Australian Family Physician July - Dermatology
Vol 40, (7) 457-552
The theme for the July issue of AFP is Dermatology.
This month's articles include Eczema, Psoriasis, Hair and nails,
Exanthems and
drug reactions, Common vulval dermatoses & Nutrition care in general
practice – are we waiting for
patients to ask?
On closer inspection
Carolyn O’Shea
For many readers of Australian Family
Physician, what they first ‘see’ about
AFP is ‘up front’ – with the latest
Circulations Audit Board audit figures
confirming, once again, that AFP’s
monthly circulation is over 40 000. For
an increasing number of people, ‘seeing’
AFP is also via the internet, either by
browsing a particular issue online or
when using a search engine such as
PubMed, from which there are, on
average, over 9000 linkouts to the AFP
website each month.
Nutrition care in general practice – are we waiting for patients to ask?
Lauren Ball
General practitioner encounters for
chronic disease management increased
considerably between 1998 and 2008.
In particular, patients presenting for the
management of hypertension increased
from 8.3 to 9.9 per 100 encounters; type
2 diabetes mellitus from 2.6 to 3.7 per
100 encounters; and lipid disorders
from 2.5 to 3.7 per 100 encounters. In
2010, chronic disease management was
estimated to comprise over one-third of
the average GP’s consultation workload.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
Eczema
Janice Charles, Ying Pan, Graeme Miller
From April 2008 to March 2010 in BEACH (Bettering the
Evaluation and Care of Health), eczema was managed at
a rate of 1.5 per 100 encounters, suggesting that it was
managed by general practitioners about 1.8 million times
per year nationally.
Psoriasis
Philip Clarke
Psoriasis is one of the more common rashes presenting to
general practice.
Hair and nails
Paul Grinzi
Hair and nails are elements of dermatology that can often
be omitted from the dermatological assessment. However,
there are common and distressing hair and nail conditions
that require diagnosis and management.
Exanthems and drug reactions
Morton Rawlin
Drug reactions are a common cause of rashes and can vary
from brief, mildly annoying, self limiting rashes to severe
conditions involving multiple organ systems.
Common vulval dermatoses
Catherine Drummond
The vulva is skin, and it is helpful to approach vulval
conditions from a dermatological perspective. The vulva is
affected by the same dermatoses as the rest of the skin, but
modified in appearance by special influences.
Prostate specific antigen
Tom Brett
This article forms part of our ‘Tests and results’ series for 2011 which aims to provide information
about common tests that general practitioners order regularly. It considers areas such as indications,
what to tell the patient, what the test can and cannot tell you, and interpretation of results.
Patient information – what is a PSA test?
Tom Brett
Prostate specific antigen (PSA) is a protein
produced by the prostate. The PSA test can
potentially be used for screening, monitoring,
or diagnosis.
Persistent hoarseness – a case study
Jennifer Morrison
Marion, a university lecturer aged 48 years,
presented to her general practitioner
complaining of persistent hoarseness for 4–5
weeks. Over the preceding 5 months she had
suffered two prolonged episodes of bacterial
sinusitis and an infective exacerbation of
her asthma, each requiring several weeks of
various antibiotics and oral prednisone, and
each associated with transient hoarseness.
Multiple facial plaques – a case study
Chris Fessa, Pablo Fernández-Peñas
Mrs AA, female, 27 years of age and of Middle
Eastern descent, presented with a 1 year history
of nonpruritic facial plaques. On examination,
these plaques were 0.2–1.0 cm, scaly, atrophic,
annular, hyperpigmented and located on her
forehead, nose, chin and adjacent to her lips.
Adult intraosseous access – experiences in a remote emergency department
Donald Howarth
Difficult intravenous access can be a very stressful experience, especially in a remote
emergency department. Adult intraosseous access can provide rapid access for fluids
and drugs in a critically ill patient in whom intravenous access is difficult or impossible.
This article presents two case reports of patients in whom rapid intraosseous access was
lifesaving.
Cosmetic surgery on children – professional and legal obligations in Australia
Leon Kitipornchai, Shih-Ning Then
Public awareness and concern about cosmetic surgery on children is increasing.
Nationally and internationally questions have been raised by the media and government
bodies about the appropriateness of children undergoing cosmetic surgery.
Primary palliative care – facing twin challenges
Geoffrey K Mitchell
As Australia’s population ages, three
things are inevitable: more people will
develop chronic illnesses; more will grow
very ill and more will die. Blueprints
for the future suggest an increasingly
important role for general practitioners
and primary healthcare in palliative care.
Cholesterol lowering medication – patients’ knowledge, attitudes and experiences
Angela Gialamas, Paul Aylward, Simon Vanlint, Nigel P Stocks
Despite evidence of the efficacy of
cholesterol lowering medication, it
is known there is suboptimal patient
adherence to this medication. The aim
of this study is to investigate patient
knowledge, attitudes and experiences
of their cholesterol lowering medication,
and explore patient views regarding
programs to support self management.
AUSDRISK – application in general practice
Kam Cheong Wong, Anthony M Brown, Stephen CH Li
The Australian Type 2 Diabetes Risk
Assessment Tool (AUSDRISK) has been
promoted since July 2008. We studied
its application rate and the profile of
a sample of general practice patients
within Central West New South Wales
from June to December 2010.
Nondiabetic retinal pathology – prevalence in diabetic retinopathy screening
Nathan Nielsen, Claire Jackson, Geoffrey Spurling, Peter Cranstoun
To determine the prevalence of
photographic signs of nondiabetic
retinal pathology in Australian general
practice patients with diabetes.
Chronic hepatitis B – a clinical audit of GP management
Anouk Dev, James Ngoc Huong Nguyen, Lili Munafo,
Eve Hardie, Linda Iacono
Hepatitis B virus (HBV) infection represents a growing health burden
in Australia. This clinical audit aimed to enhance general practitioner
awareness of the recommended management for patients with chronic
hepatitis B.
The pre-employment medical – nuisance or great opportunity?
Peter Fenner
This article forms part of our ‘Paperwork’ series for 2011, providing information about a range
of paperwork that general practitioners complete regularly. The aim of the series is to provide
information on the purpose of the paperwork, and hints on how to complete it accurately. This
will allow the GP to be more efficient and the patient to have an accurately completed piece of
paperwork for the purpose required.
Book reviews
Books reviewed this month are Murtagh’s general practice fifth edition by John Murtagh and A guide to evidence based integrative and complementary medicine by Vicki Kotsirilos, Luis Vitetta & Avni Sali
Clinical challenge
Nyoli Valentine
Questions for this month’s clinical challenge are based on articles in this issue. The style and
scope of questions is in keeping with the multiple choice questions of the RACGP Fellowship
exam. The quiz is endorsed by the RACGP Quality Improvement and Continuing Professional
Development Program and has been allocated 4 Category 2 points per issue.