Dermatology in practice - 2008

Comment: Take a seat … and start worrying
Neil H Cox
pp 3-3
Some readers will have heard part of this at a Royal Society of Medicine (RSM) dermatology meeting. But it is worth repeating, as it took me into an area of totally new literature. Also, some of the audience may have been asleep, so I shall push on. My theme was that any idea can be turned into research.
Lessons from a rheumatoid arthritis biologics register
Kath D Watson and Kimme L Hyrich
pp 4-6
The introduction of anti-tumour necrosis factor (anti-TNF) therapy for the management of rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis has significantly improved the outcome for patients suffering from those severe rheumatic diseases. Similar benefits have also been observed in patients with inflammatory bowel disease, and most recently in patients with psoriasis. However, despite demonstrated safety compared with placebo in early clinical trials in all these conditions, there are still many uncertainties about the long-term safety of these agents, particularly with respect to serious infection and malignancy. There also remains a concern about rare and unexpected adverse events.
Dermatoses of pregnancy: a guide to diagnosis
Katherine Mellor, L John Cook and Hywel L Cooper
pp 8-12
The dermatoses of pregnancy are a heterogenous group of conditions specific to the pregnant or postpartum woman and are linked by their pruritic nature. The subject has been historically complicated by a variety of misleading and confusing terminologies. This article aims to give an overview of the current classification and diagnosis of these dermatoses, as making the correct diagnosis in a timely fashion has crucial implications for both the mother and the fetus.
NICE guideline on eczema care: achieve best practice
Thomas Poyner and Gail Sibley
pp 16-19
Eczema accounts for approximately 30% of general practice dermatology consultations, yet most healthcare professionals receive little or no relevant dermatological training. This professional knowledge gap often cascades into the community, causing confusion, anxiety, frustration and guilt among carers and patients. When considered together, the social, emotional and financial effects appear greater for a family looking after a child with moderate to-severe eczema than for a family caring for a child with type 1 diabetes.
A practical approach to using azathioprine
Anand Patel and Neill Hepburn
pp 20-22
Azathioprine is a useful immunosuppressant in dermatology. Introduced as a steroid-sparing agent in the 1960s for renal transplant recipients, it has been used as both an immunosuppressant and a steroid-sparing agent for inflammatory disease. In dermatology, it is particularly useful for treating patients with immunobullous diseases, lupus erythematosus, vasculitis, chronic actinic dermatitis and severe atopic eczema. The onset of action is slow, taking six to eight weeks, so it is more suitable for long-term disease control and is of little use in managing flares.
Early recognition of scarring alopecia: part 1
Maeve L Walsh and Neil H Cox
pp 24-27
Hair is a characteristic associated with an individual’s identity and body image. Hair loss (alopecia) can have a profoundly damaging effect on an individual’s self-confidence. Scarring (cicatricial) alopecias are potentially even more devastating conditions as, once scarred, the follicle cannot produce hair any longer and, therefore, such hair loss is irreversible. While there are non-scarring alopecias in which the prospect for hair regrowth may realistically be small, in a scarring process the potential for regrowth is nil.
Transdermal absorption of topical drugs: the facts
Khalid M Al Aboud, Pawha Manish and V Ramesh
pp 28-30
Day after day, topical drugs are being packaged in newer formulations and hitting the market as wonder drugs. Do all these newer formulations work? Do these drugs actually penetrate the skin and reach those sites that the pharmaceutical companies claim they do? These questions cannot be answered by a simple yes or no; the answer is much more complex and determined by many factors.
Monk's moments: Making a name for yourself
Barry Monk
pp 31-31
It is only the truly great figures of science who find their names preserved for posterity in the form of units of measurement (Newton, Watt, Joule, Volta) or, in the case of a very select few, in the name of an element (curium named after Marie and Pierre Curie, einsteinium named after Albert Einstein, fermium named after Enrico Fermi). Robert van de Graaff, who devised the eponymous apparatus beloved of every schoolchild for demonstrating the effects of static electricity, had the unique accolade of having a heavy metal rock group named after him.