Dermatology in practice - 2009


Comment: Pure garbage and drivel
Neil H Cox
pp 3-3
While I was doing an intercalated degree some years ago, the initials and inverse ability to communicate knowledge of one of the tutors had provided his nickname, ‘Pure Garbage And Drivel’. This had lain undisturbed in my memory for some decades, but resurfaced recently while I was trying to complete the Choose and Book ‘Finding Services Effectively’ template.
Why nail psoriasis remains difficult to treat
Felicity Edwards and David De Berker
pp 4-7
Psoriatic nail disease has a lifetime incidence of up to 90% in patients with psoriasis; in addition to the cosmetic impact, it causes pain and interferes with activities of daily living in a large proportion of those affected. Treatment of nail psoriasis has been unsatisfactory in the past (with a paucity of good evidence for therapies used) and has been limited by temporary efficacy or adverse side-effect profiles.
Recognising rashes in babies
Mark Griffiths and Annette Loffeld
pp 8-10
Rashes in babies cause considerable concern among parents and healthcare professionals. They are very common and may be the primary reason for consultation or an incidental finding. Many rashes are physiological, marking the transition from the womb to the outside world, or reflecting the immaturity of the skin appendages or vascular physiology. In these cases, reassurance is usually all that is necessary. There are a number of rashes that reflect skin or internal pathology and, in these cases, further investigation and treatment may be required. Correct identification is a vital tool for healthcare professionals.
Anaphylaxis and angioedema: part 1 – causes and diagnosis
Gavin P Spickett
pp 12-15
Anaphylaxis represents the most severe form of immediate allergic reaction and is due to the presence of immunoglobulin E (IgE) antibodies (type I hypersensitivity). Angioedema refers to localised deep tissue swelling and can occur as part of an anaphylactic reaction. This two-part article will cover causes and diagnosis of anaphylaxis and angioedema (part 1) and management of both conditions (part 2, to be published in Dermatology in practice 17.4).
Choosing a dermatoscope made easy
Jonathan Bowling
pp 18-20
Skin lesion diagnosis is not without its pitfalls, due to the myriad of ways in which skin lesions can present. Dermatologists undertake extensive training to identify subtle clinical features. However, absolute diagnostic features are often lacking. When this is the case, the use of simple, hand-held dermoscopy instruments can be of enormous benefit. The benefit is twofold; first, a greater diagnostic accuracy is achieved; second, fewer unnecessary surgical procedures are performed and more benign lesions are left in situ, thus helping make better use of our scarce resources and improving the standard of care.
A practical approach to using methotrexate
Sivanie Vivehanantha and Neill Hepburn
pp 22-25
Methotrexate is an antimetabolite that was first introduced as an anticancer drug. Due to its anti-inflammatory properties, it is now used – in much lower doses – for the treatment of joint, bowel and skin conditions. In dermatology, low-dose methotrexate is most commonly used to treat psoriasis that has not responded to topical treatments or phototherapy. It is also useful as a steroid sparing agent in bullous pemphigoid, pemphigus, sarcoidosis, dermatomyositis and the vasculitides. Recently, it has been used in morphoea and in mycosis fungoides.
Key information on safe sun and vitamin D

pp 26-26
The National Osteoporosis Society (NOS) and the British Association of Dermatologists (BAD) have issued a statement about safe sun and vitamin D. ‘In the UK, people should try to get outdoors for ten minutes once or twice a day without sunscreen, which blocks the manufacture of vitamin D. If you are at high risk of skin cancer, you should obtain your vitamin D from diet and supplements rather than by further increasing your skin cancer risk.
Enhancing dermatology teaching and learning: part 2
Jonathan MR Goulding and Vinod Patel
pp 28-30
This is the second of a two-part article on teaching and learning in dermatology. Having first reviewed principles of educational theory, the article now offers tips on incorporating these to improve ‘on the job’ teaching, as well as advice on delivering an effective presentation and ways to optimise lectures and small-group teaching.
Monk's moments: Sunny days
Barry Monk
pp 31-31
I write this piece as the sun beats down from a cloudless midsummer sky. Faced with an endlessly rising demand for healthcare competing with a limited budget, the new Secretary of State for Health, Andy Burnham (the sixth health minister since Labour came to power in 1997), has recently announced that the NHS will, in future, give much greater priority to preventive medicine. Noble though this sentiment is, the harsh reality is that preventive medicine takes a long time to reap its rewards.