Dermatology in practice - 2005


Comment: Evidence-based medicine?
Neil H Cox
pp 4-4
In the last issue, I discussed some items from Copland’s 1844 Medical Dictionary. We only got as far as erysipelas, so here are a few more.
The impact of cosmetics on black skin and hair
Jonathan White and Anthony du Vivier
pp 6-9
The beauty and cosmetics industry is estimated to be worth US$160 billion per year worldwide. This includes US$24 billion for skin care, US$18 billion for make-up, US$38 billion for hair care and US$15 billion for fragrances. Different groups are targeted for sales, including those of African or Afro-Caribbean descent living in the UK. According to the 2001 census, out of a total population of 54,153,898 in the UK, there were 1,148,738 people labelling themselves as ‘black’ or ‘black British’, 43% of whom live in Greater London. Cosmetic products that have been designed primarily for darker skin types, such as Dark & Lovely, Fashion Fair and Sofn’free, are widely used.
Towards understanding and managing pain in leg ulcers
Deborah Hofman and Susan Cooper
pp 10-12
Until recently, pain associated with leg ulceration was hardly recognised as being a problem and was consequently under-treated, resulting in considerable suffering in a largely stoic population of patients. Although most practitioners are now much more aware of the problem, leg ulcer pain remains very difficult to manage, largely due to the complexities of the pathologies giving rise to pain.
Sunscreens – considering perception versus reality
Brian Diffey
pp 14-16
In a survey examining people’s beliefs about reducing the risk of skin cancer,1 the measure regarded most widely as being very important by almost everyone questioned was the use of sunscreen. The other measures listed – avoiding the midday sun, staying in the shade, wearing a wide-brimmed hat, and wearing cover-up clothing – were considered less important. So, given that sunscreen use is generally regarded as the most important and, by implication, the most effective, sun protection measure, is perception borne out by reality?
Essential clinical anatomy for cutaneous surgery: Part 2. The danger zones
Andrew Morris and Richard Motley
pp 17-19
There is often considerable anxiety when first performing cutaneous surgery on the face, mainly due to concerns of damage to important structures such as the facial nerve. Fortunately, the body is well designed to protect itself and most of the important structures are deeply placed and the risk of inadvertent injury is low. However, there are a number of areas where these structures are closer to the surface and at higher risk – the socalled ‘danger zones’.
Dear doctor – tips for GPs on writing referral letters
Barry Monk
pp 20-21
The separation of primary and secondary care is a feature of British medical practice that does not exist in most other healthcare systems. In Britain, patients are seen by hospital consultants on referral from their GP (except in cases for genitourinary clinics and accident and emergency departments). Where dermatology is concerned, some 500 consultants each receive an average of 2,000 GP referrals per annum, so approximately one million letters are sent each year.
An update on laser treatment
Jaideep Bhat and Sean W Lanigan
pp 22-24
The term ‘laser’ is an acronym for ‘light amplification by stimulated emission of radiation’. Laser light is coherent and can therefore be focused to a very small spot size maintaining a very high irradiance. Lasers are named by the lasing medium that is stimulated to produce light, which in turn determines the characteristics of the light emitted. The light is delivered as a continuous, pulsed or pseudocontinuous beam.
How I approach primary hyperhidrosis management
Gina M Kavanagh
pp 24-26
An article on managing localised hyperhidrosis appeared in these pages three years ago. In it, Kleyn and Hepburn reviewed the problem of excessive sweating and several ways of treating it. Subsequently, botulinum toxin A – Botox® (Allergan Ltd, UK) – has represented a breakthrough in the treatment of hyperhidrosis. Since its advent I have seen a marked increase in the number of referrals for the management of this problem. I offer here an account of my approach to hyperhidrosis, with updated information on its prevalence and information on how to obtain some useful pharmacological agents.
Networking for clinical trials
Kim Thomas and Hywel Williams
pp 28-30
The UK Dermatology Clinical Trials Network (UK DCTN) is a collaborative group of over 170 people, including dermatologists, dermatology nurses, GPs, health services researchers, pharmacists and patient representatives. Its aim is to conduct high-quality, randomised, controlled clinical trials for the treatment or prevention of skin disease – particularly in relation to less common diseases, where the existence of a national network is essential to ensure adequate participant numbers.
Monk's moments: A lesson from history
Barry Monk
pp 31-31
A few weeks ago I was asked to see a patient who had been admitted on the acute medical take. He gave a history of severe malaise, anorexia and bone pain, with recent weight loss, and the physicians suspected a possible malignancy. I was asked to see him because of his ‘rash’.