Dermatology in practice - 2009

Comment: Mandatory or madness?
Neil H Cox
pp 3-3
I thought I might share my predictions for the NHS. What NHS, do I hear? Quite right, the whole thing is going bonkers. The process by which everything cascades down to somebody with an increasingly narrow range of skills will probably mean that my cat will be learning to do hernias soon. But the collapse could come earlier than anticipated, as mandatory and ‘expected’ training courses combine with appraisal / reaccreditation / revalidation, and any time left for patients finally falls by the wayside.
Assessing the growing range of therapies for psoriasis
Mark Goodfield and Sameh Zaghloul
pp 4-8
Psoriasis is a common disorder that can begin at any age, although it most commonly appears for the first time between the ages of 15 and 25, with a second peak of incidence in middle age. It is a lifelong inflammatory disease, with spontaneous remissions and exacerbations. This article reviews the increasing range of treatment options: topical therapies, phototherapy and systemic therapies (non-biological and biological).
Patterns of drug-induced cutaneous eruptions: part 2
Firas Al Niaimi and Neil H Cox
pp 10-15
This is the second part of an article on drug eruptions. Part 1 (Dermatology in practice 16.4) covered the most common patterns. Part 2 discusses less common patterns, eruptions that may resemble sporadic, non-drug-related dermatoses, and more severe types of drug eruptions.
Recognising common skin lesions in children
Annette Loffeld and Mark Griffiths
pp 18-20
The identification of common skin lesions is an invaluable tool for healthcare professionals working with children, allowing for appropriate counselling and, where necessary, further management. The vast majority of paediatric skin lesions are benign but, occasionally, malignant lesions do occur. In this article, we consider the most common childhood skin lesions.
Managing lentigo maligna
David J Eedy
pp 21-23
Lentigo maligna (LM) most commonly presents in chronically sun-exposed areas in the middle-aged and elderly. Historically known by the eponym ‘Hutchinson’s melanocytic freckle’, LM presents as an often ill-defined, centrifugally expanding tan or dark brown area, usually on the face. With time, the lesion may acquire an invasive dermal component, and must then be reclassified as a lentigo maligna melanoma (LMM), which is estimated as representing some 15% of invasive melanomas.
UK dermatological surgery: how a specialty came of age
Samantha Hann and Richard Motley
pp 24-25
Thirty years ago, in the UK, dermatological surgery was spoken of in hushed tones among small gatherings of enthusiastic dermatologists. Many who had attended the meetings of the American Academy of Dermatology (AAD) were aware of the increasing role that surgery was playing in the USA, and some had taken part in US surgical workshops. In 1983, a group of British dermatologists – including Stan Comaish, Mike Dahl, Rodney Dawber, Peter Kersey, Cliff Lawrence and Peter Holt – formed the British Dermatological Surgery Group (BDSG) – later to become the British Society for Dermatological Surgery (BSDS).
What thyroid disease can do to the skin, hair and nails
Iaisha Ali
pp 26-27
Thyroid hormone is required by all metabolically active cells and, therefore, thyroid disease has widespread effects on all organ systems. The skin, hair and nails are no exception and thyroid disease can manifest itself in various guises. Hypothyroidism is the most common pathological hormone deficiency in humans. The incidence of hypothyroidism increases with age and it is more common in women; the largest epidemiological study in the UK showed a prevalence rate of 1.9% in the female population and 0.2% in males.
A guide to cutaneous horns and their basal pathologies
Robert Radcliffe and Sandeep Varma
pp 28-30
People growing horns: it sounds, at first reading, like something out of a science fiction book. However, ‘cutaneous horn’ is a term used to describe a clinical sign. As we shall see, that sign may be associated with a number of different dermatological conditions. At the base of a cutaneous horn can be found a range of pathologies. These may be benign, premalignant or frankly malignant. In this article, we describe the clinical features and pathophysiology of cutaneous horns, before considering diagnosis of the base pathologies, factors associated with a higher risk of basal malignancy and management.
Monk's moments: Here we go round the mulberry bush
Barry Monk
pp 31-31
One of the most useful functions of hospital outpatient clinics, and one perhaps least understood by managers and health planners, is the informal networking that goes on between consultants in different specialties. At various times of the week, I have outpatient clinics in neighbouring consulting rooms to rheumatologists, haematologists, urologists, and so on. We are able, on an ad hoc basis, to discuss clinical problems and to learn from each other.