Dermatology in practice - 2006


Comment: Appraisal, revalidation and the medical murderer
Neil H Cox
pp 4-4
Let me confess that I don’t think appraisal, revalidation or lay dominance of General Medical Council (GMC) membership will stop doctors committing murder if that is their intent, because I think the powers that be have got it the wrong way round. That some action must follow the Shipman saga is inevitable, but it may be that he is an example of a murderer who happened to be a doctor, not the other way around, even if his profession generated opportunities. This editorial discusses an older version of the same story.
Dermatological emergencies
Vishal Madan and Neil H Cox
pp 6-9
The term ‘dermatological emergencies’ encompasses numerous skin conditions that pose a potential threat to the integrity of the integument. Many of these conditions also reflect the presence of underlying systemic illness and some cause considerable cutaneous or systemic morbidity and can be potentially lethal. Recognising these conditions early and correctly can minimise such danger. Identification of the signs associated with these skin conditions will help in making an accurate diagnosis, thereby leading to early referral to secondary or tertiary centres geared to manage these patients.
The psychology of psoriasis
Ray Jobling
pp 10-11
All skin problems have the potential to cause concern and distress, ranging from mild self-consciousness and sensitivity to the curiosity of others, through in some cases to acute anxiety and deep depression. A disorder like psoriasis can have a potentially profound impact on individual behaviour and interaction, leading in severe instances to social withdrawal. Even among the majority of those with skin problems who have never had to face direct rejection or explicit discrimination, self-doubt and a sense of risk and anticipated threat may come to blight their lives.
What is homeopathic therapy, and how does it work?
Nick Avery
pp 12-14
Some cynics would say that there are only three treatments for dermatological conditions – steroids, antibiotics or both! However, there are actually many complementary or alternative forms of treatment for skin maladies, and homeopathy is one of them. Homeopathy is a therapeutic system based on the Similia Principle. The name comes from the Greek: homoios-pathos, which literally means ‘like suffering’. In other words, a medicine that causes symptoms can be used to treat a condition that produces those same symptoms. Traditionally the spelling has been ‘homoeopathy’ but the middle ‘o’ is no longer used and the internationally accepted version is ‘homeopathy’.
Eczema herpeticum
Nicola Cooke
pp 16-17
Eczema herpeticum (EH) was first described by Moritz Kaposi in 1887. Today, the term Kaposi’s varicelliform eruption (KVE) is used to describe cutaneous herpes simplex virus (HSV) infection affecting any underlying skin disease, whereas EH is restricted to disseminated HSV infection of atopic dermatitis (AD) and other forms of dermatitis. KVE has been reported in association with Darier’s disease, cutaneous T-cell lymphoma, pityriasis rubra pilaris and Hailey- Hailey disease, among others.
Chaperoning in dermatology
Janet McLelland
pp 18-19
Do you always offer a chaperone before performing an intimate examination, defined by the General Medical Council (GMC) as an examination of the breasts, genitalia or rectum? What do you do if you are carrying out a general examination and suddenly wonder if the diagnosis is scabies and want to examine the patient’s breasts? Do you offer a chaperone irrespective of the gender of yourself and the patient? If you do have a chaperone present, do you record the chaperone’s identity in the notes? If you do not, you are not following the GMC guidelines from December 2001.
Psoriasis fish treatment – a patient’s account
Gary M Hill
pp 20-20
Deep in the mountains of central Turkey, near the small town of Kangal, lies a healthcare centre with a difference. Clear spring water runs through the site of Balikli. The water is heated from within the earth by volcanic activity and is fortified with minerals, in particular selenium. The water is home to a small species of fish known colloquially as ‘Doctor fish’.
In the last 40 years – the evolution of acne treatment
William J Cunliffe
pp 22-25
I was 16 years old. I had discovered what puberty is all about. I also just discovered zits. My GP knew very little about it. The treatment was worse than the disease. No chocolates or pork (I asked, ‘Do Jewish adolescents not get acne?’). Topical treatment was 2% sulphur ointment; this was unbelievably foul smelling and the smell lasted for hours after I had washed the stuff off my skin. There was certainly no need for contraception! What was even worse was the oral treatment, which consisted of brimstone (another sulphur-based preparation) and treacle. That was just plain horrible.
Monk's moments: A noble thought
Barry Monk
pp 27-27
The Nobel Prize for medicine (officially for discoveries in physiology or medicine) was first awarded in 1901. Many of the awards in the early years were for work that transformed medical practice, especially in relation to infectious disease: von Behring (1901) for his work on diphtheria, Ronald Ross (1902) for the discovery of the malaria parasite and its life cycle, Koch (1905), and Ehrlich (1908). The only dermatologist to have won a Nobel Prize was Finsen (1903) for his work on phototherapy in the treatment of lupus vulgaris (cutaneous tuberculosis).