Is enough dermatology training given to primary health physicians?

Large numbers of patients with minor skin ailments are being referred by primary health physicians to skin clinics with little attempt at diagnosing and treating these cases. This study evaluated whether primary health physicians were exposed to enough dermatology in their training to diagnose and treat simple dermatoses. In this retrospective cross-sectional survey the diagnosis, treatment, source of referral of all patients seen between January and June 1997 in two health centres in East Trinidad, Sangre Grande (SG) and Arima (A), were reviewed. There werer 146 registered patients at Sangre Grande and 189 at Arima. The commonest skin disorder was eczema (SG 37 percent, A 38 percent). The ability to diagnose this condition was 25 percent in Arima and 7 percent in Sangre Grande. Atopic exzema was the commonest in childhood (A 16 percent, SG 13 percent). Fungal infections, which included tinea corpois (A 8 percent, SG 7 percent) and tinea capitis ( A 15 percent, SG 8 percent), were the next most common dermatoses seen. The diagnostic ability for tinea corpois was: A 13 percent SG 0 percent; but there was a higher diagnostic index for tinea capitis (A 52 percent, SG 50 percent). Psoriasis (A 21 percent, SG 7 percent), like tinea capitis, had a diagnosis index of 50 percent. The most common referring diagnosis was skin rash (43 percent, SG 45 percent) or fungal rash (A 38 percent, SG 36 percent). There were significant differences in gender (P <0.05) and ethnicity (P<0.001) in Arima. In conclusion, the commonest dermatoses seen in both centres, were the eczemas, fungal infections and psoriasis. Diagnostic ability was low for the eczemas and tinea corporis, the commonest skin disorders, but better for tinea capitis and psoriasis. Increase referrals fof common skin disorders leads to overcrowding, decreasing the time for the dermatologist to do procedures, to teach and to give earlier and more frequent appointments to needy patients. Cost of treatment of patients and to Government is lower when the diagnosis is made on the initial visit, and loss of school days for tinea capitis can be decreased by prompt and effective treatment.(AU)

Incidence of skin disease in rural Jamaica

The incidence of skin disease in people seeking health care in rural Jamaica during the period January to December 1985 has been studied. Results indicate that of 14,179 clinic visits reviewed, 6 percent involved a primary dermatological diagnosis. Infectious and parasitic diseases predominated, with scabies, impetigo, and tinea being the most common diagnoses. Of these, scabies accounted for nearly one third of all dermatologic visits. Noninfectious skin disease accounted for less than 10 percent of dermatologic diagnosis, with unclassified eczema making up the majority. Undiagnosed skin conditions contributed one third of dermatologic visits, with an incidence inversely related to the incidence of scabies visits. This relationship suggests that many evaluations of skin conditions were based on the exclusion of scabies with no alternative diagnosis. (AU)

The incidence of mycoses in the Eastern Caribbean area: Guyana, Trinidad and Barbados

This report details the distribution and importance of fungal disease in Barbados, Trinidad and Guyana. Detailed statistics are not available largely because of the absence of specialised mycological diagnostic facilities. However, there is sufficient data to establish that mycoses particularly superficial infections, are very prevalent and to justify the establishment of diagnostic facilities for mycoses and following this a more detailed analysis of the problem. (AU)

Sickle cell beta thalassaemia in Jamaica

An analysis of the radiological appearances in a skeletal survey of 48 patients in Jamaica with sickle cell beta thalassaemia is presented. The appearances are similar to those in homozygous sickle cell disease and SC disease and a confident distinction between the conditions on radiological grounds alone is likely. (AU)