Clinical and Experimental Dermatology最新文献

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients' quality of life and mental health. Effective management often involves both medical and surgical interventions. The aim of the study was to assess the effectiveness of wide local excision and secondary intention healing in improving quality of life and mental health in patients with moderate to severe HS.

Methods: A single-center prospective study was conducted with 40 patients suffering from moderate to severe HS, refractory to prior treatments. Pre-surgical ultrasound mapping of lesions was performed using Ultra High-Frequency Ultrasound (UHFUS). Patients underwent wide surgical excision followed by secondary intention healing based on HS-TIME principles. Quality of life was measured using Skindex-16, and mental health was assessed using the Hospital Anxiety and Depression Scale (HADS), with subscales for anxiety (HADS-A) and depression (HADS-D). Assessments were conducted at baseline, 4 weeks post-surgery, and after complete wound healing. Statistical analyses included paired t-tests and multiple linear regression to determine factors influencing outcomes.

Results: The study included 14 males and 26 females with a mean age of 39 years. Significant improvements were observed in Skindex-16 scores (pre: 57.92, post: 16.03) and HADS scores (HADS-A: pre: 6.13, post: 2.63; HADS-D: pre: 5.50, post: 3.21), indicating reduced pain, discomfort, and psychological distress. Multivariate analysis revealed that improvements were associated with male sex, HS stage II, longer disease duration, and lower BMI.

Conclusion: Wide local excision combined with secondary intention healing significantly improves quality of life and mental health in HS patients. The findings suggest that a comprehensive approach addressing both surgical and psychological aspects can enhance patient outcomes. Future research should focus on long-term benefits and the development of standardized postoperative care protocols.

Obtaining valid consent is an ethical and legal requirement in clinical practice, ensuring patients are adequately informed about their treatments. Recent updates in consent policies, including GMC guidance, the Patterson inquiry report, and key legal rulings like Montgomery, emphasise a shift towards patient-centred care and the importance of a comprehensive patient-clinician dialogue. Budget constraints and increasing NHS demand have led to the adoption of digital solutions and streamlined pathways, such as teledermatology and direct booking to surgery, potentially compromising the consent process. This review examines the current state of informed consent in UK dermatology, particularly in light of the Montgomery ruling, which requires clinicians to ensure patients are aware of all material risks and alternatives associated with their treatments. The two-stage consent process, involving consent at two distinct points, is advocated to allow patients adequate time for reflection and decision-making. However, challenges remain in pathways like one-stop clinics and direct booking for surgery, where limited face-to-face interaction and time constraints can undermine the quality of informed consent. To mitigate these issues, integrating multimedia tools and standardised procedure-specific consent forms can enhance patient comprehension and satisfaction. These tools ensure consistent and clear communication of risks, benefits, and alternatives, maintaining robust informed consent amidst evolving healthcare delivery models. Sustaining a thorough and individualised dialogue throughout the patient care journey is essential for upholding patient autonomy and shared decision-making in dermatological surgery.

Background: The lack of dermatological knowledge by non-dermatologists is exposed by the increasing number of requests made for inpatient dermatological consultations. Patients have been commenced on inappropriate treatment because of poor dermatology training.

Objectives: To determine the burden and accuracy of inpatient dermatology referrals.

Methods: A retrospective cohort study using paper inpatient dermatology referrals from one Health Board between June 2007 and July 2021. Data analysis included timing of referrals; referring speciality; diagnosis and treatment. Descriptive statistics, using Excel, were used for analyses.

Results: The average number of referrals per year was 106 (79-166). The most frequent day of referral was Monday (26%). Most referrals were from medical teams (73%).Differential diagnosis was suggested by the referring team in 59% of referrals. In only 29% of referrals the dermatology team agreed with the differential diagnosis. There was discrepancy in the correctness of diagnosis in all categories, however the paediatricians were most likely to offer a correct differential (44%). In 44% of referrals treatment was commenced by the referring team, most commonly antibiotics.

Conclusions: There is an extra burden on dermatology teams to cover inpatients. Our figures highlight two important issues - the need for better dermatological education in medical schools to improve diagnosis accuracy and management of conditions as well as the need to recognise the need for an inpatient dermatology service to review inpatient referrals and advise in diagnosis and management of dermatology cases on the wards, and to protect the service from being uncoupled from the main hospital.