Patients come to us, their family physicians, with a broad range of skin problems, so we need to be able to recognize both common and uncommon skin conditions and understand the best approaches to diagnosis and management.
This edition of FP Essentials provides updates on several important autoimmune skin conditions. Section One focuses on psoriasis, a chronic inflammatory skin condition that affects approximately 3% of the US population. Patients with psoriasis are at increased risk of many other conditions, notably depression, hypertension, hyperlipidemia, and diabetes. I learned that psoriatic arthritis occurs in up to 30% of patients with psoriasis, but the arthritis often is undiagnosed. Section Two addresses the autoimmune blistering conditions, with a focus on bullous pemphigoid and pemphigus vulgaris. Because these conditions have significant morbidity and mortality, early recognition and appropriate management are essential. Section Three covers systemic sclerosis (formerly called scleroderma), which is uncommon but has characteristic cutaneous features that are key to making the diagnosis. Systemic sclerosis affects not only the skin but also the lungs, gastrointestinal system, kidneys, and heart. Section Four deals with cutaneous lupus erythematosus (CLE). Although the classic malar or butterfly rash of acute CLE may be the most well-known skin finding of lupus, I learned that discoid lupus erythematosus is more common, representing up to 80% of cases. Two key elements of treatment for all patients with CLE are smoking cessation and avoidance of UV light exposure. I hope you find the information in this edition of FP Essentials useful in your practice.
When you have finished studying these four sections and are ready to submit your posttest answers, please take a moment to tell us what was most useful and what we can do to improve. We look forward to hearing your ideas for topics you would like to see covered in future editions.
Karl T. Rew, MD, Associate Medical Editor
Associate Professor, Department of Family Medicine
University of Michigan Medical School, Ann Arbor
