Dermatology in practice - 2007

Comment: When medical ‘humour’ meets Scottish ‘cuisine’
Neil H Cox
pp 3-3
The last couple of decades seem to have seen a steady erosion of any sense of fun in medicine. However, one thing that can save us is journals that are still prepared to publish quirky items of research, especially if they have an undercurrent of seriousness. Published in the pre-Christmas edition of The Lancet a few years ago, two researchers investigated whether the ‘deep-fried Mars bar’ was a true item of Scottish cuisine or just an urban myth. They opened the batting by explaining that although they both live and work in Scotland, they had never seen such a thing for sale.
Psoriasis and heart disease – is there a link?
Ewan A Langan, Jennifer Black and Christopher EM Griffiths
pp 4-7
Psoriasis affects 2% of the UK population. Although an association with inflammatory arthritis has been recognised for almost 200 years, only now is evidence mounting of a significant association with cardiovascular disease. Given the prevalence of psoriasis it is important to clarify which patients are at risk. Such information may shift the perception of psoriasis from ‘life-ruining’ to potentially ‘life- threatening’.
Varicella zoster virus – part 2: herpes zoster
Maeve L Walsh and Neil H Cox
pp 8-10
This is the second part of a two-part article about varicella zoster virus; this part discusses herpes zoster (shingles). After the primary infection, the virus lies dormant in the dorsal ganglia. It is thought that host cell-mediated immunity prevents viral reactivation and herpes zoster. Immunoglobulins can be detected almost immediately after the initial rash of varicella zoster appears; they neutralise the virus but do not prevent its reactivation. Any factor impairing the cellular immune system can trigger viral replication and viraemia. The most common factors in the general population are concurrent illness, trauma, advancing age, stress and sunburn.
Vulval dermatoses – a quick and easy guide to diagnosis
Fiona M Lewis
pp 12-14
Patients present to the vulval clinic with a range of conditions – infections, pain syndromes, neoplasia and, most commonly, inflammatory dermatoses. In some dermatoses, the vulva may be the only site affected, whereas in many others, the vulva is involved as part of more generalised disease. A knowledge of the basic features of the common dermatoses can lead to rapid diagnosis and the correct management for these women, who may well have delayed seeking advice because of embarrassment or fear of a sexually transmitted disease. This article gives a brief overview of the common inflammatory dermatoses that affect the vulva.
Fungal infections – the last 30 years
Elisabeth Higgins
pp 16-18
The prevalence of fungal infections has increased significantly over the past 30 years. During that time there has also been a major change in both the nature of the pathogenic fungi responsible for common dermatoses and the availability of effective treatment. Additionally, with the rising prevalence of immunosuppression over the past three decades, both as a result of long-term treatment options now available and as a consequence of the emergence of HIV disease, opportunistic infections are no longer rare, and clinicians need to be alert to such atypical presentations.
Wigs and the NHS – myths and preconceptions
Mark Taylor
pp 19-21
This article outlines the different types of wig available and describes how wigs are made. Some commonly asked questions regarding supply of wigs by the NHS are discussed, and advice is given on the services that NHS suppliers should be providing.
Bites and stings – what you need to know
Mehnaz Afsal and Andrew Morris
pp 22-24
It is an unpleasant fact that most people experience bites and stings at least some times in their lives. Although they occur in almost all parts of the world, certain areas have a greater prevalence than others. The severity of an insect sting reaction varies from person to person, and in extreme cases, anaphylaxis may occur. Because bites are not commonly seen in daily medical practice, this clinically important issue can sometimes be underestimated.
Uses of isotretinoin in disorders other than acne
Haytham Al-Rawi and Philip J Hampton
pp 26-28
Isotretinoin (13-cis-retinoic acid) is a vitamin A analogue that has been used for many years for the treatment of severe acne vulgaris. It was licensed in the UK in 1983 for the treatment of severe forms of acne (nodular, conglobate and scarring) only. More recently, it has been available in a topical formulation. However, over the years, dermatologists have used it with success in the treatment of a number of different skin conditions, including other acneiform conditions such as rosacea and hidradenitis suppurativa, as well as in disorders of keratinisation, the prevention of photoaging, and the prevention and treatment of skin cancers.
Monk's moments: Missing the target
Barry Monk
pp 30-30
As a medical student in the early ’70s, I spent a happy day in Kent exploring two long-abandoned institutions – the Joyce Green Smallpox Hospital (closed in 1948) and Long Reach. The latter was so-called because it was the furthest point up the Thames Estuary that a ship showing a fever flag had been permitted to travel. At the time, it appeared to us that in an era of immunisation and antibiotics, infectious disease was as much a part of medical history as leeches and chloroform.