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EDITORIALS: Ronald M Davis, Edward G Wagner, and Trish Groves Advances in managing chronic disease BMJ 2000; 320: 525-526 [Full text]

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Management of chronic skin diseases

Peter Lapsley   (14 March 2000)

Management of chronic skin diseases 14 March 2000
Peter Lapsley, Co-ordinator The Skin Care Campaign Send response to journal: Re: Management of chronic skin diseases	We have become increasingly concerned recently that in its preoccupation with cancer, heart disease and mental health, the Department of Health has begun to lose sight of the quality of life issues surrounding long-term illness. We were particularly pleased therefore that the BMJ’s issue 7234 (26 February 2000) should have taken as its theme the importance of considering the needs of people with chronic conditions. We were however disappointed not to see any examples from dermatology in the papers presented. Unlike many other chronic conditions, skin diseases are often stigmatising to a greater extent even than depression, but there is little understanding amongst health professionals or the public of the impact they can have on people’s quality of life. In the report on its Enquiry into the training of healthcare professionals who come into contact with skin diseases, (London, July 1998) the All Party Parliamentary Group on Skin called for funding to be made available for skin disease management clinics in primary care comparable with that already provided for asthma and diabetes. Since then, we have been working with NHSE to acquire the evidence necessary to secure such funding. Skin diseases can be notoriously difficult to diagnose and diagnosis must, therefore, be undertaken at an appropriate level within the healthcare system. Thereafter, though, many conditions could most effectively be managed in (probably nurse-led) primary care clinics, improving compliance and patient satisfaction and reducing the burden on the NHS. There would, of course, be a cost associated with the establishment of clinics of this sort. At present,and as the APPG report demonstrated, dermatology training for nurses and GPs ranges from negligible to nil. That would have to change, but given that skin diseases occupy some fifteen percent of the average GP’s caseload, it ought to be changing anyway.