Dermatology in general practice

• In a study of one area of London 55% of adults examined had some form of skin disease*

• Of those with moderate or severe conditions only 24% had made use of medical facilities in the previous six months

• In the same study 30% of patients with skin conditions medicated themselves

• Eight per cent of patients attending a general practitioner for a skin condition are referred to a dermatologistf

• A large reservoir of people in the community with skin conditions do not seek medical attention but can be expected to do so as awareness of skin conditions increasesj

• General practitioners with postgraduate training in dermatology and dermatology liaison nurses linked to specialist centres are needed so that the increasing demand for dermatology services can be met

• In countries with specialist care, basic training in the essentials of daignosis and treatment of skin conditions enables health officers to make a considerable impact on these conditions in the community

*Rea JN, Newhouse ML, Halil T. Skin disease in Lambeth: a community study of prevalence and use of medical care.

Br JPrev Soc Med 1976;30:107-14

fCarmichael AJ. Achieving an accessible dermatology service.

Dermatol Pract 1995;3:13-16

JSavin J. The hidden face of dermatology. Clin Exp Dermatol


Hospital consultation

current drugs the patient is taking. Knowledge of the dermatological conditions associated with systemic disease, and conditions that may mimic them, is clearly important. A bilateral malar rash with photosensitivity in a woman should suggest the possibility of lupus erythematosus and appropriate investigations instituted. However, a completely typical case of rosacea does not require extensive investigation. The most useful diagnostic aids in general practice are:

• Skin scrapings and a sellotape strip should be sent for mycology whenever there is an area of itching inflammatory change, particularly in the flexures, that is not responding to treatment.

• A swab for bacteriology should be sent from any area of dermatitis that develops crusting and exudate.

• An incisional biopsy can be carried out to confirm a significant diagnosis, for example in a patch of Bowen's disease This is not usually needed to make a diagnosis of granuloma annulare, which has a very characteristic presentation. All lesions removed by excision or curettage or cautery should be sent for histology.

• Patch testing is not practicable in general practice as a rule because of the large number of reagents and specialised nursing skills required. Patients suspected of having contact dermatitis should be referred to the appropriate unit.

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