Dermatology in practice - 2002

Comment: Hair gel and the teenage brain
Neil Cox
pp 4-4
Personal experience is often a good starting point for research. How many of us have developed an entire research project from a single patient chance observation? I’m sure we should all keep our minds open to the possibility of research on this basis – from small acorns mighty oaks grow, and all that.
Psoriatic arthritis
Andrew JK Ostor and Alexander J Chamberlain
pp 6-9
Psoriasis is a common inflammatory skin disorder with a spectrum of presentation varying from minor cutaneous involvement to severely disabling generalised disease. An associated arthritis affects a proportion of patients with psoriasis and may lead to significant morbidity. Methodological difficulties have hindered precise determination of the frequency of psoriatic arthritis (PsA), but recent studies estimate the prevalence to be about 0.1%.
Using emollients effectively
Allan Highet
pp 12-15
Emollients are used to soften and hydrate the skin. Compared with other treatments, emollients may seem simple and unsophisticated, and may not receive the understanding and respect they deserve. However, as with other drugs, a considered view of their actions, indications, adverse effects and interactions is important. Dryness of the skin results from a decrease or abnormality in skin surface lipids. This allows increased transepidermal water loss (the water which passes directly through the skin surface, rather than through sweat glands) so that the water content of the horny layer (stratum corneum) of the epidermis is indeed reduced. These changes result in poor elasticity of the epidermis, scaliness, fissuring, irritability, soreness and impairment of the barrier function.
Hazards of alternative medicines
Barry Monk
pp 18-19
Whatever one’s personal feelings about alternative medicine, such therapies are popular and widely used by patients. It is difficult to know the true prevalence of usage; a study in the USA of patients undergoing skin cancer surgery found that about 19% were using some form of alternative treatment (usually for some other reason). It seems certain that the figure would be higher in patients with chronic inflammatory skin disease, such as eczema, psoriasis and urticaria, where conventional treatments are sometimes only of modest benefit or are not curative.
Herbal medicine – the role of the dermatologist
Edzard Ernst
pp 20-22
In the USA and the UK, herbal medicinal products (HMPs) are marketed as dietary supplements, largely outside the control of the regulatory agencies. In Britain, HMPs are more popular than any other complementary therapy. A systematic review of survey data showed that 35–69% of dermatological patients use some form of complementary medicine, of which herbal medicines are the most prevalent. There is evidence to suggest that many patients do not tell their doctor about HMP use, meaning that HMP use is therefore likely to be underestimated by physicians; there is also evidence that the popularity of HMPs is increasing sharply. Given this background, one may ask what the role of the dermatologist might be in dealing with HMPs. Some answers to this complex question are supplied in the following discussion, which is aimed primarily at stimulating a debate on this subject.
The skin disorders of abdominal stomas
Calum C Lyon
pp 24-30
Approximately one-third of stomas are formed because of malignant disease of the bowel or renal tract, one-third because of inflammatory bowel disease and one-third for a range of other disorders. There are no reliable national figures for the numbers of stomas formed each year in the UK, but patient groups estimate that at any one time there are 100,000–150,000 people with abdominal stomas in the UK. GPs with average-sized practices can therefore expect to have three or four stoma patients on their list. According to our research, as many as two-thirds of stoma patients will experience significant peristomal skin problems at some time.
Monk's moments: Playing by the rules
Barry Monk
pp 31-31
At Christmas we often find ourselves having longer and more prolonged contact with young children than most of us are used to, and occasionally this can prove something of a strain. One of the delights of children of a certain age is making up games and playing them with an unsuspecting adult. I write this piece as Christmas approaches, and I have just been re-reading my favourite seasonal poem by the Rastafarian writer Benjamin Zephaniah, which begins with the lines: ‘Be nice to yu turkeys dis Christmas Cos turkeys jus wanna have fun’.