The significance of skin disease

A large proportion of the population suffers from skin diseases, which make up about 10% of all consultations in primary care in the United Kingdom. However, community studies show that over 20% of the population have a medically significant skin condition and less than 25% of these consulted a doctor.

The skin is not only the largest organ of the body, it also forms a living biological barrier and is the aspect of ourselves we present to the world. It is therefore not surprising that there is great interest in "skin care", with the associated vast cosmetic industry. The impairment of the normal functions of the skin can lead to acute and chronic illness with considerable disability and sometimes a need for hospital treatment.

A wide variety of tumours, both benign and malignant, arise in the skin. Fortunately the majority are harmless and most moles never develop dysplastic change.

Most cancers arising in the skin remain localised and are only invasive locally, but others may metastasise. It is important therefore to recognise the features of benign and malignant tumours, particularly those, such as malignant melanoma, that

Lupus erythematosus

Skin tags—examples of benign tumours

Skin tags—examples of benign tumours can develop widespread metastases. Recognition of typical benign tumours saves the patient unneccessary investigations and the anxiety involved in waiting for results.

Although a wide range of internal diseases produce physical signs in the skin, most skin diseases do not themselves have serious physical effects. However there can be significant psychological effects and problems with personal relationships, employment, and sporting activity. It is therefore important to use what Dr Papworth called "wide angle lenses" in assessing the patient and their disease. So, in addition to concentrating on the skin changes, the overall health and demeanour of the patient should be taken into account. This also means making sure that there are no other signs, such as involvement of the nails, mucous membranes, or other parts of the skin. The general physical condition and psychological state of the patient should be assessed, with more specific examination if indicated.

Epidermis

Epidermis

b) Melanin pigment below epidermis c) Erythema due to dilated dermal blood vessels d) Inflammation in dermis b) Melanin pigment below epidermis c) Erythema due to dilated dermal blood vessels d) Inflammation in dermis

Mole Removal

Mole Removal

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