Dermatology in practice - 2009


Comment: Poor swines, mad cows and headless chickens
Neil H Cox
pp 3-3
Those of my vintage and varied musical tastes (remember ‘Poor Swine’ by Kevin Coyne?) may think I’m in the 70s again, but I’m sitting in a state of some disbelief, watching emails cascade down from ‘the centre’ regarding the swine flu pandemic alert, with the first two cases confirmed 100 miles north from here (phew, westerly wind today).
What is new in methotrexate for psoriasis?
Claire Martyn-Simmons and Catherine Smith
pp 4-7
Psoriasis is a chronic, immune-mediated inflammatory skin disease that affects approximately 2–3% of the world’s population. For many patients, it is a lifelong condition; 20–30% of patients will have severe psoriasis and will often require systemic therapy to achieve disease control. Methotrexate was first introduced as a treatment for psoriasis over 50 years ago and, in spite of the development of many new biological treatments, it remains the gold standard systemic therapy for psoriasis in Europe.
P-phenylenediamine: the usual suspect
Melissa Williams and John English
pp 8-10
The practice of colouring hair dates back to before the Middle Ages. The main agents used of old were natural vegetable extracts, but those are hardly used any more, whether in home hair dye kits or in hair dyes applied by professionals. For the last 100 years or so, p-phenylenediamine (PPD) has been the main agent used in permanent and semi-permanent hair dyes. It has a number of properties that make it a far more effective hair dye than other agents. However, it is also an important allergen.
A practical approach to using ciclosporin
Neill Hepburn
pp 13-15
Ciclosporin is an immunosuppressant drug used in dermatology to treat patients with severe or recalcitrant psoriasis, or with severe atopic eczema. It has important adverse effects, particularly on the kidneys, so careful counselling and monitoring are required. Ciclosporin was discovered in 1970 during a search for antifungal agents, and was found to have potent immunosuppressive properties. In the 1980s, it was licensed to prevent organ rejection following transplantation. Its beneficial effects on patients with psoriasis were found fortuitously. It has since been used to treat many immunologically mediated conditions.
Enhancing dermatology teaching and learning: part 1
Jonathan MR Goulding and Vinod Patel
pp 18-20
The teaching and training of students, doctors and other members of the multidisciplinary team is a major tenet of the General Medical Council’s ‘Good Medical Practice’. Its significance lies in the fact that effective teaching and learning has a direct impact on the quality of care received by patients. Through the course of a two-part article, we aim to illustrate how teaching and learning in dermatology may be enhanced. In this first part, we review relevant principles of educational theory underpinning teaching and learning in practice.
Rheumatological conditions: manifestations in the skin
Anne-Marie Skellett and Clive Grattan
pp 21-26
This review discusses the most common cutaneous features associated with rheumatological conditions, and their management. The term ‘lupus erythemateaux’ was first used by Cazenave in the mid-1800s to differentiate cutaneous lupus from lupus vulgaris (cutaneous tuberculosis). It was not until 1964 that the concept of lupus as a spectrum – from cutaneous lesions only, to life-threatening internal disease – was recognised by Dubois and Gilliam.
How to deal with herpes simplex virus infections
Firas Al Niaimi, Neil H Cox and Belinda Stanley
pp 27-30
Herpes simplex virus (HSV) is one of eight human herpes viruses. HSV occurs worldwide, in both sexes and all age groups. Herpes viruses establish lifelong latency. Once infection has occurred, they cannot be eradicated. HSV infections may reactivate, spontaneously or with identifiable triggers. HSV occurs as two subtypes, HSV1 and HSV2. The term ‘primary infection’ is used to describe infection with either subtype of HSV for the first time; infection with one subtype in an individual previously infected with the other subtype is termed ‘non-primary, first episode disease’.
Monk's moments: Take it slowly
Barry Monk
pp 31-31
The Prime Minister, Gordon Brown, has said that he wants the NHS to provide more personalised care. It is a laudable intention, yet the paradox is that, in reality, we are being forced to see patients faster and faster and to provide care that is increasingly impersonal. Under the ‘Choose and Book’ system, patients can no longer see the consultant of their choice and, in hospitals, we are put under immense pressure to send patients back to primary care, rather than follow them up.