Volume 16, Number 2

Anand Patel BMedSc BMBS ST1 Doctor; Neill Hepburn MD FRCP Consultant Dermatologist, Lincoln County Hospital, Lincoln

Azathioprine is a useful immunosuppressant in dermatology. Introduced as a steroid-sparing agent in the 1960s for renal transplant recipients, it has been used as both an immunosuppressant and a steroid-sparing agent for inflammatory disease. In dermatology, it is particularly useful for treating patients with immunobullous diseases, lupus erythematosus, vasculitis, chronic actinic dermatitis and severe atopic eczema. The onset of action is slow, taking six to eight weeks, so it is more suitable for long-term disease control and is of little use in managing flares.

Katherine Mellor BMBCh BA(Hons) Senior House Officer; L John Cook FRCP Consultant; Hywel L Cooper BM BMedSci MRCP Specialist Registrar, Portsmouth Dermatology Unit, St Mary’s Hospital, Portsmouth

The dermatoses of pregnancy are a heterogenous group of conditions specific to the pregnant or postpartum woman and are linked by their pruritic nature. The subject has been historically complicated by a variety of misleading and confusing terminologies. This article aims to give an overview of the current classification and diagnosis of these dermatoses, as making the correct diagnosis in a timely fashion has crucial implications for both the mother and the fetus.

Maeve L Walsh BSc(Hons) MRCP Dermatology LAT, Bristol Royal Infirmary, Bristol; Neil H Cox BSc(Hons) FRCP Consultant Dermatologist, Cumberland Infirmary, Carlisle

Hair is a characteristic associated with an individual’s identity and body image. Hair loss (alopecia) can have a profoundly damaging effect on an individual’s self-confidence. Scarring (cicatricial) alopecias are potentially even more devastating conditions as, once scarred, the follicle cannot produce hair any longer and, therefore, such hair loss is irreversible. While there are non-scarring alopecias in which the prospect for hair regrowth may realistically be small, in a scarring process the potential for regrowth is nil. Early recognition and intervention may stabilise the situation and produce good results, treating inflammation before significant scarring occurs, so this is an important group of conditions to diagnose.

Kath D Watson PhD Research Associate; Kimme L Hyrich MD PhD FRCPC Senior Lecturer in Rheumatic Disease Epidemiology, Honorary Rheumatology Consultant, arc Epidemiology Unit, University of Manchester

The introduction of anti-tumour necrosis factor (anti-TNF) therapy for the management of rheumatoid arthritis (RA), ankylosing spondylitis, psoriatic arthritis and juvenile idiopathic arthritis has significantly improved the outcome for patients suffering from those severe rheumatic diseases. Similar benefits have also been observed in patients with inflammatory bowel disease, and most recently in patients with psoriasis. However, despite demonstrated safety compared with placebo in early clinical trials in all these conditions, there are still many uncertainties about the long-term safety of these agents, particularly with respect to serious infection and malignancy. There also remains a concern about rare and unexpected adverse events.

Barry Monk MA FRCP Consultant Dermatologist, Bedford Hospital

It is only the truly great figures of science who find their names preserved for posterity in the form of units of measurement (Newton, Watt, Joule, Volta) or, in the case of a very select few, in the name of an element (curium named after Marie and Pierre Curie, einsteinium named after Albert Einstein, fermium named after Enrico Fermi). Robert van de Graaff, who devised the eponymous apparatus beloved of every schoolchild for demonstrating the effects of static electricity, had the unique accolade of having a heavy metal rock group named after him, though sadly the musicians failed to get their spelling right, calling themselves ‘Van der Graaf Generator’.

Thomas Poyner FRCP(Lond) FRCP(Glasg) FRCGP DPD GP, Stockton-on-Tees; Honorary Lecturer, University of Durham; Gail Sibley

Eczema accounts for approximately 30% of general practice dermatology consultations, yet most healthcare professionals receive little or no relevant dermatological training. This professional knowledge gap often cascades into the community, causing confusion, anxiety, frustration and guilt among carers and patients.

Neil H Cox, Editor

Some readers will have heard part of this at a Royal Society of Medicine (RSM) dermatology meeting. But it is worth repeating, as it took me into an area of totally new literature. Also, some of the audience may have been asleep, so I shall push on.

Khalid M Al Aboud MD Medical Director, Consultant Dermatologist, Dermatology Department, King Faisal Hospital, Mecca, Saudi Arabia; Pahwa Manish MD Dermatologist; V Ramesh MD Dermatologist, Safdarjang Hospital and VM Medical College, New Delhi, India

Day after day, topical drugs are being packaged in newer formulations and hitting the market as wonder drugs. Do all these newer formulations work? Do these drugs actually penetrate the skin and reach those sites that the pharmaceutical companies claim they do? These questions cannot be answered by a simple yes or no; the answer is much more complex and determined by many factors.