Dermatology in practice - 2017

Comment: Moves to the community
Neill Hepburn
pp 3-3
The NHS is going through one of its periodic existential crises. How can it meet the ever-increasing demands placed upon it by rising numbers of older people, hugely expensive biological treatments for inflammatory diseases and cancer, and the very high expectations of the population?
Acne in ethnic skin: epidemiology, aetiopathogenesis and clinical manifestations – Part 1
Kiasha Govender and Ncoza C Dlova
pp 4-9
Acne vulgaris remains one of the most prevalent dermatological disorders globally and is the most common skin complaint in patients with ethnic skin. Although the pathogenic factors leading to acne vulgaris are similar in all Fitzpatrick skin phototypes, there are conflicting reports as to whether certain characteristics, such as sebum production and sebaceous gland size, differ in people with ethnic skin. While the same clinical lesions occur in all patients, acne in ethnic skin is associated with a much greater degree of inflammation, even within lesions previously thought of as ‘non- inflammatory’. The heightened inflammatory response, combined with other characteristics of ethnic skin, leads to more persistent hyperpigmentation and severe scarring.
What if we could cut skin cancer death rates in half?
pp 10-12
Skin cancer kills approximately 2,500 people every year in the UK (see Box 1). Moreover, more men than women die of malignant melanoma; men aged 30–34 have a 1.5 fold higher risk of dying compared to similarly aged women, and this rate increases to 1.7 fold for those aged between 55 to 64 years. There is a considerable economic burden on the NHS for treating malignant melanoma; costs were estimated to be over £105 million in 2008 – 2009 and are projected to exceed £180 million by 2020.
Diagnosing syphilis in the 21st century – case studies report
Colm O'Mahony
pp 13-21
Syphilis continues to be a major cause of morbidity throughout the world. Even in developed countries, with good medical care, the incidence of syphilis is rising dramatically, and it is even more worrying that many cases are associated with HIV infection. Public Health England released figures in July 2016 showing that since 2010 the number of cases of syphilis in Londoners had increased by 163%, with a 22% increase in the year from 2014 to 2015. The total number of cases for England in 2015 was 5,042.
Severe plantar presentation of doxorubicin-resistant classical subtype of Kaposi’s sarcoma
Michael Zumwalt and Sharon E Jacob
pp 23-24
An 80-year-old man with a history of HIV negative classic Kaposi’s sarcoma treated with doxorubicin was referred to dermatology for clinical re-evaluation of rapidly growing, painful and intermittently bleeding bilateral lesions of his feet, which were limiting ambulation.
Changing Faces launches free online training module
Changing Faces
pp 24-24
Skin conditions are extremely common. Every year approximately 54% of the UK population experience a skin condition. The most common reasons for seeing a GP are skin infection and eczema. Changing Faces, a charity that supports and represents people with disfigurements, including those caused by dermatological conditions, have found that patients often experience depression, anxiety, embarrassment, lack of confidence, low self-esteem and, in extreme cases, contemplate suicide. They also regularly have to cope with staring, intrusive questions and unhelpful or inappropriate comments.
pp 26-26
Happy New Year! I hope you all enjoyed the festivities and have had a well-earned break from the adverse conditions of the NHS.
Introducing the British Skin Foundation
Matthew Patey
pp 26-26
Established in 1996, the British Skin Foundation was set up to raise money for research into skin disease and skin cancer. Our mission is to find cures and better treatments for all skin conditions. We receive no statutory funding, so fundraising is crucial to our work and has helped us to give out £15,000,000 in grants to top-quality skin research over the past 20 years.
Monk's moments: In distinguished company
Barry Monk
pp 27-27
Occasionally I get nice thank-you cards from grateful patients, but I always find that the most effusive thanks come from those for whom I haven’t really done very much, and that patients for whom I have ‘gone the extra mile’ don’t seem to acknowledge me at all.