Dr JENNIFER YELL

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

Consultant Dermatologist
Secretary : 07977 128421
Email: denisewhelan@talktalk.net

Spire Hale Clinic

159 Ashley Road Hale
Cheshire WA15 9SF
Tel: 0161 927 3878
Fax: 0161 927 3870

Spire Cheshire Hospital

Fir Tree Close Stretton
WARRINGTON WA4 4LU
Tel : 0845 6022500
Fax : 0800 1953572
Appointments: 01925 215087

Our Ref : DW/12859218

5 November 2014
Dr I S Allen
Brookfield Surgery
Whitbarrow Road
Lymm
Cheshire WA13 9AD
Dear Dr Allen
Re:
Address :
Seen :

Mr William HEMSWORTH - dob 13/05/93

6 Hazel Drive Lymm Cheshire WA13 0LE
05.11.2014

Diagnosis :- Clinical Diagnosis: Penile lichen sclerosus

The periurethral cigarette paper atrophy has resolved following Dermovate use. William has used
Dermovate twice a day for a month, once a day for a month, alternate days for a month. The ventral
pallor persists. He has no features of skin atrophy. I have asked him to use Dermovate ointment
twice a day for the next two months and then only if he notices his pallor or itch returning. There is a
small risk of squamous cell carcinoma which presents as a lump or an ulcer which fails to settle when
Dermovate is applied and, therefore, annual review is recommended. William is comfortable to see
you for annual review.
As far as investigations go, you have repeated his Full Blood Count. His ESR in July was normal at 2
suggesting that there is unlikely to be a major underlying systemic inflammatory disorder
contributing to his symptoms. His White Cell Count has now completely recovered. It was
marginally low in July.
He is atopic. His IgE is elevated which may explain some of his itching sensation. I am assuming his
ANA and Double Stranded DNA Antibodies are negative, although they were not in the blood tests
that he brought with him today.
continued/ 2

William Hemsworth (continued)

He has some concerns about Sjogrens syndrome. Examination of his mouth today reveals bilateral
bite marks and he wonders if he had lichen planus. There is no classical evidence of lichen planus,
apart from the bite marks, but time should tell. The extractable nuclear antigen (looking particularly
for Ro), should he require blood tests in the future, would exclude Sjogrens syndrome on blood
tests.
He is due to see his Urologist this afternoon as he has nocturia. He wakes four to five times at night.
He is also concerned about Multiple Sclerosis. I have explained to him that this can be very non
specific. He may decide that he wishes to see one of the Neurologists in the private sector. I have
asked him to research cost.
I did ask him about anxiety contributing to his symptoms but he feels that he copes quite well with
stress, although he is now working from home because he feels the symptoms are better than going
into an office environment.
I have reassured him that his lichen sclerosus is a purely cutaneous abnormality, although can be
associated with other immune diseases. I am assuming his Thyroid Function has also been checked
as this is the most common endocrine association. He did have some concerns about his endocrine
system.
I have arranged review only if there are concerns.
The following results were obtained subsequent to his appointment:
Normal Vitamin D level at 81, total IgE elevated at 200 (<15) with a negative reaction to food mix, a
positive reaction at 0.44 (<0.35) which is a mild reaction to nut panel, however, it was an insufficient
sample to analyse the specific IgE to peanuts, hazel nuts, Brazil nuts and almond nuts and it was
recommended that his blood test was repeated, which I am grateful to you for arranging.
His coconut level was 0.53 (<0.35) which is a mild reaction, with a negative reaction to cashew nuts,
pistachios and moulds and house dust mite.
There is an insufficient sample to analyse pecan nuts and dog dander. His reaction to grass was
negative but to birch pollen was positive at 2.27 (<0.35).
So in summary, his highest reaction is to birch pollen. He had a mild reaction to coconut and a repeat
IgE of peanuts, hazel nuts, Brazil nuts, almond nuts and pecan nuts is recommended.
Yours sincerely
Dictated but not signed for speed
Dr Jennifer Yell
Consultant Dermatologist
Cc
Mr William Hemsworth
6 Hazel Drive
Lymm
Cheshire
WA13 0LE