Dermatology in practice - 2000

Comment: What’s in a statistic?
Neil Cox
pp 4-4
Travelling by train is described by words that range from ‘relaxing’, or even ‘romantic’, to a selection of terms from the more basic end of the evolutionary spectrum of language. ‘What a joy’ (or an equivalent) is a frequently overheard remark when trying to find an unbooked seat on the 17:33 West Coast train out of Euston (which I rarely manage to catch, so it’s not a big problem).
Flexural rashes and their management
Maria Roest and Ravi Ratnavel
pp 6-9
Many common dermatoses affect the skinfolds. However, when the distribution is exclusively flexural, diagnostic difficulties can occur. Flexural skin is prone to maceration and friction leading to alteration of the characteristic appearance of dermatoses. Similarly, a mixed clinical picture may result from superimposed infection. It is therapeutically important to reduce skin vulnerability by addressing physical factors such as obesity, sweating, incontinence and soiling. We discuss a number of dermatoses that occur within the skin flexures, with or without involvement elsewhere.
Lichen sclerosus
Nonhlanhla P Khumalo and Fenella Wojnarowska
pp 10-11
Lichen sclerosus is an inflammatory condition of unknown aetiology that may involve genital and/or extragenital skin. It is described in literature under various names such as lichen albus, kraurosis vulvae, lichen sclerosus et atrophicus and balanitis xerotica obliterans, but the term lichen sclerosus is preferred by the International Society for the Study of Vulvovaginal Disease.
Rationale for dermatology clinics in general practice
Tom Poyner
pp 14-16
Skin disease is common; at least a quarter of the population have a skin condition at any one time. At present, dermatology accounts for approximately 10% of a GP’s workload and this figure is likely to increase. However, many GPs have difficulty in coping with the present demand. They have had very little dermatological education1 and do not have the facilities to provide an adequate service.
Managing pruritus ani
Neill Hepburn
pp 18-20
Pruritus ani is a common ‘heartsink’ problem. Many patients have no apparent underlying cause and a significant number appear refractory to treatment. This can lead to frustration all round. This article describes a management strategy to detect those with significant underlying pathology and help those without. It may help both patients and physicians.
The treatment of atopic eczema in adults
Carolyn Charman
pp 21-24
Atopic eczema is a chronic inflammatory skin disease that predominantly occurs in childhood, with the majority (60%) of cases clearing spontaneously by adolescence. However, around 2% of adults are also affected by the disease, and in these patients the disease usually represents a lifelong chronic management problem. Most patients are managed in the community, where adults represent over a third of all atopic eczema cases.1 In this article, we discuss the current treatment options available for these patients, highlighting areas where evidence for treatments remains lacking.
Troublesome terms in dermatopathology
Gina M Kavanagh
pp 28-30
In an ideal world, if a dermatological diagnosis is not clear clinically, a skin biopsy will provide the answer. In reality, if the clinical picture is puzzling, the pathologist is unlikely to give a ‘eureka’ diagnosis. What you are likely to get is a descriptive report, perhaps with a ‘non-specific’ conclusion, and it is up to you to make sense of it all. However, a good pathology report describes the salient features, and offers a diagnosis or a differential.
A spot of Savin: Hurrah for the Baa Bra
John Savin
pp 31-31
A few weeks ago, I found myself flicking idly through the index of the latest Rook Book1 – a harmless activity, quickly rewarded when my eye fell on the words ‘Baa Bra’ sandwiched between two equally obscure items – the B syndrome and babeosis. Clearly dermatology had livened up since the last edition, and I decided to find out more about the ‘Baa Bra’ by turning eagerly to page 3161.