LAUSR

In 2020, the British Association of Dermatologists (BAD) marks its one hundredth year since inception. One of its founding principles is to foster research to improve the care of those with skin disease. It does this in several ways including financial support for the British Skin Foundation, which makes grants available for dermatology research, and via its journals, the BJD and Clinical and Experimental Dermatology (CED). As part of the centenary celebrations a look back at some of the best papers in the BJD and CED is warranted. There are some real gems, including landmark publications introducing Sweet syndrome, orf, Lyell syndrome (toxic epidermal necrolysis, TEN), Ludwig’s classification of androgenetic alopecia and the Dermatology Life Quality Index (DLQI). Let’s start from the 1920s and work forwards to the present day. The paper by Cranston Low published in the October 1928 issue of The British Journal of Dermatology and Syphilis (subsequently renamed the BJD), highlights the ‘eczema– asthma–prurigo–complex’. It provides an early description of atopy, which in the 1920s was not well recognized, a situation that is difficult to contemplate now. In 1937, Peterkin reported that contagious pustular dermatosis of sheep (‘orf’) can also affect humans, presenting five cases including one affecting a veterinary student. Considering the 1940s, we felt that a wartime theme was important to recognize and so selected the paper by Twiston Davies and Barker from 1944 concerning textile dermatitis due to khaki uniforms. Out of 670 admissions to the dermatology wards of a military hospital, 110 (16%) were due to contact dermatitis provoked by khaki woollen textiles. From the 1950s onwards, citation data are available to help guide the choice of article in each decade that has had the greatest impact. Lyell’s description of TEN has received three times as many citations as any other paper from the 1950s. He carefully described four cases of a toxic eruption resembling scalding of the skin, one of which proved fatal, noting the epidermal necrosis and suspecting a drug reaction in most cases. Sweet’s paper from 1964, describing an acute febrile neutrophilic dermatosis in a series of eight patients, has attracted 760 citations in peer-reviewed journals to date. Sweet, working in a district general hospital, took 15 years to assemble and characterize his cases, noting the clinical features, histology and neutrophil leucocytosis and carefully excluding infection. Ludwig’s classification of androgenetic alopecia in women was published in the BJD in 1977. His paper provides a sequential photographic description of advancing disease, stratified into three grades from observation of 468 cases. A good example of translational experimental research published in BJD is the paper by Cerio and coauthors from 1989, in which dermal dendritic cells were demonstrated using immunocytochemistry. These observations contributed to our understanding of the mechanisms of cutaneous immunity and inflammation, paving the way for the development of immunomodulatory therapies. In the midst of this celebration of high-impact papers published in the BJD, there is room for some publishing humility. Finlay and Khan submitted their DLQI paper to the BJD and were turned down. Fortunately, CED saw the unmet need in terms of quantifying impact of skin conditions on quality of life and published the paper in 1994. It has since attracted more than 2000 citations in peer-reviewed journals and has become a pivotal outcome instrument for routine patient care and clinical trials. Publishing randomized controlled trials (RCTs) meeting CONSORT standards is an important element of the BJD. A good example is one of the first RCTs of etanercept for psoriasis, published by Papp and colleagues in 2005. The 583 participants with severe psoriasis were randomized to receive etanercept 50-mg twice weekly, 25-mg twice weekly or placebo and the proportions achieving a 75% reduction in baseline Psoriasis Area and Severity Index (PASI 75) after 12 weeks were 49%, 34% and 3%, respectively. Epidemiology and evidence-based dermatology represent two more of the BJD’s methodological sections. The systematic review of worldwide incidence of nonmelanoma skin cancer (NMSC) by Lomas and colleagues involves both of these disciplines and represents the most-cited BJD paper since 2010. The highest incidence rates were in Australia, with rates greater than 1000 per 100 000 person-years for basal cell carcinoma. These figures are very important for public health and for planning of dermatology services to meet the rapidly increasing demands that NMSC poses in many parts of the world. Looking back at the history of dermatology publishing in BJD and CED we really are standing on the shoulders of giants. If these brief descriptions have whetted your appetite then take a look at the online issue on the BJD website to read the articles in full. It is now our responsibility to continue this work to improve dermatology care worldwide.