Dermatology

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  Melanoma
'While I'm here could you just have a look at this mole Doc?' How many times have you been asked that? And sometimes it is easy, it isn't even a mole at all but a cherry angioma or a wart. But so often it isn't that easy and we are left wondering if we made the right decision.
  Silver dressings: do they work
My nurses have given me a simple but firm word of advice about the dressings in our cupboard at work: don't! By that they mean that if I want anything other than a simple non-adherent dressing, I should ask. And wise advice it is too, as I know virtually nothing about dressings.
  Onychomycosis (fungal nails)

The key questions seem to be:

Are you sure it is fungal?
Does any treatment work? If so, which is better; oral or topical?
What are the relapse rates after apparently successful treatment?
  Lichen sclerosus
  Head lice, pubic lice and scabies
The issue here is not about making the diagnosis but about ensuring patients use the treatments correctly – which means ignoring the instructions in the packet!
  Hyperhidrosis
The BMJ summarised the treatments available for hyperhidrosis, along with a patient's perspective showing the huge impact this condition can have on individuals. Here is a summary of their recommendation for treatment.
  Impetigo
Our PCT recently audited our antibiotic prescribing. We have always been proud of our low and rational prescribing (pride comes before a fall..!) so we were a bit shocked when the PCT informed us that our prescribing didn't meet local guidelines. 
  Imiquimod
Imiquimod is an immune response modifier. It induces interferon alpha and other cytokines. I've noticed the dermatologists seem to be increasingly turning to imiquimod as the treatment for some early skin malignancies.
  Basal cell carcinomas
In 2006 NICE produced guidance which, in effect, meant referring all BCCs for treatment, rather than being able to offer those services within the practice. However, new guidance has just been issued updating this advice.
  Alopecia
For me, when a patient comes in worrying about hair loss, my heart sinks. I know they will either have genuine alopecia, which is really distressing, or they seem to have normal hair but are very worried about hair loss, which is a consulting challenge!
  Athlete's foot
  Psoriasis
SIGN have recently issued guidance on the diagnosis and management of psoriasis. They do not give examples of drugs but simply suggest a class of drug. I have added examples from the BNF to help (usually the cheapest in that class).
  Warts
Left untreated, most viral warts will eventually disappear. Are we medicalising a problem just because some feel warts are socially unacceptable? Here I will focus on treatments.
  Acne
When choosing a drug decide first if you are trying to deal with inflammatory lesions (pustules) or non-inflammatory lesions (comedones) or both
  Eczema
SIGN have recently produced new guidance on eczema. It applies to adults and children (SIGN 125, 2011). In addition the now rather old NICE guidance (NICE 2007, CG57) does have some useful points that I have added in where helpful (amalgamated with the SIGN guidance, but marked (NICE) at the end of the sentence).
 
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