Shelley's 77 Skins

Abstract

This set of flashcards with illustrations of common dermatological disorders is marketed as a ‘refresher course for doctors, nurses and students’. The stated claim is that ‘when you know these, you know 95% of all you need to know’. Each card has an illustration and, on the reverse, some key features of the disease plus a catchy slogan such as for acne: ‘from zits to pits’. I tried out the cards on a handful of dermatology consultants and specialist registrars, a new dermatology SHO, medical students, and a dermatology-phobic general practitioner (my husband). The consultants and specialist registrars did not do particularly well, finding that the skin appearance of some rashes suggested a wide differential. Without a history, a red patch on a back could be due to any number of conditions, but with a typical history a fixed drug eruption is easier to diagnose. In addition, some of the illustrations were atypical—for example, granuloma annulare is shown in its unusual widespread form rather than the typical ring on the back of a hand or dorsum of a foot. The SHO thought the cards were interesting and might be useful to flick through on starting dermatology. The medical students were a little bemused, finding the cards very difficult and the GP was exasperated with the chickenpox illustrations of two vesicles that could have been insect bites. The concept is laudable and the quality of most of the illustrations is good. Some of the photos are excellent examples, such as the cutaneous larva migrans, psoriasis and the urticarial wheals. One glaring omission is melanoma (apart from the metastatic disease). Melanoma surely must rank in the need-to-know category. Disappointingly, the leg ulcer is out of focus and the aetiology is undefined. A good example of a venous ulcer and a punched out arterial ulcer would be useful additions. The most likely users of these cards would be new dermatology SHOs or GP clinical assistants. If the target is to be doctors just starting out in dermatology, the illustrations need to be typical in appearance. Just a few changes and these cards could be really useful, and probably even more useful on a CD Rom.