The essential guide to becoming a doctor PDF
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British Association of Dermatologists' Management Guidelines Edited by Neil H. Cox BSe, MBChB, FRCP (Lond &Edin) Consultant dermatologist Cumberland Infirmary Carlisle UK John S.c. English MBBS, FRCP Consultant dermatologist Nottingham University Hospital Nottingham UK (11WILEY- BLACKWELL AJohn Wiley &.Sons, Ltd., Publication This edition firstpublished 2011,©2011 Britb.h Association ofDerm'lIologisls Black••·."•" Publishing wasacquired byJohn Wiley &Sons in February 2007. BhlCkwdJ's puhlishing program has been merged with Wiley's global Sckntific, Technical and Medical business toform Wilcy·Black\wll. Registeml office:John Wiley &Sons, LId,Th~Atrium. Southern Gate, Chichester. WestSus:.cx, POI98SQ, UK EditorialofJin's: 9600 Garsington Road, Oxford, OX42DQ, UK The Atrium, Southern Gate, Chichester, WestSussex, POl9 ~SQ, UK III River Street, Hoboken, NJ07030-5774, USA Fordetails ofour global editorial offices, forcustomer services and forinformation about how toapply forpermission toreuse thecopyright material inthis book please seeour \vebsite atww\•••w.iley.coml wiley-blackwell The right oftheauthor tobeidentified asth.:author ofthis work hasbeen asserted inaccordance Wilhthe UK Copyright, Designs and Patents Act 1988. AU rights reserved. Nopart ofthis publication Illaybereproduced, stored inarl.'lrieval syslem, or transmitted. inany form orbyany means, dectronic. mechanical, photocopying. recording orotherwise, excepl aspermilled hythe UKCopyright, Designs ,md Palents Ad 1988.without rheprior permission ('If the publisher. Designations used bycompanies todistinguish their products areoften claimed astradcmarks. 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The puhlisher andthe author make norepresentations or w;uranties with respect tothe accuracy orcompleteness ofthe contents ufrhis work and specifically disclaim allwarranties, including without limitation any implied warranties offitness foraparticular purpose. Inviewofongoing research, I.'quipmentlllodifications, changes ingovernmental regulations, and theconstallt flowofinformarion relating tothe useof medicines, equipmellt. and devices. the reader isurged to review and evaluate the information provided inthe package insert orinstructions foreach medicine, etluipment, ordevice for.among other things. illl)' changes in rheinsrructions orindicarion ofUsagl'and foradded warnings :lIldprecautions. Readers should consult with aspecialist where appropriate. The factthat anorganization or Website;s referred ro inthis work asacitation and/or apotenti,ll ~OllrceoffUrlhl'f information docs not mean that the author or the publisher endorses the information theorganization or\Vebsitc Ill'.yproYidt' or recoll1mendations itmay m<lkc.Funher, readers ShOllldbeaware Ihat Inlcrnd Websi••.s.listed inthis work may havechanged ordisappeared between when this work waswrillen olndwhen itisread. Nowarranty maybecrealed or cxrended byanypromotional statements forthis work. Neither the publisher nor theauthor sh311beliable foranydamages arising herefrom. Lihrary ofCongressCataloging-in.Publica/it", Vaf,' British Association ofDermatologists. B.-iti:>hA::.::.oci,ltiv'i01Do.:rmarologi:;t:;'management guidelines Iedited h}'NeilH.Cox. 'ohn S.c. Eng.lish. p.:cm. Includes bibliographical references. ISBN978-1-444)-3552-1 I.Skin-Diseases-Trealment-Stand<lrds. :t.l)crmatolog}'-Srandards-<Jreat Uril"in. I.Cox, NeilH. II.English.lohn S.C. III.Title. IDNLM: I.Skin Diseases--therapy-Praclio" Guideline 1.Derm:nolog)'-ml'lhnds-PracticC" (~uidelillc. WR 650 B862 2011] RLlIO.B752011 616.S-dc22 2010024518 ISBN:9780470654552 Acatalogue record fOlthi::.book isaVililahlefrail! the British Library. This book ispublished inthe following eleclronic formats: cPDF 9lSI444329872; Wile)'Online Library ':I781444:}29865i ePub 9781444329889 Setin9.25111.5pt Minion byAptara@ Inc, New Ddhi, India Printed and bound in Siugapoft' by F;lbulolls PriTHers Ptc Ltd 2011 Contents A tribute to Professor Neil H. Cox, vii John S.C. English Introduction, viii Colin Holden Preface, ix Neil H. Cox and John S.c. English Background to the British Association of Dermatologists clinical guidelines, x Neil H. Cox and John S.c. English Writing a BritishAssociation of Dermatologists clinical guideline: an update on the process and guidance for authors, xiv H.K. Bell and A.K. Ormerod Guideline topics 1 Inflammatory Dermatoses, 1 Alopecia areata, 2 Bullous pemphigoid, 11 Contact dermatitis, 20 Lichen sclerosus,30 Pemphigus vulgaris, 42 Urticaria, 55 Vitiligo, 64 2 Infections, 91 Cutaneous warts, 92 Onychomycosis, 101 Tinea capitis, 111 3 Neoplasms, 118 Actinic keratoses, 120 Basalcellcarcinoma, 130 Bowen's disease, 145 Squamous cellcarcinoma, 157 Melanoma, 170 Cutaneous Tcell Lymphomas, 191 v vi Contents 4 Specific therapeutic agents, 205 Acitretin, 206 Azathioprine, 219 Biological agents in psoriasis,230 Isotretinoin in acne, 265 Ultraviolet radiation (dosimetry and calibration), 274 Topical PUVA, 284 Topical photodynamic therapy, 295 Index, 319 A tribute to Professor Neil H. Cox Unfortunately, Neil died suddenly in December 2009. I 'babies' ashehad contributed more tothe BADguidelines had known Neil since the mid 1980s when we were both than anyother author and soknew them inside out. Ihope registrars in Glasgow with Professor Rona Mackie. Neil Ihave done him and his guidelines justice in helping edit very quickly developed the high degree ofskill in writing this compendium. and editing dermatology papers and book chapters; to a level that I will never achieve. This book was one of his Dr John S.c. English 2010 vii Introduction It iswith great pleasure that Iintroduce this compilation us that they were highly cited articles and reprints were of the British Association of Dermatologists guidelines. I requested internationally. was an Honorary Secretary of the British Association of People enjoy access to information through many Dermatologists from 1996 to 2000 when the guidelines routes and it seemed to me that a compilation of the process was initially developed through the auspices of guidelines in a book would make the information avail- the then Drug and Therapeutics Committee. Asdescribed able in another useful format. later inthe book, wewanted the guidelines not only to rep- The hard work of Neil Cox, in particular, along with resent best practice but also to reflect aconsensus ofviews John English has brought this to fruition. Reading itnow, of British dermatologists. So we published draft docu- itseems not only asource for knowledge about the man- ments in the BAD newsletter for a3-month consultation agement ofand therapies used inskin conditions but also before submission to the British Journal of Dermatology. an illustration of the evolution of the guidelines process We hoped that the guidelines might act as a reference over the last decade; a process in which Neil Cox was source for the development of dermatology education intimately involved. resources for health care practitioners, patients and the Sadly, asNeil's last work ithas also become atribute to general public. Hence, when we developed our website his memory. they were made freely downloadable. Ihope you find the book enjoyable and informative. When I became President of the BAD some 10 years later, it was clear that the guideline process was a great Dr Colin Holden BSc,MD, FRCP success - atribute tothe innumerable clinicians who took Past President part intheir development. The editors ofthe BJDalso told British Association of Dermatologists viii Preface The guidelines contained in this publication have mostly of other guidelines and reviews, mostly by use of web been published in the British Journal of Dermatology addresses. within the last 10years, and are all available online from Finally, guidelines need to be useful. The BAD guide- the British Association of Dermatologists (BAD) website lines are written primarily for dermatologists and other www.bad.org.uk. In preparing this compendium of the specialists. They have been produced in summary for- guidelines, wehave been aware of three main factors. mat, capable of being copied and laminated for quick Firstly, many of the guidelines have now been updated reference. They have also included other tools for the since they were first published. Most of the updates have user, such assome suggested audit points. For this com- given greater prominence to therapeutics, especially with pendium, wehavetried toextend this usefulness byadding regard to newer approaches, and to areas of controversy. guidelines that may be more applicable to primary care Bycomparison, the initial versions generally 'set the scene' users (e.g. Clinical Knowledge Summaries (CKS) and ref- and contained more text about epidemiology and older erence material from the NewZealand DermNet). Wehave treatments than inthe updated versions. Therefore, many also included some guidance from bodies such asthe UK ofthese earlier versions stillhave value asreview material, National Health Service (NHS) and the UKNational Insti- and wefelt that references to these should be included. tute for Health and Clinical Excellence (NICE), aswell as Secondly, the whole process of assimilating, assessing material from other national dermatology bodies (such and extrapolating evidence to be applied in clinical set- as the American Academy of Dermatology) and a vari- tings hasbeen arapidly changing field.This isdiscussed in ety of cancer organisations. We have also supplemented more detail on pX.Although there isnow apreferred style each topic, where applicable, with patient information of citation of evidence and recommendations for BAD resources that provide Patient Information Leaflets (PILs) guidelines (see pX), the style differs somewhat between or web-based information about specific conditions, pre- guidelines. This, in part, reflects styles in use at the time vention ofdisease, or about treatments. of writing as well as pragmatic issues such as ease of Thus, for each guideline, in addition to reproducing updating and of collaborating with other specialists to the published version, we have included a web address produce multidisciplinary guidelines. Additionally, some for the guideline, some editorial comment, selected addi- ofthe guidelines were produced asconsensus documents tional guidelines or other references for users, web details (British Photodermatology Group) and have a different of the BAD's own PIL and details of additional patient- style. orientated sources of information. Thirdly, no evidence isever perfect, multiply replicated Wehope that these measures will increase the utility of and applicable in allscenarios. Even with good evidence, the guidelines beyond the original presentation. the strength ofarecommendation may vary between indi- We thank all guideline authors for their dedication to viduals who have assessed that evidence. External factors this project, and to current and previous members ofthe such as different healthcare systems or edicts by gov- BAD'sTherapy Guidelines and Audit Subcommittee who ernment bodies may influence recommendations. Newly have overseen the production of guidelines throughout emerging evidence needs to be put in context, and some the last decade. evidence may create as many questions as it answers. Therefore, wehaveadded some editorial comments about N.H. Cox & I.S.C. English each guideline, and some details of recent evidence and Editors 2009 ix
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