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M.B., Ch.B., F.R.C.P., M.D.

Consultant Dermatologist
Secretary : 07977 128421

Spire Hale Clinic

Spire Cheshire Hospital

159 Ashley Road Hale

Cheshire WA15 9SF

Fir Tree Close Stretton


Tel: 0161 927 3878

Fax: 0161 927 3870

Tel : 0845 6022500

Fax : 0800 1953572
Appointments: 01925 215087

Our Ref : DW/12859218

12 September 2014
Dr Irvin S Allen
Brookfield Surgery
Whitbarrow Road
WA13 9AD

Dear Dr Allen
Address :
Seen :

Mr William HEMSWORTH - dob 13/05/93

6 Hazel Drive Lymm Cheshire WA13 0LE

Diagnosis :- 1.

Clinical diagnosis lichen sclerosus

Fatigue, abdominal cramps, hyperhidrosis of the palms, with dizziness,
marginally low White Cell Count (neutropenia) on Full Blood Count July

Current Medication:-

Beconase nasal spray. CT scan confirmed mild sinusitis

Please check repeat Full Blood Count to see if his White Cell Count has returned to normal,
ANA, Double Stranded DNA, IgE: to tree, grass pollens, dogs, house dust mite, moulds, nuts,
wheat, cows milk protein
Thank you for referring this twenty-one year old computer programmer who dropped out of
university to become a full-time games programmer. He was fit and well until the beginning of the
year when he developed a range of distressing, but non specific, symptoms, well described in your
referral letter in the notes from the Gastro-Enterologist and ENT Surgeon at Spire. He has a post
nasal drip which on CT has been confirmed as mild sinusitis and is partly responsive to Beconase.
He feels it came on when the family got a dog.

William Hemsworth (continued)

He has had an episode of uncontrollable shaking for twenty minutes which took him to A&E in
Warrington. He does recall them taking his temperature. He is not sure if he was pyrexial. They
prescribed antibiotics and, because subsequent to this he had nocturia up to ten times at night, he had
a full course of Amoxyl two months ago on holiday in Greece.
He did have a urinary tract infection in 2003 as a child and an ultrasound at the time revealed no
renal abnormality. You have checked his mid stream urine subsequent to this and this was clear in
General Practice.
He was undergoing investigations for Coeliac disease or malabsorption syndrome through Dr
Ramakrishnan. He had an MR scan this morning and is awaiting ultrasound of his abdomen.
His particular skin concern is pallor on the prepuce, around the urethral opening, extending on to the
ventral surface, which is indeed clinically lichen sclerosus with cigarette paper atrophy and well
defined pallor. I would recommend that this is treated as per college guidelines with: Dermovate
ointment twice a day for a month, once a day for a month and alternate days for a month. He will
need review to ensure the lichen sclerosus has resolved. It can be intermittently chronic and
relapsing. At the first sign of pallor or symptoms, I would restart Dermovate ointment.
William has noticed that he does have very severe itching, as if insects are crawling under his skin,
particularly on the left hip but also affecting the right hip. He has areas of prurigo (excoriation on the
left hip) but not enough to suggest significant eczema. He could use some of the Dermovate
ointment that I have prescribed for his lichen sclerosus on this site. Otherwise a simple anti-itch
emollient would be reasonable, such as Balneum Plus cream.
Because he has one immune disease (lichen sclerosus) William is concerned that his symptoms may
be due to another immune disease. Certainly from a skin point of view, the vasculitides,
dermatomyositis, scleroderma are all excluded. Systemic lupus erythematosus can be very non
specific. He would have to have to fulfil at least four out of the eleven criteria. The only criteria
currently would be his low White Cell Count but it is worth checking his ANA and Double Stranded
DNA to exclude this for his own peace of mind.
As he feels that his catarrh symptoms started when the family got a dog and he has concerns about
the above allergens, for his own peace of mind it would be worth checking his IgEs to the above
allergens which I am grateful to you for arranging as he is self funding.
Finally, he has a 6mm lymph node overlying the right iliac crest, a 1cm lymph node in the right groin
and a similar sized lymph node in the left groin, which I have explained to him was within normal
limits. He had no neck or axillary or epitrochlear lymphadenopathy.
I have explained to him that if all his investigations are negative, in a young person this would
probably be put down to post viral fatigue which can take some time to settle but usually patients
make a complete recovery. Further investigations will clarify this.
I have arranged review in three months.

-3Yours sincerely

Dictated but not signed for speed

Dr Jennifer Yell
Consultant Dermatologist
Mr William Hemsworth
6 Hazel Drive
WA13 0LE