Dermatology in practice - 2015


Comment: Maintaining a relevant skill set
Neill Hepburn
pp 47-47
I am writing this comment in my study, looking out of the window as the (much needed) rain falls on the garden where, until an hour ago, I had been toiling away. Despite the many dermatological hazards associated with gardening, it remains one of my pleasures. I don’t know much about the plants, trees and wildlife; but I do appreciate them.
Antimalarials: A practical guide for dermatologists
Felicity Ferguson and Ian H Coulson
pp 48-52
Quinine is an alkaloid derived from the bark of several species of the South American Cinchona tree. The bark was initially used for its antipyretic effects, but by the beginning of the 19th century, quinine was becoming popular as an antimalarial agent. Antimalarials are believed to have been first used in dermatology by Payne in 1894, when he attempted treatment of discoid lupus erythematosus with quinine. World War I prompted large scale synthesis of antimalarials, including mepacrine (1930), chloroquine (1934) and hydroxychloroquine (1946). These three drugs are the most common antimalarial agents used in current dermatology practice.
When nappy rash is more than just a sore subject
Natalia M Spierings, Manuraj Singh and Naomi Goldstraw
pp 54-57
Nappy rash is extremely common; virtually every baby will experience this unsightly, sore skin eruption at least once. The skin of a baby is delicate and, when exposed to the corrosive compounds found in urine and stool, even for a brief period, it can become inflamed and break down. Most babies with nappy rash never present to a GP, but occasionally the rash does not clear with conventional over the counter remedies. At this point, it is important for the GP to consider a differential diagnosis to account for other ailments beyond just simple nappy rash.
An introduction to vulvar dermatoses
Ying Teo and Sarah Walsh
pp 60-62
Diagnosing vulvar dermatoses can be challenging as changes can be subtle and present significantly differently from elsewhere on the skin. Classifying clinical signs by morphology can guide the diagnostic process. Here, we discuss common vulvar dermatoses and the approaches to management.
HLRCC – A patient’s perspective
Antony Horton
pp 63-63
In September 2011, I paid a routine visit to a dermatologist at the Beth Israel Medical Centre, New York City, for a general consultation on a skin condition that had affected me for several years. Having had numerous unsightly and sometimes painful ‘skin-bumps’ removed over many years, this visit did not seem particularly special. I was previously told that these ‘skin-bumps’ were actually called ‘leiomyomas’ and took the form of a benign tumour of smooth muscle cells, originating from within the erector-pili of hair follicles. On this particular occasion, my dermatologist took a more detailed family history and flagged up something I was not previously aware of, a condition called ‘Reed’s syndrome’. This condition is also referred to by the more descriptive terms: multiple cutaneous and uterine leiomyomas and hereditary leiomyomatosis and renal cell cancer.
Practical tips: Assessing lesions and learning aids
Lucia Pozo-Garcia
pp 64-67
Dermoscopy is a useful diagnostic tool, based on illumination and skin magnification, which forms part of the routine of dermatological examination. It should not be used in isolation, but rather to complement a detailed clinical history and examination. This article outlines a simple approach to help the novice get started and suggests some learning resources.
GPwSIs and credentialing: A pilot project
Julia K Schofield
pp 68-70
The delivery of community and intermediate dermatology services by General Practitioners with a Special Interest (GPwSI) provides an opportunity to improve access to care for patients with skin conditions. Private providers are often keen to employ GPwSI to deliver care and this is likely to increase with the wider use of ‘Any Qualified Provider’ in the expanding NHS marketplace. Patients receiving care from GPwSI services need to feel reassured that the clinician is competent and accredited to deliver care. This article considers the history and future challenges of GPwSI accreditation in the context of the demise of the Primary Care Trusts, who were previously responsible for this process. A new approach, credentialing, will be described and the results of a recent joint British Association of Dermatology and Royal College of General Practitioners pilot project will be discussed.
Can we afford it?
Barry Monk
pp 71-71
The cost of new drugs is a major issue in the NHS; some of the recently introduced therapeutic agents are eye-wateringly expensive, and this can create challenging situations for those who struggle to do their best for individual patients, while their managers try to keep some sort of overall budgetary control. Dermatology is not immune to this, with important but expensive new treatments for psoriasis, melanoma and basal cell carcinoma.