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

1999;18:393-5

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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