Dermatology in practice - 2014


Comment: Further thoughts for modern dermatologists
Neill Hepburn
pp 3-3
Last week I attended the Annual UK Dermatology Course for Consultants, which took place in London. It was the first time I had attended since giving a talk about fifteen years ago on dermatological problems in the returning traveller – something I was familiar with at the time, having only recently left the Army. The course provided a good general update, covering a broad range of topics in a practical way, with some humour added in. In many ways it mirrored Dermatology in practice – although our readership is more diverse – featuring topics such as body image in dermatology, and thalidomide, which also feature in this issue.
Thalidomide: what you need to know
Agnes I Otto and Neill Hepburn
pp 4-6
Thalidomide was first introduced to the market as a sedative and anti-emetic for use in pregnancy in the 1950s. Distributed as Contergan in 1956, it was a popular over-the-counter product to quell morning sickness. The drug’s approval was delayed in the US after concerns emerged about a potential link between thalidomide and peripheral neuropathy, with its application eventually being refused by the US Food and Drug Administration in 1960. The first published report of the association between thalidomide and phocomelia was in a letter to The Lancet in 1961 by William McBride, an Australian obstetrician. Worldwide, the number of affected infants ranged between 8,000 and 12,000. As a result, thalidomide was withdrawn from the market in the early 1960s.
Food allergy in children with atopic dermatitis
Christina Green
pp 7-10
This article provides a summary of the evidence associating food allergy with atopic dermatitis. It emphasises the value of taking a history that includes symptoms relating to other organs, and highlights the importance of taking a wider view of the mechanisms of food allergy, to include non-immunoglobulin E related food allergy. Training is required to ensure the correct interpretation of test results, and for this reason referral of patients to centres of expertise is encouraged.
Pitfalls in diagnosing melanomas
Marie-Louise Lovgren and Angela Drummond
pp 11-12
With an incidence that is four times higher than it was in the 1970s and still increasing, melanoma is now the fifth most common cancer in the UK, with 13,348 new cases reported in 2011. Between 1995–2009, one third of all legal claims in England relating to dermatology pertained to misdiagnosis, and of these, three-quarters were related to skin cancer. The accuracy of clinical diagnosis ranges from 29% to 88%, and is dependent on the experience of the dermatologist. For instance, GPs may only see a malignant melanoma once every five years, some even less frequently, and are therefore less likely to make an accurate diagnosis. In the UK, the single most common reason for patients to visit their doctor is skin disease, and yet it is rare for medical students to receive more than ten days of dermatology teaching, even less at post-graduate level.
Body image concern in dermatology – could we do better? Part 1
Inge M Kreuser-Genis, Reena B Shah and Andrew Affleck
pp 14-18
Most of us are familiar with the following situation: a patient is sitting in front of you, extremely distressed by an aspect of their skin. You find yourself straining to see what exactly it is they see, while starting to feel slightly unsympathetic in your busy clinic. Welcome to the concept of body image concern.
A lot to answer for
Barry Monk
pp 19-19
One of my former bosses, a man of Czech ancestry, once said to me ‘A Hungarian is the only person who can go into a revolving door behind you and come out in front’. I can only imagine that the residents of a country that has been through so many invasions and revolutions over the years must have a certain spirit of ingenuity. Erno Rubik, the mathematician who developed his eponymous cube was a Hungarian, as was a newspaper editor called Laszlo Biro. Biro was fed up with his leaky fountain pen and smudged writing, so with his brother, an industrial chemist, he looked for a solution, and came up with the ballpoint.