Rapid Responses to:

CLINICAL REVIEW: Catherine H Smith and J N W N Barker Psoriasis and its management BMJ 2006; 333: 380-384 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

GP knowledge and education

Charles T Heatley   (19 August 2006)

Psorasis and its management

Fiona Woollard   (21 August 2006)

GP knowledge and education 19 August 2006
Charles T Heatley, GP Birley Health Centre, Sheffield, UK S12 3BP Send response to journal: Re: GP knowledge and education	I had a mildly reactionary response to an otherwise useful and informative article. Ask any group of GPs where their weak spots are clinically and they will usually say, "dermatology." Medical students seem to get very little training and as a GP tutor I try to cover common conditions and at least encourage them to make a rational assessment of skin problems including learning commonly accepted descriptive terms. However I suggest that enhanced dermatology skills lie in pattern recognition in response to repeated exposure to different conditions. Research has shown that GPs who are given additional training enhance the quality of referrals but that this effect is subject to attrition within months. If the answer lies in teaching and encouraging patients to use topical treatments correctly and consistently, how about directing training at practice nurses and health care assistants? Competing interests: None declared
Psorasis and its management 21 August 2006
Fiona Woollard, BA (Hons) Med Sec Dip YO24 1EP Send response to journal: Re: Psorasis and its management	Thank you for identifying the gene responsible. However, in my case it is 22q11.2 deletion syndrome. I don’t think I need any more to add to the growing list! However, there are other causes for psorasisis including hypoparathyroidism and hypcocalcaemia. Since appropriate treatment for hypocalcaemia – Calciltriol and Calcium Sandaz the psorasis has improved dramatically but it has taken two years because the iodnized calcium was so low. Other topical treatment such as Elcon Scalp solution, Hydroxychloroquine tablets 20 mgs, E45 cream, E45 ointment and zinc sulphate have all been used and have been helpful. I have used in effectively nearly all over- the- counter shampoos without success. Not only blood tests should be done to identify the cytopenias are needed but also an ANA which identified autoimmune disease – mixed connective tissue disorder. I have had far too much of the psychological mentality when in fact it was serious underlying illness which was missed and included DiGeorge syndrome/22q11 deletion syndrome, cytopenias – in particular T-cell disorders – CD3, CD4 and CD8. I am classed as immuno-compromised and skin infections are part of the whole clinical picture and skin infections part of the T-Cell disorders. “Anxiety and depression affects up to 25% of patients with psoriasis, and is often missed in clinical practice”. Might help if that was appropriately managed too – which means anti-anxiety tablets and anti-depressives. Whilst CBT specialists are helpful in other areas, practice counselors and such can actually make matters worse and some have no knowledge of medicine whatsoever and can cause a lot of grief. Other important illnesses were also missed as part of this focus on stress and anxiety. It is no doubt that certain unnecessary stress act as a trigger that includes inappropriate use of psychological medicine. An immunologist now manages my case and includes a rheumatologist who deal with the various aspects of my gene deletion, whilst the deletion can’t be treated, the symptoms can be treated. Competing interests: None declared