Dermatology in practice - 2005

Comment: Some new uses for pets and creepy crawly things
Neil H Cox
pp 4-4
Regular readers of this column (there I go, making assumptions before I’ve even finished the first sentence) will know that I occasionally dip into veterinary literature or otherwise gain editorial inspiration from the exploits of our feathered or furry friends. So, herewith a few more interesting, non-human snippets for you – although most are really a bit of a cheat, because they probably say more about the humans behind the idea than about the animals involved.
Therapeutic uses for topically applied imiquimod
Sandeep Varma
pp 6-8
Imiquimod 5% cream is an imidazoquinoline amine and is a novel synthetic immune response modifier (IRM). By increasing the production of certain cytokines, it enhances the body’s innate immunity and cell-mediated immunity, which results in viral and tumour death. Several large studies have demonstrated its efficacy in the treatment of cutaneous malignancies and precancers. Recently, it has been approved for the topical treatment of small, superficial basal cell carcinomas. Significant evidence is accumulating of its efficacy in other skin conditions, such as actinic keratoses, Bowen’s disease, lentigo maligna, warts and molluscum contagiosum.
How we approach blisters on the lower extremities
Emma C Veysey and John D Wilkinson
pp 10-14
When approaching blistering disorders, it is essential to know whether or not the lesions in question are actually blisters. Blisters are visible accumulations of fluid within or beneath the epidermis and can be divided into vesicles or bullae, according to size. Vesicles are less than 0.5 cm in diameter, and are often grouped. Bullae are over 0.5 cm and can be multilocular or unilocular.
Dermatological problems in the catering industry
Jason D Williams and Michael H Beck
pp 16-17
The catering industry includes a varied range of occupational activities. Not only are individuals exposed to a wide variety of products capable of causing dermatitis, but the catering population includes such varied jobs as chefs, sandwich makers, bakers, restaurant workers and so on, each working in their own defined location with their own inherent risks.
A primary care treatment pathway for actinic keratoses
Neil Walker
pp 18-19
Actinic keratoses (AK), also known as solar keratoses, are epidermal lesions with a dry, irregular, scaly surface, which are caused by excessive sun exposure. In the UK, the prevalence in the over-40s is around 21% and for those over 70, this increases to more than 50%. The number of cases identified is increasing, although this may in part be due to the public’s increased awareness of the need to have any unusual or changing lesions checked by their GP.
Commissioning of high-cost drugs in the NHS
Ronald G Pate
pp 20-22
Escalating drug use and associated expenditure has been a cause of concern for many governments over the years. In 1994 the Department of Health (DH) introduced guidance to secondary care on the managed entry of new drugs via its executive letter EL(94) 72. This required hospitals to take a more robust approach to the introduction of new technologies and take into account the primary care perspective of its service commissioners.
Management of common dermatoses in ethnic skin
Simon Dawe and Elizabeth Higgins
pp 24-26
The changing demographics of the UK are posing challenging problems for dermatologists who may have greater experience in examining Caucasian patients. Patients with pigmented skin present with different morphological lesions (where erythema is often masked) and with a different spectrum of disease. This article concentrates on the more common of these dermatoses and, where appropriate, discusses the diseases that are common to the whole population, but may have a different presentation in pigmented skin.
The role of urea in emollients
Ronald Marks
pp 28-29
Urea is an important component of a number of emollient preparations. In this brief review I will discuss the rationale for its use and describe its role in the treatment of dry skin conditions. Firstly, what do we mean by ‘dry skin conditions’? Essentially, the term is used to describe any skin disorder marked by scaling. Xeroderma is also often used to categorise a particular group of patients with dry skin who have ‘constitutionally dry skin’, which is worse in conditions of low relative humidity and in the wintertime.