{"title":"Autoimmune blistering skin diseases","authors":"Guy Fletcher, Kathy Taghipour","doi":"10.1016/j.mpmed.2025.05.008","DOIUrl":"10.1016/j.mpmed.2025.05.008","url":null,"abstract":"<div><div>Autoimmune blistering diseases are a rare group of disorders characterized by blistering and/or erosions of the skin and/or mucous membranes. There may be associated skin fragility and scarring. An accurate and timely diagnosis affects the management and prognosis. This is usually achieved through a careful history, thorough mucocutaneous examination and histology and immunofluorescence tests of skin and serum. It is important to determine the level of blister formation as this distinguishes subepidermal from intraepidermal diseases.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 8","pages":"Pages 504-511"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724185","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":"Diagnosis and management of skin cancer","authors":"Emma Craythorne, Prini Nicholson","doi":"10.1016/j.mpmed.2025.05.006","DOIUrl":"10.1016/j.mpmed.2025.05.006","url":null,"abstract":"<div><div>Skin cancer is the most common cancer in the UK, and incidence rates continue to increase. We discuss the common presentations, clinical features, examination techniques, referral guidelines, management and prognosis of both non-melanoma skin cancer (basal cell carcinoma, squamous cell carcinoma) and melanoma.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 8","pages":"Pages 524-529"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724188","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":"Skin pigmentation","authors":"Manpreet Kaur Lakhan, Magnus Lynch","doi":"10.1016/j.mpmed.2025.05.002","DOIUrl":"10.1016/j.mpmed.2025.05.002","url":null,"abstract":"<div><div>The colour of skin is determined primarily by the amount and distribution of melanin in it. In the absence of disease the number of melanocytes does not vary significantly between individuals, irrespective of ethnicity. Increased pigmentation (hyperpigmentation) results from an increase in melanin production and/or the number of melanocytes. It can also be secondary to exogenous substances or extravasation of chemicals deposited in the skin. Its causes can be subdivided according to whether the changes are localized to one or a small number of discrete body sites or are generalized – affecting a large proportion of the skin. Conditions leading to loss of pigment in the skin generally result from decreased melanin synthesis or absence of melanocytes. The term ‘hypopigmentation’ describes any reduction in pigment in comparison with the normal state of pigmentation for that individual; depigmentation refers to a total lack of skin pigmentation from loss of pre-existing melanocytes, for example with vitiligo. Pigmentary disorders are often associated with significant psychological and social impacts for the patient. Some disorders can be challenging and recalcitrant to treatment. Therefore, it is imperative that health professionals address underlying psychosocial impacts, which is best achieved in the context of a multidisciplinary team approach.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 8","pages":"Pages 538-543"},"PeriodicalIF":0.0,"publicationDate":"2025-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724191","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":"Vascular and lymphatic abnormalities","authors":"Julian Pearce, Kristiana Gordon, Peter Mortimer","doi":"10.1016/j.mpmed.2025.05.001","DOIUrl":"10.1016/j.mpmed.2025.05.001","url":null,"abstract":"<div><div>Skin manifestations caused by vascular and lymphatic abnormalities are numerous. Damage to blood vessels whether through inflammation, arterial atherosclerosis or venous hypertension results in restricted blood flow, hindering micronutrient and oxygen delivery to the local skin. Localized cutaneous changes can give clues regarding aetiology, and localized ischaemia and ulceration can result in significant morbidity. The lymphatic system has been a neglected area of medicine, but the discovery of lymphatic-specific genes and immunohistochemical markers has revolutionized knowledge of lymphatic biology and involvement in diseases such as infection and cancer. Lymphoedema results from a failure of lymph drainage because of a genetic fault and/or secondary damage to the lymphatic channels. Clinicians must be aware of the multifactorial causes of swelling and the associated cutaneous changes, including sequelae such as lipodermatosclerosis and cellulitis, which can often be diagnostically challenging.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 8","pages":"Pages 494-496"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724179","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":"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}
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