Dermatology in practice - 2007


Comment: The communication of the dancing bomb-sniffer
Neil H Cox
pp 3-3
Many years ago, I did an A level biology course that consisted mainly of ‘free periods’ and self-learning – strange at that time, and still remarkably unstructured even by today’s standards. It did, however, lead to me reading all sorts of books that I would probably never have encountered during a more formal course. I was reminded of one such book recently when I read a newspaper article about honeybees being used to sniff out bombs. This sounds bizarre, but is actually an active investigation at the Los Alamos National Laboratory in New Mexico.
Treating psoriasis over the past 40 years
Roger Allen
pp 4-7
Progress in medicine, as with evolution, is mostly continuous and generally insidious, but interspersed with occasional, sudden changes, such as those we are currently witnessing in psoriasis with the introduction of the new biologicals. Reflecting on the 40 years or so that I have worked in dermatology, there has been a steady and almost imperceptible transition in our understanding and management of psoriasis, and over this time there must have been as many discarded therapeutic options as there have been theories as to its cause.
The use of biologics in a typical DGH clinical practice
Anthony MR Downs
pp 8-10
Psoriasis is a serious medical condition with a significant morbidity. Twenty to thirty per cent of all patients have severe disease and 2–5% have associated joint disease. Standard systemic therapies are associated with a wide range of toxic reactions. Biologic agents for psoriasis target the cytokine TNF-a (etanercept, infliximab, adalimumab) or the T-cell/antigen-presenting cell interaction (efalizumab). Over the last five years, these ‘designer drugs’ have emerged as rapidly effective and well-tolerated treatment options. Dermatology prescribing of these drugs in the UK has been extremely slow.
Varicella zoster virus – part 1: general aspects and varicella
Maeve L Walsh and Neil H Cox
pp 12-14
Varicella zoster virus causes varicella (chickenpox) and herpes zoster (shingles). Varicella is predominantly a childhood illness manifesting with a febrile illness and vesicular eruption. It is usually self-limiting but occasionally can lead to secondary bacterial infections, pneumonia or central nervous system involvement. Herpes zoster is caused by activation of dormant varicella zoster virus in the dorsal root ganglion. It classically presents with dermatomal paraethesia and vesicular rash. This two-part article will discuss general aspects and varicella in part 1, and herpes zoster in part 2.
Understanding vulval pain
Fiona Lewis
pp 16-17
Vulval pain can be a symptom of many conditions. For example, if a patient has fissures as a result of lichen sclerosus or psoriasis, they will complain of pain. Pain is also frequently described in Behcet’s disease, vulval Crohn’s disease and erosive lichen planus, to name but a few. Gynaecological and neurological disorders, including pudendal nerve entrapment, endometriosis and pelvic radiotherapy may also give rise to pain. There are, however, patients who describe vulval pain but have no obvious cause for their symptoms.
Nickel allergy
Janakan Natkunarajah and David Orton
pp 18-20
Despite the high frequency of nickel allergy and the natural tendency of many clinicians to downplay its relative importance, there are few allergens that evoke so much controversy in contact dermatitis literature. Nickel is used in metal plating and is present in many alloys and chemical compounds. It is consistently the most common cause of allergic contact dermatitis, particularly in women. High rates of allergy are also seen among children.
New concepts in the measurement of itch
Caroline Siân Murray
pp 22-24
We tend not to rely on ‘measurements’ much in dermatology. We might record the dimensions of a naevus for later reference, but when making a diagnosis or monitoring the success of treatment, we usually have to rely on ‘softer’ signs; for example, does the patient report more or less itch? The problem with this approach is that it is difficult to relate one person’s interpretation of intensity to another’s.
Non-melanoma skin cancer
Fionna Martin, James Crane, Rachel Jacoby and Sandeep Varma
pp 26-28
Non-melanoma skin cancers (NMSCs) are the most common cancers in the UK, steadily increasing in incidence since the 1970s. NMSC has always remained more common in men than women and increases with age in both sexes. There are around 400 deaths annually from NMSC, although rates are low in patients under the age of 50. Ultraviolet light exposure is the greatest aetiological factor for NMSC.
Monk's moments: Something special
Barry Monk
pp 30-30
My uncle was a distinguished surgeon; during his national service he did two years of neurosurgery, he wrote his MD thesis on fractures of the tibia, and his MS was a study on postoperative adhesions following laparotomy. In short, there was nothing that he could not have turned his hand to, although he did once ruefully admit that he had never been referred a case of carotid body tumour.