Dermatology in practice - 2000


Comment: Hedgehogs – from test tube to health hazard
Neil Cox
pp 4-4
If you have a sufficiently strange personality disorder to search MEDLINE for the word hedgehog(s) you will find about 600 references from 1996–99 (OK, I admit it, I’ve done it). A few of these pertain to the small spiky creature of Beatrix Potter fame (of which more later), but most are erudite scientific articles on embryology or carcinogenesis.
Combined clinics for skin tumours
Mary M Carr
pp 6-8
The concept of a multidisciplinary clinic is by no means new in dermatology. Combined clinics, comprised usually of dermatologists, plastic surgeons, and radiotherapists, have been in existence in some centres for the past 40 years, particularly for the treatment of skin cancers. The Calman–Hine Policy Framework for Common Commissioning of Cancer Services (1995) established the principle of uniform high-quality care for all cancer patients, into which the contribution of a multidisciplinary team fits easily. The British Association of Dermatologists, in its documents on skin cancer service provision, strongly supports such arrangements.
Athletes’ dermatoses
Simon Tucker and John O’Driscoll
pp 12-14
Participation in sporting activity is now extremely popular in this country. Inevitably, the skin, which straddles the barrier between the athlete and the sporting environment, is vulnerable to assault from various sources. As a consequence of this widespread interest in sport, the dermatologist must become acquainted with the variety of skin reaction patterns peculiar to these patients.
Clinical governance and the management of eczema in primary care
John Buchan
pp 16-17
Like it or not, we are all going to be involved in clinical governance. Despite the amount written on the subject it is hard to pin down an exact definition. This article attempts to outline an approach to clinical governance and the management of eczema in primary care.
Immunofluorescence
Nonhlanhla P Khumalo and Fenella Wojnarowska
pp 18-18
Immunofluorescence is a laboratory technique used for the diagnosis of autoimmune diseases. In dermatology it is largely used for the diagnosis of autoimmune blistering diseases. Blistering is the common feature in these diseases and is believed to occur as a result of immunological attack. This attack is directed against antigenic components of desmosomes (which are responsible for epidermal cell-to-cell attachments) in the pemphigus group of diseases, or against the basement membrane zone (which is responsible for basal cell-to-matrix attachment) in the cases of subepidermal autoimmune bullous diseases, the commonest of which is bullous pemphigoid.
Itch without rash
Neil Cox
pp 20-25
Generalised pruritus is something of a heartsink topic, partly because evaluation of the patient is often very time consuming and partly because identification of a cause which is both provable and fully treatable is relatively uncommon. However, some causes of this symptom are of great importance and some are immensely satisfying to treat. This article outlines the main areas for investigation and suggests a practical approach to evaluation of the patient.
The use of emollients in dermatology
Tom Poyner
pp 26-27
The skin acts as a barrier to the hostile environment, protecting against irritants, stopping the entry of allergens and preventing water loss. Itchy, dry skin may reflect damage to this epidermal barrier. Causes of itchy, dry skin include atopic xerosis, ichthyosis, contact with irritants and degreasing chemicals; dryness also occurs as part of several other inflammatory dermatoses. Treatment should be aimed at preserving and restoring this epidermal barrier. Topical steroids should be used to reduce inflammation, with emollients to maintain the epidermal barrier.
Headaches in the management of itchy scalps
Susan Lipscombe
pp 28-29
When patients complain of scalp problems I find that there are two major variable factors: the severity of the problem as perceived by us both and the ability I have to diagnose it. Individuals seem remarkably variable in their tolerance of the itching and scaliness of scalps. Some seem greatly distressed by a few microscopic spots, while others apologise for troubling me when their head is a total cosmetic disaster. My heart tends to sink with either end of the spectrum!
A spot of Savin: Seeing red
John Savin
pp 30-30
In 1879, Francis Galton became the only person ever to assess the ‘average tint of the complexion of the British upper classes’; and no one could have been better fitted for such an important task. Upper-class himself, he was also hugely intelligent, with an IQ later estimated to be 200 – on the basis of his mastery of Latin grammar at the age of four. He had been trained in both mathematics and medicine.