Dermatology in practice - 2003


Comment: Things ain’t what they seem …
Neil Cox
pp 4-4
The ability of humans to manipulate their surroundings has never been greater. Nobody reading this can be unaware of the genetic manipulation of foods, and gene therapy in medicine is expanding. Electronic communication and advances in computerisation have changed beyond recognition in recent years – but are there dangers that it may all go too far?
Diagnostic difficulties
Lisa D Gordon and David M Tillman
pp 6-10
An examination of the entire skin, including the scalp, nails and mucous membranes, is essential as the diagnosis of skin disease involves an appreciation of several features: the pattern of distribution of lesions, the morphology of individual lesions and whether or not the nails, mucous membranes and/or scalp are involved. Description of an individual skin lesion is often perceived to be difficult by non-dermatologists, but if time is taken to formally describe the lesion, the diagnosis often becomes clear.
Therapeutic advances in the treatment of atopic dermatitis
Amin Karim and Catherine H Smith
pp 12-15
The prevalence of atopic dermatitis has increased two- to threefold since the 1960s and continues to rise, now affecting 15–20% of children in developed countries. Topical corticosteroids remain a key component of therapy for patients with atopic dermatitis, although this treatment has become increasingly unpopular with patients, especially with regard to the risks of skin thinning, telangiectases and systemic toxicity. The media often exaggerates these risks, with the result that patients’ fears are perhaps the greatest barrier to effective control of their dermatitis.
Assessing and treating androgenetic alopecia
Katherine Finucane and David deBerker
pp 18-20
The definition of androgenetic alopecia (AGA) may be problematic but the diagnosis tends to be simple. By the age of 50 years, at least 50% of men and 25% of women will have lost cosmetically significant amounts of hair due to the aging process. This hair loss occurs from puberty onwards and increases in prevalence until, at 80 years of age, it affects 80% of men. AGA is, therefore, the most common cause of baldness, and some argue that it should be called age-related hair loss to distinguish it from a disease. It can cause significant psychosocial impact, usually in circumstances where it is deemed an inappropriate appearance in terms of cultural norms for age or gender. The good news for sufferers is that treatments that produce a degree of benefit are now becoming available.
Naevoid basal cell carcinoma syndrome (Gorlin’s syndrome)
Lucy Matthews and Sandeep Varma
pp 22-25
Naevoid basal cell carcinoma syndrome (NBCCS), also called Gorlin’s syndrome and basal cell naevus syndrome, is a rare autosomal dominant disorder with an estimated prevalence of one in 55,600. Multiple names exist for the syndrome as none of them describes the condition perfectly. Professor Gorlin himself is opposed to the use of eponyms, yet he also feels that the syndrome’s current name of naevoid basal cell carcinoma syndrome is misleading, since not all patients manifest significant numbers of basal cell carcinomas (BCCs), particularly aggressive ones. However, NBCCS is characterised by multiple basal cell carcinomas and jaw cysts, which occur in over 90% of patients by 40 years of age; skeletal malformations; characteristic facies due to an enlarged calvarium; and palmoplantar pits. The syndrome was first described as early as 1894, but recent developments in molecular genetics have been interesting as evidence of a two-hit genetic hypothesis has replaced the previous belief that a tumour-suppression gene action was responsible.
Common problems in the treatment of scabies
Charles M Quartey-Papafio
pp 27-30
Scabies is the most pruritic of all skin conditions and affects all ages. It is estimated to affect about 300 million people worldwide at any time. It is caused by the mite Sarcoptes scabiei, a parasite that only infests humans. It is very infectious and transmission is by close body contact; it is, therefore, commonly contracted in the family, workplace and institutions, and by sexual contact. Treatment of scabies, if correctly carried out with the effective medications available, is expected to give a 100% cure rate. Scabies is an endemic condition not only because of missed diagnosis but also due to improper treatment. Immunosuppressed patients experience extensive infestation because of the altered host response, and treatment can be difficult.
Monk' moments: Economical with the truth
Barry Monk
pp 31-31
It is a sad thought for doctors that most of the major improvements in health in the past 100 years have arisen through economic rather than medical advances. Changes in housing and sanitation have undoubtedly transformed millions of lives. The health problems of the developing world relate more to the lack of adequate supplies of food and water than to the availability of modern medical techniques. Yet most of us pay scant attention to the world of economics; who among you could, for example, name a single winner of the Nobel Prize for Economics, or say what he (yes, they’ve all been men) had done?