Endocrinology and the skin.

This article discusses various cutaneous features associated with endocrine disease, which are of general medical relevance. Many of these, such as features associated with hypothyroidism, are common, while others, such as features of adrenal insufficiency, are relatively rare but important.

A literally blinded trial of palpation in dermatologic diagnosis.

BACKGROUND: As an adjunct to visual inspection, dermatologists routinely palpate the skin during clinical examination. The value of palpation in isolation is unproven. METHODS: To determine whether palpation alone could distinguish between two common dermatoses, atopic dermatitis and plaque psoriasis, a cohort of 16 patients were examined by a dermatologist using touch alone, with screens to prevent visualisation of the lesions. RESULTS: The diagnosis was correctly made in 14 of 16 cases (P = .012). LIMITATIONS: Patients were not consecutive as availability of the dermatologist and nursing staff was required, and several exclusion criteria applied. There was no formal power calculation. The study aimed to prove a concept about dissociating sensory modalities and does not prove that palpation would necessarily have provided "added value" to a visual diagnosis in the cases selected. CONCLUSION: This study demonstrates that dissociation between sensory inputs that are usually concurrent (in this case, visual and tactile) is a feasible experiment in dermatology, and that such dissociation did not remove the diagnostic input of the sole sensory modality that was permitted-in this case, confirming that palpation alone does have some importance in dermatologic diagnosis. It may explain some of the reservations about accuracy of teledermatology diagnoses of dermatoses, where palpation is not possible.

Feasibility study to inform the design of a UK multi-centre randomised controlled trial of prophylactic antibiotics for the prevention of recurrent cellulitis of the leg.

BACKGROUND: This paper describes the results of a feasibility study for a randomised controlled trial (RCT). METHODS: Twenty-nine members of the UK Dermatology Clinical Trials Network (UK DCTN) expressed an interest in recruiting for this study. Of these, 17 obtained full ethics and Research & Development (R&D) approval, and 15 successfully recruited patients into the study. A total of 70 participants with a diagnosis of cellulitis of the leg were enrolled over a 5-month period. These participants were largely recruited from medical admissions wards, although some were identified from dermatology, orthopaedic, geriatric and general surgery wards. Data were collected on patient demographics, clinical features and willingness to take part in a future RCT. RESULTS: Despite being a relatively common condition, cellulitis patients were difficult to locate through our network of UK DCTN clinicians. This was largely because patients were rarely seen by dermatologists, and admissions were not co-ordinated centrally. In addition, the impact of the proposed exclusion criteria was high; only 26 (37%) of those enrolled in the study fulfilled all of the inclusion criteria for the subsequent RCT, and were willing to be randomised to treatment. Of the 70 participants identified during the study as having cellulitis of the leg (as confirmed by a dermatologist), only 59 (84%) had all 3 of the defining features of: i) erythema, ii) oedema, and iii) warmth with acute pain/tenderness upon examination. Twenty-two (32%) patients experienced a previous episode of cellulitis within the last 3 years. The median time to recurrence (estimated as the time since the most recent previous attack) was 205 days (95% CI 102 to 308). Service users were generally supportive of the trial, although several expressed concerns about taking antibiotics for lengthy periods, and felt that multiple morbidity/old age would limit entry into a 3-year study. CONCLUSION: This pilot study has been crucial in highlighting some key issues for the conduct of a future RCT. As a result of these findings, changes have been made to i) the planned recruitment strategy, ii) the proposed inclusion criteria and ii) the definition of cellulitis for use in the future trial.