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Development of contact allergy and allergic contact dermatitis is on the increase – in spite of preventive measures and increased awareness.

In a study, published in the British Journal of Dermatology1, a team of researchers in Denmark2 looked at the incidence rate and persistence of contact allergy and allergic contact dermatitis in a group of 8th grade school children followed up 15 years later.

The study showed that cases of allergic contact dermatitis to nickel had not only persisted but had increased in number - despite increased awareness and preventative measures having been introduced, such as the EU Nickel Directive.

Contact allergy and allergic contact dermatitis occur when the skin comes into contact with a specific contact allergen in the environment – commonly things like nickel, perfume in cosmetic products, ingredients in hair dye. It is a condition that can have a big impact on sufferers lives and may affect their ability to work, accounting for 70-90% of all occupational skin disorders.3

Deborah Mason, spokesperson for the British Association of Dermatologists, said: “It is interesting that this study found that nickel was still the most common contact allergen, with new cases occurring despite the EU Nickel Directive that limits the amount of nickel released from items of jewellery. The British Society for Cutaneous Allergy has recently publicised its concern that the Royal Mint are producing nickel-plated coins in the UK4. Whilst this may not contravene the EU Directive, the continuing prevalence of nickel as a contact allergen in the general population adds to concerns about nickel in coins and the risk of allergic contact dermatitis especially in people who handle coins at work.”

This study was the first to study both contact allergy and allergic contact dermatitis developing from adolescence to adulthood. To do this the research group had access to the Odense Adolescence Cohort Study which was conducted in 1995-1996. The same researchers from 1995 were able, in 2010, to use the same questionnaires, interviews and clinical examinations in order to conduct the 15 year follow up. In 1995 the cohort was circa. 14 years old, in 2010 the participants were circa. 28-30 years of age.5

The results showed that the prevalence at time of testing of contact allergy increased from 15.1% (of those studied) to 20.1% and that reported past or present allergic contact dermatitis increased from 7.2% to 12.9%.6

In the 15 years between the first observation and the most recent one, several new cases of contact allergy and allergic contact dermatitis had developed. The contact allergen causing the greatest number of new cases was Nickel which the researchers found surprising because in the intervening period the nickel regulations of 1990 would have been fully implemented.

In 2010 the most common sensitisers (found in things like jewellery, sticking plasters, and hair dyes) were nickel sulphate, cobalt chloride, colophony, thimerosal and p-phenylenediamine.7 The researchers noted that the drop in prevalence of sensitivity to Fragrance Mix I might be explained by the replacement of old fragrance chemicals by new ones in cosmetic products.

Charlotte Gotthard Mørtz, one of the researchers said “The results suggest that Fragrance mix 1 is now a poor marker for history of eczematous skin reactions to perfumed products, it seems likely that many of the ingredients have now been superseded in cosmetic products by newer ones.”

Notes to editors:

1. The information in this press release is embargoed until 00:01 on 30th November 2012. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists
For more information please contact: Deborah Mason, British Association of Dermatologists, Phone: 0207 391 6349, Email: comms@bad.org.uk, Website: www.bad.org.uk

2. C. G Mortz, C. Bindslev-Jensen, K. E. Andersen, Department of Dermatology and Allergy Centre, Odense University Hospital, University of Southern Denmark, DK-5000 Odense C, Denmark

3. Nicholson P J & Llewellyn D (Editors). Occupational contact dermatitis & urticaria. British Occupational Health Research Foundation. London. 2010. Research Working Group. Occupational contact dermatitis & urticaria. Systematic review & recommendations. British Occupational Health Research Foundaton. London. 2010. Review date 2015. ISBN 978-0-9564949-0-1
4. Letter from David Gawkrodger & Ian White to The British Medical Journal in April 2012 “Allergy risk from Royal Mint’s new nickel plated steel coins should be publicly assessed.” BMJ 2012;344:e2730 (Published 19 April 2012)

5. The Odense Adolescence Cohort Study is a cohort of 1501 unselected 8th grade schoolchildren established 15 years ago with the aim to follow the course of contact allergy and allergic contact dermatitis from school age to adult life.

6. Contact allergy was defined as a positive patch test using True®Test. Allergic Contact Dermatitis is defined as a the consequence of exposure to a contact allergen exceeding an individual threshold concentration in a contact-sensitised person. The cross sectional study included questionnaires, interviews and clinical examinations, blood samples for IgE measurement and patch tests. Phase two was conducted in 1996-7 as a case-control study in selected groups of school children. Phase three is a 15 year follow up study in the same population and the examination and testing was undertaken by the same investigator who performed the phase one and two studies.

7 Common sensitisers;
Nickel Sulphate (11.8%) – nickel is commonly used in jewellery, metal plating and coinage
Cobalt chloride (2.3%) – used in metal plating
Colophony (2.0%) is a type of plant resin (it is also sometimes called rosin) It has a variety of uses including as the glue in sticking plasters, it can also be found in printing ink, varnishes, glue, soap, paper.
Thimerosal (1.4%) is an organomercury compound used as an anti-fungal and anti-septic
p-phenylenediamine (1.1%) – also known as PPD it is commonly used as a dye and can be found in many hair dyes.


The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease. The British Journal of Dermatology (BJD) strives to publish the highest quality dermatological research. In so doing, the journal aims to advance understanding, management and treatment of skin disease and improve patient outcomes. BJD is an official organ of the British Association of Dermatologists but attracts contributions from all countries in which sound research is carried out, and its circulation is equally international. The overriding criteria for publication are scientific merit, originality and interest to a multidisciplinary audience. Journal content and further information-including author guidelines and submission details-can be found online at www.brjdermatol.org. The 2011 impact factor is 3.666

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Dopamine, a key neurotransmitter in Parkinson’s disease, may have novel use in fighting unwanted hair growth

Following reports of patients suffering hair loss during treatment for Parkinson’s Disease, scientists have discovered that a neurotransmitter* associated with the disease may have a new use in the fight against unwanted excess hair, new research published the British Journal of Dermatology reveals. 

Researchers at The University of Manchester as well as research centres in Germany and Hungary looked at the role of a chemical called dopamine in relation to hair growth and discovered that, when tested in the laboratory, dopamine increases the number of hair follicles that are in the catagen phase of the hair cycle, the period at which the hair stops growing and prepares to fall out.

Dopamine is a neurotransmitter produced in the brain that has many functions in the body, including in behavioural roles such as reward seeking behaviour. Decreased levels of dopamine are associated with several common disorders, including Parkinson’s Disease and Restless Leg Syndrome. A drug called L-DOPA or levodopa is commonly used in the treatment of Parkinson’s to replace depleted dopamine levels caused by the disease.

Anecdotally, treatment with levodopa or other chemicals that imitate the actions of dopamine have been associated with diffuse hair loss, predominantly in women. Given the widespread use of both dopamine agonists and antagonists (i.e. drugs that either mimic or inhibit dopamine actions) in clinical practice, the researchers examined whether dopamine can directly alter human hair follicle growth.

The scientists found that treating healthy human scalp hair follicles with 1000nM of dopamine, in a laboratory setting rather than on living subjects, more than doubled the percentage of hair follicles in catagen, i.e. of “hair factories” that have stopped producing a hair shaft. Around 19 per cent of hair follicles were in catagen in the control group compared to 53 per cent of hair follicles treated with dopamine 1000nM in the laboratory.

Ralf Paus, Professor of Cutaneous Medicine at The University of Manchester and one of the study’s authors said: “This study provides the first direct evidence that dopamine treatment negatively affects human hair growth, namely that it pushes hair follicles out of their phase of growth and active hair shaft production. This is entirely consistent with case reports of hair loss in women being treated with dopamine agonists.”

Nina Goad of the British Association of Dermatologists said: “This is a perfect example of research confirming the experiences of patients that have been reported but not previously backed up by any hard clinical data. Having this scientific evidence may lead to new treatments for hirsutism - when an individual grows too much body or facial hair, which can cause huge embarrassment and greatly alter their quality of life. In principle, it is conceivable that dopamine could be selectively administered externally to hirsute skin in a cream or lotion.”

Ends

*Neurotransmitters are the molecules that the nervous system uses for communication between cells.

Notes to editors:

1. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists

2. For more information please contact: Nina Goad, British Association of Dermatologists, Phone: 0207 391 6094, Email: nina@bad.org.uk, Website: www.bad.org.uk

3. Articles in the BJD can be viewed online: www.brjdermatol.org
British Journal of Dermatology: Dopamine is a novel, direct inducer of catagen in human scalp hair follicles in vitro.
E.A. Langan,1,2 E. Lisztes,3 T. Bíró,3 W. Funk,4 J.E. Kloepper,2 C.E.M. Griffiths1 and R. Paus1,2
1Dermatology Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.
2Experimental Dermatology, Universitätsklinikum Schleswig Holstein, Lübeck, Germany
3DE-MTA ‘Lendulet’ Cellular Physiology Research Group, Department of Physiology, University of Debrecen, H-4032 Debrecen, Hungary
4Clinic Dr Kozlowski, Munich, Germany
DOI REFERENCE: DOI 10.1111/bjd.12113
Accepted for publication, 7th October 2012


The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.

Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com

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Itching can have a visual trigger, British Journal of Dermatology reveals

Itching is so contagious that just seeing a photo of something we imagine would itch – like ants or an insect bite – can trigger a physical response, new research suggests; the authors say their findings could be of benefit to patients with skin conditions like eczema.

Writing in the British Journal of Dermatology, researchers from Liverpool John Moores University (LJMU) and The University of Manchester tested whether visual cues could generate feelings of itch and provoke a scratch response. A secondary aim was to assess whether the content of some pictures more effectively evoked these sensations. The study also revealed that simply watching someone scratch may trigger feelings of itchiness, just like seeing someone yawn can be contagious.

Thirty participants viewed static images that could either be itch-related (for example ants, fleas or skin conditions) or neutral (butterflies or healthy skin). The itch-evoking images were further split into three sub-categories: ‘skin contact’ (for example ants crawling on the hand or a butterfly on a finger), ‘skin response’ (scratching an insect bite or washing the hands) or ‘context only’, in which itchy or neutral stimuli were seen in the environment but not on the body (for example viewing midges or birds flying, with no reference to skin).

For each picture, the volunteers were asked how itchy they felt looking at the image, and how itchy they thought the person in the picture felt, where relevant. In addition, the researchers recorded the number of times the volunteers scratched themselves while looking at the images.

The scientists discovered that visual cues alone (without application of any irritant to the skin) do indeed elicit sensations of itch in an observer and provoke a scratch response.

Furthermore, watching something that we associate with itchiness causes us to admit to feeling itchy, but in fact it is watching another person scratch themselves (rather than just seeing the cause of the itch) that causes us to subconsciously scratch ourselves also, without necessarily vocalising this or knowing we are doing it.

Professor Francis McGlone, a cognitive neuroscientist at LJMU and the study’s lead author, explained: “The results of the present study confirm that visual cues pertaining to itch-related events are effective in transmitting the sensation of itch from the visual to the somatosensory domain (the body’s system relating to the sensation of touch) and provoking a scratch response. The results suggest that, whereas the sensation of itch may be effectively transmitted by viewing others experiencing itch-related stimuli on the body, the desire to scratch is more effectively provoked by viewing others scratching.
“Our findings may help to improve the efficiency of treatment programmes for people suffering from chronic itch. Knowing the specific triggers of an individual’s chronic itch and how visual stimuli translate to the physical may also provide insight into the mechanisms of ‘psychosomatic itch’, in which there are no physical triggers.”

Nina Goad of the British Association of Dermatologists said: “Itch is often the worst symptom for people with skin disorders, and any research into its causes that may lead to new methods of alleviation will be greatly welcomed by the millions of skin patients. Combining elements of psychology with dermatology is an increasingly important area of research.”

Ends

Notes to editors:

1. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists

2. For more information please contact: Nina Goad, British Association of Dermatologists, Phone: 0207 391 6094, Email: nina@bad.org.uk, Website: www.bad.org.uk

3. Articles in the BJD can be viewed online: www.brjdermatol.org
British Journal of Dermatology: Can itch-related visual stimuli alone provoke a scratch
response in healthy individuals? D. M. Lloyd1, E. Hall1, S. Hall1 and F. P. McGlone2*
1School of Psychological Sciences, University of Manchester, M13 9PL
2School of Natural Sciences & Psychology, Liverpool John Moores University, L3 3AF
 

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.

Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com

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Screening for genetic markers in the blood of melanoma patients could improve chances of survival

Scientists have discovered the tumour cells which make melanoma patients more likely to have their cancer spread or come back following treatment, according to a study published in the British Journal of Dermatology.

A team of researchers in Western Australia and Boston in the U.S. looked at the role of melanoma cells circulating in the blood of patients who had already been diagnosed with the disease, and how these cells relate to recurrence of the disease and treatment efficacy. The aim of the research was to identify those subgroups of patients who are more likely to suffer disease recurrence or poor treatment outcomes, in order to provide them with more targeted treatments at an earlier stage, which could improve survival rates.

The study was the first to measure not only the presence of less aggressive cancer cells spread by melanoma tumours into the bloodstream, but also the presence of the destructive minority of cancer ‘stem’ cells, which represent the driving force behind the growth of tumours. To do this, blood was collected from 230 patients with both primary melanoma (where it has not spread) and metastatic melanoma (spreading to other parts of the body), and compared with the blood of 152 healthy controls.

The researchers found that the presence of tumour cells in a person’s blood alone does not necessarily correlate with disease spread or recurrence, as these cells can still be present even when a patient is considered clinically disease free. It is in fact the behaviour and characteristics (phenotype) of these cells that is particularly important.

Therefore, a test for the different genes produced by tumour cells was used to identify those patients more likely to have their cancer spread or come back following treatment. The researchers looked at five different ‘genetic markers’, which are genes or pieces of DNA that allow scientists to tell what different cells are doing. These markers are all found in melanoma tumour cells, of which there are many different types.

The presence and level of different genetic markers in the blood was shown to be useful in assessing a patient’s disease spread, response to treatment, and risk of relapse.

The results revealed increased levels of one gene, called the MCAM marker, correlated with patients whose melanoma had spread to other parts of the body. The link between MCAM genes and a poor response to therapy was also confirmed in the findings, with higher levels of MCAM seen in patients whose treatment had been unsuccessful. 40 of the 62 patients with late stage (IV) melanoma in the study had a negative treatment outcome (progression and/or death); 43% of this subgroup expressed the MCAM marker in their blood.

Lead author of the study, Dr Ziman of the Edith Cowan University, Perth, said: “Patients with metastatic (spreading) melanoma have, to date, shown a poor response rate to conventional treatments. MCAM expression could now be used to monitor treatment resistance, and help to identify a subset of patients who may benefit from an alternative treatment regime.”

The scientists also looked at recurrence of the disease, and were able to identify that two markers called MLANA and ABCB5 were linked with relapse. In the 73 patients who had a relapse, these markers were found to be expressed considerably more frequently (45% and 49% respectively) than in patients without recurrence (23% and 34% respectively). Therefore, the specific detection of ABCB5 and MLANA expressing tumour cells in a patient’s blood could be a valuable predictor of clinical outcome and disease recurrence. The ABCB5 gene marks a subset of rare, chemotherapy-resistant melanoma stem cells.

Another of the study’s authors, Markus Frank, Assistant Professor of Paediatrics and Dermatology at the Harvard Medical School, said: “This has very important implications for melanoma patients. The development of a minimally invasive method of measuring the frequency of melanoma cells, and melanoma stem cells in particular, can be used to follow patient responses to current or novel and emerging melanoma therapies. In turn this will help determine if a particular therapy is capable of eliminating the aggressive cancer stem cell population required for the complete eradication of the cancer, potentially achieving a cure.”

Melanoma is the deadliest form of skin cancer, which is the most common cancer type in the UK. There are approximately 13,000 new cases of melanoma diagnosed every year in the UK and 2,300 deaths.

Kimberley Carter of the British Association of Dermatologists said: “Melanoma has a high potential to spread and patients who develop distant metastases, where the cancer spreads to remote parts or organs of the body, currently only have a ten year survival rate of 16 per cent. Therefore, studies like this one which look to find methods of detecting melanoma spread at early stages are critical to care of melanoma patients. Research of this kind will hopefully help to deliver more accurate and targeted treatments to melanoma patients in the future, especially those who have not responded well to first-line treatments.”

Five genetic markers in the patients’ blood were examined: MLANA, PAX3d, TGFβ2, MCAM and ABCB5. MLANA and PAX3d are both expressed by melanocyte cells, TGFβ2 and MCAM are both tumour cell markers, and ABCB5 is a stem cell marker. MCAM is a known marker of melanoma tumour progression.

ENDS

 

 

Notes to editors:

1. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists
For more information please contact: Kimberley Carter, British Association of Dermatologists, Phone: 0207 391 6084, Email: kimberleycarter@bad.org.uk, Website: www.bad.org.uk

2. Articles in the BJD can be viewed online: www.brjdermatol.org
British Journal of Dermatology: Markers of circulating tumour cell in the peripheral blood of melanoma patients correlates with disease recurrence and progression.
A.L. Reid1 M. Millward2, R. Pearce1, M.Lee2, M.H. Frank3, A. Ireland2, L. Monshizadeh2, T. Rai1 and M. Ziman14
1. School of Medical Sciences, Edith Cowan University, Perth, WA, Australia
2. Department of Medicine and 4. School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia
3. Transplantation Research Center, Children’s Hospital Boston and Brigham & Women’s Hospital, Harvard Medical School, Boston, MA, U.S.A
Accepted for publication 14 September 2012

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.

Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com

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Vitiligo patients three times less likely to get skin cancer, study reveals

People with vitiligo, one of the most common skin diseases, are three times less likely to develop skin cancer, new research due to be published in the British Journal of Dermatology will reveal.

Vitiligo is a condition in which areas of skin lose their normal pigment and so become white. It is common, affecting about one in every hundred people in the world, and as it can be very visible, it is often a psychological burden to patients.

However a study carried out by researchers in The Netherlands has discovered that vitiligo patients have a threefold lower chance of developing both melanoma, the least common but deadliest type of skin cancer, and non-melanoma skin cancers, which are less dangerous but more common.

The scientists compared skin cancer rates in 1307 vitiligo patients, compared to 788 control subjects without vitiligo. They also examined other factors that might influence skin cancer development, such as sun exposure, number of sunburns in childhood, sun protective measures, outdoor work or hobbies and the individual’s number of moles, and these variables were factored into the results.

Of the 1307 patients with vitiligo who answered the survey, seven (0.54%) had been diagnosed with melanoma during their lifetime. All melanomas had occurred in areas of skin not affected by the vitiligo. Of the 788 non-vitiligo controls, 12 individuals (1.53%) had been diagnosed with 14 melanomas. When the results were adjusted for other risk factors, vitiligo remained associated with a threefold decreased likelihood of developing this skin cancer

The results were similar for non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma). 30 of the vitiligo patients had been diagnosed with a total of 37 basal cell carcinomas (BCCs) during their lifetimes. In addition, five patients with vitiligo had each been diagnosed with one squamous cell carcinoma (SCC), and one patient had experienced one BCC and one SCC (a total of 44 non-melanoma skin cancers in 36 patients). In the control group, 47 of 788 non-vitiligo volunteers had been diagnosed with a total of 61 BCCs, and four patients had suffered an SCC (a total of 65 non-melanoma skin cancers in 51 patients). When adjusted for all risk factors that were significantly associated with non-melanoma skin cancer development in the analysis, patients with vitiligo had a threefold decreased probability of non-melanoma skin cancer.

Dr Hansje-Eva Teulings in the group of drs Wietze van der Veen and Rosalie Luiten of the Department of Dermatology at the Academic Medical Center of the University of Amsterdam said: “We observed a significant threefold lower odds for melanoma during lifetime in vitiligo patients. The anti-melanocyte immune response in vitiligo, in which melanocytes are destroyed in the skin, may be responsible for the observed decrease in melanoma lifetime prevalence.
We also found that patients with vitiligo have a threefold decreased probability of developing non-melanoma skin cancer during their lifetime. This finding seems to be counterintuitive, as the lack of protective pigmentation is supposed to increase the risk of these cancers. The lower probability may relate to the observed decreased photodamage and increased levels of wild-type p53 expression in keratinocytes (skin cells) in patients with vitiligo. This is a tumour suppressor which may protect against UV damage and the development of keratinocyte cancer.”

Nina Goad of the British Association of Dermatologists said: “A very interesting aspect of this study is that no increased skin cancer prevalence was seen in phototherapy-treated patients compared with patients who had never undergone phototherapy. This differs from patients with another common skin disease, psoriasis, where long-term phototherapy treatment has been linked to an increases risk of some skin cancers. As phototherapy is one of the recommended treatments for vitiligo, this may prove a very positive finding.

“Similarly, vitiligo patients may worry that their paler patches of skin are more likely to develop skin cancer, as it is generally known that people with fairer skin types are more at risk of the disease. However this is not the case for skin that is affected by vitiligo.
“Vitiligo can have a strong psychological and emotional impact as it can be very visible, especially in darker skin types, so any research that eases the burden on these patients is most welcome.”

The pigment that gives skin its normal colour is melanin, which is made by cells called melanocytes. In patches of vitiligo the melanocytes are absent, and the reason for this is not fully understood. However, vitiligo is considered to be an autoimmune condition in which the body’s own immune system rejects some of its own tissues (melanocytes in the case of vitiligo). It affects men and women of all ethnicities equally, but is most obvious in people with dark skin.

Notes to editors:

1. If using this information, please ensure you mention that the study is being released in the British Journal of Dermatology, the official publication of the British Association of Dermatologists

2. For more information please contact: Nina Goad, British Association of Dermatologists, Phone: 0207 391 6094, Email: nina@bad.org.uk, Website: www.bad.org.uk

3. Articles in the BJD can be viewed online: www.brjdermatol.org
British Journal of Dermatology: Decreased risk of melanoma and nonmelanoma skin cancer in patients with vitiligo: a survey among 1307 patients and their partners
H.E. Teulings,1,2 M. Overkamp,1 E. Ceylan,1 L. Nieuweboer-Krobotova,1,2 J.D. Bos,1 T. Nijsten,3 A.W. Wolkerstorfer,1 R.M. Luiten1 and J.P.W. van der Veen1,2
1 Department of Dermatology and the Netherlands Institute for Pigment Disorders (SNIP), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
2 Skin and Melanoma Center, the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital (NKI-AVL), Amsterdam, the Netherlands
3Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands.
DOI REFERENCE:TBC (request from press office), Accepted for publication, 7.10.12

The British Association of Dermatologists is the central association of practising UK dermatologists. Our aim is to continually improve the treatment and understanding of skin disease.

Wiley-Blackwell, created in February 2007 by merging Blackwell Publishing with Wiley's Global Scientific, Technical, and Medical business, is now one of the world's foremost academic and professional publishers and the largest society publisher. With a combined list of more than 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal, this new business sets the standard for publishing in the life and physical sciences, medicine and allied health, engineering, humanities and social sciences. For more information visit www.wiley.com

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