Dr Shirin Zaheri

BMJ Best Practce Polymorphous light eruption

With the summer sunshine and recent heatwave, it's a good time to raise awareness of polymorphous light eruption (PMLE)—the most common immune-mediated photosensitivity disorder. PMLE is often mistaken for simple sunburn or a heat rash, yet it can have a significant impact on quality of life. It typically presents as an intensely itchy rash that develops hours to days after sun exposure, particularly during the spring and summer months when UV exposure increases. Early recognition and appropriate advice on photoprotection and management can make a real difference for patients. I'm pleased to have contributed to the BMJ Best Practice topic on PMLE, which provides an evidence-based overview of its diagnosis and management for healthcare professionals. You can read it here: BMJ Best Practice – Polymorphous Light Eruption https://bestpractice.bmj.com/topics/en-gb/626 As temperatures rise and more people spend time outdoors, it's a timely reminder to promote sun safety and consider PMLE in patients presenting with recurrent itchy eruptions after sun exposure. #Dermatology #PrimaryCare #MedicalEducation #BMJBestPractice #Photosensitivity #PMLE #SkinHealth #SunSafety #SummerHealth

BMJ Best Practice update on paronychia

Delighted to have authored the latest BMJ Best Practice update on paronychia. Writing this update was an excellent opportunity to revisit the evolving evidence on a condition that is frequently encountered across primary care, emergency medicine and dermatology, yet is often managed inconsistently. Distilling the literature into practical, evidence-based recommendations for clinicians was particularly rewarding. Key clinical messages: • Differentiate acute from chronic paronychia. Acute paronychia is most commonly a bacterial infection following disruption of the nail fold barrier, whereas chronic paronychia is increasingly recognised as an inflammatory disorder resulting from repeated irritant exposure and barrier dysfunction, rather than a primary fungal infection. • Assess for abscess formation. This remains the key determinant of management. Early acute paronychia without abscess can often be managed conservatively, while incision and drainage is the definitive treatment when an abscess is present. Antibiotics should be reserved for selected patients with cellulitis, systemic features or other high-risk factors, in keeping with antimicrobial stewardship principles. • Address the underlying cause. Successful management of chronic paronychia relies on restoring the integrity of the nail fold through avoidance of irritants and prolonged moisture exposure, skin barrier protection, and topical anti-inflammatory therapy where indicated. Preventing recurrence is just as important as treating the acute presentation. One of the most interesting aspects of reviewing the evidence was the shift in our understanding of chronic paronychia—from an infection-focused paradigm to one centred on inflammation and barrier dysfunction. This change has important implications for clinical practice, particularly in reducing unnecessary antimicrobial use and improving long-term outcomes. Thank you to the BMJ Best Practice editorial team for the opportunity to contribute to this update. Reference BMJ Best Practice. Paronychia. Updated June 2024; evidence reviewed June 2026. #BMJBestPractice #Dermatology #PrimaryCare #EvidenceBasedMedicine #AntimicrobialStewardship #MedicalEducation