Dermatology in practice - 2003

Comment: Is this a question?
Neil H Cox
pp 4-4
One of the good things about publishing in medicine is that it can stir others into activity. Most of us who have the research bug can think of projects that have sparked off useful discussions, even leading to new areas of research. Sometimes, correspondence arising from a publication can just be a bit of fun.
Managing alopecia areata
Susan Macdonald Hull
pp 6-8
Alopecia areata is defined as hair loss that leaves discrete, often round, areas of shiny baldness. These areas of shiny baldness can be on the scalp (most common), in the beard area or in any hair-bearing part of the body. Alopecia areata can present as a single patch in any site, or as multiple patches in one or several sites, while diffuse alopecia areata (less common) presents as a generalised profuse thinning involving the whole scalp. In comparison to alopecia areata, alopecia totalis is defined as the complete loss of scalp hair but with no other hair loss, while alopecia universalis is loss of all scalp, face and bodily hair. (Extensive hair loss that does not amount to complete loss can be termed alopecia sub-totalis or sub-universalis.) Nail dystrophy is another feature of alopecia areata and should always be looked for and documented. It takes the form of very fine pitting, much finer than psoriatic nail pitting, and can progress to loss of the nail. As with the hair, spontaneous regrowth is possible. A rare long-term feature is the development of cataracts.
Childhood exanthems
Helen M Goodyear
pp 10-13
Children develop an exanthem with a variety of viral infections. In the majority of cases, there is no particular need to identify the causal agent. However, in some cases, it is important to make a diagnosis for infection control advice, or if the patient is immunocompromised or if there is a pregnant mother or contact. Childhood exanthems due to measles and rubella are now rarely seen due to measles/mumps/rubella vaccination at 13–18 months of age. Each viral-specific exanthem has distinctive features that enable a clinical diagnosis to be made and this can be confirmed by a viral-specific IgM. Childhood viral exanthems need to be distinguished from early meningococcal disease, scarlet fever, Kawasaki disease, erythema multiforme, systemic juvenile chronic arthritis, allergy and drug eruption. This article will focus on viral exanthems, scarlet fever and Kawasaki disease.
Therapeutic options for seborrhoeic dermatitis
Ian H Coulson
pp 16-18
A chronic relapsing condition affecting about 3–5% of the adult population, seborrhoeic dermatitis is defined by its appearance. The pink-red patches with an overlying greasy scale in the eyebrows, over the scalp and hairline, around the nasolabial folds spreading onto the cheeks, and the presternal, intrascapular and retroauricular lesions should need no introduction to this readership. Scalp lesions may range in severity from mere dandruff to full-blown pityriasis amiantacea.
Digital photography in clinical dermatology
Roland M Strauss and Mark JD Goodfield
pp 19-20
Pictorial documentation of pathological skin conditions has occurred since ancient times. While drawings and paintings had to suffice for clinical illustration in medical texts for centuries, the introduction of photography, in particular colour photography, allowed for more detailed documentation of clinical signs and subsequent assessment of clinical progress. Photography has become an invaluable teaching and documentation tool and now forms part of the daily practice for most dermatologists.
Flea bites and environmental flea control
Neil H Cox
pp 22-26
Flea bites cause many problems. They may not be suspected, are difficult to prove, and the diagnosis may be met with an antagonistic response. Treatment is primarily of the source – usually a pet and its environment – but most doctors are not experts on this topic. Environmental control of fleas is crucial. This article discusses the various stages in diagnosis and management of flea bites: suspicion, proof, treatment of the human, treatment of the source animal, treatment of the environment, other preventive measures.
Contact dermatitis and the construction industry
John SC English
pp 28-30
Allergic contact dermatitis (ACD) from chromium in cement is of historical interest in Scandinavian countries but not in the rest of the world. Why is this? Since the 1980s, ferrous sulphate has been added to cement in Scandinavia, which makes it much less allergenic. Unfortunately, in the rest of the world ferrous sulphate is not added! In this article, I will mainly concentrate on chromium allergy from cement.
Monk's moments: A worrying development
Barry Monk
pp 31-31
In the 19th century, any well-educated man would regard a knowledge of science as being as important as a knowledge of the arts or literature. By contrast, there are now so few applicants for university places in some science subjects, especially chemistry, that in some institutions courses may no longer be offered at all.