Dermatology in practice - 2007

Comment: Agminated own goals
Neil H Cox
pp 3-3
Readers of this column may not recognise that each of my offerings involves many hours of wading through trivia (and some serious stuff) to find material that may provide some light relief from the daily drudgery. All potential grist to my mill has to be carefully stored and collated (anybody who has seen the opencast filing in my office will know that I’m not being entirely truthful about the careful storage aspect), and something vaguely dermatological inserted, so that I can generate some sort of theme to unleash upon the lucky reader who reputedly reads this page.
Service delivery and reform
Keith Freeman
pp 4-5
All readers will be well aware of the pressure to change the way we deliver dermatology services. I will attempt to examine these from the perspective of a consultant working in a post which is split equally between a secondary care foundation trust and a teaching primary care trust (PCT). My belief is that, while the present situation undoubtedly has the potential to destabilise traditional service models, there are also opportunities to improve services for patients if we rise to the challenge.
Anti-aging creams and cosmeceuticals
Tamara Griffiths
pp 6-7
The marketplace is inundated with topical ‘anti-aging’ creams promising to banish wrinkles and other signs of aging without the risks of painful injections or surgery. Although there is undoubtedly a role for topical rejuvenation therapy, it is an area that can be confusing to experts and consumers alike. As with any topical treatment, evidence of skin barrier penetration, clear mechanism of action, and clinical efficacy with randomised controlled trials are ideal. Such benchmarks, however, often remain unmet.
Treating actinic keratoses with Efudix® cream
Sandeep Varma
pp 9-10
Five per cent 5-fluorouracil cream (5-FU); Efudix® (Valeant Pharmaceuticals Ltd, UK) has proven to be an effective treatment for actinic keratoses. The case study described below presents a patient’s unique perspective on the inflammation and redness associated with 5% 5- FU therapy. At the end of therapy, the patient concluded that his skin hadn’t looked so well in years and that, despite the inflammation and redness the therapy was ‘worth it’.
The house dust mite and atopic dermatitis
Dev S Shah
pp 12-13
Since 1922, there has been much research into microscopic arachnids that live in our homes. The ubiquitous house dust mite (HDM) has been charged with exacerbating all atopic disorders at some point in time. Patients and their families struggle with difficult skin conditions and eradicating these pests may seem an attractive, non-medicated adjunct to therapy. This article will review the research concerning the HDM and atopic dermatitis (AD). It aims to clarify exactly what the research shows and how this may be translated into practice.
The UK DCTN: an update
Carron Layfield, Joanne Chalmers and Hywel Williams
pp 14-14
The UK Dermatology Clinical Trials Network (UK DCTN) is a collaborative network of over 250 dermatologists, dermatology nurses, health service researchers and patients throughout the UK and Republic of Ireland. Established in 2002, its objective is to conduct high-quality, multicentre randomised, controlled trials (RCTs) that answer questions of importance to both clinicians and service users.
Patients with pruritus but no rash
Jon Norris
pp 16-20
The patient who presents with a blemish-free skin but nevertheless complains of distressing pruritus must be one of the more difficult problems that a practitioner has to manage. Exactly where does one begin and how does one construct treatment for this problem? This article is written from a very practical point of view and is designed to help with the many different sorts of patients who present with the above problem. More detailed general references are suggested for further reading, including one by an author who is qualified in both dermatology and psychiatry, and who has written extensively on the overlap between these disciplines.
A dramatic bleeding story
Neil H Cox
pp 23-23
A local GP recently referred a patient whose history, described in detail, was sufficiently diagnostic that I was able to direct her to the relevant specialist without needing to see her. If one reader learns from this it will be worthwhile. Briefly, the patient was an elderly lady who had a crusted lesion on her calf. After catching it on her tights, this had bled profusely, to the extent that she had required to have all her upstairs carpets professionally cleaned and all her downstairs carpets completely replaced.
Choosing a suitable biological treatment for psoriasis
Tony Ormerod
pp 25-27
The term ‘biological’ refers to a substance made from a living organism or its products. Biologicals (‘biologics’ in the USA) may be used to prevent, diagnose or treat a disease. Antibodies, interleukins and vaccines are all biologicals. Following the development of hybridoma technology in the 1970s and the advent of genetic engineering, it has become possible to engineer and manufacture fusion proteins or monoclonal antibodies that target specific cells or receptors, and to largely replace the non-variable regions of antibodies with molecular structures derived from humans. Psoriasis treatment has benefited enormously from this technology.
Monk's moments: It’s your choice. Or not
Barry Monk
pp 28-28
It is remarkable to think just how quickly the internet has become an apparently essential part of our lives. One area where I now find it indispensable is booking flights. If you fancy a weekend away, you just click on your favourite website, and if the flights to Barcelona seem too expensive, or at the wrong time of day, you can choose to fly from another airport or on another day. It’s all so delightfully quick and foolproof.
Helping pathologists provide a useful histology report
Mitali Gangopadhyay
pp 29-31
This article is a guide for GPs and less experienced trainees on: how to provide relevant information with skin biopsies; what to biopsy or avoid; how to biopsy selected conditions and optimal handling of skin pathology specimens. The overall objective is to explain how to obtain useful final pathology reports. Skin biopsy is the mainstay of diagnosis in many skin diseases, and in many others it is carried out to confirm the clinical impression and as a basis for management of a variety of conditions. GPs send many skin biopsies for pathological interpretation.