Websites on atopic eczema

Dr Keith Barnard recommends websites relating to this week's Clinical Review.

PATCH TESTING
This independent UK site is aimed at patients and professionals, and refreshingly has a 'no advertising and no promotion' policy.

Although the pages on patch testing are a little, well, patchy, they do help unravel what may be something of a mystery to patients and GPs.

During my career this form of testing has gone from being all the rage to totally unacceptable because of fears that people would drop dead of anaphylaxis, to being acceptable once more, within limits.

These pages take you through the process of patch testing. The images show the procedure step by step and explain what you may see and learn from this form of testing. There is a glossary of terms which could be useful for patients using the site, and even an area designed for kids.

Why go there: worth looking at for the images.
Downside: lacks clinical data.
Information from: Dermatology.co.uk
Address: Please click here

TOPICAL IMMUNOMODULATORS
Many well-informed patients will ask about topical immunomodulators and their value as an alternative to steroids. This page gives you a summary of a British meta-analysis of 25 trials and asks the question, 'are tacrolimus and pimecrolimus better than steroids?'

As you might suspect, the answer is not entirely unequivocal. The conclusion is that topical steroids will remain the first line and mainstay of therapy for most patients with atopic dermatitis, but these two topical immunomodulators are effective, and are particularly good for the face and intertriginous sites.

But as ever with new treatments, there are caveats and cautions we will all do well to take on board.

Why go there: a sensible assessment.
Downside: none.
Information from: Journal Watch, New England Journal of Medicine.
Address: Please click here

THE GENETICS OF ATOPY
The genetic dimension of almost any condition these days assumes greater importance by the day as we learn more and more about the human genome.

In some cases, such as haemophilia, for example, it doesn't take a genius to understand it. But some situations are so multifaceted that it is easy to become confused.

Although this article is long and complex, it does help unravel the concept of the genetic role played in atopic disease.

You will learn, for example, that several genes may contribute to the expression of atopic dermatitis, and that, interestingly, the site originally identified as being linked to atopy in general (chromosome 11q13) has recently been linked specifically to atopic dermatitis.

Why go there: the site will greatly improve your understanding.
Downside: it might make your head spin.
Information from: Archives of Dermatology.
Address: Pease click here

Dr Barnard is a former GP in Fareham, Hampshire

WEBSITE OF THE WEEK
This New Zealand-based dermatology website is a favourite of mine and although these pages are intended for access by the public as well as doctors there is nothing wrong with the contents or the presentation. The images here are of exceptional quality. At the end of the photographs there is a link that says 'more images of atopic dermatitis'. Be sure to click it, there are dozens more excellent pictures here. There are further sections on treatment and complications.

Why go there: excellent collection of images.
Downside: none.
Information from: Dermnet NZ.
Address: www.dermnetnz.org/dermatitis/atopic.html

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