Florence Deroide's research while affiliated with Royal Free London NHS Foundation Trust and other places

Understanding wound healing is imperative for the dermatological physician to optimise surgical outcomes. Poor healing may result in negative functional, cosmetic, and psychological sequelae. This review briefly outlines the physiology of wound healing, with a view to improving the management of wounds and scars, and minimising the long term scarring complications.

A 46-year-old woman with Fitzpatrick skin type V presented with sudden-onset accelerated diffuse hair loss. Her other relevant medical history included Graves disease. Trichoscopy showed black dots, broken hairs with exclamation mark-like hairs and yellow dots. She was provisionally diagnosed with diffuse alopecia areata (AA). Laboratory work-up, including complete blood count, liver/renal parameters, antinuclear antibody and complement screen did not reveal any abnormality. Thyroid function and adjusted calcium level were all within the normal range. She had slight iron, folate and vitamin D deficiencies, which were treated with the appropriate supplements. A biopsy was taken from the scalp, and histological examination showed a nonscarring process with miniaturization, significant telogen shift and peribulbar granulomatous inflammation. Subsequent syphilis serology was negative, and serum angiotensin-converting enzyme was within normal limits. No clinical features of sarcoidosis or syphilis were observed. After careful clinicopathological correlation, she was diagnosed with granulomatous AA. We planned to treat her with diphencyprone; however, her hair grew back spontaneously after 2 months. AA is a nonscarring hair loss that can commonly affect the scalp and beard, as well as any hair-bearing surface on the body. It is a T-cell-mediated disease with characteristic histological features, including peribulbar lymphocytic inflammation with or without eosinophils, follicular miniaturization and an increase in catagen/telogen hairs. Peribulbar granulomatous inflammation is a rare histopathological finding in AA. In the context of alopecia, other conditions associated with histopathological granulomatous findings include sarcoidosis, syphilis and various forms of inflammatory and cicatrizing alopecia. To our knowledge, only five other cases of granulomatous AA have been reported. Notably, we describe the first case from the UK and only the second case internationally to show spontaneous resolution, suggesting that the prognosis of granulomatous AA is not dissimilar to histologically typical AA. To summarize, we have described a clinically typical AA with atypical histopathological findings. Granulomatous inflammation should not preclude a diagnosis of AA. This demonstrates the importance of clinicopathological correlation as the histopathology of alopecia could potentially be misleading.

Background: Access to vertical and transverse sections of a punch biopsy specimen improves the diagnosis of alopecia. Both two biopsy specimen and single-punch biopsy specimen techniques to visualize both transverse and vertical sections have been described. Their comparative diagnostic certainty is not known. We aimed to assess the diagnostic certainty of a modified HoVert (mHoVert) method, without direct immunofluorescence (DIF), compared to the St John's protocol, a two-biopsy technique with DIF. Methods: Fifty-seven cases of alopecia processed using the St John's protocol and 60 cases of alopecia processed using mHoVert were reviewed. Diagnoses made were rated as certain/probable, possible, or uncertain, depending on the language in the histopathology report. Cases processed by the St John's protocol had final diagnosis and DIF result recorded. Results: In the mHoVert group, significantly more diagnoses were certain/probable (66%, 95% confidence interval [CI]: 57%-75%), compared to 46% (95% CI: 36%-56%) of diagnoses in the St John's protocol group (p = 0.005). DIF result did not affect the final diagnosis in any of the 57 cases reviewed. Conclusions: DIF is not required in the diagnosis of most cases of alopecia. The mHoVert method provides more certain/probable diagnoses than the St John's protocol and can reduce cost and patient morbidity.

Objective To propose and develop a histopathological criteria to help diagnose vascular malformations. Methods All patients who underwent surgical resection and had a confirmed histopathological diagnosis of vascular malformations from 01 March 2018-26 February 2020 were included. A criteria based on 10 parameters was developed to help diagnose vascular malformations. Discrepancies between clinical and histopathological diagnosis were evaluated. Results A total of 18 cases were identified. There was a discrepancy between the clinical diagnosis and the initially reported histopathological diagnosis in 16 cases (88.9%). This was reduced to 7 (38.9%) and 6 cases (33.3%) with first and second time revised histopathological analysis using proposed criteria. Conclusions The discrepancy between clinical and histopathological diagnoses of vascular malformations has highlighted the requirement of an agreed criteria for histopathologists to help formulate their diagnosis. The proposed criteria may be used as a guide in addressing this and guide treatment and improve clinical practice.

In spite of wide prevalence, deliberate self-injury in the oro-facial region is rarely reported in literature. It is also associated with misinterpretation related to ‘attention seeking’ or ‘mental health crises’ leading to deficient understanding of this phenomenon. A literature review was performed using online search databases looking at dermatitis artefacta in the head and neck region. A case of a patient who was seen in our unit is also presented to give important insights into this condition. In total, 54 cases from 15 publications were included in this observational study. Female gender predilection was notable (4:1) with an average presenting age of 30 years. The face itself was more frequently injured, along with the neck and scalp. Only one-third (34%) of the patients were known to have psychiatric conditions, such as depressive and personality disorders. Dermatitis artefacta is a well-known skin condition caused by deliberate self-injury. It is a complex entity that is frequently unrecognized and underdiagnosed. CPD/Clinical Relevance: Understanding dermatitis artefacta will facilitate correct diagnosis and improve patient care.

Non-melanoma skin cancer comprises the two most common forms of malignant neoplasms found in humans, namely, basal cell carcinoma and squamous cell carcinoma. Seborrheic keratosis is one of the commonest benign epidermal skin lesions that appear in middle-aged or elderly people. Other common epidermal tumors in this chapter include melanoacanthoma, skin tags, dermatosis papulosa nigra, stucco keratosis, and cutaneous horn. Different types of keratoses will be reviewed such as actinic, lichenoid, and lymphomatoid and keratoses related to chronic exposure to arsenic and tar or after radiation therapy. Also acanthomas, namely, clear cell and large cell, and porokeratoma, an acanthoma with porokeratotic characteristics. Other entities are also disseminated superficial actinic porokeratosis, actinic cheilitis, pseudoepitheliomatous hyperplasia, and HPV-related tumors such as Bowenoid papulosis. Three different rare genodermatoses will be described, namely, nevoid BCC syndrome (Gorlin-Goltz’s syndrome), Rombo syndrome, and xeroderma pigmentosum. It is important to learn how to early recognize and diagnose these tumors and genodermatoses. Based on their characteristic features outlined in this chapter and clinical behavior, clinicians can guarantee patients’ appropriate treatment options with less morbidity, better outcomes, and overall prognosis.