Dermatology Practical & Conceptual
October 2011 Volume 1, No. 1
Introduction to Dermatology in Primary Care
Jeffrey Keir, M.D.
Keir J. Introduction to Dermatology in Primary Care [editorial]. Dermatol Pract Concept 2011;1(1):15. http://dx.doi.org/10.5826/dpc.0101a15.
©2011 Keir. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Jeffrey Keir, Northern Rivers Skin Cancer Clinic, Ballina, NSW, Australia. Email:
It is a great honour to be asked to establish and edit this new section of
Dermatology Practical & Conceptual
. I have had the good fortune to study, work and practice in countries of widely varying socioeconomic status and to be able to concentrate for the last 10 years on delivering dermatology and skin cancer care in primary care practice. This has given me the opportunity to gain a perspective on medical practice internationally and the chance to engage in research, education and teaching in a primary care setting. Having a strong interest in skin cancer management, it is with particular pleasure that I note that this journal is now the official journal of the International Dermoscopy Society and of the Skin Cancer College of Australia and New Zealand.
It is often forgotten how great the burden of skin disease is in primary care around the world, yet there is so little research in the field and even less international teaching and communication on the subject. Surveys of primary care in the Netherlands [
], Australia [
] and the United Kingdom [
] show the percentage of presentations relating to dermatological conditions are 12.4%, 10.4 % and 8.4 % respectively--about one in ten complaints dealt with in primary care are dermatologically related.
There is also much variability between countries in the medical systems that deliver dermatological care and the interface between specialist dermatologists and primary care practitioners. These range from mainly hospital-centric models, such as in the United Kingdom or Saudi Arabia; to relatively decentralized private practice, such as in Australia; to areas where primary health care is delivered by non-physicians, such as by the Health Extension Officers of Papua New Guinea; by teledermatology, as in remote areas of Canada and Australia; or self care, where there are no accessible health professionals as in so many parts of the world.
Training and education prospects vary just as widely. I recall the few hours a week of dermatology instruction over a one-month period that I was given in medical school and a textbook that had only twelve A5 pages of diagnostic images. Fortunately, that deficit has been made up as a postgraduate, but not all graduates get that opportunity.
Added to this is the evident great geographic variation of the types of diseases and case mixes encountered, whether they are infectious conditions, such as cutaneous leishmaniasis, or more environmentally influenced conditions, such as skin cancer. Over all of this is added the influence of socioeconomic development and ethnicity.
"Dermatology in Primary Care" will aim to take an international perspective, encouraging and highlighting research originating in primary care and offering teaching and review articles relevant to primary care. Although the section will be necessarily brief in early journal editions, when fully developed, each edition will contain original research, review articles, opinion and editorial comment. In recognition of primary care practitioners being mainly morphologists, and in keeping with the focus of the journal, illustrated notable cases and educational case studies will be prominent. A particular feature of each edition will be a country-by-country perspective on primary care dermatological practice and how care is delivered.
I look forward to a long relationship with the journal and its readers.
Dr. Jeffrey Keir
MBBS MFamMed(Clin) DipPracDerm
Director, Northern Rivers Skin Cancer Clinic, Ballina, NSW, Australia
1. Verhoeven EW, Kraaimaat FW, van Weel C, et al. Skin diseases in family medicine: prevalence and health care use. Ann Fam Med 2008;6(4):349-54.
2. Britt H, Miller GC, Knox S, et al. General practice activity in Australia 200405. AIHW Cat. No. GEP 18. Canberra: Australian Institute of Health and Welfare, 2005.
3. Kerr OA, Tidman MJ, Walker JJ, Aldridge RD, Benton EC. The profile of dermatological problems in primary care. Clin Exp Dermatol 2010;35(4):380-3. Epub 2009 Oct 23.
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