Christopher Harland

Epsom and St Helier University Hospitals NHS Trust · Department of Dermatology

Checkpoint inhibitor (CPI) therapy has significantly improved overall survival for metastatic melanoma, and is now approved for use in the adjuvant setting. Modulating the immune system is recognized to cause cutaneous immune‐related adverse events (irAEs). We conducted a retrospective observational cohort study of adult patients with melanoma at o...

Low vitamin D is associated with poorer prognosis, thicker tumours, ulceration and increased inflammation in primary melanoma1. Testing is recommended by the National Institute of Clinical Excellence (NICE) in the UK for any new patient diagnosed with melanoma but not for those with already established or metastatic disease. Driver mutations in BRA...

Background: The severity of Tuberous Sclerosis Complex (TSC) can vary among affected individuals. Complications of TSC can be life threatening, with significant impact on patients' quality of life. Management may vary dependent on treating physician, local and national policies, and funding. There are no current UK guidelines. We conducted a Delph...

Background: Facial hirsutism in women impairs quality of life (QoL). Laser hair removal (LHR) has been shown to confer significant improvements in QoL for up to 6 months after treatment, but the longer-term benefits have not been investigated. Aim: To assess the sustainability of LHR benefits to the QoL of hirsute women up to 30 months after tre...

Background: Tuberous Sclerosis Complex (TSC) is a multi-system genetic disorder characterised by the development of benign growths and diverse clinical manifestations, varying in severity, age at onset and with high clinical burden. Aims: This longitudinal study aims to describe the broad spectrum of clinical manifestation profiles in a large, r...

Viral warts are a common ailment. Clinicians often combine multiple treatments to boost efficacy. One such novel combination is pulsed dye laser with bleomycin intralesionally (PDL + BI), described for the successful treatment of single hand warts. To evaluate PDL + BI for the treatment of poor prognosis hand and foot warts. This 4-year retrospecti...

Recent advances have led to a multitude of image modalities being used for visualization of tissue stiffness. High-resolution images of tissue stiffness are desirable, as they have the potential to provide useful diagnostic information. A noncontact optical imaging method has the attractions of low cost, simplicity, and utility when skin contact is...

Dermatomyositis (DM) is an idiopathic inflammatory myopathy associated with characteristic cutaneous features. Panniculitis is a rarely reported clinical finding in this condition. This report describes two cases of adult-onset DM complicated by severe calcific panniculitis. In both cases, the associated pain and loss of function seemed to be best...

An 82-year-old man presented with multiple, exquisitely painful skin metastases from an atypical carcinoid tumour of the larynx. These were treated successfully with carbon dioxide laser. To our knowledge, this is the first reported case of laser treatment used in the management of neuroendocrine skin metastases.

Two children with bullous and non-bullous ichthyosiform erythroderma improved dramatically with tretinoin under occlusion and 15% urea in emollient. Treatment was well tolerated and there were no clinical or biochemical complications after 18 months of therapy. This combination appears to be effective and safe in the treatment of ichthyosiform eryt...

Background/purpose: The optical appearance of human skin is highly dependent on the interaction between the illumination (type and position), observer position and the skin surface structure. Different currently available photographic techniques record different aspects of this appearance, each providing its own incomplete description. This limits...

Three patients with cutaneous T-cell lymphoma (CTCL) are reported who had concurrent B-cell chronic lymphocytic leukaemia (B-CLL). The separate lineage and clonal nature of the individual lymphoid malignancies were confirmed by gene-rearrangement analysis. The chronology of the illnesses did not support the hypothesis that CTCL predisposes to the d...

We report a case of an immunocompromised 38-year-old Asian patient who developed several hundred atypical lesions of molluscum on her face and neck, resistant to conventional treatment. These lesions were treated successfully by potassium titanyl phosphate (KTP) laser without pigmentary disturbance. KTP laser is a novel treatment for molluscum cont...

Microvascular abnormalities (capillary elongation, widening and tortuosity) are a characteristic feature of psoriasis and form one of the pathological diagnostic criteria. These changes occur early in the progression of a psoriatic plaque, before there is clinical or histological evidence of epidermal hyperplasia. Treatment of psoriatic microvessel...

Blood flow is substantially raised in psoriatic plaques. In addition, mechanisms of vasoconstriction and vasodilatation (locally and neurally mediated), although intact, are altered in magnitude. The elevated blood flow is considered to be a result of abnormalities (increase in vessel number, width and length) in the superficial capillary loops rat...

Epidermal naevi are common and can cause marked cosmetic disability. Ablative laser treatment may be successful in their removal, but may result in significant scarring. Surprisingly the erbium:YAG laser is rarely reported for this indication even though it produces minimal tissue damage. We report our experience using this laser to treat six patie...

In the South-west Thames region there were an unprecedented number of lichenoid tattoo reactions to red ink in patients who had visited a local tattoo parlour. The red ink was found to contain mercuric sulphide, a compound known to cause allergic reactions. Topical Dermovate (clobetasol propionate 0.05%, GlaxoWellcome) ointment alone had little imp...

Skin cancer is increasingly common, and the skills involved in its diagnosis should be promoted in UK medical schools. However, there has been no scientific evaluation of the teaching methods employed by dermatology departments. The aim of this study was to evaluate, using traditional audiovisual methods, the impact of an illustrated booklet on ski...

We report a case of unusually severe, scrotal lymphangiomas that have been treated successfully with the novel combination of cutting diathermy and carbon dioxide laser.

Elongated and tortuous capillary loops are distinctive features of psoriasis. The significance of these microvascular changes in the pathogenesis of plaques, however, remains unclear. To determine what part the expanded superficial capillary bed plays in the pathogenesis of clinical lesions by selectively thermolysing psoriatic capillaries with a p...

To study the feasibility of developing targeted screening for those at high risk of melanoma by examining how attitudes relate to (a) acceptance of an invitation for a free skin check and (b) self assessed and clinically assessed risk factors for developing cutaneous melanoma. A population based cross sectional survey. A general practice with a bro...

To ensure effective primary prevention of skin cancer, aimed at changing behaviour in the sun, and ultimately at reducing the incidence and mortality rates from skin cancer, sufficient information needs to be known about the relationship between sun exposure and skin cancer, the effectiveness of sun protection measures, and the acceptability and up...

Keloid scars have been treated in many ways, with varying success. A wide variety of treatments, all in current usage, indicate that no treatment has been shown to be markedly superior to the others. Following the successful treatment of scars using the pulsed dye laser, and with the more traditional intralesional steroid injection, a pilot study w...

Good quality research to study behaviour in the sun is needed in the UK to ensure that we can develop the most effective methods for ultimately reducing the incidence of skin cancer. Many initiatives have taken place during the past two decades to reduce the level of sun exposure. However, there have been relatively few studies to evaluate the impa...

There are potential clinical benefits if non-invasive methods can be used to diagnose or exclude melanoma. We investigated high-resolution ultrasound (HRU) as a potential non-invasive diagnostic aid for pigmented skin lesions. Using a 20-MHz ultrasound B-scan imaging system interfaced to a computer, we assessed acoustic shadowing and entry echo lin...

The feasibility of targeted screening for cutaneous malignant melanoma in the UK using a postal questionnaire and invitation to screening by a consultant dermatologist was investigated in a population based cross-sectional survey. A total of 1600 people aged 25-69 years, stratified by the social deprivation score of wards within one general practic...

Urticaria pigmentosa is a chronic benign proliferation of mast cells in the skin that presents considerable cosmetic disability, for which there is no current successful treatment. We describe a 30-year-old woman with urticaria pigmentosa in whom treatment with the Nd:YAG laser produced a significant improvement in the clinical appearance of the er...

Seventeen general practitioners (GPs) were evaluated to assess their ability to recognize malignant, borderline and benign skin lesions before and after a novel, cheap and quick skin cancer educational programme. They were tested without prior warning on two occasions using two sets of 30 clinical slides. Between each test the GPs were given a lect...

Unilateral naevoid telangiectatic syndrome (UNTS) was first described in 1899 and is characterized by the dermatomal distribution of telangiectasia. It is broadly divided into congenital and acquired forms based upon the time of presentation. To date no effective treatment has been reported for this condition. In view of the vascular component of t...

Pyoderma gangrenosum (PG) is an uncommon necrotising, non-infective ulceration of the skin. The management of PG is aimed at limiting tissue destruction, promoting the healing of the wound, and providing an acceptable cosmetic result. However, skin grafting is normally avoided because of the potential risk of pathergy-the localization of skin damag...

Lupus pernio of the nose is the most characteristic cutaneous lesion of sarcoidosis. It is cosmetically disfiguring and can be the cause of significant morbidity. In particular, the affected skin is often red or purple due to increased vasculature. It is particularly resistant to both surgical and medical therapy. We describe a patient with lupus p...

We report a 25-year-old male with fever, generalized lymphadenopathy and an erythematosus maculo-papular eruption affecting face and upper body. A diagnosis of Kikuchi disease (necrotizing histiocytic lymphadenitis) was made on lymph node histology. The patient was found to be positive for the human T-cell leukaemia lymphoma virus (HTLV1). Kikuchi...

We report the case of a female infant with an intrauterine herpes simplex type II infection in zosteriform distribution. She was treated with several courses of intravenous acyclovir leading to healing of the skin with segmental scarring. This patient is unusual in that the infection occurred in zosteriform distribution without any evidence of syst...

We report a 25-year-old male with fever, generalized lymphadenopathy and an erythematosus maculo-papular eruption affecting face and upper body, A diagnosis of Kikuchi disease (necrotizing histiocytic lymphadenitis) was made on lymph node histology. The patient was found to be positive for the human T-cell leukaemia lymphoma virus (HTLV1). Kikuchi...

A pharmacogenetic predisposition to thalidomide-induced neuropathy has been investigated. Differences of drug metabolism were examined in 16 patients with severe orogenital ulceration, who were treated with thalidomide (≤200 mg/day) for 0.3–5.0 years. Eight had evidence of early peripheral neuropathy according to nerve conduction studies. Rates of...

Three patients whose chronic venous leg ulcers were complicated by pyoderma gangrenosum are reported. Illnesses which may have predisposed to the development of pyoderma gangrenosum included Crohn's colitis, rheumatoid arthritis and small bowel perforation. Pyoderma gangrenosum should be suspected in susceptible patients whose venous leg ulcers und...

Cosmetic causes of scarring alopecia are poorly documented. They include traction alopecia and hot-combing. Recently, another group has presented in the South London area, related to misuse of chemical hair straightening agents. Affected patients are young, female, of Afro-Caribbean origin, and typically display hair loss on the vertex of the scalp...

Sixteen skin tumours and one BCG vaccination granuloma were examined by 20-MHz B-scan ultrasound. Images were compared with closely matched histological sections of excised lesions. The correlation between histology and ultrasound was excellent for maximum tumour depth measurements (r = 0.96, P < 0.0001), but less good for maximum width (r = 0.84,...

The production of neopterin closely reflects activation of T-lymphocyte-mediated immunity. Oxidized and reduced forms of urine neopterin were measured by reversed-phase ion-pair high-performance liquid chromatography in patients with moderate to severe chronic plaque psoriasis (n = 40), and in a heterogeneous group of patients (n = 14) with cutaneo...

Patients' attitudes to the supply and quality of information provided about their condition were examined by questionnaire before (n = 852) and after exposure to an information leaflet campaign (n = 560) in the dermatology out-patient waiting area. A high expectation of this service was demonstrated, particularly from patients under 60 years of age...

Three patients with cutaneous T-cell lymphoma (CTCL) are reported who had concurrent B-cell chronic lymphocytic leukaemia (B-CLL). The separate lineage and clonal nature of the individual lymphoid malignancies were confirmed by gene-rearrangement analysis. The chronology of the illnesses did not support the hypothesis that CTCL predisposes to the d...

A 69-year-old man with painful, recalcitrant, localized acrodermatitis continua developed widespread pustulation which was resistant to high-dose methotrexate therapy. Low-dose cyclosporin induced a rapid and persistent remission.

Skin cancer is already one of the commonest malignancies and its incidence is increasing. Even in the U.K. its incidence is similar to that of colon and rectal cancer combined, and is exceeded only by lung cancer in males and breast cancer in women. For malignant melanoma the incidence in the U.K. nearly doubles every ten years. A characteristic of...

Current ultrasonic echo imaging systems permit the display of fine but artefactual image detail (speckle), which is caused by interference at the receive between echoes from structures which are too close to be separately resolved. We have reviewed previously various methods for reducing speckle in medical ultrasound images and have reported a meth...

We report a 59-year-old woman with severe dermatomyositis in association with high serum toxoplasma antibody titres who was successfully treated with pyrimethamine and sulphadiazine. This case supports an aetiological role for toxoplasmosis in the pathogenesis of some cases of dermatomyositis.

A case of prolonged and refractory neuroleptic malignant syndrome was treated successfully with electroconvulsive therapy. Neuroleptic malignant syndrome and its treatment are reviewed.

A 37-year-old woman presented with an aggressive leukaemic form of small T-cell Sézary syndrome. Despite this unusually malignant variant of the disease, there was a dramatic response to a modified Winkelmann regimen of chlorambucil and prednisolone, and a useful, sustained remission of 7 months. The Winkelmann regimen remains an important and rela...

The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.

Serum neopterin was measured in patients with acquired 'common variable' hypogammaglobulinaemia (CVH), X-linked agammaglobulinaemia (XLA) and healthy subjects. There was a highly significant increase in neopterin levels in the CVH patients as compared with that of the other groups, particularly in those CVH patients with non-A non-B or granulomatou...

One hundred and fifteen hospital doctors in Nottingham were examined for consistency in initiating warfarin therapy. The senior and experienced group of physicians were the most erratic prescribers, although the least convinced by the need for a protocol to guide therapy. Overanticoagulation would have occurred on more than eight per cent of occasi...