Dermatology in practice - 2002


Comment: Tackling the opposition
Neil Cox
pp 4-4
One of the less well known tasks of an editor is keeping a vague eye on the opposition. It’s not in the job description, but it can be useful – probably rather like managing a football team (I am writing this at a time when metatarsals are of marginally greater national interest than matters dermatological). However, I am of course referring to observing what other editors are getting up to.
Lymphoedema
Shamali Hoque and Peter S Mortimer
pp 6-8
Lymphoedema is oedema resulting from reduced lymphatic drainage. In most cases, this results when capillary filtration pressure exceeds lymphatic drainage for a sufficient period of time. Fluid filtration into any tissue results from disturbances to Starling forces across the blood vessel (mainly capillary) wall. Increased pressure (usually venous), reduced plasma proteins or increased vascular permeability (from inflammation) will result in increased movement of fluid from blood to tissues (interstitial space). Unless the lymph drainage increases accordingly, then oedema will result. Therefore any oedema, whatever the cause, is due to an imbalance between capillary filtration and lymph drainage.
Management of male pattern baldness
David Grant and Neill Hepburn
pp 10-14
Alopecia has a significant psychological impact on the lives of patients, who scored similarly to patients with severe psoriasis in a Dermatology Life Quality Index (DLQI). In extreme cases, this impact merges into dysmorphophobia where patients are abnormally preoccupied with their appearance (other examples include preoccupation with acne or scarring, hair thinning, nose size or shape, or their genitals). Many others regard baldness as a 'non-disease' and see treatments using 'lifestyle drugs' (analogous to those used, for example, for erectile dysfunction and obesity), as a threat to the financial sustainability of current health systems.
Radiotherapy and dermatology
Charles Kelly
pp 16-19
Radiotherapy has a role to play in the treatment of almost all malignant skin conditions and a few benign ones. Its use in the UK has been variable for several reasons. In some areas, traditional referral patterns have curtailed its use and the siting of radiotherapy departments in the larger urban areas has not given universal ease of access to all patients. Certainly radiation damage from excess radiation dose, whereby skin atrophy, telangiectasia, necrosis and ulceration even necessitated plastic surgery intervention, did occur in the past but, with better dosimetry, a wider range of radiotherapy modalities available and more careful fractionation, this is now rare.
Referring vulval skin disease to a vulval clinic
Shireen S Velangi
pp 22-26
The prevalence and importance of vulval skin disease is likely to be underestimated. Women may delay seeing a doctor because of embarrassment or worries about a possible infectious cause of their condition and many have tried over the counter ‘antipruritic’ or ‘anti-thrush’ preparations. It is estimated that GPs see three or more patients per month with vulval complaints. However, this is set to rise with increasing information in the media and via the internet. This article will outline the general approach and management of women seen in a vulval clinic, including some of the more common conditions encountered, and may help to identify the types of patient that could benefit from referral to a vulval clinic.
Topical steroid/antibiotic therapy in atopic eczema
Carolyn R Charman
pp 28-30
This article reviews the current evidence for use of combined topical steroid/antibiotic preparations in atopic eczema management. Atopic eczema is an inflammatory skin disease which is frequently colonised with Staphylococcus aureus, and may become frankly infected with the organism. S aureus is found in over 90% of areas of clinically involved skin and in 30Ð75% of areas of clinically uninvolved skin, with nasal carriage rates in patients being approximately double that of healthy individuals. In contrast S aureus is found in only 5Ð20% of normal subjects, usually restricted to nasal carriage or low density on the skin. The high colonisation rates in atopic eczema are associated with increased S aureus adherence, which may relate to exposure of receptors, such as fibronectin or alterations in skin pH and lipid composition.
Monk's moments: Sense of humour failure
Barry Monk
pp 31-31
I never cease to be astonished by the energy and enthusiasm that colleagues and friends have for raising money for charity. They seem to have an inexhaustible capacity to run marathons, do sponsored swims or organise quizzes and auctions in aid of every imaginable good cause.