Union of maxillary second and third molar

Pathological union is rare between permanent teeth. A case study of a male aged thirty, had pain and a swelling associated with two partly erupted permanent upper molars is described. An incision was made and the mucosa reflected. Removal of some bone disclosed that the second and third maxillary molars were in pathological union. These molars and a granulating mass attached to their roots were removed and the rather large cavity sutured.peer-reviewe

Dermatology

Dermatology continues to develop at a steady pace. In the past few years there have been exciting advances in our understanding of skin structure and function in health and disease and progress in genetics, epidemiology, immunology, pharmacology and clinical dermatology that have led to new approaches for managing skin diseases. This article will discuss a number of recent advances including treatments that have entered clinical practice recently or are likely to do so soon and have an impact on dermatological practice in years to come. Issues likely to be of interest to a general medical audience are emphasised.peer-reviewe

A review of a paediatric dermatology clinic in Malta

A review of a Paediatric Dermatology clinic set up in 2009 at the Department of Dermatology and Venereology, Sir Paul Boffa Hospital, was carried out in 2011. The aim of the exercise was to identify the main conditions being seen in this clinic and to analyse management and referral patterns. Data was collected on a total of 130 patients (80 new and 50 follow-up). Of the patients attending, 86 (66%) were males and 44 (34%) were females. Overall, the commonest conditions seen were acne, eczema, naevi, fungal infections and psoriasis. General practitioners accounted for 69% of referrals whereas paediatricians and other specialists accounted for the other 31%. Of the 80 new patients seen, 55% were given a follow-up appointment in the Paediatric Dermatology clinic, 30% were discharged and 15% were given an appointment for further therapy e.g. skin surgery, laser treatment or cryotherapy. Parents/carers accompanying children to the clinic all stated that Saturday was the best day of the week for them to attend.peer-reviewe

Lupus Vulgaris in a Maltese patient

Introduction The incidence of cutaneous tuberculosis (TB) in the developed world has fallen, in parallel with the decline of other forms of TB. Nevertheless cases still occur and their diagnosis may be difficult. We report a case of lupus vulgaris in a Maltese patient who went on to have an excellent response to antituberculous chemotherapy.peer-reviewe

A cross-sectional survey of a dermatology outpatient service in Malta

A survey of the outpatient service provided by a consultant dermatologist at the national dermatology department in Malta was carried out. The aims of this study were to identify the main conditions being treated and to analyze management and referral practices. Possible implications for future training of primary care physicians were also investigated. The survey was carried out for one week every season over a 12-month period, giving a total study period of four weeks. Data was collected on a total of 662 patients (401 new patients and 261 follow-ups). The average waiting time for a routine clinic appointment for new cases was 4 weeks, but 18% of patients were seen within 48 hours of referral and 7% were seen within one week. Age-specific attendance rates were highest for females over 50 years and males over 60. Overall, the commonest conditions seen were chronic leg ulcers, psoriasis, skin infections and seborrhoeic keratoses. Skin biopsy was the most frequent investigation performed and topical treatment was the commonest form of therapy. Private general practitioners and government doctors based in health centres accounted for 51% and 29% of all referrals respectively. A diagnosis was offered in 65% of referral notes. Of these, 44% had a diagnosis matching that given by the dermatologist at the patient's first visit. Treatment was attempted prior to referral in 64% of patients with acne but in only 15% of patients with viral warts.peer-reviewe

Crusted (Norwegian) scabies treated with oral ivermectin : a case report and overview

Crusted (Norwegian) scabies is a severe and highly contagious form of infestation caused by the mite Sarcoptes scabiei var. hominis. It occurs in a subgroup of patients who are either immunocompromised or physically or mentally debilitated. Due to its atypical clinical presentation as well as difficulties associated with its management it presents a number of challenges both from a therapeutic aspect as well as from public health perspective. Failure to diagnose this condition may give rise to a massive epidemic when the patient is in an institutional setting. We describe a case of crusted scabies which occurred in a nursing home leading to an institutional outbreak. She received a combination of oral ivermectin and topical scabicidal with good results. This case highlights the importance of being alert to the possible diagnosis of crusted scabies and gives an overview of the condition as well as management strategies.peer-reviewe

An unusual case of intertrigo in an adult caused by purely cutaneous Langerhans cell histiocytosis

We report a case of persistent intertrigo in an adult, eventually diagnosed as cutaneous Langerhans cell histiocytosis (LCH). It is known that LCH has a predilection for intertriginous areas, however purely cutaneous disease as in our case, is uncommon and usually other systems are affected. Following the report, literature of similar cases is reviewed to determine possible outcomes and to decide on the best possible treatment options.peer-reviewe

The use of leeches in medicine

A Leech is any parasite annelid of the class Hirudinea. While leeches can be harmful some have been used medically in the past. Infestation by leeches (hirudiasis) may be external or internal.peer-reviewe

Atopic eczema : Malta Eczema Society set up

Eczema (also called 'dermatitis') is a common skin condition that can affect up to 10% of the population at some time of their lives. In certain cases the condition may be severe and incapacitating. The word 'eczema' is derived from an ancient Greek word meaning 'to boil over'. Although many patients who have eczema have dry, sometimes flaky skin, when the condition flares up vesicles and blisters that may weep and crusts appear. Although eczema may become infected, in itself it is not contagious. There are several different types and causes of eczema. The commonest type is called 'atopic eczema'. The word 'atopy' was introduced by Coca 1 in 1923 as a convenient collective term for a group of diseases, chief among which are asthma, hay fever and eczema, which occur spontaneously in individuals who have a family history of susceptibility. In fact some 75% of patients with atopic eczema have a personal or family history of asthma or hay fever or both. Atopic eczema usually appears before the age of one year however it may develop later in childhood or even in adulthood.peer-reviewe

The human fabric in antiquity and other facets

Fossil evidence indicates that the genus Homo probably originated from crude ancestors in East Africa, perhaps around two million years ago. These early Men very gradually spread, including northwards until eventually in due course they reached the shores of the Mediterranean. Some very ancient human remains were found in Algeria. It was probably the success of simple tools in antiquity that started the trend of development, besides other factors and very gradually led to the civilizations that developed much later.peer-reviewe