Dermatology in practice - 2008


Comment: A little bit of light reading
Neil H Cox
pp 3-3
It is said that psychologists can tell a lot about an individual simply by knowing what they read. For my last long train journey, I took a copy of The World According to Clarkson (Jeremy) and the chemical pathology section of the Whittington Hospital Laboratory Handbook of 1968 by Dr T. Dormandy. If any dermato-psychologist out there can make sense of that combination without reading the rest of this editorial, I’ll be a bit surprised.
All you ever wanted to know about … psychodermatology
Anthony Bewley and Ruth Taylor
pp 4-6
Psychodermatology – or psychocutaneous medicine – refers to the interface between psychiatry and dermatology. There are several general and important points about this relatively new, developing subspecialty that it is helpful to appreciate initially. Psychodermatological conditions, which involve an interaction and crossover between the mind and the skin, can be classified into three main categories that are discussed in turn in this article.
The role of GPs with a special interest in a changing NHS
David Colin-Thomé
pp 7-9
These are the most recent facts in my possession, as I strongly appreciate the need to do more to offer better dermatology care in primary care: between 15% and 20% of GP consultations have a dermatological component; and in 2001–02, skin disease generated more than 600,000 referrals from GPs to secondary care – more than all other specialties combined. So how can current policy help?
How I approach and treat the itchy child
Nerys Roberts
pp 12-14
Itch is the cardinal symptom of atopic eczema, which now affects one in five children. It is, therefore, always the most likely diagnosis in an ‘itchy’ child. However, it should be remembered that not all itching is due to eczema. This article discusses the different causes of itch, some of the diagnoses other than eczema, and the subsequent treatments that need to be considered when faced with an itchy child.
Mohs’ micrographic surgery for high-risk skin tumours
Tom Lucke
pp 16-18
The goal of surgery in the management of any form of skin cancer is to completely remove the tumour. For the most common form of skin cancer – that is, basal cell carcinoma (BCC) – this is generally achieved by excising the tumour with a 3–4 mm margin of normal surrounding skin. Cure rates of about 90% can be achieved with this technique when treating well-defined, low-risk BCCs – such as nodular BCCs.
What causes occupational allergies to latex gloves?
Jonathan ML White
pp 20-22
Allergy to rubber may be due to the natural rubber latex or to other agents used in the manufacture of rubber materials. This article discusses problems encountered with latex, in particular with latex gloves. In the UK, under the Control of Substances Hazardous to Health (COSHH) regulations, latex has been specified as a hazardous substance, requiring employers to undertake risk assessments of glove use and to provide suitable alternatives where necessary.
Liverpool, Capital of Culture … and dermatology
Barry Monk
pp 24-24
Liverpool is one of the European Capitals of Culture for 2008. It was also the venue of the annual scientific meeting of the British Association of Dermatologists (BAD), held 1–4 July in the brand new Arena and Convention Centre. This is a personal selection of presentations that might interest those of you who were not lucky enough to have been there in person.
How does the NICE guidance on skin cancer affect GPs?
Dafydd Roberts
pp 25-27
The National Institute for Health and Clinical Excellence (NICE) guidance Improving Outcomes for People with Skin Tumours including Melanoma was published in early 2006.1 It is a guide to commissioners on how they should commission skin cancer services in England and Wales, dealing with skin tumours and with precancerous skin conditions. It acknowledges that there is a role for primary care, whereas, in all other preceding documents, management relied entirely on secondary care provision.
Early recognition of scarring alopecia: part 2
Maeve L Walsh and Neil H Cox
pp 28-30
This is the second of a two-part article on scarring alopecias. In this part, we consider some additional dermatoses specific to the scalp, some general dermatoses that may cause scarring if the scalp is involved, and differential diagnoses. As in part 1, we stress that scarring is an irreversible process. Thus, recognition that a scarring process is present, identification of the specific disease, and prompt treatment to try to halt ongoing scarring – but with explanation of the limitations of intervention – are all important issues.
Monk's moments: In the real world – tales of three patients
Barry Monk
pp 31-31
I originally wrote this piece for the ‘save Bedford Hospital campaign’ website; its appearance there so enraged the Medical Director of our Trust that he threatened me with disciplinary action – don’t worry though, he’s easily provoked. I thought the readers of Dermatology in practice might be interested to read what had so enraged him. Politicians keep telling us how wonderful the reforms to the NHS have been, but how do they affect patients in the real world? Let me tell you three illustrative tales, which all happened at the same recent outpatient clinic, and then you can judge for yourself.