Dermatology in practice - 2013


Comment: A problem shared ...
Neill Hepburn
pp 3-3
When I came to work in Lincolnshire 16 years ago, initially as a single-handed consultant, I had two principal concerns. First, what would I do when I did not know the diagnosis? Second, how I would cope with those patients with chronic, intractable dermatoses – patients with nodular prurigo, palmoplanter pustulosis, difficult atopic eczema, or severe psoriasis? I felt much better about the first group after recalling the kind and wise words of the great Dr John Savin, who taught me as a Senior Registrar in Edinburgh. I had just finished my final dermatology clinic before leaving to become a consultant. I, somewhat ruefully, remarked, ‘I’ve just done my last clinic and I haven’t got a clue what was wrong with four of the patients’. Dr Savin responded along the lines of, ‘Don’t worry, I’ve been doing dermatology for over 30 years and it keeps happening to me – that’s the fascination of dermatology!’
Hydroxychloroquine use in treating skin diseases
Rubeta Matin and Sheru George
pp 4-8
Antimalarials are used by dermatologists to treat various skin conditions. Since the 1950s, the 4-aminoquinolone derivative of quinine, hydroxychloroquine, has been widely used in dermatology, in preference to chloroquine. Compared with other immunosuppressant medications used to treat inflammatory skin conditions, hydroxychloroquine is considered safer with a more favourable side-effect profile. This article aims to summarise the uses and adverse effects of hydroxychloroquine and the monitoring of dermatological patients prescribed the drug.
Limitations of systemic therapies for psoriasis
Brian Kirby and Aisling Ryan
pp 10-15
Psoriasis is a common inflammatory and proliferative dermatosis, with a prevalence of 1–3% in most ethnic groups. It is a chronic disease of variable severity and can cause considerable physical and psychosocial morbidity. Its impact on health-related quality of life is comparable to that of other major medical illnesses.
Sofa dermatitis – the rise and fall of an allergen
Helen Horne
pp 16-17
An outbreak of contact dermatitis can be exciting and challenging to investigate. Occasionally, a series of cases involving sensitisation to a particular allergen emerges. One such outbreak occurred in 2006. This short article sets out the story of how the problem arose, and how, with good communication and international collaboration between centres investigating contact dermatitis, the cause was identified and the problem largely eliminated.
Monk's moments: Going like a bomb
Barry Monk
pp 18-18
On my first day as a clinical medical student, more years ago than I care to remember, I attended a lecture given by a distinguished psychiatrist. He explained to us that our career choices as doctors were psychologically predetermined. Orthopaedic surgeons, for example, were little boys who did not wish to grow up and who wanted to spend their lives playing with Meccano®. General surgeons, he explained, had psychopathic personalities, apparently ready to rip open people's abdomens and pull out their entrails at the drop of a hat.
Fatal lichenoid drug eruption after proton pump inhibitor therapy
Anjali Mahto and Bernadette De Silva
pp 20-20
This case discusses a patient who developed a severe lichenoid drug eruption following treatment with the proton pump inhibitors lansoprazole, omeprazole and esomeprazole. A 78-year-old lady, previously of good health, was admitted with a four-month history of a widespread pruritic rash. Initially, she had been started on lansoprazole for dyspepsia, but developed a rash several days later. Lansoprazole was discontinued and the patient was switched to omeprazole.
New technologies to aid in the diagnosis of malignant melanoma
Per Hall and Charles Hall
pp 21-27
In primary care, it is becoming increasingly important to be able to recognise malignant melanoma at an early stage. The earlier it is diagnosed, the better the prognosis. In 2008, there were 11,767 new diagnoses of melanoma in the UK, and its prevalence currently stands at one in 61 males and one in 60 females. In the same year there were 2,070 deaths due to melanoma. The National Institute for Health and Clinical Excellence recommends that any pigmented lesion, which cannot be diagnosed with certainty as benign, should be referred under the two-week wait protocol to an expert for urgent assessment.