Dermatology in practice - 2004

Comment: Timeless and priceless: effects on rational judgement
Neil H Cox
pp 4-4
Argument continues to rage about the precise date of extinction of the dodo (estimated to be 30 years after the last sighting, but there was a ‘last last sighting’ of dubious veracity some ten years after the better documented version). The age of the universe is now known to be exactly 13.7 billion years (well, give or take a few million). All of which prompted some thought about time and its control, so what better reason to tell you how science is pushing forward our knowledge about genes and circadian rhythms.
Red faces – differential diagnosis and management
Elizabeth James and Susan Burge
pp 6-11
The differential diagnosis in a patient presenting with a red face is wide and varied. Skin conditions affecting the face cause considerable distress and effective management is important. A careful history and examination are essential to reach the correct diagnosis. In this article common causes of red faces, providing clues to diagnosis, and an overview of firstline management are discussed.
Botulinum toxin – smoothes the brow and a whole lot more
James AA Langtry
pp 14-16
Cosmetic treatment with botulinum toxin injections is associated with glamour. Our expression lines speak of our experiences but they can make us look tired when we’re not, and they can make us look older than we feel. More and more people are resorting to cosmetic measures to make their deep lines go away. Due to the drive to look wrinkle-free, young and beautiful, these treatments have been embraced by the general population over recent years.
Identifying, classifying and managing chronic urticaria
Syed N Shah and Clive E Grattan
pp 17-21
Urticarial skin diseases are more common in women. Urticaria and angioedema coexist in up to 50% of patients, with urticaria occurring in 40% and angioedema in 10%. A wheal is an itchy, well-circumscribed swelling, often pale in the centre, surrounded by an erythematous flare. It evolves into a pink superficial plaque that resolves slowly and completely. It usually lasts for less than one day but new lesions may appear at other sites. There is great variation in size, shape and numbers. Angioedema is a deeper swelling of the dermis and subcutaneous or submucosal tissue involving the face and mouth but it may occur anywhere on the skin. The lesions are skin-coloured or red and may be painful rather than pruritic. They take longer to resolve.
Prescribing for chronic oedema of the lower limb
Elizabeth Coveney
pp 23-24
The right type of well-fitting compression hosiery is vital for patients who need to wear compression garments. Of course, the patient’s preference is important and the garments ought to be relatively easy to apply. The size and shape of some patients’ limbs make them unsuitable candidates for hosiery. For these patients, a course of intensive treatment with multilayer bandaging (MLB) can bring about the necessary improvements in the limb, after which appropriate hosiery can be fitted. I hope in the following pages to give an overview of some of the options available to address lower limb oedema.
Diagnosing lichen planus – dermatological features
Robin A Graham-Brown
pp 25-26
Lichen planus (LP) is not especially common, but a typical example is immediately recognisable, though there are several clinical variants that are more difficult to diagnose, and in which the possibility of LP may not be immediately obvious on first presentation. The underlying pathophysiology is an example of a classical autoimmune process, involving an interaction between T-lymphocytes and the skin.
Chondrodermatitis nodularis: painful nodule of the ear
Neill Hepburn and Neil Cox
pp 28-30
Painful nodule of the ear – chondrodermatitis nodularis (CN) – is a relatively common and distressing condition, which is characterised by pain out of proportion to the physical signs. It is particularly common in older patients, and typically leads to disturbed sleep. It may respond to conservative measures but many patients ultimately require surgery.
Monk's moments: Warning: this article may be hazardous for your health
Barry Monk
pp 31-31
Just before sitting down to write this article, I opened a packet of peanuts that I had bought from the hospital shop. Boldly displayed on the back was a warning, ‘Danger – may contain nuts’. I then went to wash my hands, and noticed that a helpful sign had been placed above the hot tap advising, ‘Warning – this water may be hot’.