Browsing by Author "Isaacs, Thuraya"

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    Clinicopathological correlation in erythema induratum
    (2020) van den Worm, Lerinza; Ngwanya, Reginald; Isaacs, Thuraya
    Background - Erythema induratum (EI) is a reactive disorder to mycobacterium tuberculosis infection, a diagnosis not to be missed. Erythema nodosum (EN) is the main clinical differential of EI, but a distinctly different pathological condition that can be difficult to distinguish from EI. Methods – In this retrospective review we assess clinical and histological features of 40 EI cases and 16 EN cases. Six experienced dermatologists blindly diagnosed these cases based on clinical images, thereafter the histology was revealed, and they adjusted their diagnoses accordingly. Fleiss Kappa statistics were applied to determine inter-rater variability. A multi-variate logistic regression model determined the clinical and histological features that contribute most to an accurate diagnosis. Results - After assessing the clinical picture 48.8% of the EI cases and 74% of the EN cases were correctly diagnosed. With added histology results 67.1% EI and 81.2% EN cases were correct. EI cases showed inter-rater variability of 0.478 (pvalue < 0.01) before and 0.469 (p-value < 0.01) after histology was revealed. These features combined in a logistic regression model had a higher diagnostic accuracy than the assessors with regard to EI cases. The model was accurate in 100% and 80% of EI and EN cases respectively. Conclusions - While the study was limited by its retrospective nature and small sample size, valuable features (ulceration, vasculitis and lobular or septal panniculitis) were identified. A biopsy of the lower leg markedly increased the diagnostic accuracy, but there was less concordance between assessors, more research is needed to confirm these results.
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    Folliculitis keloidallis nuchae severity score: development and reliability assessment
    (2020) Nyika, Dennias Toderai; Khumalo, Nonhlanhla; Isaacs, Thuraya
    Background: Folliculitis keloidalis nuchae (FKN) is a chronic inflammatory condition that targets the hair follicle, leading to keloidal scarring and alopecia. The absence of a severity scoring tool for FKN limits objective assessment of disease progression and response to treatment. Objectives: To develop and test the reliability of a severity scoring tool for FKN. Methods: The tool was developed based on lesion type, number, size and distribution on the scalp. An initial pilot period with 2 assessors was followed by the main study that used 78 anonymised and standardised clinical photographs of the back of the scalp. The participants were selected from an ongoing case control study of FKN. The assessors could allocate disease severity in one of 14 categories (with/without inflammation). However, inflammation (especially erythema) can be missed in photographs of pigmented skin. Thus, two groups of analysis were conducted first with all 14 and again with 8 categories (i.e. excluding inflammation). Assessors were 4 dermatology consultants and 7 registrars, who all independently scored the same anonymised and standardised photographs on two separate occasions, 2 weeks apart. Results: Inter-observer standard errors were higher with the 14-category compared to the 8- category analysis for both consultants and registrars. The intraclass correlation coefficient for registrars improved from poor [0.46 (0.36 -0.56)] to good [0.74 (0.68- 0.80)] with 14 compared to 8-categories, but stayed the same for consultants [0.82 (0.76 – 0.88) versus 0.81 (0.75 – 0.87)]. Limitations of the study were the use of clinical photographs instead of live participants and the problem that the signs of inflammation may be particularly difficult to judge in pigmented skin. Conclusion: We developed a severity scoring tool with poor to good reliability which also highlighted the difficulty of perceiving inflammation from clinical photographs. This improved with the seniority of the observer. The 8-category analysis has good reliability for clinical photographs for both junior and senior staff. For live patient care and clinical trials the 14-category version is likely to be more useful, but requires validation.
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    Kaposi's sarcoma: Genetic subtypes and clinical correlation in a South African population
    (2017) Isaacs, Thuraya; Todd, Gail; Katz, Arieh A
    Human herpes virus 8 (HHV8) is the aetiological agent of all forms of Kaposi's sarcoma (KS). Seven major subtypes (A, B, C, D, E, F, Z) based on genetic variability of open reading frame (ORF)-K1, have been identified. Numerous studies point to differing tumorigenic and pathogenic properties of the HHV8 subtypes. The study objective was to determine the prevalence of the HHV8 subtypes in a cohort of clinical and histologically confirmed KS in Cape Town, South Africa, and analyse associations between the different subtypes, clinico- epidemiological forms and clinical presentation of KS. The clinical data was prospectively collected and recorded on a body diagram and with photographs. Demographic data was retrospectively collected from clinical records. Tissue biopsies were taken for ORF-K1 subtyping. Out of a cohort of 103, eighty six patients were subtyped; 81 AIDS (aquired immune deficiency syndrome)-KS and 5 African endemic. Subtype A5 (42/86) and B2 (16/86) predominated. B1, B3, A1 and A4 subtypes were identified in 10/86, 9/86, 4/86 and 1/86 patients respectively. A5, B1, B2 and B3 were found in African blacks and individuals of mixed ancestry, while subtypes A1 and A4 are found only in whites and individuals of mixed ancestry. Subtype A5 was associated with >10 KS lesions at presentation in the AIDS-cohort (32/38, p=0,050), but not in the African endemic patients (2/4, p=0,600). Subtypes A1 and A4 were less likely to be associated with poor risk tumour extension (p=0,031) and A1 was associated with lower likelihood of lower limb involvement (p=0,004).
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    The clinical spectrum and outcome of dermatological conditions in patients admitted to dermatology wards of Groote Schuur Hospital-Cape Town South Africa
    (2021) Ashour, Emad; Jessop, Susan; Isaacs, Thuraya
    Background: Groote Schuur Hospital (GSH) Division of Dermatology receives many referrals from local clinics and hospitals. Some of these patients are admitted to the dermatology wards for diagnosis and/or management. It is important to look at the spectrum and outcome of these patients who are admitted to dermatology wards at the hospital, to inform policy. Objectives: To characterise the spectrum of dermatological conditions requiring admission, to determine the outcome and to describe the factors that may influence the outcome of dermatological conditions in patients admitted to the dermatology wards at Groote Schuur Hospital in South Africa. Methods: This research employed descriptive retrospective analysis to describe the dermatology inpatients who were admitted to dermatology wards at Groote Schuur Hospital over the period January 2017 to December 2017. Results: There were a total of 120 admissions to Groote Schuur Hospital Dermatology wards in 2017. Of these, 89 (74.1%) were new admissions and 31 (25.8%) re-admissions. The most frequent diagnosis was drug reaction (27.5%), followed by psoriasis (23.3%), eczema (17.5%), and bullous disease (10%). Less common indications for admission were infections, lupus erythematosus, scabies, ulcers, pyoderma gangrenosum and cutaneous small-vessel vasculitis. The outcome of the admission was usually favorable. Conclusions: The most common diagnoses on admission were drug reactions, psoriasis, eczema, and bullous diseases. The generally favorable outcomes would support the future use of inpatient care for people with severe skin disorders.
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    The progression of interface dermatitis by longitudinal examination of the histopathological features of at three-time intervals histopathology techniques in Fitzpatrick skin types III ? VI
    (2023) Williams, Gavin; Isaacs, Thuraya; Adeola Henry
    Interface dermatoses (ID) are characterized by lymphocyte infiltration of the dermo-epidermal junction. The spectrum of ID includes lichen planus, lupus erythematosus, fixed drug eruption and Stevens-Johnson syndrome. A major sequela of ID in pigmented skin is post-inflammatory hyperpigmentation (PIHP). The frequency and severity of PIHP varies amongst different ID for unclear reasons. PIHP can be disfiguring following many dermatoses and some cosmetic and medical interventions, especially in dark-skinned individuals. There is limited understanding of PIHP pathomechanisms and little progress has been made in prevention and treatment of PIHP. ID provide a platform to understanding PIHP, a condition that predominantly affects darker skin. In this study we aimed to determine the progression of PIHP by longitudinal examination of the histopathological features of interface dermatitis at three-time intervals (acute stage, during resolution and upon complete healing) using electron microscopy and light microscopy. This was a prospective study undertaken at the Groote Schuur dermatology clinic over a 16-month period (March 2021 – June 2022). The study population included all patients with interface dermatitis that were diagnosed by the attending dermatologist and confirmed on biopsy during March to December 2021 and subsequently followed up for 6 months. Biopsies were taken at three-time intervals and compared morphologically by using transmission electron microscopy and light microscopy. In this study, it was noted that the degree of melanophages present in the majority of the participants correlate with the degree of Chronic inflammatory cell (CIC) infiltration. The only 2 factors that are common amongst all the patients across all the periods were the presence of CIC infiltrate and melanophages. Fixed drug eruption and bullous fixed drug eruption (BFDE) were assessed, and the key difference was the presence of full thickness epidermal necrosis due to the necrotic keratinocytes in the epidermal layer of BFDE. Upon assessing HMB45 and Melan-A staining, it was found that in participants with atrophic epidermal features, the HMB45 and Melan-A staining count was decreased or absent. This was also observed in participants with a necrotic epidermal layer and participants with discoid lupus erythematosus, however with regeneration improvement in the HMB45 and Melan-A staining results were observed. No correlation was found between the quantity of melanophages and extracellular melanin when assessing CD68 and MF stain results. CIC infiltrate and melanophages persisted in all participants from initial to final biopsy. All data showed no statistical significance, a larger population size could be used to further assess any significance in correlation seen.