Dermatology is a fascinating subject. This is a statement you might
expect from a dermatologist, but what is the justification? It is a
highly clinical specialty and sophisticated techniques of diagnosis are
very much of secondary importance compared with clinical skills. The
skin is important not only as an organ with vital physiological
functions but also as a flag by which we communicate with the outside
world. A perfect skin is desired by all, and upon this wish is based the
multi-million pound cosmetics industry. Skin disease therefore places a
strain on sufferers out of proportion to the disturbances in function
which the pathology produces. A "leper" complex is frequent, and social
and sexual contact may be shunned because of the embarrassment caused.
It is also easy to overlook the contribution that cutaneous physical
signs make towards diagnoses of internal disorders. Even straightforward
factors such as the pallor of anaemia, the icterus of biliary
obstruction or, quite simply, the age and sex of the patient are
recognised immediately from visible signs in the skin. Like most other
organs the skin has a limited repertoire of reactions, but these can
occur in patients of all ages, combined together in an almost infinite
number of permutations; hence the fascination referred to above. It has
been estimated that 10% of consultations with general practioners are
because of a skin-related problem, and therefore a working knowledge of
dermatology is essential for anyone who has regular clinical contact
with patients.
