Management Of Skin Conditions Research Articles

Managing skin conditions due to venous leg ulceration

Those caring for patients with venous leg ulceration tend to focus on managing the ulcer, however the surrounding skin is also important. Annemarie Brown describes its effective management

Skin conditions in the pharmacy: consumer satisfaction and economic considerations

Abstract Objective To evaluate whether consumers were satisfied with advice about skin conditions received from community pharmacists in Victoria, Australia, and to estimate costs and potential savings to the consumer and government associated with managing these conditions in the pharmacy. Methods In 1997–1998, a consumer survey on costs and satisfaction was carried out in Victoria as part of a statewide education programme with community pharmacists. Pharmacists recorded details of dermatological consultations involving over-the-counter (OTC) products, and recruited pharmacy consumers for follow-up by a member of the research team. Results Consumer consultations were recorded at 126 pharmacies. One hundred and five (58.0 per cent) of the 181 consumers who were subsequently interviewed reported being very satisfied with their consultation. One hundred and thirty-two (73.0 per cent) spent up to 10 minutes consulting the pharmacist and 78 (43.1 per cent) spent between $A5 (£1.95) and $A10 on OTC products. A total of 37 consumers (20.4 per cent) consulted a medical practitioner on the advice of their pharmacist. While most of the 37 consumers spent under $A10 in the pharmacy, if the cost of medical consultation and the subsidised nature of items supplied on medical prescription were taken into account, the costs to the consumer and government would have been greater. The direct costs for a pharmacist consultation on the management of skin conditions were lower than the expected direct costs associated with a general practitioner (GP) consultation. Conclusions Consumers were satisfied with the advice and treatment they received from the pharmacist on the management of skin conditions. Pharmacists' advice also appeared to be cost-effective for both the consumer and government. Community pharmacists appear to be satisfactory primary providers of advice and treatment for people with minor skin conditions.

Evaluation of educational methods in dermatology and confidence levels: a national survey of UK medical students

The high prevalence of skin conditions makes dermatology education an essential part of the undergraduate medical curriculum. The aim of this study was to assess the impact of different educational methods on confidence levels in dermatology among UK medical students. A survey-based study was carried out to establish: (i) educational experience in dermatology, and (ii) confidence levels in the British Association of Dermatologists core curriculum learning outcomes. Measures of confidence were rated using a five-point Likert scale. Completed questionnaires were obtained from 449 final-year medical students at 14 medical schools (12.9% of 3485 final-year UK medical students). Students who received teaching from dermatologists (P ≤ 0.01), dermatology specialist nurses (P ≤ 0.001), and expert patients (P ≤ 0.001) reported higher levels of confidence. Learning in clinical settings (P ≤ 0.001) and small-group settings (P ≤ 0.001) was associated with higher confidence levels. Student-selected components in dermatology were associated with higher confidence levels (P ≤ 0.001). Confidence levels were consistently lower in dermatological emergencies compared with chronic conditions, reflecting the lack of clinical exposure. Overall, 64.9% of students were at least adequately confident in assessing, and 52.0% were similarly confident in managing patients with skin conditions. The findings of this study show that specialist clinical experiences and small-group learning had the most significant influence on confidence levels in dermatology. Many medical students nearing qualification were less than adequately confident in their abilities to assess and manage skin conditions, suggesting that a greater emphasis on dermatology is required.

Skin conditions.

While emergency nurses may be confident about managing common presentations, few are likely to have much expertise in managing skin conditions.

Skin Health and Metabolic Complications

Aging and metabolic complications (MC) such as diabetes mellitus (DM), hypertension, heart disease and hormonal changes were independent risk factors for dry and fissured skin. Rough, dry and scaly skin affects at least 75% of people with DM and other MC in aging. Intense itching (pruritus) is the most prominent in MC and enhance scratching and rubbing that aggravates dry skin condition, causing more inflammation and may end up in getting secondary infections. In MC, microvascular impairment may dehydrate the skin and cracks with erythema (redness or inflamation) and more evident in and around the involved areas in MC. Skin health plays a considerable role in managing skin conditions in chronic MC. Table 1 provides the MC and changes in skin health. It is very important to find the ways to rehydrate for healthy skin but also need to support the induction of proper epidermal differentiation.

Management of skin conditions in the older population 2

This is the second of two papers covering assessment and management of elderly skin. Part 1 of this clinical review focused on the importance of a comprehensive assessment of the skin and a detailed clinical history of the patient (Bianchi and Cameron, 2008). This second paper considers some common dermatological conditions seen in the older adult and explores suitable management strategies.

Online problem-based learning in postgraduate medical education – content analysis of reflection comments

We developed the Med-e-Conference, an online tool to teach clinical skills to medical students, which integrated problem-based learning with collaborative group tasks. The final task asked students to consider what they had done (reflection). These comments were analysed using content analysis, and 10 themes were elicited. The number of agreements and disagreements with the themes were compared to test acceptability to our students. The Med-e-Conference was perceived as educational, relevant, useful for revision, showed learning through peer interaction, helped create materials useful in general practice, increased topic problem-solving, and helped to provide confidence/reassurance in managing skin conditions. Practice also changed as a result. The tasks were sometimes criticised as repetitive, and some doctors did not have sufficient resources to fully benefit from participation. This study revealed that online collaborative tasks were acceptable to students and provided benefits beyond those seen with conventional learning methods.

Disparities in dermatology educational resources

Patients with dark skin can present with morphologic variants, subtle disease presentations, and disease manifestations requiring unique management and therapies. With African Americans, Asians, and Hispanic Americans becoming a significant portion of the population, dermatologists must be able to diagnose and manage skin conditions in people of color. In this study, core dermatology educational sources were examined to determine if they provide dermatologists and trainees with the knowledge base necessary to diagnose and treat skin disease in the ethnic patient. Overall, the coverage of dark skin at national meetings and in photographs in the major dermatology resources is limited and variable. More consistent photographic coverage and textual information describing common and serious skin diseases in people of color should be incorporated into educational resources.

DERM (Dermatologic education for residents and medical students): a pilot program of web-based dermatologic teaching to maximize efficient use of time for residents and medical students

Due to the current emphasis on cost-containment measures in health care, primary care physicians are increasingly responsible for the initial evaluation of skin disorders. Multiple studies comparing the skills of generalists with dermatologists have concluded that further dermatological training is essential for improving the knowledge of generalist physicians. Studies have also demonstrated that appropriate educational intervention can help primary care residents in managing skin conditions at a level approximating that of dermatologists. At the same time, significant constraints on the average resident’s time for learning with a dermatologist make this educational aim difficult. With this in mind, we created and implemented a web-based educational program for primary care residents and medical students providing them with essential information on the diagnosis, pathophysiology, and management of common skin disorders, as well as evaluating their learning through on-line quizzes. Through this pilot program we attempt to determine whether online education is an effective method of improving the dermatological knowledge of primary care residents. Method: We describe the creation of a pilot program targeting pediatric and internal medicine residents as well as medical students at the community based NEOUCOM consortium hospitals in Akron. We utilized WebCT software to provide users with recommended reference materials including links to the AAD’s medical student core curriculum website for the monthly skin topic. Topics emphasized range from acne vulgaris to skin cancer. The effectiveness of the pilot program is evaluated by comparing the results of pre-reading and post-reading quizzes administered online to the students and residents, as well as online surveys. We also describe potential spin-off projects from this initial pilot program including virtual grand rounds, continuing medical education for physicians, and internet-based communication between generalist residents and dermatologists to clarify dermatological questions. Discussion and Conclusion: Currently primary care residents in the consortium hospitals acquire only minimal clinical dermatologic education. Our web-based program has the advantage of being convenient, easily accessible, inexpensive, and more efficient than a few days of dermatology rotation in that all the essential topics are sure to be emphasized. We believe that a web-based educational program has definite potential in improving the dermatologic knowledge of primary care residents and students.

The Outcome of an Education Programme to Assist Pharmacists in Prescribing Over-the-counter (OTC) Products for Common Skin Diseases

Aim. Dermatology within the Pharmacy: an Education Programme on Common Skin Conditions for Pharmacists was developed to assist pharmacists in Australia with both the diagnosis of common skin diseases and the prescribing of appropriate non prescription medications for their treatment. The educational resources comprised a 107-page book with colour photographs and diagnostic flow charts and a video that complemented the book. The programme was evaluated to determine its effectiveness in improving pharmacists’ skills and confidence in diagnosis and management, and participants’ satisfaction with the resource. Method. Two hundred and ten community pharmacists, recruited by telephone from a list of community pharmacies, participated in the evaluation. Pharmacists were randomly allocated into three groups. Group 1 received printed educational material; group 2 received printed material and a supporting video; group 3 served as the control. A mail questionnaire to assess pharmacists’ confidence and skills in diagnosing and managing common skin conditions was distributed prior to distribution of the educational materials, and at one month and six-months after distribution. Results. One hundred and eighty-three pharmacists completed all three evaluations. Analysis at four weeks showed that groups 1 and 2 improved significantly in their skill in diagnosis whilst group 3 were relatively unaffected. Group 2 also increased significantly in their confidence in both diagnosing and managing skin conditions. Improvements were maintained six-months after the education programme. One hundred and eleven pharmacists (60.7%) completed evaluations of their satisfaction with the programme. They rated both the book and the video very highly in helping to improve their ability to diagnose and manage skin conditions. Conclusion. These data suggest that practical educational programmes such as the DEP are worthwhile in ensuring that consumers with common skin diseases receive appropriate advice in the community pharmacy setting.

The gatekeeper model is inefficient for the delivery of dermatologic services

Background: Gatekeeper-paradigm managed care systems may discourage the use of dermatologists in the management of skin conditions by limiting direct access. This may limit the quality of care patients with skin disorders receive and may be an inefficient use of medical resources. Objective: The purpose of this study was to determine the likelihood that patients with dermatologic conditions who see a primary care provider will be referred to a dermatologist. Methods: Data on the disposition of outpatient visits to primary care physicians for one and only one dermatologic diagnosis were obtained from the 1990-1994 National Ambulatory Medical Care Survey. These data were used in an econometric model to estimate the likelihood of referral to a dermatologist for an episode of care. Results: Of all visits for a single dermatologic diagnosis, 39% were to primary care physicians. The disposition of referral was more common for these dermatology-related visits than for all office visits to primary care physicians (5.8% vs 4.5%, P < .001). The most frequent diagnoses associated with referral were common dermatologic problems, not rare disorders. The number of visits per episode of care was highly dependent on the assumptions of the analysis, resulting in estimate ranges for referral rates per episode between 6.8% and 18.5% for pediatricians, 8.2% and 23% for family and general practitioners, and 16.6% and 46.5% for internists. Conclusion: The relative difficulty for primary care providers of managing skin problems is reflected by their frequent need to refer patients with common skin problems and by the greater likelihood of referral for skin disorders than for other medical conditions. The high rates of referral per episode of care supports the cost-effectiveness of direct access to dermatologists. (J Am Acad Dermatol 1999;40:426-32.)

Influence of culture and pigment on skin conditions in children.

1. James G. Dinulos, MD* 2. Elinor A. Graham, MD, MPH† 1. 2. *Department of Medicine, Division of Dermatology. 3. 4. †Departments of Pediatrics, University of Washington, Seattle, WA. 1. Superficial inflammatory skin conditions commonly appear different in dark skin because of exaggeration of normal cutaneous reaction patterns. 2. Dyspigmentation from skin inflammation or injury may result in permanent color changes. Prompt diagnosis and appropriate management can modify adverse cosmetic outcomes from pigment changes. 3. Several skin conditions are more common in children who have dark skin, and common disorders such as atopic dermatitis and pityriasis rosea may have different presentations. 4. All patients who have dark skin should be counseled about the potential pigmentary changes that can occur with all classes of topical steroids. However, conditions that produce intense inflammation should be treated with appropriate-strength steroid to attempt to minimize long-lasting pigmentary changes. Many common skin disorders manifest themselves differently in children who have dark skin. This altered appearance is thought to occur in part because of exaggerated cutaneous reaction patterns to internal and external influences. Normal variations in pigment may be confused with bruises or disease. People from various cultures alter their skin as part of healing and grooming practices. Knowledge of the appearance of common skin disorders in dark skin, normal variations, and unique cultural skin manipulations is vital to the diagnosis and management of skin conditions in this group of patients. Excellent recent reviews have been published in the dermatology literature on this subject (see Suggested Reading). This review outlines distinctive reaction patterns, the common skin conditions affected by them, and suggestions for effective management. We also discuss common cultural practices and non-Western healing techniques that result in unique skin findings. Pigment lability, follicular response, and mesenchymal response are three primary cutaneous reactions responsible for the altered appearance of common skin disorders in children who have dark skin. They represent normal cutaneous responses that are seen in all skin types, although they are exaggerated in many children who have …

Advice about management of skin conditions in the community: Who are the providers?

A survey was undertaken in the central Victorian city of Maryborough to investigate the use of pharmacies and general practitioners as sources of advice about skin problems. In a 2 week period consumers purchasing either prescription or over the counter (OTC) products for skin, hair and nails in pharmacies were approached for interview. Simultaneously, each of the city's general practitioners (GP) completed questionnaires on all patients presenting with conditions of skin, hair and nails. Seventy per cent of the 315 consumers interviewed were purchasing OTC products and 50% prescription items. Of the OTC products, 42% were originally recommended by pharmacy staff and 18% by doctors. Over one-third of consumers buying OTC products described symptoms to pharmacy staff and in about half of the cases it was to the pharmacy assistant. One-third of people describing symptoms had already seen a doctor. Problems most frequently reported were dermatitis, skin dryness, acne and tinea. General practitioners recorded 265 conditions (of which 54% were new) in patients. The most common condition treated was solar keratosis, and GP wrote a prescription for 45% and recommended OTC products for 7% of conditions. People in Maryborough are seeking advice for their skin conditions from a variety of sources including GP, pharmacies and others.