Summary
Background
Lichen sclerosus (LS) is a chronic inflammatory dermatosis with a predilection for the anogenital region, which mainly affects prepubertal girls and postmenopausal women. The cause is unknown, but a number of potential aetiological factors have been identified.
Aim
To examine a cohort of patients with prepubertal‐onset vulval LS (VLS) and assess baseline characteristics, clinical presentation, potential precipitating and predisposing factors, and response to treatment.
Methods
Data were collected from case notes on patients aged < 18 years diagnosed with prepubertal‐onset VLS attending a specialist vulval dermatology service. Data included clinical presentation, comorbidities, family history, therapy and response to treatment.
Results
In total, 26 paediatric patients were identified. The median age at onset of symptoms was 5 years (range 2–8.5 years). Many previously identified potential aetiological factors for the development of VLS were identified, including family history, trauma, autoimmune disease and hormonal factors. A significant proportion of patients had a history of urinary tract symptoms, including incontinence and urinary tract infection. Most patients responded well to a standard course of induction topical therapy followed by maintenance therapy, but some, including three patients with ongoing urinary incontinence and three postpubertal patients, continued to have active disease.
Conclusion
A detailed assessment is essential in patients with VLS so that potential predisposing factors and comorbidities can be identified and managed. Urinary incontinence may be implicated in the development of paediatric VLS and may prevent adequate disease control. Paediatric VLS can persist through puberty, thus long‐term follow‐up is advised.
Summary
Background
Psoriasis impacts the health and psychosocial functioning of patients, conferring a significant economic burden on healthcare systems. There remain unmet needs in psoriasis care, which if addressed by research, could improve clinical outcomes.
Aim
To research priorities and identify a health service delivery model from the UK Psoriasis Priority Setting Partnership (PsPSP).
Methods
Between July 2017 and November 2018, we invited people with lived experience of psoriasis and healthcare professionals to (i) identify unmet needs, and (ii) prioritize the order in which these should be addressed by research. We collaborated with the Psoriasis Association and used methodology established by the James Lind Alliance, which pioneers the joint setting of research priorities by patients and clinicians worldwide.
Results
In our initial harvesting survey (Survey 1), 2133 questions were submitted by 805 individuals. Submissions that had not been answered by research (true uncertainties) were supplemented with evidence gaps from systematic reviews/guidelines published in the previous 5 years and refined to produce 55 indicative questions. Voting in Survey 2, by 1154 individuals, enabled a shortlist of questions, which were prioritized during the final workshop to produce a top 20 list of research questions. Submissions on health service delivery (5.8% of the total submissions), which were analysed separately, described a blueprint for psoriasis care.
Conclusions
The PsPSP will inform the translational research agenda, ensuring that future research is relevant for the needs of people with psoriasis and those who manage the disease. Submissions on health service delivery describe a model of holistic, patient‐focused care providing high‐quality, effective management for patients with psoriasis.
Daun belimbing wuluh (Averrhoa bilimbi Linn) mengandung senyawa metabolit sekunder yaitu flavonoid dan tanin yang dapat digunakan sebagai antibakteri. Penelitian ini bertujuan untuk mengetahui aktivitas antibakteri pada sediaan gel ekstrak etanol daun belimbing wuluh dengan konsentrasi 30%, 35% dan 40%. Daun belimbing wuluh yang sudah diserbukan kemudian di ekstraksi dengan metode maserasi menggunakan etanol 96% kemudian diuapkan dengan oven sampai menjadi ekstrak kental. Uji aktivitas antibakteri pada gel daun belimbing wuluh menggunakan difusi cakram terhadap bakteri Staphylococcus epidermidis dengan mengukur zona hambat pertumbuhan bakteri. Formulasi sediaan gel ekstrak etanol daun belimbing wuluh yaitu F1 30%, F2 35% dan F3 40%, kontrol negatif (Aquadest steril) dan control positif (Klindamisin disk). Evaluasi sediaan gel meliputi uji organoleptis, homogenitas, pH, daya sebar, dan viskositas. Pada hasil penelitian didapat bahwa ekstrak etanol 96% daun belimbing wuluh yang diformulasikan dalam bentuk sediaan gel memiliki antibakteri terhadap Staphylococcus epidermidis dan memberikan zona hambat terbesar pada konsentrasi 40% dibandingkan dengan gel konsentrasi 30% dan 35%.
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