R.P.R. Dawber's research while affiliated with Churchill College and other places
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Publications (232)
Like its predecessors, Text Atlas of Nail Disorders, Third Edition is destined to become an invaluable diagnostic tool. The authors comprehensively cover pathologies affecting the toe and finger nails. They profile each pathology, from common to rare disorders, and support them with extensive color photographs. The editors take a differential diagn...
This chapter contains section titled:
ChildhoodComposition and Morphology of the Nail in ChildhoodNail Plate ChangesSoft Tissue FeaturesInfectionMiscellaneousThe Nail in Old AgeAetiology of Senile ChangesLinear Nail GrowthVariations in the Contour of the NailVariations in the ColourVariations in Thickness and ConsistencyMechanical Factors and Nail ChangesIngrowing ToenailTumours in the...
Modification in the Configuration of the NailModification of the Nail SurfaceModification of the Nail Plate and Soft Tissue AttachmentsModifications in Perionychial TissuesModification in the Consistency of the NailModification in Colour: Chromonychia or Dyschromia
This chapter contains section titled:
The authors revise two kinds of dermatoses: I) Those ones that characteristically show nail alterations such as the psoriasis, emphasizing its clinical forms, complications of syndromes with similar clinical features such as the acropustuloses, psoriatic arthritis, Reiters syndrome, acrokeratosis pareneoplasica of Bazex and Dupre, pityriasis rubra...
AnatomyPhysiologyHistory and Patient ExaminationPreoperative MeasuresInstrumentationAnaesthesiaIncisionDressingBiopsy of the Nail AreaElectroradiosurgeryMiscroscopically Controlled SurgeryNon-scalpel TechniquesTraumaMiscellaneous Nail DystrophiesComplications in Nail SurgeryInfectionBurnsChemical BurnsThe Painful Nail
The optimum experimental conditions have been investigated for the measurement of the birth-rate in human psoriatic epidermis using the vinca alkaloids vinblastine and vincristine. The dose response characteristics of the two drugs were assessed over a 2.5 h collection period; although the dose response characteristics differed between the two agen...
We describe the clinicopathological findings in five cases of an acquired vascular tumour involving periungual or subungual tissue. We believe that these represent acral arteriovenous tumours (cirsoid aneurysms). There are no previous reports of subungual or periungual acral arteriovenous tumours.
We report a case where occurrence of linear Darier's disease along Blaschko's lines followed radiotherapy due to the subject's recurrence of a longstanding carcinoma of the bladder. Scattered papules on the chest and hack preceded the exacerbation of the disease. In this case, localised linear disease may he triggered on a background of a more diss...
Aim We aimed to clarity the effectivenes of our staging of LM over a I-year period.
Background Cryosurgery has become accepted as a simple and effective treatment for lentigo maligna (LM) but not necessarily lentigo maligna melanoma (LMM). Pigmented epithelial cells are extremely sensitive to cold injury. If adequate freezing is delivered to the pr...
Objective A pilot study to determine the efficacy of cryosurgery for the treatment of vulvar intraepithelial neoplasia (VIN) using a standardized treatment schedule.
Background Cryosurgery is known to be an effective epithelial cell killer in cutaneous neoplasia and pre-neoplasia at other sites. It is widely available, inexpensive and most importan...
Hereditary hypotrichosis of Marie Unna type is a rare distinctive syndrome of hair loss which is inherited with an autosomal dominant gene. We report a family with more than half affected individuals in 4 subsequent generations which supports the very strong autosomal dominant pattern of inheritance.
Approximately 80% of women are affected by the presence of excessive hair growth in a 'male-like' pattern. Excessive facial hair in particular can be a source of distress to such women and can lead to psychological problems such as anxiety, depression and a reduced quality of life.Current cosmetic methods of hair removal include shaving, depilatori...
Pili annulati is a rare autosomal inherited hair shaft abnormality of unknown pathogenesis in which clinical examination reveals alternating light and dark bands leading to a shiny appearance of the hair due to cavities within the cortex of the hair shaft. This is the first investigation of the proposed cytokeratin defect in pili annulati hair foll...
A feature of black African hair is an apparent increased fragility of the hair shaft compared to other ethnic groups (as measured by the tensile force needed to break the hair fibre). This has certain similarities to that reported for trichorrhexis nodosa (weathering secondary to physical damage) and trichothiodystrophy [a genetic disorder associat...
Hair and nails are often stated to have much in common in relation to their origin, anatomical structures, and common involvement in many diseases. Hair and nails are predominantly epithelial structures derived from primitive epidermis and made up of keratinous fibrils embedded in a sulfur-rich matrix. It was first noted early in the 20th century t...
Pili annulati is an inherited hair shaft abnormality with a wide range of clinical expression.
We have examined closely three kindreds to reveal levels and character of expression of the phenotype and supplement current literature on the threshold for detection and aspects of hair shaft fragility.
Eleven cases of pili annulati from three families w...
A 74-year-old woman presented with an 18-month history of broken vertex scalp hairs as a consequence of chronic rubbing. Light microscopy of the 1-2 cm hairs demonstrated distal brush-like splitting. Education and behavioural therapy were instituted. After 4 months of reduced rubbing of the vertex scalp hairs, the hairs re-grew with no evidence of...
Pili annulati is a rare autosomal dominant inherited hair shaft abnormality in which clinical examination reveals alternating light and dark bands leading to a shiny appearance of the hair. The clinically light bands are the abnormal areas due to cavities within the cortex. The pathogenesis remains unknown.
To investigate the expression of the base...
Hypertrichosis has been reported more frequently in females than in males who use minoxidil topical solution (MTS) for the treatment of androgenetic alopecia (AGA). This article examines the occurrence of MTS-induced hypertrichosis in females.
Data from placebo-controlled clinical trials in females (up to 5% MTS) were analysed based on spontaneous...
For decades, scientists and clinicians have examined methods of measuring scalp hair growth. With the development of drugs that stem or even reverse the miniaturization of androgenetic alopecia, there has been a greater need for reliable, economical and minimally invasive means of measuring hair growth and, specifically, response to therapy. We rev...
Three cases of androgen-dependent disease in females with myotonic dystrophy are described. Serum androgens in individuals affected by myotonic dystrophy are known to be lower on average than in normal controls. Despite this these three females developed diseases that are androgen dependent, including acne, hidradenitis suppurativa, androgenetic al...
Androgenetic alopecia (AGA), also known in women as female pattern hair loss, is caused by androgens in genetically susceptible women and men. The thinning begins between ages 12 and 40 years, the inheritance pattern is polygenic, and the incidence is the same as in men. In susceptible hair follicles, dihydrotestosterone binds to the androgen recep...
Onycholysis refers to the detachment of the nail from its bed at its distal and/or lateral attachments (Figure 4.1). The pattern of separation of the plate from the nail bed takes many forms. Sometimes it resembles closely the damage from a splinter under the nail, the detachment extending proximally along a convex line, giving the appearance of a...
The bulbous digital deformity known as clubbing (Figure 2.1a, b) was described as early as the fifth century BC when Hippocrates noted such changes in patients suffering from empyema. The diagnostic signs comprise: 1 Overcurvature of the nails in the proximal to distal and transverse planes (Figure 2.2).
Distal lateral subungual onychomycosis (DLSO) is the most common type of onychomycosis (Figures 8.3, 8.4, 8.5, 8.7-8.9). Responsible Table 8.1 Causes of onychomycosis Type of organism Prevalence (%) Dermatophytes 83 Non-dermatophytic moulds 15 (approx.) Yeasts < 1 frequently Trichophyton rubrum), moulds (Scytalidium spp., Scopulariopsis spp., Fusar...
There are some important points to note concerning the examination of abnormal nails for colour changes. The nails should be studied with the fingers completely relaxed and not pressed against any surface. Failure to do this alters the haemodynamics of the nail and changes its appearance. The finger tips should then be blanched by pressing them on...
The human nail, chemically similar to horn and hoof, is not essential to the survival of Homo sapiens, but it has many important functions that are crucial for the efficient use of the hands and feet. It is also a prime route for the transmission of organisms (both macro- and microscopic), toxins, irritants and allergens. Maintaining nail cleanline...
Like its predecessors, Text Atlas of Nail Disorders, third edition is destined to become an invaluable diagnostic tool. The authors comprehensively cover pathologies affecting the toe and finger nails. They profile each pathology, from common to rare disorders, and support them with extensive color photographs. This latest edition contains new mate...
The changes in brittle, friable nails are often confined to the surface of the nail plate; this occurs in superficial white onychomycosis and may be seen after the application of nail polish or base coat which causes 'granulations' in the nail keratin. In advanced psoriasis and fungal infection the friability may extend throughout the entire nail.
Hirsuties is an androgen-dependent differentiation and growth of hair in females in the same pattern and sequence as that which develops in the normal postpubertal male, but of less quantity and varying in severity. The clinical diagnosis implies underlying pathology and necessitates systematic consideration. The assessment must be adequate to dist...
We report two cases of keratosis follicularis spinulosa decalvans in a Caucasian family involving a 28-year-old woman and her mother. This is an unusual family in that no male relatives are similarly affected. Secondly, both patients have no significant eye changes but quite extensive scarring alopecia. To the best of our knowledge this is the seco...
Onychomycosis is common, affecting approximately 5% of the population, and is the most resistant form of superficial fungal infection. Dermatologists often view the nail apparatus in static terms and unfortunately give little consideration to the functional aspects of the digit. In the case of toenails, it is important to consider the toes and foot...
Certain scalp hair shafts from 2 of 10 cases of pili annulati examined by scanning electron microscopy exhibited an unusual weathering pattern. The majority of affected hair shafts showed minor surface abnormalities at regular intervals (nodes) associated with the underlying spaces. However, in a few examples, there was marked damage to the cuticle...
The hair of normal black Africans forms a mat of tightly interwoven hair shafts. The effect of this on the structure of the hair shaft and the response to grooming is unknown.
Our purpose was to use light and scanning electron microscopy (SEM) to examine the structure of Negroid-type hairs and effects of combing in black African volunteers.
Hair sa...
Differentiation within the nail unit was examined using a range of antikeratin monoclonal antibodies including the recently described antibody LHTric-1, specific to the acidic hair-type keratin Ha1. Keratinocytes of the nail matrix, nail bed and the digit pulp were characterized by different patterns of keratin expression. Nail matrix was the sole...
In this review, the current state of knowledge concerning nail melanoma is summarized. The pathogenesis, histological findings, clinical presentation, treatment and prognosis of this rare form of cutaneous melanoma are discussed. Important clinical clues to the early diagnosis of nail melanoma are highlighted and recommendations to improve the mana...
Netherton's syndrome is a rare autosomal recessive condition with variable expression. It comprises an ichthyosiform dermatitis and erythroderma of variable intensity and manifestations, associated with hair abnormalities. The pathognomonic finding (required for diagnosis) is that of trichorrhexis invaginata identified by light and scanning electro...
In a series of 18 patients with folliculitis decalvans attending the Oxford hair clinic, eight were found to have areas of tufted folliculitis either at presentation or follow-up. There was no difference between these two groups in their presentation, clinical course, growth of causative organism (Staphylococcus aureus) or investigations including...
Nail apparatus melanoma (or subungual melanoma) is rare and accounts for only 1.4% of all cutaneous melanomas in the United Kingdom. We report the use of fixed-tissue Mohs micrographic surgery to treat a biopsy-proven Clark level I in situ nail apparatus melanoma, presenting with diffuse longitudinal melanonychia.
We report two patients, mother and daughter, with Erythrokeratoderma variabilis (EV). This rare genodermatosis is characterized by the presence of two components: migratory erythema and fixed hyperkeratosis. Our patients experienced symptomatic relief of pruritus associated with erythema with the use of an oral, low-sedating H1-antihistamine. Revis...
We report two patients, mother and daughter, with Erythrokeratoderma variabilis (EV). This rare genodermatosis is characterized by the presence of two components: migratory erythema and fixed hyperkeratosis. Our patients experienced symptomatic relief of pruritus associated with erythema with the use of an oral, low-sedating H1antihistamine. Revisi...
Our population-based study establishes epidemiological data on age-specific incidence rates, clinical presentation, Breslow microstaging, treatment and survival of nail apparatus melanoma (NAM) patients in England. Four cancer registries, covering a population of 10.6 million, recorded 105 cases of NAM during the period 1984-93. During the same dec...
It has become routine practice in many centers to use two successive freeze-thaw cycles in the treatment of the common types of basal cell carcinoma. Because of the potential morbidity caused by this, we have investigated the cure rate achieved with one freeze-thaw cycle compared with that achieved with two freeze-thaw cycles in the treatment of fa...
This article discusses the up-to-date clinical and laboratory diagnostic criteria in well-known conditions of hair disorders.
Monilethrix is characterized by beaded or moniliform hair, which results from the periodic thinning of the hair shaft. The beaded hair thus produced is subject to excess weathering and premature fracturing at the internodes. Clinically, monilethrix presents with short, fragile, broken hair. The follicular abnormalities range from subtle perifollicu...
We present a case of Netherton disease, where the hairs lacked the characteristic microscopic feature of trichorrhexis invaginata. In its place were certain hairs with a golf tee morphology. These represent the proximal half of the invaginate node seen in typical Netherton disease. Scanning electron microscopy demonstrated the three-dimensional qua...
Three possible mechanisms of the hair shaft abnormality in cheveux incoiffables have been investigated in nine patients. Cheveux incoiffables hairs were found to exhibit a normal distribution of cystine-rich protein within both the cuticle and the cortex, as determined by silver methenamine ultrastructural cytochemistry. Resistance to stretching, a...
The anatomy of the epidermis, dermis and subcutaneous tissues of the nail apparatus is distinct from that of non-appendageal skin. Apart from the demonstration of the longitudinal configuration of the dermal-epidermal junction of the nail bed, there have been no studies of the composition of the basement membrane zone of the nail apparatus. We obta...
The morphology of hair follicles was examined in psoriatic scalp biopsies and compared with normal scalp. In scalp psoriasis the lower outer root sheath and hair matrix were not affected by the psoriatic changes, although there was an irregular expansion in the proximal lower outer root sheath. This area has been characterized, by the presence of k...
The scalp is a relatively common site of cutaneous metastasis. The usual presentation is of single or multiple firm scalp nodules. A well-recognized but rarer presentation is alopecia neoplastica that is seen as single or multiple areas of cicatricial alopecia. We describe a unique presentation of scalp metastasis in a patient with breast carcinoma...
Two patients suffering from pemphigus vulgaris were found to have nail dystrophies which antedated the onset of mucocutaneous lesions by many years. The nail changes improved substantially on treatment of the bullous disease. One patient had nail matrix histology consistent with pemphigus, and both had positive direct immunofluorescence with interc...
We have studied 10 cases of scarring alopecia, and investigated the diagnostic reliability of immunofluorescence and histopathology in lichen planopilaris and pseudopelade. In the light of our findings, we discuss the possible pathomechanisms of both disease processes.
We describe two sisters aged 2 and 7 years, with monilethrix. The older sister was clinically less severely affected but, microscopically, the features of weathering and alternating nodes and internodes were more obvious. The younger girl had more severe alopecia, with shorter hair, but the microscopic features were less marked. Scanning-electron m...
Many of the effects of the freezing methods employed in clinical practice produce inflammatory changes that are probably important for successful treatment; therefore morbidity, side effects and complications cannot always be treated as separate entities in cryosurgery, as is seen with many of the changes described below. Specific complications dep...
Trends in admission rates, patterns of readmission, lengths of stay and clinical caseload for in-patient dermatology from 1976 to 1985 are described using data from the Oxford record-linkage study. Age-specific admission rates were considerably higher in people aged 50 years and over than in younger people. Admission rates declined over time in mos...
Hypotrichosis of the Marie-Unna variety is a distinctive syndrome eponymously named following a publication in 1925 describing a family in which 27 individuals in seven generations were affected by a previously unreported type of hypotrichosis. Its inheritance is determined by an autosomal dominant gene and it usually occurs as an isolated abnormal...
The clinicopathological features of the scarring alopecia of discoid lupus erythematosus (DLE) were studied. Scarring alopecia was present in 34% of 89 patients with DLE and was associated with a prolonged disease course. More than half these patients had scalp involvement at the onset of the disease. There was a significant reduction in size of se...
Citations
... Characteristic microscopic nail changes in alopecia areata include lymphocytic infiltration and spongiotic vesiculation in the nail base epithelium. [22] The prominent microscopic changes observed in all the 3 cases were parakeratosis and plasma crusting of the nail plate with inflammatory infiltrate in the subungual tissue. [ Figure 6b] ...
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... Nail pitting may rarely occur in pityriasis rosea and secondary syphilis. 84,85 Psoriasis Pitting is the most common nail abnormality in psoriasis. Fingernail pitting is more common than that of the toenails and is attributed to the psoriatic pathology involving the proximal nail matrix leading to retention of the parakeratotic cells focally in the nail plate, which shed off leaving behind pits. ...
Reference: "Pitted" lesions in dermatology
... The common physical signs of OM are altered nail colour, nail plate separation, hyperproliferation of the nail bed, and destruction of the nail plate leading to an abnormal appearance. [1] Description of mycotic infections of the nail appeared fi rst in the year 1829 in a treatise on scalp ringworm, which compared 'favus of the nail' to the statue of Daphne, a beautiful woman who changed into a laurel tree to escape from amorous advances of Apollo. [2] Until the late 1990s, OM was a lesser discussed topic in medical science. ...
... A standard deviation of 1 mm for distal phalanx length was used, as proposed by Aydinlioglu et al. 2 Acquired racquet nails have been associated with hyperparathyroidism with underlying resorption of the distal terminal phalanges 8 and psoriatic arthropathy and nail biting. 9 Acquired generalized racquet nails with resorption of the terminal phalanx has been reported in Erasmus syndrome, a syndrome characterized by the co-occurrence of systemic sclerosis with silicosis. 10 We contribute to the literature a novel case of brachyonychia in BBS. ...
... When the literature is reviewed, it seems that the frequency of nail involvement has been reported in up to 10% of patients with LP [6,9,10]. In the present study 25 (60%) of the patients showed at least one statistically significant dermoscopic finding (at least one of the multiple splinter haemorrhage, multiple leukonychia, longitudinal erythronychia, prominence of hyponychial vas- . ...
... It leads to the formation of a very typical pattern of the disease. The pattern of nail invasion is usually produced by the dermatophytes responsible for endothrix type of hair invasion [12,13,14]. ...
Reference: Clinico-mycological updates on Onychomycosis
... It frequently starts in the fourth web space. [5] Elderly patients often have poor vision, walk barefoot on contaminated surfaces and may acquire the infection easily. Also, they may not mistake it for the common dry skin related pruritus. ...
... AGA is heritable and polygenic (Yap et al., 2018), with several identified patterns and progressions (Lee & Lee, 2012), and is considered a disease with a genetic predisposition. Importantly, some researchers suggest that the early onset of alopecia (before the age of 36 years) is genetically different from the late onset of alopecia (Dawber et al., 1998). Further, there have been studies regarding diseases associated with AGA. ...
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... summarizes the findings of various studies on the genetics of AGA.3,11,27,[31][32][33][34][35][36][37][38] ...
... Longitudinal ridging are indentations or projections in the relief of the nail plate due to trauma, physiological or secondary alterations to diseases such as: Lichen planus, rheumatoid arthritis, Darier's disease, peripheral vasculopathies and genetic abnormalities. They can also occur due to tumors, near the area of the matrix, that exert compression in the same, leading to changes in the relief of the blade [16,17]. In our study, this change was seen in 64% of CRF patients. ...