Dermatology in practice - 2002

Comment: Floating or failing to sink?
Neil Cox
pp 4-4
Is it any clearer if I add the subtitle ‘On nuts and naevi’? Maybe not, but the reason why a particular feature of muesli is now linked in my mind with a histopathological feature of Spitz naevi will be revealed to those readers who are brave enough to continue this exploration of cereal, naevus cells and cerebral mechanisms.
Topical photodynamic therapy – extending horizons
Joyce A Leman and Colin A Morton
pp 6-10
Topical photodynamic therapy is used to treat a variety of premalignant and malignant skin lesions. Its place in the therapy of inflammatory dermatoses remains to be defined. PDT involves the destruction of tumour cells by a photochemical process. A photosensitiser is administered topically or systemically and concentrates in the tissue to be treated. An oxygendependent photochemical reaction is triggered by illumination with light of a wavelength matching the absorption spectrum of the photosensitiser. Highly reactive singlet oxygen is produced, resulting in the destruction of the target cells while the surrounding normal skin is left relatively unharmed.
When does bacterial colonisation become infection?
Richard EA Williams
pp 12-14
Most lay people would be horrified if they knew that every square centimetre of their skin provided a home for millions of bacteria! The vast majority of these bacteria are completely harmless and never cause any problems. In certain circumstances, however, some can become pathogenic. The distinction between living happily and harmlessly on the surface of the skin and causing morbidity is the difference between colonisation and infection. Usually it is easy to differentiate between colonisation (bacteria present but doing no harm) and infection (bacteria present and causing harm), but there are many occasions when this division is not clear-cut and decisions concerning antibacterial therapy have to be made on both clinical and bacteriological grounds.
Psoriasis treatment at the Blue Lagoon
Barry Monk
pp 16-17
The therapeutic benefits of bathing in the mineral- or mud-rich waters of various exotic locations have been espoused from ancient times. In the last few years, there has been considerable interest in the lay press in the alleged benefits in psoriasis of bathing in the waters of the Blue Lagoon in Iceland. In May 2001 I had the opportunity of visiting the Blue Lagoon skin treatment centre with a group of British dermatologists under the auspices of the Dowling Club, and of meeting the local dermatologists.
Dermatological problems at the beach
Ian H Coulson
pp 18-20
To dermatologists, the beach is a place of mixed emotions! The anxiety-provoking hazards to their own skin posed by sunshine and the dangers that lurk within the sand and the sea must be tempered by the anticipation of the wonderful pathology that is on show for all to see. The beach dermatologist is easy to spot – usually found lurking in the shade, and any skin not swaddled by clothing is haddock white or, more likely, glistening with high concentrations of micronised titanium dioxide sunscreen.
The management of localised hyperhidrosis
Elise Kleyn and Neill C Hepburn
pp 22-25
Hyperhidrosis, or excessive sweating, affects about 1% of the UK population. It causes considerable social, psychological and occupational problems. While it may be difficult to treat, there are several therapeutic options, including antiperspirants, anticholinergics, iontophoresis, botulinum toxin injections and sympathectomy. This article suggests an approach to help patients with primary localised hyperhidrosis.
Habit reversal and atopic skin disease
Richard Staughton and Christopher Bridgett
pp 28-30
The central thesis of this article is that repeated surface trauma to the skin is the single most significant amplifying factor in atopic skin disease (ASD). Whatever the initiating immunopathological or allergic trigger event for itching in eczema, it is the 100–1,000 daily scratching events that can change acute eczema into a miserable chronic condition. If such predominantly habitual scratching can be significantly reduced, the skin will heal. What was a gloomy negative illness can become something treatable, simply by achieving a change in the patient’s behaviour.
Monk's moments: An icon for our age
Barry Monk
pp 31-31
In recent years there has been an increasing realisation that a patient’s condition can be much influenced by his or her surroundings. Bleak wards have an adverse effect not just on the mental condition, but on the speed of recovery from physical disorders and operations. With this in mind, efforts have been made to enliven hospitals with works of art designed to brighten otherwise cheerless wards and corridors. As a consequence the NHS has become a significant and valuable patron of art, bringing it to many who would not normally think of visiting a gallery or exhibition.