Five years of dermatological disease requiring specialist care in the Kimberley region of Western Australia.

BACKGROUND: Epidemiological studies that document the burden of skin diseases in rural and remote regions of Australia are vital in ensuring proper health-care planning and management. The purpose of this study was to establish the burden of skin disease requiring specialist dermatology input for both the Aboriginal and non-Aboriginal communities in the Kimberley. METHODS: A retrospective audit of all outpatient encounters with the primary Country Health Service visiting dermatology specialist in the Kimberley region between January 2012 and January 2017. RESULTS: A total of 2281 encounters were recorded with 1459 unique patients seen. The most common disease categories seen in the general population were premalignant and malignant skin disease (40%), eczema and dermatitis (17%) and benign skin neoplasms (12%). Among Aboriginal patients, the most common conditions were eczema and dermatitis (19%), autoimmune connective tissue disease/rheumatological and autoinflammatory syndromes (17%), adnexal diseases (10%), pigmentary disorders (7%) and benign skin neoplasms (7%). CONCLUSION: These findings can be used to enhance, direct and plan dermatological services for both the Aboriginal and non-Aboriginal populations in the Kimberley region.

Active sunscreen ingredients in Australia.

UV radiation exposure is the major contributor to photocarcinogenesis and photoageing. Reducing UV radiation exposure can be achieved by using adequate sunscreen preparations. The use of sunscreen can significantly reduce the incidence of squamous cell carcinoma, actinic keratoses and invasive melanoma. In the Australian market over 900 sunscreen products are available, each with their own brand, formulation and ingredients. It can be difficult for dermatologists and consumers to determine which are the most effective and appropriate products to use. We discuss the specific active ingredients found in sunscreen formulations available in Australia, their mode of protection, photostability, solubility, and side-effects and the methods used by the Therapeutic Goods Administration to determine the ratings and efficacy of each sunscreen.

Mycophenolic acid in dermatology a century after its discovery.

Mycophenolic acid was first discovered in 1913 and first used clinically in the 1970s as an immunosuppressant to prevent organ transplantation rejection. It was later used in the treatment of psoriasis. However due to its side-effect profile and fears over its carcinogenic potential it was abandoned. From the late 1990s a prodrug, mycophenolate mofetil (MMF), was developed and more recently, enteric-coated mycophenolate sodium (EC-MPS), both of which have gained increasing use in the field of dermatology for a variety of skin conditions. This review discusses the pharmacology, mechanisms of action, side-effects and current clinical applications in dermatology of MMF and EC-MPS.

Non-infectious skin disease in Indigenous Australians.

The burden of non-infectious skin disease in the Indigenous Australian population has not been previously examined. This study considers the published data on the epidemiology and clinical features of a number of non-infectious skin diseases in Indigenous Australians. It also outlines hypotheses for the possible differences in the prevalence of such diseases in this group compared with the general Australian population. There is a paucity of literature on the topic but, from the material available, Indigenous Australians appear to have a reduced prevalence of psoriasis, type 1 hypersensitivity reactions and skin cancer but increased rates of lupus erythematosus, kava dermopathy and vitamin D deficiency when compared to the non-Indigenous Australian population. This article profiles the prevalence and presentation of non-infectious skin diseases in the Indigenous Australian population to synthesise our limited knowledge and highlight deficiencies in our understanding.

Tanning bed and nail lamp use and the risk of cutaneous malignancy: a review of the literature.

Malignant melanoma (MM) and non-melanoma skin cancer (NMSC) are increasingly common and both can be fatal. In 2009 the World Health Organization (WHO) classified the whole ultraviolet spectrum and tanning beds as carcinogenic to humans, placing them in the same category as asbestos and tobacco. Despite this, the trend for indoor tanning continues. A growing body of evidence has now associated indoor tanning with an increased risk of MM and NMSC. As a result, there has been an upsurge in regulations in the tanning industry ranging from age restrictions to complete bans on commercial tanning. This article examines the evidence and strengthens the case for a complete ban of a recognised modifiable risk factor for cutaneous malignancy.

Non-antibiotic properties of tetracyclines and their clinical application in dermatology.

Dermatologists have used tetracyclines since the 1950s to treat disorders that do not necessarily have an infectious aetiology. Their anti-inflammatory and anti-collagenase properties contribute significantly to their success in treating diseases such as rosacea and acne. This article reviews the non-antibiotic properties of tetracyclines and their clinical application in dermatology.

Lupus vulgaris: difficulties in diagnosis.

Lupus vulgaris is one of the most common forms of cutaneous tuberculosis. It presents a diagnostic challenge due to its paucibacillary nature. This is a report of a case of a delayed diagnosis of lupus vulgaris, presenting as perianal and peristomal plaques, followed by a review of the diagnostic tools for lupus vulgaris and their limitations.

Impact on the dermatology educational experience of medical students with the introduction of online teaching support modules to help address the reduction in clinical teaching.

BACKGROUND/OBJECTIVES: With increasing medical student numbers and decreasing clinical teaching opportunities, there has been a need to develop alternative learning resources. The aim of this study was to examine the effectiveness of a new dermatology online teaching resource, from a student perspective. METHODS: The Australasian College of Dermatologists developed an undergraduate dermatology curriculum and subsequently created online teaching modules in partnership with the University of Sydney. These modules were introduced to final year medical students at the University of Western Australia in 2010. The dermatology learning experiences of these 142 students were compared with the 2009 medical student cohort who did not have access to this resource. A self-administered questionnaire, with a 5-point rating scale, was used. RESULTS: The 2010 cohort described an improved educational experience using the online modules. Despite a reduction in the number of clinics attended, knowledge and skills gained were scored higher among the 2010 cohort. The student's confidence in their ability to manage common dermatological conditions was also statistically higher in the cohort with the online teaching resource. The learning experience for dermatology compared to other subspecialty teaching in medical school was ranked as a significantly more positive experience in the 2010 cohort. CONCLUSIONS: Our results suggest that the introduction of the online modules described in this paper to support learning have improved the perceived educational experience of medical students and should be incorporated as a way to improve student teaching in the face of reduced clinic teaching.

Sclerosing lipogranuloma of the penis.

We present a case of sclerosing lipogranuloma of the penis in a 25-year-old man of Burmese origin complicating injection of an unknown non-biodegradable oily foreign material into his external genitalia. Despite frequent complications, penile augmentation with exogenous paraffin material is still practised in some parts of the world. Sclerosing lipogranuloma is a rare condition in Australia that dermatologists need to consider in the differential of a genital ulcer or indurated penile mass, particularly in young men from South-East Asia. A causal relationship between the procedure and adverse events may not be made because complications are frequently delayed for many years. A high degree of clinical suspicion and a skin biopsy is essential, as a history of injection may not be disclosed.

Melanoma in private practice: do dermatologists make a difference?

Malignant melanoma is a major contributor to Australian morbidity and mortality. In this era of resource rationalisation, we seek to address the issue of whether routine full-skin examination by a dermatologist, rather than focussed examination of flagged lesions, will increase melanoma diagnosis. A retrospective chart review was undertaken between 1 July 2007 and 30 June 2008 in a private dermatology group practice in order to ascertain the number and characteristics of incidentally detected melanomas on routine skin examination. A total of 94 melanomas were detected during this 12-month period. Of these, 57 (60.6%) were incidentally detected by the dermatologist, 41 (71.9%) were in situ melanomas and 16 (28.1%) were invasive melanoma. Of the invasive lesions, 15 (94%) were 'thin' (less than 1.0 mm Breslow thickness). The majority of melanomas were found in men, and were distributed in areas of high cumulative sun exposure. Nine (9.6%) lesions were clinically misdiagnosed by the dermatologists and picked up on histopathology. This audit reaffirms the usefulness of routine full-skin examination by dermatologists in detecting de novo melanoma as part of the global strategy in reducing the burden of melanoma in Australia.

Use of infliximab in pyoderma gangrenosum.

A 57-year-old man, with a 2-year history of Crohn's disease, presented with a rapidly progressive abdominal ulcer. It was clinically and histologically consistent with pyoderma gangrenosum but it did not respond to either high-dose oral prednisolone or intravenous hydrocortisone. Infliximab resulted in an early, dramatic and sustained improvement. His bowel symptoms, which flared a few weeks prior to the onset of pyoderma gangrenosum, only partially improved. Despite six infliximab infusions, the inflammatory bowel disease is poorly controlled, whereas the pyoderma gangrenosum remains healed.