Browsing by Author "Jessop, Susan"

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    Open Access
    Do Calcium and Vitamin D Levels in Blood Predict Clinical Features and/or Response to Treatment in People with Psoriasis?
    (2022) Waghid, Sihan; Jessop, Susan; Omar, Fierdoz
    Context: Psoriasis is an immune-mediated skin disease which is chronic and inflammatory, with multiple clinical types and variable severity. It is renowned for its significantly negative effect on quality of life and presents with recurrent relapses and remissions. The selection of treatment of psoriasis is dependent on the psoriasis type, impact on the individual and the severity of the disease. Variable factors that remain incompletely understood influence response to systemic treatment. It is of interest to establish whether calcium or vitamin D serum levels are linked with response to treatment in people with variable (moderate to severe) psoriasis in our population. Aims: This study aims to establish whether: 1. Clinical type or severity of psoriasis is correlated with serum calcium or vitamin D; 2. Calcium or vitamin D serum levels and response to treatment with systemic agents, including methotrexate, cyclosporine, acitretin and ultraviolet light, are associated in people with variable (moderate to severe) psoriasis; 3. Calcium and vitamin D serum levels differ in psoriatic patients compared with such levels in a control group. Materials and methods: As a case control (prospective) study, one hundred people (n = 100) were recruited, fifty having psoriasis and fifty control subjects. The psoriatic participants began a new systemic treatment and/or ultraviolet light for moderate to severe psoriasis. On the basis of a PASI score at both baseline and a three-month follow-up, response to treatment was assessed. The calcium and vitamin D serum levels were measured in psoriatic patients and controls. The collected blood samples were processed by the National Health Laboratory Services. Data collected from interviews, examination and laboratory results were recorded on a data capture sheet. The study was planned to be conducted for one year, but, due to the coronavirus pandemic, it was extended into a second year. For the psoriasis group, visits at one month and three months were recorded. Standard psoriasis treatment was provided by the dermatology health care professionals at Groote Schuur Hospital. ANOVA statistics and the Chi-squared test were applied to determine whether there is a correlation between variables. Results: No significant difference in calcium serum levels was found in psoriatic patients with different types of psoriasis (p = 0.63) or in those with varying severity of psoriasis (p = 0.48). A significant difference in the vitamin D serum levels in relation to different types of psoriasis (p = 0.62) or the severity of psoriasis (p = 0.31), was also absent. Psoriatic patients' response to treatment were less in those patients with low vitamin D serum levels. People with a higher vitamin D level had a significantly greater change in the PASI score (p = 0.01). No correlation was seen between calcium serum levels and changes in PASI score at follow-up. In other words no relationship between serum calcium level and response to treatment in psoriasis (p = 0.49) was found. This study exhibited no difference in calcium levels between the control group and psoriatic group (p = 0.79). However, there were significantly lower vitamin D levels in the psoriatic group compared to the controls (p = 0.01). The mean vitamin D level was 49,92 nmol/L in the control group (SD 20.69) and the mean vitamin D level in the psoriatic group equalled 39.82 nmol/L (SD 19.49). Conclusion: We established that psoriatic patients had lower vitamin D serum levels than controls and psoriatic patients with higher vitamin D serum levels responded better to systemic treatment. However, our findings are limited by small numbers and further studies need to be performed to corroborate this result. It is possible that treatment with Vitamin D could improve outcomes in our patients. This study demonstrated that calcium serum levels did not differ between the two groups and did not correlate with response to systemic treatment.
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    Does alopecia have diagnostic weight in systemic lupus erythematosus?
    (2022) Knight, Lauren Kerry; Jessop, Susan; Gcelu, Ayanda
    Systemic lupus erythematosus (SLE) is a systemic autoimmune disorder characterised by autoantibody production and a wide spectrum of clinical manifestations. Non-scarring alopecia (hair loss) is reported to occur in up to 80% of individuals with SLE, occurring primarily in the active phase. Alopecia is also reported in up to a third of the general population, begging the question of how much diagnostic weight alopecia really has in SLE. METHODS We conducted a cross-sectional cohort study of patients with confirmed SLE, by the 2012 Systemic Lupus International Collaborating Clinics (SLICC) classification criteria, managed at the Lupus clinic at Groote Schuur Hospital, a tertiary referral hospital in Cape Town, South Africa. Age, sex and race matched controls were recruited from the Dermatology clinic at the same hospital. Participants were questioned about alopecia (‘self-reported') and examined for alopecia clinically and dermoscopically (‘confirmed alopecia'). Alopecia was classified according to the likely cause and evaluated as to whether or not it was related to SLE and to disease activity. RESULTS The study included 90 participants with SLE and 90 controls. Females predominated in the study population, with a mean age of 37.13 (range 18-69) for cases and 37.62 (range 18-72) in controls. Demographics of the 2 groups were equally matched, with two thirds (64.4%) of cases and controls self- identified as being mixed race, 33.3% as black african and 2.3% as white. Alopecia (self-reported and confirmed) was found equally in cases and control groups. In a third of the people with SLE (34, 38%) alopecia was recorded by the clinician as one of the classification criteria used by the clinician in recording the diagnosis of SLE. In 7/34 (21%) of these patients, the classification of SLE would not have been made by criteria in the absence of alopecia. Forty patients were found to have clinically apparent alopecia, 7 of these (17.5%) having diffuse alopecia. Of the remaining 33 patients with alopecia, androgenic alopecia (12/33) was the commonest form. Likewise, androgenic alopecia was the commonest type of confirmed alopecia in controls (11/33, 33.3%). Patients with self-reported alopecia had significantly higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores than people without hair loss. However, there was no statistically significant difference in SLEDAI scores between those with clinically confirmed alopecia and those with self-reported alopecia (n = 40, M = 2.88, SD = 3.35 vs n = 50, M = 2.56, SD = 3.37; t = 0.44, p = 0.660, d = 0.09). CONCLUSION Within our population the incidence of alopecia was the same in people with SLE and in controls. Hair loss was identified as androgenic alopecia in the majority of affected cases and controls. This lack of difference in type of alopecia among participants highlights the low specificity of non-scarring alopecia as a criterion for SLE and further supports the weighting of classification criteria within the various domains in the EULAR/ACR criteria.
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    Motivational factors and post procedure impact of facial dermal fillers: a qualitative descriptive study
    (2019) Hirschfeld, Eugene Rouf; Jessop, Susan; Murphy, Katherine
    Background: Over the past decade there has been a worldwide increase in the number of minimally invasive cosmetic procedures, such as dermal fillers. As there are few studies in this field, with most focussing on cosmetic surgery, we conducted research into perceptions around use of dermal fillers, which could contribute to standards of care in administering minimally invasive aesthetic procedures. Objectives: 1. To determine the motivational factors and perceived benefits in people who have had dermal fillers. 2. To assess the need for pre- and post-procedure counselling Methods: We conducted in depth semi-structured patient interviews in people who had had dermal fillers. All 6 participants were adult women. A qualitative comparative approach was used to analyse interview scripts, generating categories and subcategories. Data was further analysed using the theory of planned behaviour. Results: Motivational factors were classified as follows: pressure from immediate social circle, occupational exposure, societal pressure, perceived benefits, and influence of media. Participants supported counselling, to establish motivational factors, screen for psychiatric disorders, gain informed consent and obtain post-procedure feedback. Limitations: Sampling was from a single dermatology practice. Participants were mostly middle-aged, White women from a high-income group. As volunteers chose to participate there may have been selection bias. Our findings may therefore have limited generalisability. Conclusions: Motivations for dermal fillers were influenced by personal and societal beliefs. The findings emphasize the importance of pre- and post-procedure counselling in cosmetic dermatology. Further qualitative research across a more diverse group might yield additional insights.
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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.