Dermatology in practice - 2005

Comment: Pros, cons and great minds
Neil H Cox
pp 4-4
I discovered recently that the idea that great minds think alike is actually true, although it’s undoubtedly a concept we also invoke to our convenience. There’s less discussion about great minds not thinking alike – although, as it happens, that would also be pertinent to this editorial. Let’s look at the thinking alike version first. The editorial board meeting for Dermatology in Practice (DIP) is always, thankfully, a lively affair with lots of ideas generated. Many of the ideas are ‘one-offs’ for a single article, but on the most recent occasion we came up with a few themed ideas as well.
Exploring the positive aspects of teledermatology
James Vestey
pp 6-8
Teledermatology has developed over the last 30–40 years. Numerous studies have investigated combinations of computer, video, telecommunications and camera equipment to deliver dermatological advice to patients at a distance. Most were small pilot projects examining systems and equipment, usually abandoned subsequently. However, they demonstrated that it is possible to transmit diagnostically useful clinical data with supporting images from referring clinicians to a distant dermatologist to seek advice on diagnosis and management of patients. Of all applications of telemedicine, teledermatology may be the most appropriate.
Teledermatology – discussing its limitations in practice
Richard B Mallett
pp 9-10
Doctors are constantly being urged to embrace new information technologies and develop new ways of working. Teledermatology is digital and it uses the latest developments in information technology, but is it a new way of working and can it provide our patients with the standards of care expected of a modern health service? The drive to develop telemedicine began in the 1950s and came from the need to provide specialist healthcare to remote, geographically isolated communities in the United States. The aim was to provide a facility that allowed the patient and referring physician to consult a specialist in real time via a televisual link.
Could this be HIV? Cutaneous signs of the infection
Alena Salim
pp 12-15
The current pandemic of infection due to human immunodeficiency virus (HIV) is a huge global problem. In the UK, it has been estimated that at the end of 2003 approximately 32,000 people were living with HIV. The skin can be involved at any stage of HIV infection. With the introduction of highly active antiretroviral therapy (HAART), many of the common HIV-associated skin disorders are now seen less frequently but new side-effects, resulting from longer survival and from the immune reconstitution syndrome, have emerged.
Contact dermatitis in the last 30 years – a personal view
Angela Forsyth
pp 16-18
Contact dermatitis is a result of the skin reacting to environmental factors. This seems straightforward enough until we realise that the environment is constantly changing and the susceptibility of skin to the environment is also constantly changing. Our knowledge of the biological mechanisms involved has improved and cultural changes have taken place. All of these factors have contributed to differences between the mid-1970s and the present day.
Prescribing isotretinoin
Mark Goodfield
pp 20-21
Some 80% of teenagers suffer with acne that would benefit from treatment. In men, the spontaneous remission rate is very high, so that only 1% of 25-year-old men have acne, while the figure for women is near to 30%, falling to 10% for the over-40s. There is also considerable variation in the severity of acne, depending on the type of clinical disease, its ability to produce scarring and its psychological effects. All of these factors will influence the choices of treatment. In addition, the nature of the patient’s response to their disease is critical.
What GPs need to know about TNF-a inhibitors
Sandra Winhoven and Christopher EM Griffiths
pp 22-24
Psoriasis is a chronic skin disorder that affects around 2% of the population in the UK. Approximately 20% of patients have moderate-to-severe disease requiring either systemic therapy or phototherapy. The use of these traditional systemic therapies is limited by their side-effects, particularly organ toxicity. Advances in the understanding of the pathogenesis of a number of inflammatory diseases, including rheumatoid arthritis (RA) and psoriasis, have led to the development of more precisely targeted biological therapies.
Actinic keratoses – a guide for those in primary care
Rona MacKie
pp 26-28
Actinic, or solar, keratoses are red, scaling lesions, usually 1–2 cm in diameter, found on sun-exposed skin, mainly in older, white-skinned individuals. Therefore, they will frequently be seen incidentally in a primary care setting. A patient with actinic keratoses (AKs) may be attending the surgery or receiving home visits from the practice nurse for quite a different problem, such as blood pressure measurement or a leg ulcer dressing. The lesions may be noticed by chance at a time when the patient may not even be aware of them.
Monk's moments: Saved by the bell
Barry Monk
pp 31-31
Every doctor must have a happy memory of having been ‘saved by the bell’ – that glorious moment in final exams when you have just been asked some impossible question and you are trying desperately to disguise your ignorance, when the bell rings and the examiner realises that once again his quarry has escaped. Just when he thought that he had you cornered, your ordeal is over and you can escape to join your fellow students in the pub.