Dermatology in practice - 2016


Comment: Can't wait to sizzle in the summer sun? ...Think again!
Neill Hepburn
pp 59-59
The summer is always a busy time in dermatology clinics – it’s as if people take their clothes off and get a shock at what they see! Consequently, we need to run additional clinics, not only to compensate for holidays, but also to deal with the sudden increase in ‘two week wait’ referrals. Dermoscopy is a great help, however, the images are so unlike the naked eye appearances of lesions, getting up to speed is like learning dermatology all over again. I like to try to understand the reason for appearances – hence histology has always fascinated me. Rakesh Anand’s article on histopathological correlations with dermoscopic structures, helped me interpret what I see through the dermoscope.
Childhood nail disorders
Sarah Hughes & Anita Takwale
pp 60-65
Nail conditions are estimated to affect 3–11% of the paediatric population. A wide variety are encountered in general practice and, although they may cause parental concern, most are benign. However, some nail disorders, such as nail–patella syndrome, may be linked with systemic disease.
Histopathological correlation with dermoscopic structures
Rakesh Lal Anand, Mark Wilsher & Ben Esdaile
pp 66-70
With the incidence of skin malignancies increasing worldwide, dermoscopy provides a useful tool to aid clinical diagnosis. Dermoscopy allows visualisation of structures and colours not visible to the naked eye. These structures can be correlated to specific histopathological features, which can aid diagnosis. This article aims to provide an overview of the main dermoscopic colours and structures with their associated histopathological correlates, in order to guide clinical management and improve diagnostic accuracy.
Bleach baths for atopic dermatitis
Arvin Chandran, Nicola Housam & Krisztina Scharrer
pp 72-73
Atopic dermatitis (eczema) is a common, chronic, relapsing itchy, inflammatory skin disease. It is characterised by abnormalities in skin barrier structures, an exaggerated immune response to environmental antigens, defects in innate immunity and alteration in skin flora. This can result in increased susceptibility to bacterial, fungal and viral infections. Clinically, infected (impetiginised) eczema is erythematous, pustular, exudative, crusted and spreads rapidly. Overgrowth of Staphylococcus aureus is an important contributing factor to exacerbations of eczema, independent of true secondary infection. With this in mind, clinicians are increasingly recommending antiseptic treatments, including diluted bleach baths, for decolonisation therapy. Bleach baths are recommended by the American Academy of Dermatology and National Eczema Association as an adjunct to the treatment of severe eczema with recurrent infections4 and interest in this therapy is now increasing around the world.
Don't let the bed bugs bite!
Ian Burgess
pp 74-77
Bed bugs are the household pests of our time. They secret themselves among furnishings, lurking in the areas where we sleep and emerge in the dark to take large blood meals that result in a sensitivity reaction. Some people can develop severe pathological responses to components of bug saliva, which can be exacerbated by regular exposure.
Facial hyper pigmentation in darker skin types
Harini Rajgopal Bala & Michelle Rodrigues
pp 79-82
Disorders of hyperpigmentation are generally more prevalent in those with darker skin, with facial pigmentation cited as one of the most common presenting complaints in this population. A wide range of conditions may result in facial hyperpigmentation and these may be associated with significant psychological distress. While some general measures are useful for all hyperpigmentary conditions, specific treatments vary according to the underlying cause, and the patient’s skin phototype and preference. Despite the plethora of medical and physical therapies available for hyperpigmentation, it remains a challenging condition to treat. A thorough understanding of the common causes of facial pigmentation and the complex presentations in patients with darker skin will help to care for patients, both holistically and effectively.
PCDS
Dr Julian Pearce
pp 82-82
We live in uncertain times; the events of the 23rd June may have long reaching implications for us all and the way we work in the future. In the space of a few short hours, things that we previously held to be self-evident must now be questioned and things that once seemed certain, became obscure. In the midst of this potential chaos, we need points of stability to guide us through the choppy waters ahead. I would like to think, that when it comes to dermatology education, the PCDS can provide a steady hand on the tiller as we steam onwards to ‘the undiscovered country’.
Facing the great white shark
Barry Monk
pp 83-83
Last winter, I fulfilled a long-held ambition to travel to Cape Town and watch England play cricket at the beautiful Newlands ground. The captain of the South African team, AB de Villiers, is an iconic figure in a sports mad country, and widely regarded as the best cricketer in the world! Such is his fame that he is simply called “AB”, and he did not let his supporters down, scoring a splendid match-winning century.