{"title":"Psoriasis","authors":"Soo Min Yap, Alexandra Bonsall","doi":"10.1016/j.mpmed.2025.04.019","DOIUrl":"10.1016/j.mpmed.2025.04.019","url":null,"abstract":"<div><div>Psoriasis is a chronic, immune-mediated skin condition affecting millions of individuals globally, including around 1.3–2.8% people in the UK. It is characterized by rapid turnover of skin cell leading to the build-up of thick scaly plaques. The disease has a complex pathophysiology involving genetics, immune dysregulation and environmental factors. There are multiple subtypes, chronic plaque psoriasis being the most prevalent. It commonly affects areas such as the extensor surfaces of the limbs, scalp, trunk and nails. Early diagnosis and treatment are helpful as the condition can severely impact quality of life. Psoriasis is also associated with several co-morbidities, including psoriatic arthritis, metabolic syndrome, cardiovascular disease and psychological issues. Treatment options include topical therapies, phototherapy, systemic medications, immunosuppression and injectable biologic agents, with continuing research driving further advancements.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 441-448"},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Common cutaneous infections","authors":"Naomi Jones, Alexandra Bonsall","doi":"10.1016/j.mpmed.2025.04.021","DOIUrl":"10.1016/j.mpmed.2025.04.021","url":null,"abstract":"<div><div>Cutaneous infections are commonly encountered in medical settings. To provide high-quality care, all clinicians need a strong understanding of the most common pathogens, presentations and available treatments. In many cases, the history and clinical features observed on the skin are sufficient to form a diagnosis and allow for management to be instigated, while in others, diagnostic testing can be needed. Minor skin infections may be treated in the community, but more complicated infections can require more specialized investigation, treatment and monitoring within a hospital or outpatient setting.</div><div>This article gives an overview of common cutaneous infections including presentation, investigation and management principles.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 467-471"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Atopic dermatitis","authors":"Clive B Archer","doi":"10.1016/j.mpmed.2025.04.015","DOIUrl":"10.1016/j.mpmed.2025.04.015","url":null,"abstract":"<div><div>Atopic dermatitis (AD) and atopic eczema are interchangeable names for a condition that affects 15–30% of children and up to 10% of adults. Filaggrin plays a key role in epidermal barrier function; null mutations in the filaggrin gene are associated with AD, with resultant barrier dysfunction. AD affects many aspects of family life. Patient and parent education is an important aspect of management. Emollients applied frequently, even when the eczema has resolved, help prevent flares. Appropriate use of topical corticosteroids is still a mainstay of treatment. Topical calcineurin inhibitors can be useful immunomodulators, particularly in children. Intermittent use of sedative antihistamines and oral or topical antibiotics can be required. In a secondary care setting, it is often more effective to gain control of the disease using a combination of treatments and then maintain control once this is achieved. Second-line treatments with narrow-band ultraviolet B or immunosuppressive drugs such as ciclosporin or methotrexate can be required for chronic severe AD. The biological agents dupilumab and tralokinumab are now established for use in patients with moderate-to-severe AD who are candidates for systemic therapy. Baricitinib, an inhibitor of the Janus kinases JAK1 and JAK2 is a relatively new oral treatment for this patient group, and has been approved by the National Institute for Health and Care Excellence (NICE) in the UK.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 449-453"},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dermatological history and examination","authors":"Flora Kiss, Jui Vyas","doi":"10.1016/j.mpmed.2025.04.016","DOIUrl":"10.1016/j.mpmed.2025.04.016","url":null,"abstract":"<div><div>Skin diseases are highly prevalent, affecting over half the population at some point. Although many skin conditions have a good prognosis, some, including skin cancers and infections, are life-threatening and require urgent intervention. Most non-dermatological medical practitioners have little training in skin disease despite its prevalence. A broad understanding of skin disease is an important aspect of higher medical training. This article focuses on how to take a comprehensive dermatological history and examination for skin lesions and rashes. Examination of the hair, nails and mucosae is also highlighted. Physicians should be particularly aware of skin changes that could be associated with systemic disease such as vasculitis or connective tissue disease. A careful history and thorough dermatological examination often allow diagnosis without the need for investigations. The practitioner needs to appreciate how skin tone affects the appearance of skin disease. Use of a hand-held dermoscope allows the user to visualize sub-macroscopic structures and is essential in evaluating suspected skin cancer. Chronic skin diseases such as psoriasis are often associated with profound psychosocial upset and impaired quality of life. The latter should be evaluated in order to provide holistic care.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 423-429"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dermatological pharmacology: topical agents","authors":"Vincent CY Li, Mahbub MU Chowdhury","doi":"10.1016/j.mpmed.2025.04.014","DOIUrl":"10.1016/j.mpmed.2025.04.014","url":null,"abstract":"<div><div>Topical therapies constitute an important aspect of dermatological treatments. This article covers the principles of topical treatments, the vehicles used and a number of commonly used topical agents, including corticosteroids. Indications for use and common adverse effects of these topical agents are outlined.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 430-434"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hair loss disorders (alopecias)","authors":"Elisabetta Muttoni, Susan Holmes","doi":"10.1016/j.mpmed.2025.04.017","DOIUrl":"10.1016/j.mpmed.2025.04.017","url":null,"abstract":"<div><div>This article focuses on hair loss disorders (alopecias). Hair loss can be broadly classified into scarring and non-scarring. Taking a tailored clinical history and performing a detailed examination helps guide the physician to the diagnosis. A scalp biopsy can be indicated, particularly when scarring hair loss is suspected. The aim of treatment is to prevent or slow further hair loss and promote hair regrowth where possible. Hair loss can be a cause of significant emotional and psychological distress, and it is important for this aspect of alopecia to be recognized and acknowledged. However, as treatment options can be limited, it is important to be realistic about what can be achieved therapeutically. The recent approval by the UK National Institute for Health and Care Excellence and Scottish Medicines Consortium of the Janus kinase inhibitor ritlecitinib for severe alopecia areata in patients aged ≥12 years represents a major therapeutic advance in the treatment of this difficult to manage condition.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 472-475"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Introduction to precision medicine","authors":"Stefanie Lip, Sandosh Padmanabhan","doi":"10.1016/j.mpmed.2025.04.018","DOIUrl":"10.1016/j.mpmed.2025.04.018","url":null,"abstract":"<div><div>Precision medicine is revolutionizing healthcare by transitioning from the traditional ‘one-size-fits-all’ approach to a more individualized strategy. This paradigm tailors diagnostics and treatments based on each patient's unique genetic, molecular and environmental profiles by leveraging advanced technologies such as omics profiling, imaging techniques and artificial intelligence artificial intelligence (AI)-driven data analytics. This reduces the reliance on trial-and-error prescribing, minimizes adverse effects and enhances overall treatment efficacy. As a consequence, disease taxonomy is evolving to more accurately reflect the underlying pathology of several diseases such as cancer, Alzheimer disease and various chronic illnesses, along with therapeutic insights accelerating the creation of targeted therapies. Despite its transformative potential, precision medicine faces significant challenges. While the initial costs of implementing precision medicine may be higher, the long-term benefits – including improved patient outcomes, cost-effectiveness and optimized resource utilization – underscore its potential to transform global healthcare systems. Unequal access to advanced diagnostics and therapies can worsen existing health disparities, limiting the benefits of precision medicine to more affluent and well-resourced populations. For medical trainees, understanding and applying evolving molecular insights and a commitment to inclusivity and innovation will ensure that the full advantages of precision medicine are realized for all patients.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 476-482"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dermatological pharmacology: systemic drugs","authors":"Sarah H Wakelin","doi":"10.1016/j.mpmed.2025.04.020","DOIUrl":"10.1016/j.mpmed.2025.04.020","url":null,"abstract":"<div><div>Systemic treatment of skin disease continues to evolve with biological drugs (‘biologics’) and new small molecules. This has been made possible by a deepening understanding of the pathogenesis of inflammatory dermatoses and skin cancer at a molecular level. As well as a range of biologics for psoriasis, there are now licensed biologics for eczema, urticaria and hidradenitis suppurativa. Biologic therapy also offers the chance of improved survival for patients with advanced melanoma. Biologics and new drugs may be highly effective but their expense limits patient access to those with severe disease where other systemic treatments have failed or are inappropriate. Many patients with skin disease are therefore prescribed traditional immunosuppressive or anti-inflammatory medication. These drugs require careful patient selection, prescribing and monitoring for adverse effects to reduce the risk of harm. The prescriber also needs to be able to advise patients of the risks versus benefits of different treatment options so they can make an informed choice about their care.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 435-440"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acne, hidradenitis suppurativa and hyperhidrosis","authors":"Natalie Rachel Attard","doi":"10.1016/j.mpmed.2025.04.010","DOIUrl":"10.1016/j.mpmed.2025.04.010","url":null,"abstract":"<div><div>Acne, hidradenitis suppurativa and hyperhidrosis are three distinct skin disorders. In this article, the key clinical features, medical associations and important aspects of management are highlighted.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 461-466"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Structure and function of skin, hair and nails","authors":"John A McGrath","doi":"10.1016/j.mpmed.2025.04.013","DOIUrl":"10.1016/j.mpmed.2025.04.013","url":null,"abstract":"<div><div>The skin is the largest organ of the human body. It is a complex epithelial and mesenchymal tissue comprising a multilayered stratified epidermis, adnexal structures such as hair follicles, sweat glands and sebaceous glands, a dermis containing collagen and elastic fibres, and underlying subcutaneous fat. More than 1000 disease entities involving the skin have been described, and up to 20% of all general practitioner consultations involve skin pathology. Infections, drug reactions and diseases such as psoriasis, eczema, urticaria and skin cancer impose a considerable burden on healthcare resources and significantly affect patients' quality of life. Knowledge of the structure and function of the skin and its appendages is paramount for understanding the biology of healthy skin and the pathophysiology of skin diseases.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 7","pages":"Pages 417-422"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144491785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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