The Eleventh Meeting of BEES (British Epidermo-EpidemiologySociety)

Programme and Abstracts

09:00 Coffee and registration

09:45 The BEES Guest Overseas Lecture Atopic disease: should we be looking within?

Prof. Bengt Bjorksten, Sweden

10:30 *Randomized controlled trial of short bursts of a potent topical corticosteroid versus more prolonged use of a mild preparation for childrenwith atopic eczema

Dr Kim Thomas, Nottingham

10:45 *Are patients satisfied with a teledermatology consultation?Dr John English, Nottingham

11:00 Tea/Coffee

11:30 Complexity theory and dermatology waiting listsDr. Dominic Smethurst, Nottingham

12:15 *Severe cutaneous adverse reactions: time latency between beginning of drug use and onset of reaction

Dr Maja Mockenhaupt, Germany

12:30 Lunch

14:00 Action on dermatology past and future

Mr Nicholas Evans, NHS Modernisation Agency

14:45 *A cost-effectiveness rationale for the selection of antimicrobial therapy in acne: a randomized controlled trial

Ms Mara Ozolins, Nottingham

15:00 The future of electronic publishing

Dr. Richard Smith, British Medical Journal

15:45 Meeting ends

15:45 AGM for BEES Members Only

Lunchtime/coffee breaks: Poster/database presentation

Use of an electronic cancer registry in a district general hospital

Dr Tessa Frost and Dr Andrew Warin

*Denotes submitted abstract.

British Journal of Dermatology 2002; 146: 541–543.

Ó 2002 British Association of Dermatologists 541

Abstracts

1Randomized controlled trial of short bursts of a potent topical

corticosteroid versus more prolonged use of a mild prepara-

tion for children with atopic eczema

K.THOMAS, H.WILLIAMS, S.ARMSTRONG, C.O’NEILL,* T.AVERY,A.LI WAN PO,  J.THOMAS

University of Nottingham U.K.

 School of Public Policy, Law and Economics, University of Ulster, U.K.*Centre for Evidence-Based Pharmacotherapy, Aston University, U.K.

Aims This study aimed to determine whether a 3-day burst of a potent

steroid is more effective than a weak preparation used for 7 days in

treating disease exacerbations and in maintaining remissions inchildren with atopic eczema.

Methods A randomized, double-blind, parallel group study of

18 weeks’ duration. 174 patients with mild or moderate atopic

eczema were recruitment from 13 general practices in the Notting-ham area. Two primary outcomes were evaluated: (i) the total

number of scratch-free days and (ii) the number of disease relapses.

Secondary outcomes included the median duration of the 1st diseaserelapse; the number of nights when sleep was not disturbed; disease

severity (SASSAD), two quality-of-life measures (CLQI and DFI) and

the number of treatment ÔfailuresÕ in each arm. Skin thickness was

measured using B-mode ultrasound.Results We found no differences between the two groups for any of

the outcome measures used. The median number of scratch free days

was 118.0 for the hydrocortisone group and 117.5 for the beta-

methasone valerate group (95% CI median difference )2–4,P ¼ 0.53). The median number of relapses for both groups was 1.

Both groups showed clinically significant improvements in disease

severity and quality-of-life compared to baseline. No significantchanges in skin thickness were observed.

Conclusions For children with mild or moderate atopic eczema in the

community, both 1% hydrocortisone used for 7 days, or betameth-

asone valerate 0.1% used for 3 days, are effective in controlling dis-ease symptoms.

2Are patients satisfied with a teledermatology consultation?

R.STOCKLEY, J.ENGLISH, A.MORRIS AND R.EMERSON

Department of Dermatology, Queen’s Medical Centre, Nottingham NG7

2UH, U.K.Background Many dermatologists have expressed concerns about the

development of teledermatology. It is a radical shift from the tradi-

tional face-to-face consultation with the dermatologist as the GPtakes digital images of the patient’s skin condition and emails them

with the history to the consultant dermatologist for his or her opin-

ion. The dermatologist emails the opinion back to the GP who then

informs the patient. The objective of this study was to see if thepatients who had undergone a teledermatology consultation were

satisfied with the service. This was an attempt to involve patients in

the decision-making process regarding the development of a new

health care service.Methods A postal questionnaire was sent to the first 180 patients of

the teledermatology pilot service. 114 (64% response rate) were

returned, 52 (46%) of patients did not require a hospital attendance

and 62 (54%) did.

Questionnaire

Prefer to use the telederm service or wait to see the dermatologist face to face?

Prefer to wait for hospital consultation rather than use the telederm service if

this meant a much longer wait?

Would you use the telederm service again?

Satisfied or very satisfied with the telederm service (had to choose one of five

options)

Did NOT require hospital visit

64% yes

21% yes

98% yes

80%

Did require hospital visit

49% yes

19% yes

87% yes

64%

Results and Conclusions There were some differences in the responses

between those patients that required a hospital visit and those that

did not. A traditional face-to-face consultation would have beenpreferred by 20% of patients . The patients that did attend hospital

seemed to have a preference for traditional face-to-face consultation

compared those that did not attend hospital but nearly 90% of all

patients returning the questionnaire would use the service again.

3

Severe cutaneous adverse reactions time latency betweenbeginning of drug use and onset of reaction

M.MOCKENHAUPT, J.SCHLINGMANN AND E.SCHOPF

Dokumentationszentrum schwerer Hautreaktionen (dZh), Department ofDermatology, University of Freiburg, Germany

Background Toxic epidermal necrolysis (TEN) and Stevens–Johnson

syndrome (SJS) are acute life-threatening severe cutaneous adverse

reactions (SCAR) with an unclear pathogenesis mainly caused bydrugs. Allopurinol and trimethoprim ⁄ sulphamethoxazole (TMS) are

both well known to be associated with these conditions. In addition,

TMS is known to induce generalized bullous fixed drug eruption

(GBFDE), a less severe condition with a very short induction periodthat is clinically often confused with SJS or TEN.

Aim We want to further investigate the risk profile of allopurinol and

TMS for inducing SCAR, as the hazard functions of these substances

are different. Furthermore, the re-review of cases using more specificcriteria to differentiate between SCAR and GBFDE should allow us to

detect misclassification of cases.

Methods 984 cases of SJS, SJS ⁄ TEN overlap and TEN were ascertainedby a population-based registry between 1990 and 1999. The fol-

lowing analysis is based on a random sample of 115 cases earlier

accepted as SJS or TEN, which were exposed to either allopurinol or

TMS, and 38 cases excluded in the previous review. An independentexpert committee blinded for possible causes re-reviewed these

cases in clinical terms, as the original review process took place

over a period of 10 years. In this analysis special emphasis is given

to the time latency between beginning of drug use and onset ofSCAR.

5 4 2 A B S T R A C T S

Ó 2002 British Association of Dermatologists, British Journal of Dermatology, 146, 541–543

Results Before re-review 162 ⁄ 984 patients with SCAR reported the

use of allopurinol and 131 ⁄ 984 the use of TMS within 2 weeks priorto the onset of the adverse reaction. After the re-review the per-

centage of doubtful cases was higher for TMS (28 ⁄ 57) than for

allopurinol (30 ⁄ 83). For definite cases of SJS or TEN the range

between the lower and upper quartile of the time latency betweenbeginning of drug use and onset of SCAR was 14–34 days for allo-

purinol, in contrast to 5–15 days for TMS. The time latency for

doubtful and excluded cases after the use of TMS was much shorter(2.5 and 2 days, respectively).

Conclusions The high numberof doubtful cases after the re-review

reveals the difficulty of applying approved detailed definitions to the

variety of clinical patterns of cutaneous adverse reactions. We couldconfirm a high correlation of time latency between beginning of drug

use and onset of SCAR and GBFDE for allopurinol and TMS, which

may have an important impact on the risk profile of these and other

suspected drugs, as well as on pathogenetic and therapeutic consid-erations of severe adverse events. When drug exposure occurs outside

the relevant interval of time latency for SJS and TEN, other risk fac-

tors and ⁄ or differential diagnoses such as GBFDE should be consid-ered.

4A cost-effectiveness rationale for the selection of antimicro-

bial therapy in acne: a randomized controlled trial

M.OZOLINS,* E.A.EADY,  A.AVERY,* W.J.CUNLIFFE, A.LI WAN

PO,à C.O’NEILL,** N.B.SIMPSON,– C.E.WALTERS,  E.CARNEGIE, J.B.LEWIS,  J.DADA,  M.HAYNES,* K.WILLIAMS* AND

H.C.WILLIAMS

*University of Nottingham, U.K.

 Department of Microbiology, University of Leeds, U.K.àCentre forEvidence-Based Pharmacotherapy, Aston University, U.K.

§School of Public Policy Law and Economics, University of Ulster, U.K.

–Department of Dermatology, Royal Victoria Infirmary, Newcastle, U.K.

** Dermatology, Leeds General Infirmary U.K.Background This NHS ⁄ HTA-funded study aimed to rank five com-

monly used antimicrobial therapies for acne in order of their clinical

effectiveness and cost-effectiveness. We also wanted to identify which

agents are less likely to promote resistance and those which areeffective in patients who harbour high numbers of resistant Propi-

onibacterium acnes strains.

Methods From surgeries and colleges in the Nottingham and Leedsareas, 649 patients with mild to moderate facial acne were recruited.

The two primary outcome measures were patient self-assessment of

improvement in overall acne severity and reduction in inflamed

lesion count, measured at 18 weeks. Secondary outcome measuresincluded two acne severity scores, assessors’ global estimation of

improvement, quality of life and utility scores, enumeration of anti-

biotic resistant propionibacteria, and the incidence of adverse events.

Results and Conclusions The most effective treatments (percentagewith at least moderate improvement according to patients, mean

change in lesion count) were the topical BenzamycinÒ b.d. (66%,

) 27) and its components given separately (topical erythromycino.d. + 5% benzoyl peroxide o.d.) (63%, ) 26), followed by 5% benzoyl

peroxide b.d. (60%, ) 23). The least effective were oral oxytetracy-

cline (55%, ) 18) and minocycline (54%, ) 22). The most cost-

effective treatment was benzoyl peroxide and least cost-effective wasminocycline. In terms of quality of life, benzoyl peroxide moved down

the rankings and minocycline moved up. The two topical erythro-

mycin-containing regimens produced the largest reductions and the

oral treatments the smallest in the prevalence and population densityof cutaneous propionibacteria. Prior bacterial colonisation did not

affect outcome in the topical groups. Efficacy of both oral preparations

was influenced by tetracycline resistant P. acnes strains.

Disclaimer The views and opinions expressed are those of the authorsand do not necessarily reflect those of the Department of Health.

Poster/database presentation

5

Use of an electronic cancer registry in a district general hos-

pitalT.A.FROST AND A. WARIN

Dermatology Department, Royal Devon & Exeter Hospital, Barrack Road,

Exeter EX2 5DW, U.K.Background Skin cancers from a large proportion of UK Dermatologists’

work are inaccurately recorded. Increasingly we are expected to audit

our work for quality and timeliness of diagnosis and treatment.

Methods Since the beginning of 2000 we have incorporated the use ofa database in our day-to-day work to record clinical and management

details of all nonmelanoma skin cancers treated in the Dermatology

outpatients clinic. Malignant melanoma detected in our Health

Authority area have been recorded since 1987. The same databasesystem can be used as an epidemiological tool or to follow the progress

of individual patients through follow-up data. Whenever a person is

alive as defined through a confirmed R D & E contact this fact is

automatically entered onto the database, allowing our mortalitytables to be reasonably accurate. We are in control of the data entry

and are able to check for accuracy against histological records on a

regular quarterly basis, demonstrating unequivocally how in-

accurate are Regional Cancer Registries. We monitor waiting timesof patients, numbers and types of procedures and activity of different

doctors.

Results Since 1987 malignant melanoma has increased from 20 per100 000–30 per 100 000 with a marked change in gender inci-

dence. The major increase has been in early and in situ melanoma,

except in men where we show a disturbing increase in invasive

lesions. In Exeter half the nonmelanoma skin cancers come to us withthe site and age range as expected. As time goes on we should get a

good idea of our recurrence rate. Thus far, this is not a large pro-

portion of our work, but we have no idea how much goes to the

plastic surgeons. In addition, there are fairly small numbers needingflaps, grafts, second procedures or referral on to surgeons.

Results The case for increased resourcing can be easily supported by

reports generated in a timely manner by such a system.

A B S T R A C T S 5 4 3

Ó 2002 British Association of Dermatologists, British Journal of Dermatology, 146, 541–543