Dermatology in practice - 2012

Comment: Dermatology in changing times
Neill Hepburn
pp 3-3
The three infamous ancient Chinese proverbs often come to my mind. May you live in interesting times. May you come to the attention of those in authority. May you find what you are looking for. The pace of change in the NHS seems to ever quicken; no sooner are one set of reforms set in motion, than another are set upon us. Of course, it is the same story throughout the public sector – just ask any teacher or local government officer.
An update on sunscreens
Robert Dawe
pp 4-7
For the purposes of this article, sunscreen is a substance applied to the human skin to reduce transmission of components of the solar spectrum. What are the uses of such a sunscreen? One purpose, and a use a doctor may recommend a sunscreen for, is to minimise the damaging effects of sunlight (photoprotection). Another purpose, and one that is still a major use of sunscreens, is to avoid the discomfort of sunburn (a damaging effect) to allow greater sunlight exposure. This is sometimes done, but not always, with the purpose of attaining a tan (another marker of damage), which in some cultures is considered desirable.
The genetics of skin cancer
Veronique Bataille
pp 8-10
Like all cancers, melanoma can cluster in some families, with 10% of melanoma cases reporting a family history. The hunt for melanoma genes started in the early nineties, when it was observed that many melanomas lost similar chromosomal regions. This article describes progress in our understanding of the genetics of melanoma.
Monk's moments: Home from home
Barry Monk
pp 11-11
‘Care closer to home’ is one of the latest brainwaves dreamed up by the Department of Health; in-so-far as I understand it, it is all about keeping patients away from hospital specialists who, it is feared, might spend money on expensive investigations and treatments. In fact, I have, not for the first time, beaten them to it. On my very first day as a consultant in October 1987, I was asked by a GP to see a patient as a domiciliary case. A domiciliary visit (DV) was not something that had ever formed part of my training as a senior registrar, and I made a slightly inauspicious start by knocking on the door of the wrong house.
The PASI score: how to measure it and what it tells us
Mark Griffiths and Helen Lewis
pp 12-13
The Psoriasis Area and Severity Index (PASI) was created in 1978 by Fredriksson and Pettersson. It is a measure of overt redness, thickness (induration) and scaliness of the psoriatic plaques weighted by the area of involvement. A low score generally indicates mild psoriasis. The PASI score is designed for patients with plaque psoriasis, so it is not useful for either palmoplantar or pustular psoriasis.
How to use potassium permanganate soaks
Ian Coulson
pp 14-15
Potassium permanganate solution is a ‘desert island drug’ for the dermatologist; it is cheap, for the right condition it relieves symptoms rapidly and nothing else works quite like it. It is invaluable for drying up weepy exudative conditions, such as acute eczema, pompholyx, leg ulcers and pemphigoid. Infected eczema that oozes and sticks to clothing is demoralising and a couple of days of permanganate soaks, as part of a therapeutic approach, can greatly improve quality of life. This article aims to guide healthcare professionals and patients alike in the application of permanganate soaks.
Diagnosis and treatment of cutaneous leishmaniasis
Mahreen Ameen
pp 16-18
Leishmaniasis is a major tropical infection, which is endemic in more than 80 countries. Its global incidence is rising and it is emerging in previously unaffected geographical regions. In the UK, it is an increasingly significant problem in migrants, as well as in travellers and military personnel returning from endemic regions.