reading

Contents

Cover

Title Page

A tribute to Professor Neil H. Cox

Introduction

Preface

Background to the British Association of Dermatologists clinical guidelines

Writing a British Association of Dermatologists clinical guideline: an update on the process and guidance for authors

1: Inflammatory dermatoses

PROFESSIONAL RESOURCES

2: Infections

3: Neoplasms

ADDITIONAL PROFESSIONAL RESOURCES AND REFERENCES

GENERAL PATIENT INFORMATION ON SKIN CANCERS AND TREATMENTS

SUMMARY

DISCLAIMER

DEFINITION

INCIDENCE, AETIOLOGY AND PREVENTION

CLINICAL PRESENTATION

DIAGNOSIS

COMMUNICATION

PROGNOSIS

FACTORS AFFECTING METASTATIC POTENTIAL OF CUTANEOUS SCC

TREATMENT

AUDIT POINTS

APPENDIX 1

APPENDIX 2

4: Specific therapeutic agents

NARROWBAND UVB and PUVA

Index

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Library of Congress Cataloging-in-Publication Data

British Association of Dermatologists.
British Association of Dermatologists' management guidelines / edited by Neil H. Cox, John S.C. English.
p. ; cm.
Includes bibliographical references.
ISBN 978-1-4443-3552-1
1. Skin–Diseases–Treatment–Standards. 2. Dermatology–Standards–Great Britain. I. Cox, Neil H. II. English, John S. C. III. Title.
[DNLM: 1. Skin Diseases–therapy–Practice Guideline. 2. Dermatology–methods–Practice Guideline. WR 650 B862 2011]
RL110.B75 2011
616.5–dc22
2010024518

ISBN: 9780470654552

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF 9781444329872; Wiley Online Library 9781444329865; ePub 9781444329889

A tribute to Professor Neil H. Cox

Unfortunately, Neil died suddenly in December 2009. I had known Neil since the mid 1980s when we were both registrars in Glasgow with Professor Rona Mackie. Neil very quickly developed the high degree of skill in writing and editing dermatology papers and book chapters; to a level that I will never achieve. This book was one of his `babies' as he had contributed more to the BAD guidelines than any other author and so knew them inside out. I hope I have done him and his guidelines justice in helping edit this compendium.

Dr John S.C. English 2010

Introduction

It is with great pleasure that I introduce this compilation of the British Association of Dermatologists guidelines. I was an Honorary Secretary of the British Association of Dermatologists from 1996 to 2000 when the guidelines process was initially developed through the auspices of the then Drug and Therapeutics Committee. As described later in the book, we wanted the guidelines not only to represent best practice but also to reflect a consensus of views of British dermatologists. So we published draft documents in the BAD newsletter for a 3-month consultation before submission to the British Journal of Dermatology.

We hoped that the guidelines might act as a reference source for the development of dermatology education resources for healthcare practitioners, patients and the general public. Hence, when we developed our website they were made freely downloadable.

When I became President of the BAD some 10 years later, it was clear that the guideline process was a great success -- a tribute to the innumerable clinicians who took part in their development. The editors of the BJD also told us that they were highly cited articles and reprints were requested internationally.

People enjoy access to information through many routes and it seemed to me that a compilation of the guidelines in a book would make the information available in another useful format.

The hard work of Neil Cox, in particular, along with John English has brought this to fruition. Reading it now, it seems not only a source for knowledge about the management of and therapies used in skin conditions but also an illustration of the evolution of the guidelines process over the last decade; a process in which Neil Cox was intimately involved.

Sadly, as Neil's last work it has also become a tribute to his memory.

I hope you find the book enjoyable and informative.

Dr Colin Holden BSc, MD, FRCP,
Past President
British Association of Dermatologists

Preface

The guidelines contained in this publication have mostly been published in the British Journal of Dermatology within the last 10 years, and are all available online from the British Association of Dermatologists (BAD) website www.bad.org.uk. In preparing this compendium of the guidelines, we have been aware of three main factors.

Firstly, many of the guidelines have now been updated since they were first published. Most of the updates have given greater prominence to therapeutics, especially with regard to newer approaches, and to areas of controversy. By comparison, the initial versions generally `set the scene' and contained more text about epidemiology and older treatments than in the updated versions. Therefore, many of these earlier versions still have value as review material, and we felt that references to these should be included.

Secondly, the whole process of assimilating, assessing and extrapolating evidence to be applied in clinical settings has been a rapidly changing field. This is discussed in more detail on pX. Although there is now a preferred style of citation of evidence and recommendations for BAD guidelines (see pX), the style differs somewhat between guidelines. This, in part, reflects styles in use at the time of writing as well as pragmatic issues such as ease of updating and of collaborating with other specialists to produce multidisciplinary guidelines. Additionally, some of the guidelines were produced as consensus documents (British Photodermatology Group) and have a different style.

Thirdly, no evidence is ever perfect, multiply replicated and applicable in all scenarios. Even with good evidence, the strength of a recommendation may vary between individuals who have assessed that evidence. External factors such as different healthcare systems or edicts by government bodies may influence recommendations. Newly emerging evidence needs to be put in context, and some evidence may create as many questions as it answers. Therefore, we have added some editorial comments about each guideline, and some details of recent evidence and of other guidelines and reviews, mostly by use of web addresses.

Finally, guidelines need to be useful. The BAD guidelines are written primarily for dermatologists and other specialists. They have been produced in summary format, capable of being copied and laminated for quick reference. They have also included other tools for the user, such as some suggested audit points. For this compendium, we have tried to extend this usefulness by adding guidelines that may be more applicable to primary care users (e.g. Clinical Knowledge Summaries (CKS) and reference material from the New Zealand DermNet). We have also included some guidance from bodies such as the UK National Health Service (NHS) and the UK National Institute for Health and Clinical Excellence (NICE), as well as material from other national dermatology bodies (such as the American Academy of Dermatology) and a variety of cancer organisations. We have also supplemented each topic, where applicable, with patient information resources that provide Patient Information Leaflets (PILs) or web-based information about specific conditions, prevention of disease, or about treatments.

Thus, for each guideline, in addition to reproducing the published version, we have included a web address for the guideline, some editorial comment, selected additional guidelines or other references for users, web details of the BAD's own PIL and details of additional patient-orientated sources of information.

We hope that these measures will increase the utility of the guidelines beyond the original presentation.

We thank all guideline authors for their dedication to this project, and to current and previous members of the BAD's Therapy Guidelines and Audit Subcommittee who have overseen the production of guidelines throughout the last decade.

N.H. Cox & J.S.C. English
Editors 2009