Dermatology in practice - 2006

Comment: A sense of priority
Neil H Cox
pp 4-4
Those who regularly read this page of the journal will know that I often draw inspiration from items in the popular press. At the time I wrote this, the newspapers were full of items that were getting so boring that I had placed a self-imposed embargo on them. I therefore decided against making any mention of the words metatarsal, football, 1966 or fitness, or of discussing any individuals concerned with such matters. Which means that any other news had to be gleaned from a depressingly small number of remaining pages.
Melanoma – recent advances
Jerry Marsden
pp 6-9
In the past few years there have been remarkable advances in oncology, many of which started life as insights into disease mechanisms at the molecular level, and were subsequently translated into targeted treatment. Melanoma may seem to have been bypassed by these advances; however, the past five to ten years have seen definite improvements in our understanding and management of this disease and, perhaps as importantly, have emphasised where we should focus our efforts to improve outcomes.
Measles, mumps and rubella – can you identify them?
Susan Lipsombe
pp 10-12
Being of more mature years, not only have I seen all of these conditions but, as I was a child long before the measles, mumps and rubella (MMR) vaccine became available, I have had them all. I was lucky – I had them when young and have not had any sequelae from them except memories. Years later, the MMR vaccine came in, somewhat piecemeal. First the measles jab as a baby and then rubella at school. Later, the two were combined and mumps was added to form the MMR vaccine.
PBC – how do you make the case for biologicals?
Ronald G Pate
pp 14-16
The National Institute for Health and Clinical Excellence (NICE) technology appraisal guidance 103, Etanercept and efalizumab for the treatment of adults with psoriasis, was issued in July 2006. It recommends that etanercept (Enbrel®, Wyeth, UK) be used within its licensed indications in patients with severe plaque psoriasis when other treatments have not worked or the patient is intolerant to or has a contraindication to these treatments. A definition is given in the guidance of severe psoriasis but no definition is provided for what is meant by ‘intolerant to’.
Exploring the significance of birthmarks
Sheena JR Allan, Louise KM Roy and Aileen RM Taylor
pp 18-21
Lesions seen on neonatal skin may be transient and of no importance; however, some lesions are permanent and a small proportion of these may have serious implications. They may be due to structures normally present in the skin but abnormal in quantity or quality. The majority of vascular birthmarks are either infantile haemangiomas (strawberry naevi) or vascular malformations. Ninety per cent of infantile haemangiomas are apparent by four weeks of age, and the vast majority undergo spontaneous regression during childhood. Vascular malformations, however, are always present at birth and persist throughout life.
In the last 30 years – treating atopic dermatitis
Sam Bunting and Malcol Rustin
pp 22-25
The relentless increase in the prevalence of atopic dermatitis (AD), particularly in developed countries, presents a challenge to all dermatologists. The condition affects as many as 15–20% of British school children and 2–10% of adults and the impact of uncontrolled disease on the individual and family unit as a whole cannot be underestimated. The clinical expression of AD probably results from an interplay between genetic, immunological and environmental factors.
Monk's moments: Hoist by my own petard
Barry Monk
pp 27-27
We are all familiar with the phrase ‘hoist by his own petard’ but I am not certain how many people know what a petard actually is. In fact it was a medieval bomb used in sieges and such like, and the phrase entered the English language in Shakespeare’s ‘Hamlet’ where it was used, as now, to describe someone who had fallen foul of their own deceit.