Dermatology in practice - 2013


Comment: The place for dermatology
Neill Hepburn
pp 3-3
Last month I had to present the United Lincolnshire Hospitals NHS Trust’s mortality data and action plan at a ‘mortality summit’ with our clinical commissioning group partners and the local area team from NHS England. As a dermatologist, whose specialty is generally regarded as somewhat less than acute, I felt uncomfortable. I recalled the aphorism, ‘skin patients never die, but nor do they get better!’. Of course, our work has changed greatly over the past 20 years; the increasing prevalence of melanoma and the widespread adoption of immunomodulatory treatments ensure we do look after patients in their final months of life and many of our patients do ‘get better’.
Hyperhidrosis - how to help our patients
Julie Halford and Neill Hepburn
pp 4-9
Sweating is essential to maintain normal body temperature. It is controlled by the sympathetic nervous system, although the nerves involved actually use acetylcholine as the neurotransmitter, acting on the eccrine glands. A normal adult can produce over 0.5 l of sweat per hour, although acclimatised individuals in a hot environment can produce up to 3–4 l per hour. Hyperhidrosis is a distressing problem that can have a devastating effect on sufferers’ lives. It is probably best defined as perspiration in excess of the physiological amount necessary to maintain thermal homeostasis.
Does dermatology have a place in secondary care?
Julia K Schofield
pp 10-13
These are challenging times in the NHS – structurally and financially. The reforms outlined in the Health and Social Care Act 2012 are being implemented rapidly. This is at a time when cost savings are high on the agenda of commissioners and providers of care, despite the emphasis placed on delivering high-quality, patient-centred care. The changes will see more competition in the NHS marketplace, so clarity of which services sit best where, and for what reasons, would be helpful to inform the new clinical commissioning groups. This article considers the specific issues relating to the configuration of dermatology services and, in particular, the question of whether dermatology has a place in secondary care. Before answering this question, consideration will be given to the meaning of ‘secondary care’ and ‘dermatology’.
Dealing with artefactual skin disorders
Alia Ahmed, Reena Shah and Anthony Bewley
pp 14-16
Dermatitis artefacta (DA) is a factitious skin disorder, which often occurs as a response to traumatic life events (such as physical/sexual abuse as a child or adult, or bereavement), or as a behaviour that may result in secondary gain (for example, financial reward or attention from others). Less often, it is the result of a dissociated state. Patients will create skin lesions themselves and then deny having done so. It is notoriously difficult to engage these patients with health services. DA is recognised in the Diagnostic and Statistical Manual of Mental Disorders (4th edn) as a mental health disorder, under the label of ‘factitious disorder’.
Monk's moments: The sad death of the post-mortem
Barry Monk
pp 18-18
I recently asked a group of final year medical students how many post-mortem examinations they had seen during their student years. The answers varied between none and one, and most seemed surprised that I even asked the question. Their experience could not have been more different from my own, now rather distant days at Westminster Medical School (itself now sadly also deceased). Every day, promptly at 1.30 pm, one was expected to attend the Department of Pathology. The Professor of Medicine and senior consultants would all be there, along with housemen and students.
The dermal anchor - an evolving trend
Andrew Atkinson, Romeo Lucas and Charles Hux
pp 19-21
Andrew Atkinson MD Resident Physician Romeo Lucas DO Resident Physician Charles Hux MD Perinatologist, Jersey Shore University Medical Center, New Jersey, USA A 22-year-old, morbidly obese Caucasian female, who was 38 weeks pregnant, presented to the emergency room with complaints of sudden onset of diffuse abdominal pain accompanied by nausea and vomiting. This was the patient’s first pregnancy and her prenatal course had been uncomplicated thus far. The patient denied any medical or surgical history, she was given intravenous hydration and labs were drawn. When the labs returned, the diagnosis of acute pancreatitis was made, as evidenced by an amylase of 2,188 u/l and a lipase of 3,154 u/l with all other labs within normal limits. At that point, the patient was sent to have a right upper quadrant ultrasound to rule out gallstone pancreatitis.
PCDS Spring Meeting 2013
Stephen Hayes
pp 22-22
The 2013 Primary Care Dermatology Society Spring Meeting (PCDS) was held in Manchester on 16–17 March. The meeting was addressed by Professors Giuseppe Argenziano and Iris Zalaudek. An alternative programme was held in the morning and also well attended. Resident PCDS surgical trainer Dr Christy Chou led a practical skin surgery workshop. In the dermoscopy masterclass, Professor Argenziano reminded us of the need to put the clinical and dermoscopic pictures together. He gave us seven rules to avoid missing melanomas.