Dermatology in practice - 2014

Comment: A modern dermatologist
Neill Hepburn
pp 3-3
In many ways it’s an exciting time to be practicing dermatology. First immunosuppressive medications, and now the biological revolution, have transformed, and continue to improve, our management of patients with inflammatory disease. In the biologics clinic this afternoon, patients, many of who have been ‘old friends’ for years (and for whom I had little new to offer to them for years), came along exhibiting almost normal skin. Nearly all these patients are enrolled in monitoring studies to document the safety and efficacy of their treatment. We chatted about how things have changed.
Management of cutaneous squamous cell carcinoma - could we do better?
Helen M Cordey and Andrew Affleck
pp 4-9
Cutaneous squamous cell carcinoma (cSCC) is the second most common type of skin cancer and it is increasing in incidence worldwide. As with its much more common ‘cousin’, basal cell carcinoma (BCC), tumours arise in keratinocytes, so both cancers are often lumped together as ‘non-melanoma’ or ‘keratinocytic’ skin cancer. However, it is desirable to distinguish the two types clinically to facilitate optimum management, as their biological behaviour may differ. Most cSCCs are classified as carrying ‘low or no risk’ of metastatic disease,but a small subgroup of patients are at ‘high risk’ and deaths do occur. The overall rate of metastasis is less than 5%, but the five-year survival is poor in the subset of patients who do develop distant metastases. In the majority of cases, patients with cSCC initially present to their GP. Knowledge of the clinical features and high-risk characteristics of cSCC is, therefore, invaluable for GPs, who have an important role to play in detecting these sometimes difficult to diagnose tumours, and in referring patients for appropriate and timely management.
How to approach flexural psoriasis
Janika Borg and David Burden
pp 10-14
Flexural psoriasis is a variant of psoriasis that affects the intertriginous areas of the skin, namely the axillae and the inframammary skin, the retroauricular area, the periumbilical area, the intergluteal cleft and the inguinal creases. It is thought that between 3% and 12% of patients with psoriasis have flexural involvement. Flexural psoriasis may coexist with psoriasis elsewhere on the skin, most commonly chronic plaque psoriasis; however, involvement may be solely flexural, in which case the term ‘inverse psoriasis’ is sometimes used. It often coexists with psoriasis affecting the genital skin. The flexural areas may also be involved as part of generalised pustular psoriasis, a less common type of psoriasis which is characterised by widespread pustules on a background of erythematous, tender skin. Flexural involvement is particularly common in infants and young children, and in fact a significant proportion of those diagnosed with napkin seborrhoeic dermatitis go on to develop psoriasis later on in life.
Common problems with tattoos - an overview
Victoria Scott-Lang
pp 18-21
Tattooing in the 21st century is a big business, with an estimated one in five of the British population having a tattoo, as well as millions of individuals worldwide. There are over 1,500 registered parlours across the UK, not including unlicensed tattoo artists. Tattooing is now deeply ingrained in mainstream popular culture.
Uncompromising excellence
Barry Monk
pp 22-22
Unless you are a collector of obscure medical eponyms (Plummer’s nails, Plummer–Vinson syndrome), you have almost certainly never heard of Dr Henry Plummer (1874–1936), and that’s a pity, because he is one of the most important people in 20th-century medicine and we have a lot to learn from him.