Dermatology in practice - 2002


Comment: A job for life?
Neil Cox
pp 4-4
Medicine is generally viewed as a secure and prosperous vocation, acquisition of the GP partnership or hospital consultant post providing the ‘job for life’. Increasingly it seems that this ideal is not being achieved, with more and more doctors at all ages moving from post to post, or away from medicine entirely.
Medicolegal aspects of dermatological surgery
Gerard Panting
pp 6-8
For patients who are dissatisfied with the outcome of any medical treatment, there are a number of potential remedies. They may complain – either via the NHS complaints procedure or to the General Medical Council (GMC) – or sue, in the hope of proving negligence and being awarded damages as a result.
Autoantibodies in lupus erythematosus
Mark Goodfield
pp 10-13
Lupus erythematosus (LE) is an autoimmune or connective-tissue disease, in which vascular, cutaneous, joint and systemic disease coexist, to a greater or lesser degree, in all patients. One of the hallmarks of LE, in addition to rheumatoid arthritis, systemic sclerosis, dermatomyositis and Sjögren’s syndrome, is the production of a variety of non-organ-specific autoantibodies.
The Associate Parliamentary Group on SkinPeter Lapsley
Peter Lapsley
pp 14-14
In April 2002, the Associate Parliamentary Group on Skin (APGS) published the Report on the Enquiry into Primary Care Dermatology Services. It comes at a key time as the government furthers its plans to devolve more responsibility to the regions, with the final primary care groups merging into primary care trusts. Additionally, the Action on Dermatology programme – implemented in 2000 to cut waiting times, to streamline care and to improve services for patients with skin conditions – is beginning to deliver promising results.
Photocontact allergy and photopatch testing
Sally H Ibbotson
pp 16-19
Photocontact allergy is uncommon and considered to be a delayed type IV hypersensitivity reaction, in which a photoactivated chemical acts as an antigen or hapten. Photopatch testing is used to investigate and diagnose photocontact allergy; sunscreen chemicals are the major group of clinically relevant photoallergens. Both sunscreen users with normal sun sensitivity and patients with existing photosensitive diseases may develop photocontact allergy, and this needs to be considered as a differential diagnosis in the presentation of a patient with a photoexposed site dermatitis or with a history of a reaction to a sunscreen.
The rising prevalence of atopic eczema and environmental trauma to the skin
Michael J Cork, Ruth Murphy, Julie Carr, David Buttle, Simon Ward, Claes Båvik and Rachid Tazi-Ahnini
pp 22-26
The prevalence of atopic eczema has increased dramatically over the last five decades, suggesting that genetic factors cannot be the only component in the development of the disease. The observation that the rise in the number of cases of atopic eczema coincides with a growing rate of exposure to environmental agents which break down the skin barrier, such as soaps, detergents and house-dust mites, has led to the hypothesis that these agents are another key factor in the expression of the disease. This article reviews the evidence for an association between environmental factors and the expression of atopic eczema, and highlights the need to make modifications to the home environment to reduce the growing number of triggers to the condition.
Marigold treatment of foot conditions
M Tariq Khan and M Taufiq Khan
pp 28-30
A number of the podiatric disorders seen in foot clinics are relieved only in the short term by traditional treatments, necessitating repeated clinic attendance every few weeks. Some chronic conditions may not respond at all to traditional treatments. Furthermore, the chemical and surgical treatments that are commonly used in podiatric practice are invasive and can cause pain or discomfort, especially the postoperative complications of surgery. Certain treatments are contraindicated for ‘at-risk’ patients – for example, diabetic patients and the elderly.
Monk's moments: Don’t even think about it
Barry Monk
pp 31-31
A few months ago, I wrote to the medical director of our trust, asking whether I might be allowed a three-month ‘sabbatical’. I explained that, having worked for the NHS for 27 years without a break, I felt in need of a period of reflection – to help maintain my enthusiasm for the next dozen or so years, and to think about what I might want to do during that time.