Dermatology in practice - 2008

Comment: Sign of the times?
Neil H Cox
pp 3-3
Although most of my back catalogue of amusing curios is drawn from newspapers and Department of Health documents, signposts often yield their own inspiration (hence the snappy title). My own place of work, or at least the private finance company that owns it, has been cited in the national press recently for its wonderful sign in the car park that read ‘Car Parking for White Circular Permit Holders Only’. The potential racist (non-white) and shapist (non-circular) implications were acknowledged and a new, more grammatically correct, sign has been created – though not before it had been noted as DIP editorial material.
Dermatology behind bars
Rod Tucker
pp 4-6
There is an old joke among prisoners about how paracetamol cures all ills, from a headache to a broken leg. The joke reflects the feelings expressed by many prisoners about the way that they are medically treated once ‘inside’. This article describes some general issues surrouding healthcare and dermatology in prisons, with a personal account of setting up and running a pharmacist-led dermatology clinic in an all-male prison at HMP Moorland in Doncaster.
Assessing the long-term safety of biologics for psoriasis
Anthony Ormerod and Kathleen McElhone
pp 8-11
Biologic therapies are a relatively new treatment option for patients with psoriasis. However, their long-term safety has not been assessed yet. The British Association of Dermatologists (BAD) has set up a register – the British Association of Dermatologists’ Biologics Intervention Register (BADBIR) – to investigate the long-term outcome of psoriasis patients treated with biologic agents, and thus better assess the risks associated with such treatments. This article explains how this new register works and why it was established.
A practical approach to using 5-fluorouracil cream
Neill Hepburn
pp 12-13
In the early 1960s, 5-fluorouracil was developed as an anticancer drug. It is a thymine analogue antimetabolite, which is incorporated into ribonucleic acid (RNA) and inhibits DNA synthesis, ultimately leading to cell death. A patient who was receiving systemic treatment was observed to develop inflammation and then clearing of his actinic keratosis. A cream formulation was subsequently found to be effective in clearing actinic keratoses. Since then, it has also been used to treat Bowen’s disease, superficial basal cell carcinomas, keratoacanthomas and viral warts. It is available in the UK as a 5% cream (Efudix®, Valeant Pharmaceuticals Ltd, UK).
Serum autoantibodies and connective tissue disorders
Andrew Sherley-Dale
pp 14-18
Understanding the results of serum autoantibody tests for the diagnosis of connective tissue disorders (CTDs) can present challenges. This article highlights the utility and limitations of some of the commonly available tests. Antinuclear antibodies (ANAs) were first reported in 1957 and extractable nuclear antigens (ENAs) in 1959. Despite decades of research, it is still not entirely clear why such antibodies arise, nor have the roles of their target antigens been fully elucidated.
What’s new in vitiligo?
W Stewart Douglas and Maxine E Whitton
pp 19-22
Vitiligo is an acquired inflammatory disorder, with underlying genetic susceptibility, resulting in death or loss of function of skin melanocytes and a consequent disappearance of the principal brown pigment of the skin, melanin. It is the most common hypopigmenting disease, affecting ~1% of the population worldwide – with considerable geographical and racial variation. Prevalence tends to be highest in dark-skinned populations, where depigmentation is most visible and carries most stigma. In pale-skinned populations, vitiligo could well be underestimated, as it may only become apparent when unaffected skin becomes tanned.
A guide to annular eruptions
Lynsey C Smith, Neil H Cox and Goutam Dawn
pp 24-27
Many skin disorders produce lesions with particular shapes or patterns. The term ‘annular’ describes lesions that appear as open circles or in a ring-like configuration. They are seen in many dermatoses and may lead to a certain diagnosis or to a specific differential diagnosis. Diagnostically, it is important to qualify the description of annular lesions, particularly with regard to their evolution and to the presence of scaling. It should be noted, however, that recent topical applications may conceal scaling.
How to improve quality of life in patients with psoriasis
Richard Parslew
pp 28-30
Around 1.2 million people in the UK suffer from psoriasis. All the clinical variants of psoriasis can undermine the health-related quality of life (HRQoL) of patients at any age. But their impact on HRQoL and the psychological burden are often under-appreciated by clinicians in primary and secondary care. A cure for psoriasis remains elusive. However, prescribing appropriate topical treatments and judiciously referring patients to secondary care can improve the quality of life of this large patient group.
Monk's moments: Donor organs: the gift of life
Barry Monk
pp 31-31
I recently saw a 69-year-old man in my clinic, referred to me with a suspected skin cancer. Taking a history, I asked him what his occupation had been. He was rather affronted, and told me that he was still working full time, installing TV aerials; I looked at him again, and realised, to my slight embarrassment, that a few months previously he had been clambering over the roof of my house fixing my satellite dish. As I proceeded with his history, I discovered that, about nine years earlier, he had been the recipient of a heart transplant.