Dermatology in practice - 2012

Comment: Continuing the learning curve
Neill Hepburn
pp 3-3
I still feel nervous when asked to see neonates on the postnatal wards. Over 20 years ago, as a newly appointed Senior Registrar in Edinburgh, I was asked to come to see a newborn with blisters, on a Saturday afternoon. With thoughts of rare blistering conditions, such as epidermolysis bullosa (EB), on my mind, as I cycled into The Royal Infirmary of Edinburgh, I firmly counselled myself to remember more common conditions, such as bullous impetigo. When I saw the child I felt unsure, but, with more confidence than I felt, I took swabs for bacteriology and prescribed flucloxacillin. I promised to come back on Monday. You can imagine my consternation when the mother asked me if it might be EB!
Epidermolysis bullosa in childhood
Ruth Ward
pp 4-8
This article aims to give an overview of the presentation, complications and management of epidermolysis bullosa (EB), a distressing, fragile skin condition seen in childhood. EB is a complex genetic condition that requires input from a variety of disciplines, including dermatology, paediatrics, dental practice, ophthalmology, dietetics, physiotherapy, psychology and social services. In the UK there is a unified national service, funded by the National Specialised Commissioning Group and supported by the charity DEBRA.
Diagnosis and treatment of nodular prurigo
Natasha Harper and Neill Hepburn
pp 9-10
Nodular prurigo, also known as prurigo nodularis, is a distressing, chronic condition characterised by intensely itchy nodules. It can be very difficult to manage effectively and causes frustration for both patients and doctors.
Running a wart clinic – warts and all
Brian Malcolm
pp 12-15
When my patients used to come to me for advice about warts, I used to jokingly say that when I was young they were potentially fatal. Once they had recovered from the shock, I would explain that when I was at school you would be inspected before entering the swimming pool and, if warts were detected, you would not be allowed to swim. Hence, you never learned to swim, so your risk of drowning in later life increased. Needless to say, you have to select those of your patients whom you know to have a sense of humour.
Monk's moments: Chance observation
Barry Monk
pp 16-16
The development by Sir James Black of the betablocker propranolol, in the early 1960s, was a remarkable achievement. Not only did it result in what was to become, at one time, the world’s topselling drug, but it changed the way in which new pharmaceutical agents were developed. Whereas up until this point, drugs had been developed by a trial and error approach, here, for the first time, a molecule had been designed with a structure intended to produce a specific effect on receptors in the body.
Dealing with head lice
Ian Burgess
pp 17-19
Unlike many other countries, it is relatively rare for dermatologists in the UK to be confronted with a case of head louse infestation, unless it has specifically been referred because other practitioners have failed to deal with it or there are complications arising from it. However, knowing what to do, if asked, is difficult in a field that has changed more rapidly in the past decade than during the previous 50 years. Head lice have not, themselves, changed, but human activity has influenced their epidemiology in various ways that seem to have made management more difficult.