Home > 2 SYSTEM-BASED DISEASES > 21 Skin disease
21 Skin disease
O.M.V. SCHOFIELD
J.L. REES
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Skin disease is common. Surveys in Europe suggest that approximately 1 in 7 to 1 in 10 of all visits to a primary care physician is for a skin problem and that for many hospitals the number of patients attending for dermatological diagnosis and treatment exceeds the total number of visits for the whole of internal medicine. Population prevalence studies are in keeping with these figures, revealing an enormous burden of undiagnosed, untreated skin disease. Skin disease appears to be becoming more common for at least three reasons. Firstly, there is a lowered threshold for seeking medical attention. Secondly, the absolute incidence of many diseases such as skin cancer and atopic dermatitis has increased steeply. Thirdly, and often neglected, the therapeutic options for a number of diseases previously viewed as untreatable have increased and awareness of these therapies is belatedly spreading.
Skin complaints affect all ages from the neonate to the elderly and cause harm in a number of ways as shown in Box 21.1. Every clinician has the opportunity to look at the skin when listening to or examining a patient and should be able to identify important and common skin disorders. This chapter emphasises those skin conditions that are frequently seen in general practice and in general medical clinics. Those skin infections not covered here, including human immunodeficiency virus (HIV) disease, are dealt with in Chapter 1, and connective tissue diseases which often involve the skin, in Chapter 20.
The aim of this chapter is to give the reader:
an idea of how to assess the patient with a rash or lesion
advice on appropriate initial management and therapy
theory underlying the mechanisms of some skin diseases and their therapies.
21.1 THE FOUR Ds
Discomfort
Most often itching or pain (e.g. eczema, post-herpetic neuralgia)
Disfigurement
Leading to embarrassment and withdrawal from society (e.g. birth marks, acne vulgaris and psoriasis)
Disability
Leading to loss of work and wages (e.g. dermatitis of the hands and feet)
Death
Rare but still seen (e.g. metastatic melanoma and widespread blistering drug reactions)
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