Heuristics

Question 1

Give an example of a prodrome of a disease.

Answer 1

With toxic epidermal necrolysis (TEN) ….Preliminary symptoms that need treatment before the main disease manifests itself.

‘….has a prodrome of days to weeks We are patients will have mild systemically symptoms and rashes. Short-term treatments are given for symptomatic relief of these prodrome all symptoms and then the terrible ramifications of the disease manifest.”
52nd ACD Review /Research Review Australia May2019

Question 2

With some disease, what levels of evidence are doctors working with?

Answer 2

TEN-
”Dermatologists still don’t know the best method of treating these patients.’

Worldwide alternatives are such and such…in W.A. there is a new treatment protocol with such and such… All studies had small numbers with inconclusive results and none have Statistical Relevance, only suggestions. Local Burns unit will have their research protocol.

“Hopefully science will work out what is the proper approach. It is the authors opinion that nothing has really changed in 5-10 years in this area; we lack data which is scientifically and statistically relevant.”

52nd ACD Review /Research Review Australia May2019

Question 3

Contact Dermatitis…how?

Answer 3

Clinical clues spotting

Hair dyes as culprit, broad history pre patch testing to glean clinical clues. Then narrow it down

Question 4

Give examples where Dermos use injectable drugs ?

Answer 4

Psoriasis
Methotrexate (Trexject)
4syringes, 5 Repeats.
6 strengths with highest 50mg/ml
Already compounded syringes with fused lock needles.
Disposing after use is not considered cytotoxic unless rare chance it spills on the floor.
Colour coded syringes containing small volumes with some latex derivative on the tip.
They can be stored at room temperature.
Patients can inject themselves, having Lilley used an injectable biologic.(!)
Better than oral methotrexate 1) to minimise nausea but not meth fog that some patients complain about in the first 24 hours; and 2)sub-cut provides increased bioavailability and thus increasing the therapeutic response.

Significantly more expensive than the oral version , yet less so than the use of acitretin, cyclosporine or a biologic agent.