Report - 19th October 2010

Instant Dermatology – Fifteen Fantastic Facts in Forty minutes
Professor Andrew Finlay presented the Presidential address on 19th October 2010.

Andrew Finlay first came to Cardiff as a dermatology registrar in 1976 and was Professor of Dermatology and head of the academic dermatology department in Cardiff from 1999 to 2009.

The 15 Fantastic Facts included therapy tips, clinical cases, how to understand people with skin disease, aspects of decision taking and some new diseases.

Therapy Tips
1. The FingerTip Unit is half a gram.
2. A Handprint is about 1% of Body Surface Area, and The Rule of Hand is: 4 Handprints = 2 FingerTip Units = 1gram.
3. Compliance is a major problem. In Copenhagen one third of dermatology prescriptions were not taken to the chemist.
4. Oral retinoids can be successfully used over 25 years in the ichthyoses.
5. Biologics have recently revolutionised the treatment of severe psoriasis.

Clinical Cases
6. The Moon Crater sign is seen after a keratoacanthoma has self-healed.
7. Skin diseases can pattern along the lines of Blaschko.
8. Fake sun-tan lotion can show up porokeratosis.
9. Crossed-leg callosities overlie the navicular, lateral cuneiform and cuboid bones on the dorsum of the feet.

How to understand people with skin disease
10. The Dermatology Life Quality Index (DLQI) is used worldwide to measure the impact of skin disease on people’s lives (www.dermatology.org.uk).
11. The Greater Patient describes the partner and family of the patient, whose lives are also affected.

Decision taking
12. The Rule of Tens in psoriasis: if Area > 10% or PASI > 10 or DLQI > 10, a patient has “severe current psoriasis”. Active intervention should be considered.
13. There are many non-clinical influences on decision taking. We need to understand them better to ensure that most appropriate decisions are taken.

New Diseases
14. In the Finlay-Marks Syndrome (OMIM 181270, “SEN”) there is lumpy Scalp, odd shaped Ears and rudimentary Nipples.
15. Antecubital fossa petechiae occur in Scottish Country dancers who use a poor grip while birling.

Like to know more?
The Diploma in Practical Dermatology was founded by Prof Finlay in 1989. It is now a gold standard international elearning programme aimed at general practitioners, but also taken by many other specialists. There are over 3,000 graduates, you could join them …. Go to www.dermatology.org.uk.

References
1 Finlay AY, Edwards PH, Harding KG. “Fingertip unit” in dermatology. Lancet 1989; II: 55. Long CC, Finlay AY. The Fingertip unit: A new practical measure. Clin Exper Dermatol 1991; 16: 444-446

2 Thomas CL, Finlay AY. The “handprint” approximates to 1% of the total body surface area whereas the “palm minus the fingers” does not. Br J Dermatol 2007; 157: 1080-1. Long CC, Finlay AY, Averill RW. The rule of hand: 4 hand areas = 2FTU = 1g. Arch Dermatol 1992; 128: 1130-1.

3 Hallai N, Finlay AY, Godfrey J, Kamath S, Ahmed Z, Modhazam A. In-patient compliance of topical applications. Br J Dermatol 2005; 153: 446-448. Storm A, Benfeldt E, Andresen SE, Serup J. A prospective study of patient adherence to topical treatments: 95% of patients underdose. J Am Acad Dermatol 2008; 59: 27-33, 975-80.

4 Katugampola RP, Finlay AY. Oral retinoid therapy for disorders of keratinisation: single-centre retrospective 25 years experience on 23 patients. Br J Dermatol 2006; 154: 267-276.

5 Abdul-Ghaffar S, Finlay AY. Moral and cost dilemma of a psoriasis patient. Br J Dermatol 2007; 156: 186-7. Smith CH, Anstey AV, Barker JN, Burden AD, Chalmers RJ, Chandler DA, Finlay AY et al. British Association of Dermatologists’ guidelines for biologic interventions for psoriasis 2009. Br J Dermatol 2009; 161: 987-1019.

6 Eghlileb AM, Finlay AY. Healed keratoacanthoma: the “Moon Crater” sign. J Eur Acad Dermatol Venereol 2008; 22: 521-522.

7 Long CC, Finlay AY. Multiple linear lichen planus in the lines of Blaschko. Br J Dermatol 1996; 135: 275-6.

8 Katugampola RP, Finlay AY. Fake sun tan diagnosis of porokeratosis. J Eur Acad Dermatol Venereol 2006; 20: 224-6.

9 Cox NH, Finlay AY. Crossed-leg callosities. Acta Derm Venereol (Stock) 1985; 65: 559-561.

10 Finlay AY, Khan GK. Dermatology Life Quality Index (DlQI) – a simple practical measure for routine clinical use. Clin Exper Dermatol 1994; 19: 210-216. Basra MK, Fenech R, Gatt RM, Salek MS, Finlay AY. The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation and clinical results. Br J Dermatol 2008; 159: 997-1035.

11 Basra MK, Finlay AY. The family impact of skin diseases: the Greater Patient concept. Br J Dermatol 2007; 156: 929-937. Basra MKA Sue-Ho R, Finlay AY. The Family Dermatology Life Quality Index: measuring the secondary impact of skin disease. Br J Dermatol 2007; 156: 528-538.

12 Finlay AY. Current severe psoriasis and the rule of tens. Br J Dermatol 2005; 152: 861-867.

13 Hajjaj FM, Salek MS, Basra MK, Finlay AY. Nonclinical influences, beyond diagnosis and severity, on clinical decision making in dermatology: understanding the gap between guidelines and practice. Br J Dermatol 2010; 163: 789-99.

14 Finlay AY, Marks R. An hereditary syndrome of lumpy scalp, odd ears and rudimentary nipples. Br J Dermatol 1978: 99: 423-430 Sobreira NL, Brunoni D, Cernach MC, Perez AB. Finlay-Marks (SEN) syndrome: a sporadic case and the delineation of the syndrome. Am J Med Genet 2006; 140: 300-2.

15 Finlay AY, Finlay IG, Paton EL, Paton WG. Antecubital fossa petechiae in Scottish country dancers. Lancet 1985; 23: 1191.