Next steps in dermatology training: choosing to enter higher speciality training and the transition from trainee to consultant dermatologist.

Background: Junior doctors are required to make career decisions at an early stage in their postgraduate training. Trainees also feel inadequately prepared for the transition to consultant roles.

Aim: To explore the key factors influencing the choice of dermatology as a postgraduate medical career and to identify the training needs required for transition from trainee to consultant.

Treatment of paediatric eczema with narrowband ultraviolet light B therapy.

Background: Narrowband ultraviolet B phototherapy (nbUVB) is a well-established, well-tolerated and efficacious treatment for eczema. There is a distinct lack of literature surrounding the therapeutic use of nbUVB in eczema in children and especially in children with higher skin phototypes (III to VI).

Methods: We undertook a retrospective review of children aged 18 years and under with eczema who had undergone nbUVB in our department between 1 January 2011 and 31 December 2017.

Mosaic NRAS Q61R mutation in a child with giant congenital melanocytic naevus, epidermal naevus syndrome and hypophosphataemic rickets.

The association of hypophosphataemic rickets with verrucous epidermal naevus (EN) and elevated fibroblast growth factor 23 levels is known as cutaneous-skeletal hypophosphataemia syndrome (CSHS), and can be caused by somatic activating mutations in RAS genes. We report a unique patient with CSHS associated with giant congenital melanocytic naevus (CMN), neurocutaneous melanosis and EN syndrome, manifesting as facial linear sebaceous naevus, developmental delay and ocular dermoids. An activating mutation Q61R in the NRAS gene was found in affected skin and ocular tissue but not blood, implying that the disparate manifestations are due to a multilineage activating mutation (mosaic RASopathy).

Acrylate and methacrylate contact allergy and allergic contact disease: a 13-year review.

Background: (Meth)acrylates are important causes of contact allergy and allergic contact disease, such as dermatitis and stomatitis, with new and emerging sources resulting in changing clinical presentations.

Objectives: To identify the (meth)acrylates that most commonly cause allergic contact disease, highlight their usefulness for screening, and examine their relationship with occupational and clinical data.

Methods: A retrospective review of results from patch tests performed between July 2002 and September 2015, in one tertiary Cutaneous Allergy Unit, was performed

Results: A series of 28 (meth)acrylates was applied to 475 patients.

Home phototherapy for psoriasis: a review and update.

A 2006 survey of dermatologists showed that home phototherapy should be used with caution, and that general, nonevidence-based opinions were widespread about this form of therapy. This led to a randomized controlled trial to assess the safety and efficacy of home phototherapy vs. outpatient phototherapy by the same authors in 2009, which concluded that a lower burden of treatment and increased patient satisfaction were associated with home phototherapy.

Malignant melanoma of the gastro-intestinal tract: a case series.

Background: Resection of gastrointestinal (GI) metastases of malignant melanoma (MM) offers a significant survival benefit. No adjuvant therapy has been shown to be effective in the treatment of these metastases.

Methods: All resections of MM affecting the GI tract at a UK University teaching hospital between October 1999 and January 2013 were identified from a pathology database.

The effect of pulsed dye laser on the dermatology life quality index in erythematotelangiectatic rosacea patients: an assessment.

Background: Erythematotelangiectatic rosacea is a common cutaneous disorder. It has a major psychosocial impact on a patient's life.

Objective: This study aims to investigate the impact of pulsed dye laser on the quality of life of affected patients as measured by the Dermatology Life Quality Index.

A diagnostic challenge: acute generalized exanthematous pustulosis or pustular psoriasis due to terbinafine.

A 72-year-old man developed a generalized erythematous pustular eruption 11 weeks after commencing terbinafine. Clinically and histologically, the appearance was that of acute generalized exanthematous pustulosis (AGEP), and the disease was managed with topical preparations. Initial improvement was marred by relapse of acute pustulosis, now more in keeping with terbinafine-induced pustular psoriasis (PP), which was successfully treated with acitretin.

Hairy intraoral flap--an unusual indication for laser epilation: a series of 5 cases and review of the literature.

A variety of the flaps used to reconstruct defects of the head and neck region following surgery for malignant disease contain hair follicles that may result in unwanted hair growth. This can cause significant distress to the patients in a variety of ways. We report 5 cases of significant intraoral hair growth of which 4 cases were successfully managed with long-pulsed alexandrite laser.

Reduction of pain in the treatment of vascular lesions with a pulsed dye laser and pneumatic skin flattening.

The treatment of vascular lesions, including port wine stains (PWSs), with a pulsed dye laser is very painful and often requires general anaesthesia. This is particularly problematic with children. Pneumatic skin flattening (PSF) is a new technology that naturally reduces pain in laser-based aesthetic treatments.

Patient satisfaction with laser hair removal.

Background: Laser hair removal (LHR) is a widely used treatment for unwanted hair.

Aim: To determine patient satisfaction with LHR.

Methods: The clinic offered LHR by long pulse ruby, alexandrite and Nd:YAG.

Laser treatment of rosacea.

Rosacea is a common condition often resulting in persistent erythema and telangiectasia as well as rhinophyma in a number of patients. Over the last two decades lasers have been increasingly used in the treatment of these permanent changes. The literature is reviewed in terms of the different laser systems, side-effects and comparison with other surgical techniques.

Cutaneous and systemic sequelae from exposure to 2-vinylpyridine.

We present the case of an employee of a chemical production factory who became sensitized to 2-vinylpyridine despite wearing full protective polyvinyl chloride clothing. He developed severe dermatitis at the site of contact, secondary eczematization over the flexures and periungual areas, as well as marked systemic upset. Pyridines are known sensitizers although this reaction pattern has not previously been described.

Er:YAG laser resurfacing for inoperable medium-sized facial congenital melanocytic naevi in children.

Congenital melanocytic naevi (CMN) can cause significant psychosocial morbidity, especially if they are in visually exposed areas. The preferred treatment is surgical excision, though not all lesions are amenable to this because anatomical location may preclude aesthetic and functional reconstruction. Three children with inoperable facial CMN were treated with Er:YAG resurfacing under general anaesthetic.

Severe adverse cutaneous reaction to insulin due to cresol sensitivity.

We present the case of an 80-year-old lady known to be sensitive to chlorocresol (4-chloro-3-methyl phenol) who developed severe erythrodermic exfoliative dermatitis with atypical features 2 weeks after commencing subcutaneous insulin. All medications except insulin were stopped, without major improvement. It was noted that the insulin contained m-cresol (m-methyl phenol) so a parabens-based insulin was substituted.

A review of the adverse effects of laser hair removal.

Laser hair removal is ever increasing in popularity. Technology is fast advancing, and there are increasingly excessive commercial claims that laser hair removal in all skin types is free of side effects. The aim of this study is to review the evidence from published literature regarding the incidence of adverse effects after laser and light systems for hair removal.