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Department of Dermatology


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  • 2. 1 It is remarkable how time seems to go more rapidly the older we get. In the case of the academic Department of Dermatology at St. Vincent’s Hospital Melbourne it is hard to believe that we are now eight years old. But perhaps the feeling that time has passed quickly is a reflection of how much has been achieved over that time. In this fourth Biennial Report we give details of what we have achieved in the last two years, specifically related to the Operational Plan 2000-2004. These are in the areas of Clinical Services, Teaching and Research. As you will see, we have an extremely active and dedicated team working in different ways in each of these areas. Within the administrative structure, plus the service and research staff, we have a stable team who have all been with us since the last Biennial Report, and a substantial proportion of whom have been with us for many years. This continuity creates a very stable environment to support the productive endeavours of our team. In the Service area we have now moved into the new outpatient facilities which have been designed to facilitate the delivery of care in the ambulatory setting. This has worked out to be very satisfactory for not only for the staff providing the care, but also for the patients receiving it. The presence of a computer terminal on each of the desks has supported the upgraded Dermatology Database. The Photobiology Services provided under the guidance of Chris Baker and Peter Foley have been substantially enhanced by the addition of a new solar simulator, kindly provided with funds from the St. Vincent’s Hospital Foundation. This group is now one of the large photobiology centres in the world. Other specialised services include the vascular/lower leg ulcer services of Robert Kelly, the cutaneous lymphoma interest of Chris McCormack and the immunobullous diseases interest of Belinda Welsh. They are providing a highly specialised component of dermatological care which is appropriate for a tertiary teaching institution of the level of St. Vincent’s Hospital Melbourne. Of course, we still provide a general dermatological service underpinning the highly developed subspecialties. You will see in the Teaching section the wide range of education we provide from public education programs through to medical student and postgraduate medical practitioner training. St. Vincent’s Hospital Melbourne has a very special clinical school with the medical students frequently taking the large majority of prizes in the final year medical exam. It is an indication of the calibre of students who want to come into this teach-ing environment and certainly is revealed when we have them involved in dermatology as part of their training. Like any academic department the research is an important driving force that determines directions both now and in the future. The major arms, as you can see in the body of this Report, include the Health Services Research group headed by Robin Marks and Jan Campbell, along with the Hair Research group managed by Rod Sinclair and the Photobiology Research group managed by Peter Foley. Each of these groups has research/project staff helping to expand their output. The nature and extent of the work of the Department means that we are now not only well known in Victoria, but are seen as a major national group in the areas of expertise of this Department. We also have an international reputation with members of the Department being invited to present papers at many of the major international dermatological meetings throughout the world. The recent appointment as President of the International League of Dermatological Societies was a feather in the cap for Australian dermatology in general and the Department in particular. In summary, the enthusiastic and very positive approach of all members of the Department has resulted in an outstanding record, once again, for the last two years. We have received support for our work from many different groups and individuals. I am sure they will be proud of what has been done on their behalf in improving the outlook for people suffering from skin conditions in our community. I commend this Report to you. Robin Marks Professor/Director of Dermatology February 2003 Director’s Report
  • 3. 2 The clinical arm of the Department of Dermatology has continues to be an active area in the delivery of clinical services, medical student teaching and registrar training. The medical, nursing and office staff, continue to strive to deliver excellence in dermatological care. In the 2001 – 2002 biennium, in addition to inpatient admissions and consultations, 10,927 outpatient services were provided by the Department. The clinical service is an integral component of the Department complimenting and providing crucial support for the research and teaching activities. Patients attending our clinics continue to come from metropolitan Melbourne, rural Victoria and interstate, with referral source ranging from local general practitioners and the emergency department to other dermatologists and specialists. The work of the Department continues to be well supported by the Hospital administration and is therefore able to provide a range of consultative services to other units and departments. The Department offers a range of general Dermatological services and manages a all common skin problems as well as providing opinion and treatment for more complex and challenging problems. Expertise in several super-speciality areas is provided. These include cutaneous lymphoma (Dr Christopher McCormack with valuable assistance from Professor Miles Prince and Dr Gail Ryan, Peter MacCallum Cancer Institute), vascular and wound healing service (Dr Robert Kelly) and immunobullous disorders (Dr Belinda Welsh). The photodermatology clinic, under the direction of Dr Peter Foley and myself, continues to provide a unique service investigating sun sensitivity skin disorders. The photodermatology data base now encompasses 9 years of clinical experience and has undergone further development and refinement. In 2001 we commissioned the Solar Simulator which was purchased through a generous donation from the St. Vincent’s Foundation. The solar simulator is now an integral part of the phototesting regimen. Our clinical nurse, Leonie Hill, continues to perform phototesting and phototherapy services. Her exper-ience and expertise in this area is unique. The Department maintains a close working relationship with the skin and Cancer foundation. The Foundation registrar and St Vincent’s Registrar exchange positions mid year to provide a broader experience in clinical Dermatology. The Hospital has two dedicated Dermatological Trainees. These are the St Vincents Hospital Registrar and the Professorial Registrar. In addition, a number of registrars in the Victorian training program rotate through clinics at St Vincent’s, providing addition clinical support and gaining valuable training experience. Finally, the entire clinical team and in particular Professor Robin Marks and Dr Andrew Michaelides play an important role in the undergraduate training program. In July 2002, a new outpatient clinic area was opened. This is a state of the art facility on the ground floor of the Daly wing, with a comfortable well designed clinic area including PC facilities and internet access in all consulting rooms. In addition, the Department has a dedicated area for phototherapy and phototesting facilities. The upgraded facilities will allow the clinical service arm of the Department continue the high standard of services offered. To further develop patient services, the Department has recently received a grant from the William Joseph Payne Trust to develop a system of digital imaging of skin conditions and integration of this record with the patient’s file. This system combined with our new outpatient facilities should help in the diagnosis and monitoring of a patient’s condition. Once again, as Director of Clinical Services in Dermatology, I wish to thank all members of the Department and associated staff for their commitment and effort. Dr Chris Baker Director of Clinical Dermatology February 2003 Clinical Services
  • 4. 3 Patient Statistics 1995/1996 1997/1998 1999/2000 2001/02 TYPE OF CLINIC n= n= n= n= Dermatology 7876 7593 8638 6556 Dermatology Investigations 345 534 411 1044 PUVA & UVB 1784 2091 1949 2687 Photobiology 203 428 429 640 TOTAL 10,208 10,646 11,427 10,927 OUTPATIENT ATTENDANCES 1995-2000 Rate of Disease Groups for 1999/2000 and 2000-2002 *Other conditions include: mycosis fungoides, pruritis, nodular prurigo, ulcers, keratosis pilaris, lichen planus, bulous pemphigold, scars and patients with diagnoses pending. Tumours Dermatitis Melanocytic naevi Acne Fungi Psoriasis Viral Allergic Other naevi Bacterial Hair Pigment Nails Parasites *Other conditions 1999/2000 2001/02 0 5 10 15 20 25 30
  • 5. 4 Patient Statistics < Staff at the Skin & Cancer Foundation Skincare Clinic PATIENT REFERRALS 1995 1995 1996 1997 1998 1999 2000 2001 2002 % % % % % % % % % General practitioner Other outpatient clinic Dermatologist *Other Hospital inpatient 63.6 63.6 72.2 75.2 71.0 6.8.8 62.9 63.1 66.0 21.3 21.3 13.6 10.1 8.4 8.7 10.9 10.2 9.2 8.6 8.6 7.0 7.5 8.6 12.1 17.9 14.8 16.2 6.5 6.5 6.2 6.4 10.8 9.5 7.7 11.2 7.4 N/A N/A 1.0 0.8 1.1 0.8 0.9 0.6 1.1 *Other hospitals, health care facilities, correctional health services. DIAGNOSIS PROPORTION (%) 1995/1996 1997/1998 1999/2000 2001/02 % % % % Solar Keratosis Unspecified Dermatitis Fungal Infection Psoriasis Seborrhoeic Keratosis Melanocytic Naevi Basal Cell Carcinoma Warts Acne Atopic Dermatitis Other Inflammatory Dermatoses Squamous cell carcinoma TOP 10 DIAGNOSES 9.0 8.6 7.4 8.5 7.1 6.1 5.6 6.0 6.3 6.8 6.4 5.7 5.9 5.3 4.7 5.2 5.6 5.5 5.7 5.0 5.6 7.1 6.9 7.0 5.0 3.9 4.8 6.4 4.5 3.2 2.9 2.3 3.8 5.1 4.6 3.7 3.4 3.1 - - - - 2.7 - 3.3
  • 6. Dermatology education is one of the core activities of the Department with our target audience including medical students, general practitioners, dermatology registrars, paramedical staff and the general community. The many facets are highlighted in the details of this Report. The Department had substantial input into the development of the new University of Melbourne medical curriculum. This not only involved redefining the core curriculum for medical students, but also inserting a dermatology component into various semesters over the period of the course. Medical students from the old curriculum, and also the new curriculum, are still receiving clinical teaching in the St. Vincent’s Hospital clinics and at the Skin and Cancer Foundation of Victoria as they have identified this as an important contribution to their development as a medical practitioner. With the involvement of Rosemary Nixon and the Occupational Dermatology Research and Education Centre it is hoped to have involvement of Monash University medical students before long. General practitioner education was enhanced by the new booklet on diagnostic procedures developed by the Department and mailed to every general practitioner in Australia. It was a sequel to the first book on treatment of common skin conditions and will be completed by a third book on diagnosis, each produced within the Department. Department members have participated in a wide range of teaching sessions for general practitioners including those arranged by the Skin and Cancer Foundation, the Royal Australasian College of General Practitioners, the Essex series and by the GP divisions throughout Victoria. General practitioner teaching remains a very high priority of the Department. Registrar teaching at St. Vincent’s Hospital continues to be strong with all Victorian candidates for fellowship of the Australasian College of Dermatologists being successful in the last two years. The Department has coordinated a program of tutorials on clinical dermatology and dermatopathology at the Skin and Cancer Foundation of Victoria. The regular Thursday morning teaching sessions at St. Vincent’s Hospital, combined with Royal Melbourne Hospital, have continued to create interest for registrars and dermatologists. Members of the Department have published a large variety of educational articles in various medical textbooks and journals directed at medical students, general practitioners and dermatology registrars. The public educational resources of the Department developed for primary and secondary schools and Maternal and Child Health centres have extended the reach of the Department widespread into the community, as have various articles written by members of the Department in response to media approaches. In summary, the Department covers a very wide range in its teaching activities all of which we hope in the long term will contribute to improved practice by medical professionals and better access, understanding and care for those in the community with disease affecting their skin. Dr Rodney Sinclair Senior Lecturer in Dermatology February 2003 Teaching 2001/2002 5
  • 7. 6 Teaching 2001/2002 > Staff of the Friday morning Special Investigative and Photodermatology Clinic GENERAL PRACTITIONER LECTURES/WORKSHOPS Topic Date Meeting Acne Therapies/Skin Biopsy April 2001 Yarra Valley Division of GPs Techniques (PF) Advanced psoriasis (PF) June 2001 GP update series (Skin and Cancer Foundation / Essex Pharma) Novotel Glen Waverley Non-melanoma skin cancer (RM) August 2001 Dermatology Update Conference for General Practitioners, St. Vincent’s Hospital An Approach to Dermatology (PF) June 2001 Essex Pharma Lecture Series for GPs Hair and Nails (PF) August 2001 Cabrini Medical Centre GP lecture series Pigmented Lesions (RM) November 2001 Goulburn Valley Division of General Practice, Shepparton Paediatric Dermatology (CB) May 2002 Whitehorse Division of GPs Non-melanoma skin cancer (RM) May 2002 Dermatology Update Conference for General Practitioners, SVHM Acne, Warts and Hair Problems (PF) July 2002 GPEA Training Program Evening Lecture Series, Melbourne Practical Procedures in Dermatology (CB) August 2002 Yarra Valley division of GPs The Art of Medicine (RM) February 2001 IV years Sunscreens & skin cancer (RM) April 2001 Royal Victorian Eye & Ear Hospital lecture Red Scaly Rashes (CB) May 2001 6th Year Medical Students - SVHM Sunscreens & skin cancer (RM) March 2002 Royal Victorian Eye & Ear Hospital lecture New curriculum PBL 2001/2002 4th Year Medical Students - SVHM Hair diseases 2001/2002 Royal Victorian Eye & Ear Hospital lecture Weekly /fortnightly clinic attendances 2001/2002 SVHM 6th Year students (all consultants) MEDICAL STUDENTS LECTURES
  • 8. 7 JOINT RMH & SVHM TEACHING SESSIONS - DERMATOLOGY REGISTRARS & DERMATOLOGISTS 2001 March Photodynamic Therapy for Skin Malignancies Speaker: Dr Peter Foley March Approach to Urticaria Speaker: Dr Richard O’Brien April Flap Prefabrication and Tissue Engineering Speaker: Professor Wayne Morrison May Research projects in the Department of Dermatology - current update June 1. Incomplete BCC excision. Speaker: Dr Tam Dieu 2. Melanoma research July Warfarin Necrosis Speaker: Dr Cate Scarff August Immunosuppressive and immunomodulatory drugs Speaker: Associate Professor Tom Kay September Cutaneous lymphoma: Update on the Melbourne Speakers: Drs Lee Mei Yap & Cate Scarff experience October 1. Cutaneous surgery of the lower leg. Speaker: Mr Tony Pennington 2. What ever happened to Eusol? November Using cyclosporin and managing side effects Speaker: Dr Ian Fraser 2002 February Cases, quizzes and discussions March Retinoids, lipids and the skin April Cardiology concerns in cutaneous surgery: Speaker: Dr Peter Kistler Heart valves, anticoagulants, pacemakers and long CT May Special presentation by Visiting Fellow, Dr Susan Burge, Oxford University, UK July Nail Surgery Speaker: Mr Bruce Johnstone August Update on the Role of Sentinel Node Biopsy Speaker: Mr Michael Henderson in Melanoma Adjuvant Radiotherapy in Melanoma Speaker: Dr Jill Ainsley October Leprosy and Lupus Vulgaris Speakers: Drs Lee Mei Yap and Veerle Verlinden November Pruritis ani - a sore point for doctors Speaker: Mr. Joe Tjandra
  • 9. 8 Teaching 2001/2002 Australian Doctor ‘Concepts in Skin’ Series (RM) 2001 A measured response to tinea January Perioral inflammatins March Itch treatment up to scratch May Helpful advice on scaly scalps July Sensitive soles present problems August Making the call on common conditions November Australian Doctor ‘Concepts in Skin’ Series (RM) 2002 Combination of science and art helps diagnosis March Best way to shine in melanoma diagnosis April Which treatment? Follow this guide June Critical to diagnose dermatitis at work (RM and Rosemary Nixon) August Occupational Dermatology – RM and Rosemary Nixon) October How to stop treatment in Dermatology Everybody Magazine (RM) Don’t touch! Common environmental factors can play Spring havoc with our skin Stress & the skin Summer Sensitive skin - the cure may be as simple as switching products Autumn/Winter The 10 biggest sunscreen mistakes Spring TEACHING THROUGH GP JOURNALS AND LAY MAGAZINES
  • 10. 9 The research activities supported by the Department of Dermatology are diverse and wide-ranging. Projects conducted over the past two years reflect this diversity, with staff having qualifications and experience in dermatology, epidemiology, health information management, social research, quality performance measurement, health promotion and education, data management and project management. Projects carried out during 2001 and 2002 are reported under the headings of Epidemiology and Health Services, Health Promotion and Education, Hair, Photobiology and Clinical Trials. A two-year study of a cohort of psoriasis patients completed in 2000 was supported by an additional qualitative component involving face-to-face interviews with a small group of participants which was conducted during 20001. A study involving a cohort of patients with atopic dermatitis collected information on the impact that inflammatory skin conditions can have on the individual and community. The field of health promotion and community education has increased with the development of statewide education programs on common skin diseases for all secondary and primary schools in Victoria. A program for Maternal and Child Health nurses and their clients was also developed and distributed to all Maternal and Child Health centres throughout Victoria during 2002. Each of these programs has been developed in conjunction with the appropriate professional organisation and the high rate of use within each group reflects the consultative component and the research base underpinning these programs. The development of the Standardised Dermatology Database, which has been trialled successfully at St Vincent’s Hospital over the past year, has the potential to collect data from all dermatology clinics and thus contribute to epidemiology, research and quality improvement projects while also facilitating the teaching of trainees. Undergraduate Health Information Management students from La Trobe University have completed their practical placements within the department. They have been involved in a variety of projects including auditing clinical databases and quality management activities. Rod Sinclair, who specialises in hair and nail conditions, heads a team of Clinical and Genetic researchers comprising Masters of Medicine students Jack Green, Keng-Ee Thai, and Shannon Harrison, and also Bachelor of Medical Science student Desmond Gan. They have worked on a number of projects related to a variety of forms of alopecia as part of their degrees. This vibrant team has contributed much that is new and exciting to the world research into hair disorders. Peter Foley’s team who conduct research into the uses of Photobiology in Dermatology includes Chris Baker, Lee Mei Yap and Bachelor of Medical Science student, Jonathan Ng. Peter is also responsible for an increasing number of clinical trials involving new treatments for dermatological conditions which are conducted at SVHM and the Skin & Cancer Foundation. Over the past two years a number overseas visitors, in particular Andrew Messenger (UK), Veerle Verlinden (Belgium) and Mirjam Werwenike (Netherlands) have swelled the ranks of the research team and added an international flavour to the diverse range of talents within the Department. The group of people who comprised the research team during 2001 and 2002 have built on the work of all those who contributed to the first eight years of this unique Department and accomplished much that is new to facilitate the future development of the Department and Dermatology. Jan Campbell Department Manager, February 2003 Research, Health Services & Community Education
  • 11. 10 EPIDEMIOLOGY AND HEALTH SERVICES RESEARCH A one year study of the morbidity, severity and cost of having atopic eczema in Australia Nicole Harman, Jan Campbell, Maria Moore, Anne Plunkett, Robin Marks A one year study aimed to determine the morbidity, severity and cost of having atopic eczema in Australia. A total of 85 participants were recruited. Each participant attended a baseline interview where an introductory questionnaire, Dermatology Life Quality Index (DLQI) and Modified Rajka and Langeland Severity Assessment (MRLSA) were completed. Participants then had a skin examination performed by a dermatologist to determine the severity of their condition. Following this there were six follow ups, one every two months where participants were sent and asked to complete the DLQI and MRLSA questionnaires on the morbidity and severity of their atopic eczema and a diary of their atopic eczema costs and health care consultations. Of the 53 (64%) participants who returned all follow up questionnaires, 45% felt that their skin had been itchy, sore, painful or stinging, 36% spent over 10 minutes applying daily treatments, 28% were influenced by the clothes worn, 21% felt embarrassed or self conscious because of their skin and 15% had problems with the treatments for their skin i.e. making their home messy. Date Commenced: December 1998 Date Completed: March 2001 Progress of Project: Report written, publication in progress Funding Source: Core budget; Scientific Fund Australasian College of Dermatologists A Pilot Study To Investigate The Association Between Fungiform Papillary Glossitis And Atopy Cate Scarff, Jan Campbell, Robin Marks Patients often report symptoms related to the tongue. Unfortunately, our understanding of these is often limited. While some conditions such as geographic tongue are well described, they do not explain the symptoms reported by patients in all cases. The survey, which recruited 84 subjects, investigated whether atopic subjects reported more symptoms and had a different appearance of the tongue compared with non-atopic subjects. This involved a questionnaire about medical history and symptoms in the mouth, an examination of the tongue and skin prick testing to four common aeroallergens. A classification system was developed to record the spectrum on features seen on the tongue. Results showed atopic subjects tended to have an appearance of the tongue that was clustered to one end of the spectrum. The number of non-atopic subjects who volunteered was small, but their examination findings were more evenly distributed. Greater numbers of non- atopic subjects need to be recruited to see if this trend is confirmed. Date commenced: January 2001 Progress of project: Pilot completed December 2001; Report written. Funding source: Core budget, St. Vincent’s Hospital Melbourne Research grant Research Projects
  • 12. 11 A continuation of a study investigating the association between fungiform papillary glossitis and atopy Lee Mei Yap, Veerle Verlinden, Jan Campbell, Peter Foley, Robin Marks 200 subjects were recruited from St. Vincent’s Hospital Melbourne and the Skin and Cancer Foundation. Data regarding personal and family history of atopy, mouth discomfort, burn response and inflammatory changes of the fungiform papillae were collected to determine if there is an association between fungiform papillary glossitis and atopy. Date commenced: August 2002 Date completed: November 2002 Progress of project: Data being analysed. Funding source: Core budget A Qualitative Study Of Having Psoriasis In Australia: The Patient’s Viewpoint Jan Campbell This study aimed to gain further information on the morbidity that affects psoriasis sufferers, through individual face-to-face interviews with a sample of 6 participants who had completed the Psoriasis and Health Survey. The interviews provided them with the opportunity to expand on their own responses and further discuss the quality of life issues they each experience in relation to having psoriasis. Qualitative research, such as this, complements and contributes to the interpretation of the quantitative data that have been collected during the survey. Date commenced: September 2001 Progress of Project: Report in progress Funding sources: Core Budget HEALTH PROMOTION AND EDUCATION Skin - an education program for Maternal and Child Health Kate Merlin, Jan Campbell, Maria Moore, Robin Marks This program targeted Maternal and Child Health (MCH) nurses and the parents/guardians of babies and children who attend MCH centres in Victoria. The program aimed to improve the awareness and knowledge of those who advise parents/guardians about children with common skin conditions. The information concentrates on the prevention of many of these conditions, as well as treatment where appropriate, to improve the management and outcome of these children. The program was developed in consultation with MCH nurses. Nurses completed surveys which determined the most suitable resources and program strategies. The resources were trialled in a selection of MCH centres and feedback was provided through surveys and telephone interviews. The resources, comprising a folder with information and photographs for nurses and information sheets which could be photocopied for parents/guardians, were then modified, printed and distributed to all Victorian MCH nurses. Date commenced: September 2000 Date completed: May 2002 Progress of Project: Completed Funding sources: Ian Potter Foundation, George Alexander Foundation, RE Ross Trust, Gwendolyn Holly Bequest
  • 13. 12 Skin - an education program for Primary Schools Kate Merlin, Jan Campbell, Maria Moore, Robin Marks This program targets children in the upper level, grades 5 and 6, of primary schools in Victoria, their teachers and their parents. The program aims to improve their knowledge of the nature and management of particular skin conditions, shown in previous Department research to be common in this age group. A primary school teacher was employed to assist in the development of the education resources and a selection of teachers completed surveys to determine the most suitable resources and program strategies. The resources were trialled in a group of primary schools and teachers and students provided feedback through surveys and telephone interviews. All Victorian primary schools were offered a free resource kit in December 2002 and these will be delivered to schools in early 2003. The kit comprises three components: a resource book containing information about the skin and common skin conditions plus lesson plans and activities; 11 information cards about common skin conditions for use by students; and four posters highlighting important information about the Skin, Inflammatory Conditions, Infections and Infestations. Date commenced: September 2000 Date completed: December 2002 Progress of Project: Resource developed; Distribution underway Funding sources: Jack Brockhoff Foundation, Felton Bequest Development, Implementation and Evaluation of Internet Web site Nicole Harman, Jan Campbell, Kate Merlin, Robin Marks Feedback received following evaluation of the Skin Education Programs highlighted the need to set up a web site that could provide information and activities related to the programs. The aim of this project is to develop an Internet site for the Department that will be used to provide details of our activities; information about diagnoses, management and treatment of common skin diseases; and linkage to related sites. The Skin Education Programs will be a major component of this Internet site. The first phase of the project involved researching other web sites, including dermatology web sites to view different contents, styles and visual effects. Our target audience, consisting of teachers and Maternal and Child Health nurses were surveyed to find out what they required from the web site. Consultation took place with an education / IT expert and the web site prototype was developed. The web site is due to ‘go live’ at the beginning of 2003. Date Commenced: June 2002 Progress of Project: To ‘Go Live’ early 2003 Funding Source: Skin and Cancer Foundation of Victoria Research Projects
  • 14. 13 DATA COLLECTION SYSTEMS The Standardised Dermatology Database Project Nicole Harman, Kate Merlin, Maria Moore, Robin Marks In 1995, a computerised Dermatology Data Collection System was established in Victorian public hospitals to collect demographic and diagnostic data on patients attending dermatology outpatient clinics. As the hospitals were using different databases and data collection systems, a new project was established to standardise data collection system and develop a database that can be implemented across the hospitals commenced. Dermatologists and registrars at the hospitals completed a survey of their requirements for a standardised system, department heads were interviewed to discuss positive and negative aspects to their databases, and quality assurance audits were conducted on the existing systems. Using the information obtained from the interviews, surveys and audits, a new standardised system was developed and has been implemented at the hospitals. The database is currently being evaluated. Date Commenced: May 2000 Progress of Project: Database being evaluated and modified Funding Source: Australian Dermatology Research & Education Foundation (ADREF), Core budget The SDD Quality Assurance Auditing Nicole Harman, Maria Moore, Jan Campbell, Katie O’Farrell, Jessica Chudwok (Health Information Management students), Robin Marks In 2001 it was found that the database contained a large number of ‘Diagnosis pending’ codes that had not been updated. An audit was conducted in April 2002 to update ‘Diagnosis pending’ codes in the database and investigate reasons why the diagnoses had not been updated. In 2002, the SDD was implemented into SVHM. To evaluate the training sessions and identify how accurately data was being entered into the SDD, a series of 3 sequential audits of the database were performed. This involved reviewing all the essential information from the outpatient data entered into the SDD from February to August 2002. It was found that 26% of patients were not being entered into the SDD. However, the data being entered into the SDD, showed that the amount of information being entered for each patient increased over the audits, e.g. the percentage of diagnostic details entered in audit 1 was 80.4% and in audit 3 this had increased to 88.4%. Ongoing education and training to the clinicians each year is vital for the data collection system to be accurate, reliable and valid. Date Commenced: February 1995 Date Completed: Ongoing Funding Source: Core budget
  • 15. Database and Research Program – Skin and Cancer Foundation Nicole Harman, Jan Campbell, Rod Sinclair, Peter Foley This program aims to facilitate the collection and analysis of data from the clinics at the Skin and Cancer Foundation (Vic). To achieve this the Skin and Cancer Foundation has subcontracted the services of two staff members from the Department of Dermatology for 3 days a week. As from November 2002, Jan Campbell is working as a Research Fellow and Nicole Jenner as the Clinical Data Manager. The data collected has a number of potential uses including epidemiology studies; research projects; constructing continuing education programs; teaching trainees; auditing and quality assurance projects; and linking with other clinical databases such as pathology. Date Commenced: November 2002 Date Completed: ongoing Progress of Project: SCF SDD data being analysed; Questionnaires are being developed. Funding Source: Skin and Cancer Foundation of Victoria CLINICAL AND GENETIC RESEARCH Familial alopecia areata Jack Green, Rodney Sinclair Alopecia areata is an autoimmune disorder of the hair follicle that displays complex genetic inheritance. On average, 20% of individuals with alopecia areata have at least one other affected relative. The purpose of this study was to survey familial alopecia areata on the Australian continent. Methods used to ascertain families included a mail out to members of the alopecia areata support association, the internet and from our hair clinics. Probands were interviewed by phone or in person and questionnaires were completed for each pedigree. Subjects with an unclear diagnosis were examined. In 64 pedigrees, there were 169 affected family members, equally divided between females (53%) and males (47%). Other conditions frequently seen in these pedigrees included thyroid disease (46%), eczema (53%), asthma (46%), NIDDM (34%) and psoriasis (27%). The results are consistent with other reports of a majority of pedigrees having a small number of affected members, of equal sex distribution of alopecia areata and of association with other immune disorders. Date commenced: 1999 Date completed: 2001 Progress of Project: Presented at World Congress of Dermatology, 2002 Funding source/s: Core budget Research Projects 14
  • 16. 15 Genetics of Alopecia areata Shannon Harrison, Jack Green, Justine Ellis, Steven Harrap, Rod Sinclair Alopecia areata is a complex genetic disease which most likely has several genes interacting with environmental co-factors to cause disease. In the initial part of the study an analysis was undertaken in a single family with significant members over 3 generations. Linkage was assessed to candidate gene areas on chromosome 21 and no significant linkage was identified. Subsequently, an association study in alopecia areata was undertaken in 15 individuals with alopecia areata to determine if there was a genetic association between the androgen receptor gene on the X chromosome. A negative association was identified. This study is ongoing and we are currently in the process of collecting sib pairs as part of an international collaborative effort with the aim being to undertake a genome wide scan. Date commenced: February, 1999 Progress of Project: Ongoing Funding source/s: Scientific Research Fund of the Australasian College of Dermatologists: National Alopecia Areata Foundation of America Clinical diagnostic criteria for Pili annulati Jack Green, David de Berker, Rodney Sinclair Pili annulati is rare hair shaft disorder that causes banding of hairs. The alternating dark and light bands which are more obvious in those with fair hair are caused by cavities located in the cortex of the hair shaft. Most reported cases have been inherited in an autosomal dominant fashion where there have been some sporadic examples. In three families with this condition, we formally investigated their clinical and transmitted light microscopic findings. We found that most cases are sub-clinical and that grade variability exists between individuals and the number of hairs affected and within the same individual in the degree to which different hairs are affected. We also found that the clinical banding pattern can be lost after other insults to the hair cycle such as alopecia areata of telogen gravidarn. Date commenced: 2001 Date completed: 2001 Progress of Project: Published, Clinical and Experimental Dermatology, 2002 Funding source/s: University of Melbourne Collaborative Research Fund Genetics of pili annulati Jack Green, Elizabeth Fitzpatrick, Sue Forrest, Justine Ellis, Steven Harrap, Rod Sinclair Pili annulati is thought to be a single gene disorder, however, the pathogenesis of this condition is unknown. We identified 3 large families with Pili Annulati and undertook an investigation of the genetics. After extracting DNA and excluding a number of candidate gene loci, we undertook a genome wide scan in a single family. Linkage has been identified and we have excluded one candidate gene in that area by mutation analysis. We are currently in the process of undertaking mutational analysis of all the candidate genes within the target region. Date commenced: 2000 Progress of Project: Ongoing Funding source/s: Scientific Research Fund of the Australasian College of Dermatologists, Skin and Cancer Foundation.
  • 17. 16 Genetics of Marie Unna Hypotrichosis Jack Green, Elizabeth Fitzpatrick, Sue Forrest, Justine Ellis, Steven Harrap, Rod Sinclair Marie Unna Hypotrichosis is a rare, inherited hair disease that causes patterned hair loss and is also associated with irregularities of the hair shaft. We identified a large family who clinically appeared to have Marie Unna Hypotrichosis. Marie Unna Hypotrichosis has been linked to an area on chromosome 8. Our investigation of the genetics in this family failed to identify linkage to that area on chromosome 8 and, in fact, any association was excluded. We then proceeded to do a genome wide scan and were able to identify linkage to an area on another chromosome. We are planning to perform mutational analysis of that region to try and identify the causative mutation for this variant of Marie Unna Hypotrichosis. Date commenced: 2000 Progress of Project: Ongoing Funding source/s: Scientific Research Fund of the Australasian College of Dermatologists, Skin and Cancer Foundation. Genetics of Papular Atrichia Jack Green, Rod Sinclair, Abraham Zlotogorski, Angela Christiano Papular atrichia is a rare, inherited cause of complete hair loss. A causative mutation was identified in a Pakistani family in 1998. We had previously seen an individual with this condition in 1991. Our patient had an apparent autosomal dominant inheritance of this normally autosomal recessive disorder. Genetic analysis was undertaken of both the patient and his mother and it was determined that his late father was a heterozygous carrier of this condition. This is the first pseudo- dominant case of papular atrichia. Date commenced: 2001 Date completed: 2002 Progress of Project: Paper in the Journal of Investigative Dermatology, 2002 Funding source/s: Scientific Research Fund of the Australasian College of Dermatologists. De Novo Mutations in Monilethrix. Horev L, Djabali K, Green J, Sinclair R, Martinez-Mir R, Ingber A, Christiano AM, Zlotogorski A. Mutations in the hair keratins hHb1 and hHb6 have been recently reported to cause monilethrix, an autosomal dominant hair shaft disorder characterized by variable degrees of hair fragility and follicular hyperkeratosis. We found 10 families with monilethrix in which parents were not clinically affected, and sequenced the hair keratin hHb1, hHb3 and hHb6 genes in seven patients. In five patients no mutations were found, while in two patients we identified de novo mutations, at the helix termination motif. We were unable to identify any correlations between the phenotype and the genotype in affected individuals. Date commenced: 2001 Date completed: 2002 Progress of Project: Accepted for publication in Experimental Dermatology Funding source/s: Department o Dermatology, Haddad Hospital, Jerusalem Research Projects
  • 18. 17 Loose anagen syndrome Alvin Chong, Elizabeth Fitzpatrick, Sue Forrest, Rodney Sinclair Loose anagen syndrome is a rarely reported disorder, mainly of childhood, where anagen hairs a poorly anchored to the follicle and hence, easily and painlessly extracted. The condition was first described in 1984 and since then approximately 65 cases have been reported in the worldwide literature. We identified 16 families with loose anagen syndrome involving over 120 people and undertook a study of the clinical aspects and molecular genetics of the syndrome. We were able to identify that there is variation in the phenotype over time with marked fluctuations occurring in the ease with which hair can be plucked. We also determined that it is an autosomal dominant disease with incomplete penetrance after having clearly defined the clinical diagnostic criteria for this condition Date commenced: 1997 Date completed: 2001 Progress of Project: Thesis accepted for Master of Medicine, University of Melbourne Funding source/s: University of Melbourne Postgraduate Research Scholarship Androgenetic alopecia, prevalence and risk factors: findings from an Australian study Sinclair R, Severi G, Giles GG, English DR, McCredie MRE, Hopper JL. 1,390 men were recruited at random from electoral rolls to serve as controls in a case controlled study of prostate cancer. All subjects were interviewed in person and direct observations of baldness were made. Men were grouped into the falling baldness categories; no baldness, frontal baldness, vertex baldness and full baldness. The epidemiological data collected on these men was used for analysis of risk factors for baldness using unconditional logistic regression with androgenetic alopecia as the response variable adjusted for age. Further research is required to confirm the negative association between lean body mass and the completion of growth risk of androgenetic alopecia later in life. Date commenced: 2001 Date completed: 2002 Progress of Project: Submitted for publication Funding source/s: NH&MRC, Tattersall’s and Whitten Foundation. Anti Cancer Council of Victoria.
  • 19. 18 A new clinical grading scale for female androgenetic alopecia Andrew Messenger, Rodney Sinclair The pattern of hair loss seen with androgenetic alopecia differs between men and women. In women the frontal hairline seems to be preserved and women may notice just a diffuse thinning over the crown generally. The currently used grading scale to assess female androgenetic alopecia is that designed by Ludwig in the 1970’s. We developed and validated a new clinical grading scale. Women who presented with grades 1 or 2 hair loss were found on histology to have androgenetic alopecia in 60% of cases and chronic telogen effluvium in 40%. In contrast, women who presented with stage 3, 4 and 5 hair loss had a 97% chance of having androgenetic alopecia histologically. In the final evaluation the terminal to vellus hair ratios were correlated with clinical grade and a good and linear correlation was recorded between the grade of hair loss and the terminal to vellus hair ratio seen histologically. Date commenced: 2000 Date completed: 2002 Progress of Project: Being prepared for publication Funding source/s: Core budget, Monash University Alfred Hospital Histological Diagnosis of female androgenetic alopecia Rica Mallari, Damian Jolley, Jill Magee, David Whiting, Stephen Kossard, Rodney Sinclair, We undertook an investigation to evaluate the reliability of a single horizontally sectioned scalp biopsy in the diagnosis of female pattern hair loss. 207 women presenting with chronic diffuse hair loss had three 4mm punch biopsies taken from immediately adjacent skin on their mid scalp and all 3 biopsies were sectioned horizontally. The findings were compared with 305 women who underwent 2 biopsies, with one being sectioned horizontally and the other vertically. To correlate the histological diagnosis with the clinical severity mid scalp, a clinical grading scale was developed. We found that application of the current diagnostic criteria achieved accurate diagnostic definition in 98% of women with triple horizontal biopsies versus 79% with a single horizontal biopsy. 97% with a mid scalp clinical grade of 3, 4 or 5 were diagnosed on triple biopsy with female pattern hair loss. Scalp biopsy for diagnosis should therefore be reserved for women with a mid scalp clinical grade of 1 or 2. Date commenced: 1999 Date completed: 2002 Progress of Project: Accepted for publication Journal of the American Academy of Dermatology. Funding source/s: Core budget Women Who Present With Female Pattern Hair Loss Tend To Underestimate The Severity Of Their Hair Loss Seba Biondo Rodney Sinclair Female pattern hair loss can be a source of considerable distress for affected women. Our hypothesis was that women with female pattern hair loss who seek treatment would rate their condition as more severe than the treating doctor. We undertook this project to identify discrepancies between the severity ratings of the women and the clinicians. 30 women receiving treatment for biopsy proven androgenetic alopecia and 44 women on the waiting list to receive treatment for androgenetic alopecia were recruited. Each women completed a self report photographic measure on the severity of their hair loss, specifically developed for the study. No difference was found between the severity ratings of the women receiving treatment and their clinicians, it was found that women in the waiting list group Research Projects
  • 20. 19 underestimated the severity of their hair loss as compared to their clinicians ratings. The results indicate that women affected with androgenetic alopecia who seek treatment for their hair loss do not overestimate the severity of their hair loss, in fact, they tend to underestimate it. Date commenced: 2001 Date completed: 2002 Funding source/s: Department of Psychiatry, Monash University Community Prevalence of female androgenetic alopecia Desmond Gan, Rodney Sinclair In this study questionnaires have been developed to be sent out to a random sample of 6,000 people aged above 18 sampled from the Australian electoral roll in the city of Maryborough in central Victoria. The questionnaire will be used to obtain information about whether they or family members have experienced baldness, dandruff, greying of the hair or complications pertaining to baldness (solar keratosis or skin cancer of the scalp). They will be asked to self assess their hair thickness using the scale provided. 500 respondents will be invited for face to face hair and scalp examination by a dermatologist and registrars recording the degree of hair loss, greying of hair, and the presence of dandruff. Date commenced: Ongoing Funding source/s: Core budget, Pharmacia Quality of Life in Women with Female Pattern Hair Loss and the Impact of Medical Intervention Seba Biondo Rodney Sinclair Female pattern hair loss has recently become the preferred term for female androgenetic alopecia, a conditionproducing chronic progressive hair loss in women. The morbidity related to the hair loss is predominantly psychological. The purpose of this study was to examine the impact of female pattern hair loss on quality of life and the effect of comprehensive medical assessment, explanation of disease process and initiation of treatment by an experienced dermatologis. 77 women with biopsy proven female pattern hair loss receiving treatment with oral anti-androgens, 53 women on a waiting list to receive treatment for female pattern hair loss and 82 women not affected by hair loss were studied. Participants completed the women’s female pattern hair loss quality of life questionnaire. Findings confirmed the detrimental impact of hair loss on the quality of life of affected women and the lack of impact of medical intervention on quality of life at 2 months. This has significant implications for the treatment of psychological difficulties associated with female pattern hair loss and suggests a possible role for adjunctive psychological intervention in the management of this chronic dermatological condition. Date commenced: 2001 Date completed: 2002, Report completed Funding source: Department of Psychiatry, Monash University
  • 21. 20 Genetics of Androgenetic Alopecia Shannon Harrison, Justine Ellis, Steven Harrap, Rod Sinclair In recent years researchers at the Department of Physiology at the University of Melbourne have identified the genetic association between men with androgenetic alopecia and polymorphisms on the androgen receptor. There has been much recent controversy about whether female pattern hair loss is indeed the female corollary of male androgenetic alopecia. There has been a revision of terminology with female patterned hair loss becoming the preferred term because of the uncertainty about the nature of this association. In order to determine whether female pattern hair loss is genetically association with the same polymorphisms on the androgen receptor seen in male androgenetic alopecia, we undertook a study of 150 women with clinical and histological evidence of female pattern hair loss. Because women have two X chromosomes of which by lyonisation only one is active, the power required to demonstrate an association is greater than that required for the men. To date, DNA from over 100 women have been analysed and whilst a suggestive association exists, further analysis is required to achieve statistical significance. Date commenced: 2001 Progress of Project: Ongoing Funding source/s: Skin and Cancer Foundation, Department of Physiology, University of Melbourne Common Baldness, Dandruff and Greying of Hair in Twins Desmond Gan, Rodney Sinclair Common baldness, seborrheoic dermatitis and hair greying are thought to be under genetic control. In order to investigate the nature of this genetic association, we are developing a survey for monozygotic and dyzogotic twins from the Australian Twin Registry. Date commenced: 2001 Progress of Project: Ongoing Funding source/s: Core budget Treatment of female androgenetic alopecia with oral antiandrogens Miriam Wewerinke, Rodney Sinclair The prevalence of clinical hair loss in women increases with age. Most data on the use of androgen receptor antagonists pertain to their use in women with hirsutes or acne. The role of androgens in the management of women with biopsy proven androgenetic alopecia, we studied in 100 women who received anti andorgenetic treatment for more than 12 months. Pre- and post-treatment photographs were assessed side by side by three independent clinicians experienced in the treatment of patients with hair loss and scored using a visual analogue scale. The concordance between examiners was assessed. Photographs were rated as either improved, no change or worse. Fewer than 10% of women were identified as worse while on treatment and over 90% showed either no change or improved. 30% had clearly improved using the photographic documentation. Date commenced: 1999 Date completed: 2001 Funding source/s: Core budget Research Projects
  • 22. 21 Prevention of Hospital Acquired Pressure Ulcers: a randomised controlled trial in the use of a sheepskin underlay Ken Montgomery, Damian Jolley, Rodney Sinclair Pressure ulcers are a costly, burdensome and prevalent complication to hospital stay. The majority (up to 80%) have reported pressure ulcers as stage 1 or stage 2, indicating damage to the superficial layers of the skin. This type of injury is often associated with combined forces of pressure, moisture and friction and is potentially preventable with the appropriate pressure reducing/relieving support surface. Although many pressure relieving support surfaces are available, there is little reliable evidence to distinguish between them, on the basis of either efficacy or cost effectiveness. This study was a randomized trial that compared the Australian Medical Sheepskin (AMS) to standard hospital care in a large metropolitan teaching hospital. The results suggest that the AMS can provide effective reduction in the incidence of pressure ulcers in low to moderate risk hospital patients. Widespread use of the AMS has the potential to substantially reduce patient discomfort, hospital costs and possible litigation. Date commenced: 1998 Date completed: 2002 Funding source/s: NH&MRC CLINICAL TRIALS A Phase III Multicentre, Double-Blind, Active- Controlled, Parallel Study Comparing the Efficacy and Safety of ZOVIRAX™ Cold Sore Cream (Aciclovir 5% Cream) and Lidocaine 2% to ZOVIRAX™ Cold Sore Cream Alone Administered for 5 Days in Subjects with Herpes Labialis Infection Funding source: Glaxo- Wellcome (Zovirax study ZOV30009/Parexel No.22209) Date Completed: March 5th, 2001 A double-blind, single-centre, placebo- controlled clinical trial to examine the efficacy and safety of DA-5018 cream as a treatment for pruritus associated with mild/moderate atopic eczema Funding source: Stiefel (study CP S217-AUS-02) Date Completed: April 29th, 2001 A multicenter, phase III, double blind study of photodynamic therapy (PDT) with Metvix 160 mg/g cream in comparison to PDT with placebo cream in patients with primary nodular basal cell carcinoma Funding source: Photocure (study PC T308/00) Status: Ongoing Multicenter, multinational, double-blind, parallel, randomized, placebo controlled study of leflunomide in the treatment of psoriatic arthritis (PsA) Funding source: Aventis (study HWA486/3L01) Date Completed: July 15th 2002
  • 23. 22 A Multi-Centre, Double-Blind, Placebo- Controlled Parallel Group Clinical Evaluation of the Efficacy and Safety of 1.5% Ciclopirox Olamine Body and Hair Shampoo in the Topical Treatment of Tinea Versicolor (Pityriasis Versicolor) Funding source: (Stiefel study S227-AUS-03) Status: Ongoing Double Blinded Placebo controlled cross-over study to investigate hydroxychloroquine and acitretin in the treatment of cicatricial alopecia Martin Wade, Keng Ee Thai, Shannon Harrison, Edward Upjohn, Rod Sinclair Date commenced: 1999 Status: Ongoing Funding source/s: ADREF; Skin and Cancer Foundation Immiquimod studies REFERENCE LIBRARY A reference library is maintained on a bibliography database using the computer software Endnote, in order to catalogue all papers held within the department. This database, which is continuing to grow, now contains over 3,000 publications. Research Projects
  • 24. 23 Publications 2001/2002 ARTICLES 2001 Marks R. Dermatoepidemiology, Wherefore art thou in this perilous time of need? Int J Dermatol. 2001; 40: 167- 168. Marks R, Gebauer K, Shumack S, Amies M, Bryden J, Fox TL, Owens ML. Imiquimod 5% cream in the treatment of superficial basal cell carcinoma, Results of a multi-centre 6 week dose-response trial. J Am Acad Dermatol. 2001; 44:807-813. Marks R. (Guest Editor). Beyond the year 2000. Clinics in Dermatol. 2001; 19, 1. Lau PM, Marks R, Stewart K. The outcome of an education program to assist pharmacists in prescribing over-the-counter (OTC) products for common skin diseases. Pharmacy Education. 2001; 1: 83-90. Marks R, Foley PA, Sinclair RD. Dermatology. Med J Aust. 2001; 176: 10. Green A, Marks R. Invasive squamous cell carcinoma of the skin, non-metastatic. Clinical Evidence. 2001; 5: 1190-1195. Plunkett A, Lau P, Stewart K, Marks R. Skin conditions in the pharmacy, consumer satisfaction and economic considerations. Int J Pharm Practice. 2001; 9: 9-14. Marks R. The public health approach to the burden of common skin conditions in the community. J Dermatol. 2001; 28: 602-5. Marks R. Diagnosis in Dermatology - Tricks of the trade. Aust Fam Phys. 2001; 30: 1028-32. Foley P, Zuo Y, Plunkett A, Marks R. The frequency of common skin conditions in preschool-age children in Australia, 1. Atopic dermatitis. Arch. Dermatol. 137; 293-300, 2001 Ng J, Foley, PA, Crouch RB, Baker CS. A case of actinic prurigo successfully treated with thalidomide. Australas. J. Dermatol. 42; 192-5, 2001 Thai KE, Young R, Sinclair R. Nail Apparatus Melanoma. Aus J Dermatol. 2001; 42: 71-83. Green J, Sinclair R. Perceptions of acne vulgaris in final year medical student written examination answers. Aus J Dermatol. 2001; 42:98-101. De Berker D, Sinclair R. The Hair Shaft, normality, abnormality and genetics. Clinics in Dermatol. 2001; 19:129-34. Sinclair R, Dawber R. Androgenetic alopecia in men and women. Clinics in Dermatol. 2001; 19:167-78. Dawber R, Sinclair R. Hirsutes. Clinics in Dermatol. 2001; 19:187-99. Sinclair R. Commentary. Clinics in Dermatol. 2001; 19:93-94. Sinclair RD. Management of male pattern hair loss. Cutis 2001; 68(1):35-40. Curnow P, Sinclair R, Marks R. A public health model for the prevention of cancer, the Australian experience with melanoma and non melanoma skin cancer’. Austral-Asian Journal of Cancer. 2001. Thai KE, Sinclair R. Cutaneous Pili Migrans. Br J Dermatol. 2001; 144:219. Thai KE, Sinclair R. Spironolactone induced Hepatitis. Aus J Dermatol. 2001; 42: 180-182. Thai KE, Sinclair RD. Keratosis Pilaris and hereditary koilonychia without monilethrix. J Am Acad Dermatol. 2001; 45: 627-629. Green J, Sinclair RD. Oral cyclosporin does not arrest progression of androgenetic alopecia. Br J Derm. 2001; 145:842-44. 2002 Marks R. The changing incidence and mortality of melanoma in Australia. Recent Results in Cancer Research. 2002; 160: 113-21. Marks R, Foley P, Sinclair R. Updates in medicine, Dermatology. Med. J. Australas. 176, 10, 2002
  • 25. 24 Crouch R, Foley, P, Baker C. Actinic prurigo, A retrospective analysis of 21 cases referred to an Australian photobiology clinic. Australas. J. Dermatol. 43: 128-32, 2002 Wade MS, Sinclair RD. Disorders of hair in infants and children other than alopecia. Clinics in Dermatology. 2002; 20:16-28. Dolianitis C, Sinclair R. Optimal Treatment of Head Lice, Is a No-Nit Policy Justified? Clinics in Dermatology. 2002; 20: 94-95. Sinclair R. Cryosurgery in dermatology, treatment of malignant and premalignant skin disease. Medical Cryology 2002; 2:149-170. Zlotogorski A, Martinez-Mir A, Green J, Lamdagger H, Panteleyevdagger AA, Sinclair R, Christiano AM. Evidence for Pseudodominant Inheritance of Atrichia with Papular Lesions. J Invest Dermatol. 2002;118:881-886. Chong A, Sinclair R. Loose anagen syndrome, A prospective study of three families. Australas J Dermatol. 2002; 43:120-4. Giles GG, Severi G, Sinclair R, English DR, McCredie MRE, Johnson W, Hopper JL, Boyle P. Androgenetic alopecia, acne and prostate cancer, findings from an Australian case-control study. Cancer Epidemiol Biomarkers Prev 2002; 11:549-53. White PJ, Gray AC, Fogarty RD, Sinclair RD, Werther GA, Wraight CJ. C-5 propyne-modified antisence oligonucleotides penetrate the epidermis in psoriatic and not normal human skin after topical application. JID 2002;118:1003-1007. Harrison S, Sinclair RD. Telogen Effluvium. Clin Exp Dermatol. 2002;27:389-95 Harrison S, Sinclair RD. Telogen Effluvium. (German Translation) Zeitscrift fur Hautkrankenheiten. 2002;75:389-95 Wade MS, Sinclair RD. Persistent depigmentated regrowth following alopecia areata. J Am Acad Dermatol 2002; 46: 619-20 Jenner N, Campbell J, Plunkett A, Marks R. Cost of psoriasis: A study on the morbidity and financial effects of having psoriasis in Australia. Aust J Dermatol. 2002; 43: 255-61 Ciconte A, Mills A, Shipley A, Marks R. Subacute cutaneous lupus erythematosus in six year old a child, A report of a case and a review of the literature. Austral J Dermatol. 2002, 43,62-4. Marks R. The changing incidence and mortality of melanoma in Australia. Recent Results in Cancer Research. 2002; 160: 113-21. Crouch RB, Foley, PA, Baker CS. The results of photopatch testing 172 patients to sunscreening agents at the photobiology clinic, St. Vincent’s Hospital Melbourne. Australas. J. Dermatol. 43; 74: 2002 Crouch R, Foley, P, Baker C. Actinic prurigo, A retrospective analysis of 21 cases referred to an Australian photobiology clinic. Australas. J. Dermatol. 43, 128-32, 2002 CASE REPORTS Thai KE, Sinclair R. Cutaneous Pili Migrans. Br J Dermatol. 2001; 144:219. Thai KE, Sinclair R. Spironolactone induced Hepatitis. Aus J Dermatol. 2001;42:180-182. Thai KE, Sinclair RD. Keratosis Pilaris and hereditary koilonychia without monilethrix. J Am Acad Dermatol. 2001;45:627-629. Green J, Sinclair RD. Oral cyclosporin does not arrest progression of androgenetic alopecia. Br J Derm. 2001;145:842-44. Thai KE, Sinclair RD. Treatment of Bowen’s disease of the penis with imiquoimod. J Am Acad Dermatol 2002;46:470-1 Wade MS, Sinclair RD. Persistent depigmentated regrowth following alopecia areata. J Am Acad Dermatol 2002;46:619-20 Thai KE, Sinclair RD. Chronic telogen effluvium in a man. J Am Acad Dermatol. 2002;47:605-7. Publications 2001/2002
  • 26. 25 Thai KE, Sheffield L, Forshaw K, Sinclair R, Herman G, Pitt J, du Sart D. Somatic Mosaicism explains the occurrence of X-linked dominant Conradi Hunnerman Syndrome in an affected male. Aus J Dermatol 2001, 42, A13. Green J, de Berker D, Sinclair R. Marie Unna Hereditary Hypotrichosis, First Australian Family. Aus J Dermatol 2001, 42, A126 Green J, de Berker D, Sinclair R. Pili Annulati, Characterization of the Phenotype. Aus J Dermatol 2001, 42, A126 Sinclair R, Howard A. Epidermoid carcinoma of the nail apparatus treated with imiquomod 5% cream. Aus J Dermatol 2002, 43, A6 ABSTRACTS AND LETTERS Thai KE, Sheffield L, Forshaw K, Sinclair R, Herman G, Pitt J, du Sart D. Somatic Mosaicism explains the occurrence of X-linked dominant Conradi Hunnerman Syndrome in an affected male. Aus J Dermatol 2001;42:A13. Green J, de Berker D, Sinclair R. Marie Unna Hereditary Hypotrichosis: First Australian Family. Aus J Dermatol 2001;42:A126 Green J, de Berker D, Sinclair R. Pili Annulati: Characterization of the Phenotype. Aus J Dermatol 2001;42:A126 Sinclair R, Howard A. Epidermoid carcinoma of the nail apparatus treated with imiquomod 5% cream. Aus J Dermatol 2002;43:A6 Green J, Forrest S, Sinclair R. Familial alopecia areata in Australia. Ann Dermatol Venereol. 2002; 129: 1S516. Green J, Fitzpatrick E, Forrest S, Sincalir R. A possible second locus for Programd patterned alopecia. Aus J Dermatol 2002; 43:A25 Chong A, Fitzpatrick E, Forrest S, Sincalir R. Clinical and Molecular genetics of loose anagen syndrome: Results form a study of 16 families. Aus J Dermatol 2002; 43:A17 Green J, Zlotogorski A, Martinez-Mir A, Lam HM, Panteleyev A, Christiano A, Sinclair R Evidence of pseudodominant inheritance of atrichia with papular lesions. Aus J Dermatol 2002; 43:A31 Tosti A, Piraccini BM, Bergfeld WF, Camacho F, Dawber RP, Happle R, Olsen EA, Price VH, Rebora A, Shapiro J, Sinclair R, Vanneste D, Whiting DA.Occupational alopecia or alopecia areata? J Am Acad Dermatol. 2002 Oct;47(4):636-7. NON-PEER REVIEW PUBLICATIONS Thai KE, Sinclair R. Androgenetic Alopecia. Medical Observer. 19 January 2001. Thai KE, Sinclair R. Differential Diagnosis: alopecia areata vs trichotillomania. Medical Observer. 2 February 2001. Dolianitis C, Sinclair R. Management of Psoriasis. Medical Observer. 25 May 2001. BOOKS Price C, Sinclair R. Fast Facts-Minor Surgery. Health Press Limited. Oxford 2001. Sinclair R, Marks R. A guide to the performance of diagnostic procedures used in the management of common skin diseases. St. Vincent’s Hospital Department of Dermatology, Melbourne, 2002. Sinclair R, Banfield C, Dawber R. Handbook of diseases of the hair and scalp. (Italian Translation) Blackwell Science, Oxford 2002 Campbell J, Foley P, Jenner N, Marks R, Merlin K, Sinclair R, Welsh B. Skin - an education program for Maternal & Child Health. Melbourne: Department of Dermatology, St. Vincent’s Hospital Melbourne. 2002. Merlin K, Campbell J, Witherow E, Jenner N, Foley P, Marks R. Skin - an education program for Primary Schools. Melbourne: Department of Dermatology, St. Vincent’s Hospital Melbourne. 2002.
  • 27. 26 BOOK CHAPTERS Wade M, Sinclair R. Hair abnormalities in women and girls. In Parish LC, Brenner S, Ramos-e-Silva M. Eds. Women’s Dermatology. From infancy to maturity. Parthenon Publishing Group. New York 2001. Korpan NN, Amaro JA, Gonsalves JCA, Monfrecola G, Nordin P, Le Pivert PJM, Scalvenzi M, Sinclair R. Cryosurgical dermatology. In Korpan NN. Ed. Atlas of cryosurgery. Springer. Vienna. 2001. Thai KE, Sinclair R. Androgenetic Alopecia. In Lebwohl, Heymann, Berth-Jones Coulson. Ed. Treatment of Dermatological Disease.Harcourt Health Sciences. London. 2002. Scarfe C, Sinclair R. Actinic Keratosis. In Lebwohl, Heymann, Berth-Jones Coulson. Ed.Treatment of Dermatological Disease. Harcourt Health Sciences. London. 2002. Marks R, Hill D. Prevention of Skin Cancer. In, Sober AJ, Haluska FG, Eds. Skin Cancer. The American Cancer Society Atlas Series. Ontario,BC Decker Inc. 2001;325-339. Hill D, White V, Marks R, Borland R. Changes in sun-related attitudes and behaviours, and reduced sunburn prevalence in a population at high risk of melanoma. In, Public Health Communication, Evidence for behavior change. Hornik RC Ed. New Jersey,Lawrence Erlbaum Associates. 2001;163-178. OTHER ACTIVITIES The Department has been responsible for innumerable public relations/ education activities and resources such as comments in lay magazines, radio and television interviews and patient information leaflets and advice. These activities are too numerous to specify. Publications 2001/2002
  • 28. 27 Conferences CONFERENCE PRESENTER International Meetings - 2001 5th World Conference on Melanoma, Venice, Italy RM American Academy of Dermatology Annual Meeting, RS Washington DC 100th Meeting Japanese Dermatological Association, RM Tokyo, Japan Sixth Asia-Pacific Environmental and Occupational PF Dermatology Symposium The Eden IDEA Congress, Noordwijkerhout, Netherlands RM 8th World Congress on Cancer of the Skin Zurich, RM Switzerland International Society of Dermatology, Regional Meeting RM Medical Education in Dermatology, Rhodes, Greece New Zealand Dermatological Society and the PF, RS, CB, LMY Australasian College of Dermatologists Combined Meeting, Queenstown European Academy of Dermatology and Venereology, Munich PF 6th Asian Dermatology Congress, Thailand RS Australian Meetings 2001 The Australasian College of Dermatologists PF, RS, RM, JG Annual Scientific Meeting, Adelaide Australian Health Promotion Association Conference, KM Gold Coast International Meetings 2002 Global Transplant/Skin Cancer Collaborative Group Berlin, RM Germany Croatian Dermatovenerological Society of the Croatian RM Medical Association, Optija, Croatia Hellenic Dermatological Society, Scientific Meeting, RM Athens, Greece European Hair Research Society, Brussels RS, JG World Congress of Dermatology, Paris RM, RS, CB, JG,PF British Association of Dermatology, Edinburgh RS CONFERENCE PRESENTER International Meetings 2002 cont... Annual Scientific Meeting, Wellington PF 11th Congress European Academy of Dermatology & RM Venereology, Prague, Czech Republic Koelmeyer Clinical Group, WHERE???? CB Hair Forum 2002. Malayasian Society for Hair Science, RS Kuala Lumpar The Philippine League of Dermatologists 15th Regional RS Conference of Dermatology, Manilla Josef Plenck Lecture, Austrian Society for Dermatology RM and Venereology, Vienna, Austria Australian Meetings 2002 Maternal and Child Health Nurse Seminar, Melbourne PF Cutaneous Biology and Endocrinology Workshop, Melbourne RS The Australasian College of Dermatologists RM, NJ, PF, Annual Scientific Meeting,Melbourne LMY,RS, JG Maternal and Child Health Saturday RM, JC, KM, NJ Conference, RMIT, Melbourne 12th Annual Scientific Meeting Australasian Health NJ, KM and Research – Data Managers Association (AHR-DMA), Brisbane. The General Practitioner Conference and Exhibition, PF Melbourne Alopecia, Hair Today, Gone Tomorrow Cutaneous Biology RS and Endocrinology Workshop, Melbourne
  • 29. 28 2001 International – Elective Students Helen Bryden University of Glasgow Sabine Seidl University of Munich Carola Schmidt Ruprecht-Karls-Universitaet, Heidelberg, Germany Jessica Nehrling University of Maryland, Baltimore, USA International and Local Visitors to the Department Dr Julie Cronk Dermatology resident, University of Minnesota, USA Dr Mirjam Wewerinke Visiting doctor, University of Gronigen, Netherlands Dr Roger Timms GP, James Paget Hospital, Great Yamouth, UK Dr Behnaz Fazeli Visiting doctor, Elisabethinen Hospital, Linz, Austria Dr Kirstin Charlesworth GP, Daylesford 2002 International – Elective Students Elke Marksteiner University of Michigan, USA Paul Foggit St. Bartholomew’s & The Royal London Hospital, UK Katrina Barnett University of Maryland, USA Lucy Schomberg St George’s Hospital, London, UK Chantal Tomkins University of Nottingham, England Eitan Amir University of Nottingham, Manchester, UK International and Local - Visitors to the Department Dr Sue Burge Clinical Dean,Oxford University School of Medicine, and Senior Lecturer in Dermatology, The John Radcliffe, Oxford, England Dr Veerle Verlinden Dermatology Registrar, University of Leuven, Belgium Dr Andrew Messenger Senior Lecturer in Dermatology, Royal Hallamshire Hospital Sheffield, UK Prof Richard Scher Professor of Dermatology, University of Columbia New York, USA Dr Kevin White Dermatology Resident, University of Pennsylvania, USA Dr Stephen Richardson Lahey Clinic Dept, Internal Medicine, Burlington, MA, USA Dr Jane Tam GP Dr Zina Akhounova GP Dr Jim McDonald GP Visitors
  • 30. 29 The Skin and Cancer Foundation of Victoria maintains its close relationship with St. Vincent’s Hospital, the University of Melbourne and Australasian College of Dermatologists in supporting the academic Department at St. Vincent’s Hospital. This cooperative venture has been the envy of other medical disciplines who are looking at ways of maintaining their service, teaching and research bases in a time of economic rationalism when many of these components previously provided through the public hospital system are being so constrained. In service, the Department at St. Vincent’s Hospital has close links with the Skin and Cancer Foundation in many aspects. This includes the dermatology registrar at St. Vincent’s undertaking biopsies and other minor procedures on St. Vincent’s patients using the facilities at the Foundation. The St. Vincent’s registrar is able to benefit from the supervision by plastic surgeons who attend the Foundation at the time of the procedure clinic. Patients from St. Vincent’s are also referred across to the Foundation for phototherapy, for diagnostic purposes in the contact dermatitis clinic, for hair and nail advice and management and to obtain the phototherapy facilities which form such a large component of the clinical load at the Foundation these days. The skin cancer assessment clinic has acted as a teaching and training resource for medical students as well as the registrars from St. Vincent’s Hospital. Patients from this clinic have also been used in the teaching seminars for 6th year medical students provided by the Foundation throughout the year. The St. Vincent’s Department is frequently acting as an adviser to pharmaceutical companies on clinical trials of new products. To undertake the clinical trials, the Department links with the Foundation as a central trials base. This benefits both the Foundation and St. Vincent’s. Other research projects which have been shared between St. Vincent’s and Skin and Cancer Foundation include the hair and nail research activities of Dr Rodney Sinclair. The photography services of the Foundation have been a major contributor to the hair research. They have also contributed in both the research and service in supporting the Department at St. Vincent’s Hospital. Other technical resources at the Department have been supported by the Foundation such as the new internet site to back up our public and professional education programs. The Foundation has provided a grant for this project developed in the Department by Nicole Jenner. As the Department has database expertise, a contractual arrangement has been commenced in which the Department provides their expertise in developing and managing the Skin and Cancer Foundation patient database. These databases, while strictly complying with the new privacy legislation, provide extremely important research data which can be extracted and reported to enhance the clinical services provided by the Foundation. The new occupational dermatology developments of Dr Rosemary Nixon have gone from strength to strength since their establishment. Dr Nixon is an Honorary Senior Lecturer in Dermatology at the St. Vincent’s Hospital Department, and the Department also assists with advice and guidance on directions and research being undertaken by the new Centre. Dr Nixon has also been active in expanding the activities of the Foundation to Monash University as well as the initial links with the University of Melbourne. In time, no doubt, there will be sharing between University of Melbourne and Monash University medical students of the teaching that is occurring at the Foundation. The Foundation now has a very stable financial base, particularly with the development of the new Skin and Cancer Foundation Pathology. This has allowed it to take both a short and long term view in its forward planning and much of that has involved its relationship with the Department at St. Vincent’s Hospital. The relationship is a strong one. It will continue to grow and we look forward to our future activities together. Rod Sinclair President Skin & Cancer Foundation of Victoria The Skin & Cancer Foundation of Victoria
  • 31. 30 The 20th World Congress of Dermatology in Paris, in June 2002, was attended by 1,200 dermatologists. It was the largest gathering of dermatologists ever seen in the world. During the Congress, the Assembly of Delegates representing the member societies of the International League of Dermatological Societies (ILDS) met to discuss and decide future directions of the League. They elected a new board for the ILDS (the International Committee of Dermatology) who then went on to elect the President and Office bearers for the next five years. Professor Robin Marks was elected the new President. Professor Georg Stingl from Vienna was elected Secretary-General and Professor Ana Kaminsky from Buenos Aires was elected the Treasurer. This is the first time an Australian has ever held a position of this nature in international dermatology. The ILDS has a number of other strategic directions, apart from running the World Congress of Dermatology. These include the International Foundation for Dermatology, the arm of the League dedicated to improving the outlook for people affected by skin diseases in developing countries. The Foundation runs a Regional Dermatology Training Centre in Moshi, Tanzania. Over 100 paramedical trainees have graduated after a two year course at the Centre. They then return to organise dermatology practice or administration in their individual African states trying to provide some level of dermatological service for those in need. A community-based project was undertaken in Mali, West Africa, last year looking at four of the major common infestations/infections in Africa. Models of care tested in this project may be applicable to other developing countries throughout the world. The ILDS also acts as a global political body for dermatology, being the only non-government organisation in dermatology in official relations with the World Health Organisation. It has contributed to the development of the latest International Classification of Diseases list (ICD-10), as well as providing the section on dermatology in the "Essential Drugs Handbook" of the WHO. Under the Derm-Link program, the League provides small grants to dermatologists within the member societies in developing countries. These grants can provide items of equipment for a dermatology department or support travel for training purposes. One of the major new tasks, recommended by the Assembly of Delegates, is to look at and define the boundaries of dermatology. We plan to develop and publish a document showing clearly what dermatology is and what services dermatologists can provide. Individual member societies could use such a document within their own country, with the imprimatur of the ILDS the global body for dermatology, to negotiate with government and other organisations in these difficult times when dermatology seems to be being encroached upon by so many people around us. We have a marvellous International Committee of people who are widely experienced and very committed to the League. There is no doubt that there is a lot to achieve. Keep your eye on this spot - over the next five years there will be increased awareness of the activities of the League associated with steps forward in our aim of improving access and care for people with diseases affecting their skin throughout the world. Robin Marks President International League of Dermatological Societies International League of Dermatological Societies
  • 32. 31 The Department of Dermatology at St. Vincent’s Hospital Melbourne, together with the Australasian Hair and Wool Research Society, hosted the first Cutaneous Biology and Endocrinology Workshop at the Mary Aikenhead Conference Centre, St. Vincent’s Hospital Melbourne in November 2002. There were over 60 delegates, including dermatologists and basic scientists. Professor Chen Ming Chuong, a developmental biologist from San Francisco and Dr Dennis Roop from the University of Baylor in Dallas, Texas were the two international guest speakers. A variety of excellent scientific and clinical papers were delivered at the meeting much of which, although arising within the context of hair research, had applications right through cutaneous biology, particularly in the area of genetics research and gene therapy. A special part of the meeting was a registrar training forum and clinical day held at the Skin and Cancer Foundation. The meeting was an enormous success and no one who attended could fail to have been impressed by the quality of scientific cutaneous research being conducted in Australia and New Zealand. The abstracts will be published in full in Experimental Dermatology, the official journal of the Australasian Hair and Wool Research Society. Rod Sinclair Conference Convenor Cutaneous Biology and Endocrinology Workshop November 8-10, 2002
  • 33. 32 Organisational Charts 2001-2002 Robin Marks Professor of Dermatology Senior Associates Dr Abe Dorevitch A/Prof Damien Jolley Dr Harvey Rotstein Dr Andrew Michaelides Dr Rosemary Nixon Dr Chris Baker Director of Clinical Services Dr Peter Foley Senior Lecturer in Dermatology Ms Jan Campbell Department Manager Dr Rod Sinclair Senior Lecturer in Dermatology Consultant Dermatologists Dr Peter Foley Dr Robert Kelly Dr Chris Mc Cormack Dr Mei Tam Dr Belinda Walsh Dermatology Nurse Ms Leoni Hill Research Fellow Dr Lee Mei Yap Administrative Staff Ms Marlene Rennie Administrative Officer Mrs Helen Gibson Administrative Officer Registrars Dr Cate Scarff Research Registrar Dr Suresh Chandra Dr Laura Scardamaglia Hospital Registrars (shared 6 monthly) Research Staff Ms Kate Merlin Programs Officer Ms Nicole Harman Programs Officer Ms Maria Moore Programs Assistant P/T Research Fellows Ms Jack Green Doctorate Student Dr Martin Wade Doctorate Student Dr Keng-Ee Thai Masters Student Robin Marks Professor of Dermatology Honorary Senior Associates Dr Abe Dorevitch A/Prof Damien Jolley Dr Harvey Rotstein Dr Andrew Michaelides Dr David Harman Honorary Senior Lecturer Dr Rosemary Nixon Dr Chris Baker Director of Clinical Services Dr Peter Foley Senior Lecturer in Dermatology Ms Jan Campbell Department Manager Dr Rod Sinclair Senior Lecturer in Dermatology Consultant Dermatologists Dr Peter Foley Dr Robert Kelly Dr Chris Mc Cormack Dr Mei Tam Dr Belinda Walsh Dermatology Nurse Ms Leoni Hill Administrative Staff Ms Marlene Rennie Administrative Officer Mrs Helen Gibson Administrative Officer Registrars Dr Lee Mei Yap Research Registrar Dr Paul Curnow Dr Adriene Lee Hospital Registrars (shared 6 monthly) Research Staff Ms Kate Merlin Programs Manager Ms Nicole Harman Programs Manager Ms Maria Moore Programs Assistant P/T Ms Liz Whitherow Programs Assistant P/T Visiting Fellows Dr Susan Burge Dr Andrew Messenger Research Fellow Dr Stephen Gilmore MD student Research Fellow Dr Shannon Harrison DEPARTMENT OF DERMATOLOGY 2001 DEPARTMENT OF DERMATOLOGY 2002
  • 34. 33 HEAD OF DEPARTMENT Robin Marks, AM, MBBS, MPH, FRACP, FACD DEPARTMENT MANAGER Jan Campbell, BA (Hons), MA ADMINISTRATIVE STAFF Marlene Rennie, Administrative Officer Helen Gibson, Secretary/Administrative Assistant – Part Time CLINICAL STAFF Director of Clinical Dermatology Christopher Baker, MBBS, FACD Visiting Consultant Dermatologists Peter Foley, MB, BS, B Med Sc, MD, FACD Robert Kelly, MBBS, FACD Christopher McCormack, MBBS FACD Mei Tam, MBBS, FACD Belinda Welsh, MBBS, MM, FACD Andrew Michaelides, MBBS, MRCP, FACD HOSPITAL REGISTRARS 2001 Suresh Chandra, MBBS Laura Scardiamaglia, MBBS 2002 Adriene Lee, MBBS Paul Curnow, MBBS Dermatology Outpatient Department Leonie Hill, RN RESEARCH STAFF Senior Lecturers in Dermatology Rodney Sinclair, MBBS, FACD Peter Foley, MBBS, B Med Sc, MD, FACD Project Managers Kate Merlin, BMRA, GDipHSc (Hlth Prom & Hlth Ed), GCert IT Nicole Harman, BMRA, Grad.Cert.HS (CDM) Research Assistant Maria Moore, RN, BH Research Registrars 2001 Cate Scarff, MBBS 2002 Lee Mei Yap, MBBS (Hons) Bachelor of Medical Science Student 2002 Desmond Gan Honorary Research Fellows 2001 Jack Green, MBBS RACGP Keng-Ee Thai, MBBS BMed Sci 2002 Shannon Harrison, MBBS BMed Sci Staff
  • 35. 34 The Department was established in 1995 with support from: Victorian Faculty of the Australasian College of Dermatologists Skin & Cancer Foundation (Victoria) St. Vincent’s Hospital (Melbourne) Ltd The University of Melbourne F & E Bauer Foundation with corporate sponsorship from: Commonwealth Serum Laboratories Janssen-Cilag Sandoz Australia Ego Pharmaceuticals Lederle Laboratories (Wyeth) Schering-Plough Galderma Australia Roche Products Stiefel Laboratories List of Supporters Without this support, the Department would not have been possible and we express our sincere appreciation of these efforts and contributions from all those people and organisations mentioned above. The following external funding sources were used to assist research projects for 2001/2002 SOURCE PROJECT The Jack Brokhoff Foundation Skin Education Project for Primary Schools ANZ - Felton Bequest The Ian Potter Foundation Skin Education Project for Maternal and RE Ross Trust Child Health Centres Gwendolyn Holly Bequest The University of Melbourne for Loose Anagen Syndrome. Postgraduate Research Scholarship. Australasian College of Dermatologists Eczema Morbidity Study Scientific Research Fund F & E Bauer Foundation Psoriasis Qualitative Studies Skin & Cancer Foundation of Victoria Development of the Website William Joseph Payne Trust Digital camera for digital imaging of skin conditions