Epstein–Barr virus (EBV) viraemia. Serial measurements of EBV DNA showed a correlation with the deterioration in her clinical condition. We speculate that EBV reactivation triggered the development of GPP, and propose that further investigation is required into the association between EBV and GPP.
    Clinical and Experimental Dermatology 09/2014; 40(2). DOI:10.1111/ced.12493 · 1.23 Impact Factor
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    ABSTRACT: INTRODUCTION: Sun exposure is a major risk factor for the development of skin cancer. This is particularly relevant in immunosuppressed liver-transplant recipients (LTRs). Preventative strategies may help minimize the skin-cancer risk in this patient group. METHODS: We assessed 670 patients in our post-transplant clinic, using questionnaires. Patient data were collected, and we assessed whether patients had received education (such as formal talks or information from transplant coordinators or from hepatologists) on skin, sun exposure and skin cancer. In a subset of 280 of the LTRs who responded, we recorded their recall of sun-protection advice and assessed the level of patient adherence to such advice. RESULTS: The response rate was 57.5% (349/607), with a mean responder age of 51.1 years (range 19-84) and an average post-transplant time of 7.1 years (range 0-27). In the recall assessment, 37.2% reported that they were given advice about their skin, while 18.1% were seen by a dermatologist, and education on sun exposure and the risks of skin cancer was given to 65.6% and 47.9%, respectively. Over three-quarters (78%; 185/280) of the patients used mechanical sun protection (i.e. hats/clothing), while 66% reported using sunscreen; 31.8% of these used a sunscreen of the recommended sun protection factor (SPF) of > 30. Twelve patients had developed squamous cell carcinoma after a mean of 10.9 years (1-23) post-transplant; half of these had used either no sunscreen or one with an SPF of < 15. CONCLUSIONS: Despite the fact that LTRs are given information on sun-exposure and SC before and after transplantation, recall of such advice and use of sun-protection methods was only moderate, indicating that regular reinforcement of SC education is needed.
    Clinical and Experimental Dermatology 06/2013; 38(8). DOI:10.1111/ced.12159 · 1.23 Impact Factor
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    Dataset: bjd.12081
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    ABSTRACT: Introduction:  Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) describes a heterogenous group of severe adverse reactions to medications. The cutaneous phenotype has a number of guises, accompanied by a variety of systemic features including fever, haematological abnormalities and visceral involvement, most commonly the liver. Clinical markers of prognosis have not been identified. Methods:  We reviewed the clinical features, dermatopathology and outcomes of 27 consecutive cases of DRESS presenting to a single unit. Results:  4 distinct patterns of cutaneous involvement were identified: an urticated papular exanthem (13/27 patients), a morbilliform erythema (3/27), an exfoliative erythroderma (3/27) and an erythema multiforme-like (EM-like) reaction consisting of atypical targets (8/27). All patients mounted a fever, most developed lymphadenopathy (24/27) and a peripheral eosinophilia (25/27) and the most common organ involved was the liver (26/27). Review of dermatopathic features of patients with DRESS demonstrated a superficial spongiotic dermatitis in the majority of cases (16/27). A smaller number of cases showed basal cell vacuolar degeneration and necrotic keratinocytes (9/27). These patients with these biopsy findings more commonly had an erythema multiforme like cutaneous phenotype, and more severe hepatic involvement. 3 patients died, 2 following failed liver transplants. Conclusions:  Our series is the first in which a detailed dermatological assessment has been made of consecutive patients presenting with DRESS, and the largest UK series to date. Our results suggest a possible prognostic role of the cutaneous and dermatopathic findings in DRESS in predicting the severity of visceral involvement in this syndrome.
    British Journal of Dermatology 10/2012; 168(2). DOI:10.1111/bjd.12081 · 4.10 Impact Factor
  • Journal of Hepatology 04/2012; 56:S95. DOI:10.1016/S0168-8278(12)60238-4 · 10.40 Impact Factor
  • Laura E Proudfoot, Elisabeth M Higgins, Rachael Morris-Jones
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    ABSTRACT: Kerion celsi is the inflammatory extreme of tinea capitis, representing a delayed hypersensitivity reaction to the causative dermatophyte. Some authors have advocated the use of oral corticosteroids in patients with kerion formation to inhibit the host inflammatory response and minimize the risk of scarring. This retrospective study analyzed the management and outcome of all children younger than 10 years old presenting to our pediatric dermatology service with tinea capitis resulting in kerion formation between 2003 and 2009. We propose that kerion treatment be directed toward the underlying dermatophyte. Oral and intralesional corticosteroids are an unnecessary adjunct to oral antifungal therapy for children with tinea capitis presenting with kerion in urban areas.
    Pediatric Dermatology 11/2011; 28(6):655-7. DOI:10.1111/j.1525-1470.2011.01645.x · 1.52 Impact Factor
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    ABSTRACT: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, life-threatening, drug-induced illness characterised by a widespread polymorphic eruption, fever and multivisceral involvement. There is little published on the management of DRESS. Prompt recognition and withdrawal of the causative drug is essential, along with supportive treatment. However, the condition commonly progresses despite these measures. Oral corticosteroids are usually given but the response can be suboptimal and result in a prolonged exposure to systemic glucocorticoid. We conducted a prospective single-centre study to determine the efficacy of pulsed intravenous methylprednisolone followed by a short reducing course of oral prednisolone in ten patients with confirmed DRESS. Rash and fever responded rapidly to methylprednisolone in all patients. Compared to pre-treatment assessments, there was a significant reduction in eosinophil count at day 14 and AST level at day 90 post-treatment. One patient developed acute hepatic failure, necessitating a liver transplant, and died 4 months later. In the immediate post-treatment phase, 1 patient developed type 1 diabetes and 1 patient developed a corticosteroid-induced psychosis. Long-term follow-up on 8/10 revealed all patients to be well, although one patient had persistent pruritus. An aggressive corticosteroid regimen in the management of DRESS is associated with good clinical outcome and acceptable tolerance.
    European journal of dermatology: EJD 04/2011; 21(3):385-91. DOI:10.1684/ejd.2011.1300 · 1.95 Impact Factor
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    John Fleming, Salvador Diaz-Cano, Elisabeth Higgins
    Archives of dermatology 03/2011; 147(3):361-2. DOI:10.1001/archdermatol.2011.29 · 4.31 Impact Factor
  • Laura E Proudfoot, E M Higgins
    Pediatric Dermatology 05/2010; 27(3):299-300. DOI:10.1111/j.1525-1470.2010.01154.x · 1.52 Impact Factor
  • Clinical and Experimental Dermatology 07/2009; 34(7):e381-2. DOI:10.1111/j.1365-2230.2009.03346.x · 1.23 Impact Factor
  • Deirdre A. Buckley, Elisabeth M. Higgins, A W du Vivier
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    ABSTRACT: Alagille syndrome (arteriohepatic dysplasia) is a genetic disorder with autosomal dominant transmission which has been localized to chromosome 20p. Cutaneous manifestations include jaundice, pruritus, and widespread xanthomata. We report a child with severe Alagille syndrome in whom orthotopic liver transplantation caused rapid resolution of disfiguring xanthomas.
    Pediatric Dermatology 05/2009; 15(3):199-202. DOI:10.1111/j.1525-1470.1998.tb01314.x · 1.52 Impact Factor
  • J M L White, E M Higgins, L C Fuller
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    ABSTRACT: There is currently an epidemic of tinea capitis in urban areas of developed countries caused by Trichophyton tonsurans. Recurrence or re-infection with dermatophyte is not uncommon after adequate oral treatment. Asymptomatic carriers who are household contacts may partly explain this observation by forming a reservoir for infection. Two-hundred and nine household contacts of patients with tinea capitis were examined and screened for asymptomatic carriage of dermatophyte. Only 7.2% had clinically evident disease yet 44.5% had silent fungal carriage on the scalp. Children under 16 years were much more likely to be carriers than adults (P < 0.001) and males were less likely than females to be affected (P < 0.01). This evidence poses questions about factors relevant in transmission of dermatophytes. The authors propose that all household contacts of patients with tinea capitis should be offered screening to eradicate a potential reservoir of infection.
    Journal of the European Academy of Dermatology and Venereology 10/2007; 21(8):1061-4. DOI:10.1111/j.1468-3083.2007.02173.x · 3.11 Impact Factor
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    ABSTRACT: In humans, Saccharomyces cerevisiae (baker's yeast) is found infrequently as a commensal of mucosal surfaces and rarely causes infections. We describe a case of cutaneous septic emboli developing in a patient with relapsing acute myeloid leukaemia M6 who had recently been treated with clofarabine. Yeast forms were seen on skin biopsy and S. cerevisiae was isolated from her Hickman line. We are not aware of any previous case reports of cutaneous emboli associated with this organism.
    Clinical and Experimental Dermatology 08/2007; 32(4):395-7. DOI:10.1111/j.1365-2230.2007.02375.x · 1.23 Impact Factor
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    ABSTRACT: The surgical advances made in the area of organ transplantation along with the use of more efficacious immunosuppression have meant an increase in patient survival. This longer-living transplant population has started to exhibit cutaneous problems, some of which lead to an increased mortality while others lead to a decline in the quality of life. The primary objective was to determine the different types of cutaneous lesions encountered in the adult liver transplant population. Secondary objectives were to determine the impact, if any, of the duration of transplant, the type of immunosuppression involved and the degree of sun exposure and skin phototype, on the skin cancers encountered in this transplanted population. Two dermatologists examined 100 consecutive liver transplant recipients (LTRs) attending the transplant outpatient department. Skin examination included the face and whole body and lesions found were categorized into the following groups: cutaneous malignancies, squamoproliferative lesions, cutaneous infections and others that did not fall into any of these categories. The reasons for organ transplantation were numerous. The mean age at transplantation was 42.5 years. The average time since transplantation was 5.5 (range 0.75-16 years). Four patients developed skin cancers; among them there were a total of seven skin cancers (one squamous cell carcinoma, six basal cell carcinomas). Fungal infections accounted for 19% of all cutaneous infections seen, viral infections 2% and bacterial infections 5%. Triple-drug immunosuppressive therapy (ciclosporin A, azathioprine and prednisolone) was used in 35% of LTR patients, while dual therapy (tacrolimus and prednisolone) was used in 48% and monotherapy (tacrolimus) was used in 17% of LTRs. Immunosuppressive therapy is believed to be one of the most important risk factors in the development of skin cancer in solid organ transplant recipients. The relatively low prevalence of skin cancer in our liver transplant population may in part be explained by the relatively high percentage of recipients on dual and monotherapy (48% and 17% respectively), and the shorter duration of therapy. Our study suggests that although LTRs are at higher risk of developing nonmelanoma skin cancer than the general population, the risk is comparable with other solid organ transplant recipients.
    British Journal of Dermatology 06/2006; 154(5):868-72. DOI:10.1111/j.1365-2133.2006.07154.x · 4.10 Impact Factor
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    Clinical and Experimental Dermatology 06/2006; 31(3):487-8. DOI:10.1111/j.1365-2230.2005.02046.x · 1.23 Impact Factor
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    Katherine A Short, L Claire Fuller, Elisabeth M Higgins
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    ABSTRACT: Molluscum contagiosum is a common viral infection of the skin that frequently affects children. Lesions take between 6 and 18 months to resolve spontaneously and are a source of great embarrassment to both caretakers and children, often affecting attendance at school and limiting social activity. Treatment options to date have been poorly tolerated by children but recent studies have suggested that potassium hydroxide may be beneficial. This double-blind, randomized, placebo-controlled study compared 10% potassium hydroxide with placebo (normal saline). Twenty patients, aged 2 to 12 years, were recruited. Parents applied a solution twice daily to lesional skin until signs of inflammation appeared. Children were examined by the same observer on days 0, 15, 30, 60, and 90. Seventy percent of children receiving topical potassium hydroxide cleared, compared with 20% in the placebo group. Further dosing studies are required to identify whether weaker concentrations of potassium hydroxide are as efficacious, with less irritancy.
    Pediatric Dermatology 05/2006; 23(3):279-81. DOI:10.1111/j.1525-1470.2006.00235.x · 1.52 Impact Factor
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    ABSTRACT: We report the rare instance of four family members with numerous cutaneous lesions of Leishmania major contracted while on holiday in Algeria. Treatment was successful with oral itraconazole for the children and intralesional sodium stibogluconate for the mother. Cutaneous leishmaniasis should be considered in those with apparently sterile plaques returning from endemic areas. These results suggest that itraconazole, which is ideally suited for use in children, is an effective monotherapy for L. major.
    Pediatric Dermatology 01/2006; 23(1):78-80. DOI:10.1111/j.1525-1470.2006.00177.x · 1.52 Impact Factor
  • SA Dawe, J R Salisbury, E Higgins
    Clinical and Experimental Dermatology 12/2005; 30(6):712-3. DOI:10.1111/j.1365-2230.2005.01867.x · 1.23 Impact Factor

Publication Stats

1k Citations
388.31 Total Impact Points


  • 1990–2015
    • King's College London
      • Department of Immunobiology
      Londinium, England, United Kingdom
  • 2005–2011
    • ICL
      Londinium, England, United Kingdom
    • The Princess Grace Hospital
      Londinium, England, United Kingdom
  • 2002–2005
    • The Kings College
      Denmark, South Carolina, United States
  • 1996
    • Kent Hospital
      Warwick, Rhode Island, United States