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Coding of dermatology surgery procedures allows the trust to be paid for these services. This is dependent on accurate documentation from the operating doctor. Historically, this relied on a laborious process of analysing paper notes that were often incomplete, hard to decipher or sometimes missing altogether. This led to low reimbursement for activities carried out by our department and we sought to utilise the new electronic medical records (EMR), Cerner, system to be able …

Males with genital skin disease may present to clinicians in primary care, dermatology, genitourinary medicine, or urology clinics. Male genital dermatoses encompass a wide variety of skin lesions and rashes, some of which are limited to the genital area whereas others, such as psoriasis, can be part of a more generalised skin disorder. Genital skin disease can impact on the physical, psychological, and sexual wellbeing of men. Some dermatoses are precancerous, and cancer of the penis is associated with morbidity and mortality and litigation.1 This clinical update provides a guide to normal anatomical variations of the penis, how to recognise and manage common benign male genital dermatoses, and when to refer for specialist opinion. #### Sources and selection criteria We searched PubMed and Google Scholar for clinically relevant studies (Jan 2000 to Jul 2016), and the Cochrane Library, using the search terms “Balanitis”, “Balanoposthitis”, “Penile Dermatoses”, “Genital Dermatoses”, along with terms specific to each condition. We consulted the Cochrane Library, National Institute for Health and Care Excellence, British Association of Dermatologists, and British Association for Sexual Health and HIV for guidelines. Patients may be asymptomatic or describe pruritus, soreness, pain, dyspareunia, splitting of the foreskin, non-retractile foreskin (phimosis) or foreskin fixed in retraction (paraphimosis), scaling, erosion, and ulceration.2 3 The foreskin is a delicate tissue that is in close contact with urine, sweat, moisture, sexual secretions, desquamative products, detergents, potential allergens, and microbes. These factors may expose the foreskin to general irritation, pain, and dysfunction (eg, paraphimosis or phimosis, dribbling of urine, dyspareunia).3 4 Further progression of infection and inflammation can cause scarring, disfigurement, and, rarely, precancerous or cancerous lesions. Most men presenting to a specialist male genital dermatology clinic are uncircumcised.5 Circumcision protects men from inflammatory genital dermatoses, including psoriasis, seborrhoeic dermatitis, lichen planus, and lichen sclerosus.5 Predisposition to …

Summary Aim. To determine whether there is an association between the use of angiotensin-converting enzyme (ACE) inhibitors, beta-blockers and nonsteroidal anti-inflammatory drugs (NSAIDS) in women with mucosal (oral and vulval) lichen planus (LP) compared with a control population. Methods. This was a retrospective review of medical records in dedicated vulval and oral clinics in hospitals. The study population comprised 141 women with vulval LP and 106 women with oral LP. Medications taken at the time of diagnosis were recorded. Results. Patients with mucosal LP were more likely to be on NSAIDS and beta-blockers, but less likely to be on ACE inhibitors compared with controls. All three groups were found to have an inverse relationship with ACE inhibitors, but no association was found between patients with oral LP and beta-blockers. Conclusions. Beta-blockers and NSAIDS are associated with LP, suggesting that withdrawal of these drugs should be considered. Further studies are needed to confirm or refute the inverse relationship between mucosal LP and use of ACE inhibitors.

Hirsutism can be a source of great distress and social embarrassment and in some cases can indicate underlying endocrine or malignant disease. More is known about the metabolic consequences of hyperandrogenism including risk of developing cardiovascular disease, insulin resistance or diabetes. Full assessment is vital in light of the potential health consequences of hirsutism.

The changes in androgen levels after the menopause and the effects of hormone replacement therapy (HRT) itself and the mode of HRT have not been established. The objectives of this study were to document the effect of age on androgen levels in a normal population of postmenopausal women and to investigate the effect of oral or transdermal HRT on androgen, oestradiol and sex hormone binding globulin (SHBG) values.: A cross-sectional study was conducted on 182 postmenopausal females aged 45–100 years, randomly recruited from the community. Serum levels of dehydroepiandrosterone sulphate (DHEAS), androstenedione, testosterone, free androgen index (FAI) and SHBG in a reference group of women, subdivided by age, menopausal status, HRT replacement and mode of HRT replacement.: Age was a significant factor affecting androstenedione (: The observations suggest the need to provide age-specific reference intervals for androstenedione and DHEAS but not for testosterone and SHBG. The significant effect of HRT treatment would also suggest a need for treatment associated reference intervals for androstenedione, SHBG and FAI. Suggested reference intervals for each of these partitioned groups are presented.Clin Chem Lab Med 2009;47:202–7.

“Your baby is suffering from a genetic skin disorder, her skin is too fragile, she'll probably not make it over the next few days.” Shock and bewilderment summed up our family's emotions. Now, 10 years later, although not cured, our niece Myra is doing quite well, and we can reflect on our experiences. As medical students we are painfully aware of the different priorities of doctors and patients; as second generation members of an immigrant Pakistani family we have struggled to reconcile traditional beliefs with Western medicine. Myra suffers from recessive dystrophic epidermolysis bullosa (EB), a congenital skin disorder characterised by blistering of skin and mucous membranes on even mild mechanical trauma. When she was born we had not heard of EB. The first few weeks after discharge from hospital were particularly stressful. Although the nursing staff had encouraged us to handle, feed, and bandage her, being away from the hospital setting gave us great cause for anxiety. What would we do if something happened? It was no comfort to find that medical staff seemed to share our ignorance. Nobody seemed to know what care entailed apart from careful handling to prevent blisters from forming, or what to do about blisters once they had appeared. We were advised to cover them with dressings and leave them …