An International Journal for Community Skin Health EDITORIAL: PUBLIC HEALTH AND SKIN DISEASE R J Hay DM FRCP record which is often unrecognised. For International Foundation of instance, in the early part of the twenti- Dermatology eth century many countries had policies Professor of Dermatology for the control of scalp ringworm which Faculty of Medicine and Health Sciences ranged from school exclusion orders to special treatment facilities. It resulted in Queen’s University, Belfast, UK partial control but, in the absence of an effective remedy, elimination remained ost of the work of dermato- a distant goal. With the discovery of logists is concerned with the drug, griseofulvin, the potential to the treatment of individ- provide a wider programme based on Mual patients to the highest standards the treatment of communities became achievable with the facilities and skills possible and, in some areas, there was a available. However, it is seldom possible concerted effort to eliminate tinea capi- to apply this to large populations in tis using control teams. Afghan refugee child most parts of the developing world, par- Yaws and leprosy are further exam- ticularly where the lack of resources and ples of diseases where control measures, sparse populations make the adoption of backed by international collaboration, this model of health care unattainable. have focused on elimination of infection In assessing the needs for these groups a by early identification of cases and con- different approach is necessary. tacts and mass drug treatment. Public Health and Skin Skin Disease and the Western Disease World Dermatological public health has sel- In recent years, the focus of public dom been prioritised as a key objec- health in 'western world' dermatology tive in the overall management of has concentrated on the control of the At a Health Centre, Afgooye, Somalia skin diseases, although it has a strong modern epidemic of a non-infectious Photos: Murray McGavin CONTENTS J Comm Dermatol 2005; 2: 1–16 Issue No. 2 EDITORIAL QUIZ Public Health and Are All White Spots Skin Disease Rod Hay 1 Vitiligo? Claire Fuller 10 REVIEW ARTICLES Treatment of Leprosy Antoon Baar & TEACHING AIDS Ben Naafs 3 Teaching Aids at How I Manage Eczema Low Cost (TALC) David Chandler 13 in the Community Najeeb Ahmad Safdar & Jane Sterling 6 ABSTRACTS ESSENTIAL DRUGS IN DERMATOLOGY Journal Extracts and 1. Gentian Violet RDTC Reports Neil Cox 15 2. Whitfield’s Ointment Ramadhan Mawenzi 9 COMMUNITY DERMATOLOGY: 2005; 2: 1–16 Issue No. 2 1 Editorial condition – skin cancer. The relationship Training and Primary Care ment of a more severe underlying between skin cancer and sun exposure problem are recognised and managed A key strategic target has been to redress is well established although individual appropriately, if necessary by referral to this balance by providing highly focused susceptibility and sun avoidance practices a specialist centre. The skin is the mir- training for primary care staff, either are all elements of the complex equation ror of many other events affecting the through the development of diagnostic in the development of skin cancer. School human body. A good example here is and therapeutic algorithms or through and general public education, the identi- HIV/AIDS where the early recognition focused training and practical instruc- fication of risk and the development of of skin or mucosal signs may provide tion. An example of the former is the early recognition programmes have all the earliest clues for investigation, coun- development of a training programme for been brought forward in many countries selling and treatment. The increasing doctors and nurses at primary care level – with promising results in reducing the availability of anti-retrovirals in parts of in Mali where the four commonest dis- incidence of skin cancer and improving the developing world, where previously eases, pyoderma, tinea capitis, scabies and long term survival. There is, therefore, these had been unavailable, makes this eczema are targeted. A second example is a well estab lished basis for the develop- approach both justifiable and practica- the work of Estrada and colleagues in ment of a public health approach to skin ble. Similarly, leprosy and onchocerciasis Mexico where the focus of education is disease. are both examples of important diseases the primary care team – doctors, nurses where skin signs allow early recognition and health promoters – through formal and treatment. Developing Countries and focused training sessions using patient- Skin Disease based education. A third approach has been to teach future health care teachers Public Health, Education and In the developing world, the major- and leaders. The Regional Dermatology Communities ity of skin conditions are common Training Centre in Moshi, Tanzania, was It is possible to develop programmes, infective diseases for which there is set up to train the future dermatologi- based on practical education, which can usually a simple remedy. The problems cal leaders in this field amongst medical reduce the prevalence of certain diseases that arise in the effective management officers and, latterly, through a regional and bring prompt, effective treatment at of these cases are the result of a com- dermatology residency programme, der- primary care level. It remains less clear bination of poor disease recognition, matologists. The key to the successful whether it will be possible to eliminate generally because there are insufficient implementation of all these initiatives these conditions from particular areas. individuals with appropriate skills at has been to show, firstly, that the educa- In almost all cases these programmes primary care level, and poor treatment tion provided has led to an improvement are best developed through adopting an regimens, due to unavailability or lack in learning and, secondly, that it has had approach which targets communities. of knowledge. Treatment regimens are an impact on local disease levels. also often inadequately explained. This Such public health initiatives have much results in much misdiagnosis and, in Good Management and to contribute to dermatology. consequence, wasted funding. Large Specialist Centres amounts of scarce resources available to health centres, depen dant on inadequate The second part of a public health state or personal funds, are wasted on delivery approach is to ensure that those treating skin disease badly. with skin lesions that signal the develop- An International Journal for Community Skin Health DEVELOPING Journals available FREE MENTAL Volume 2 Issue No. 2 2004 HEALTH An International Journal for Mental Health Care EDITORIAL: COMMUNITY DERMATOLOGY – WHAT IS IT? Developing Mental Health: Issue No. 2 to Developing Countries Andrew Sims Diagnosis n most of the world, health care is MA MD FRCPsych FRCP Diagnosis is really provided not by doctors but by other Past President, only a technical term Ihealth care workers, such as nurses, Royal College of Psychiatrists, UK for what all profes- the majority of them in small rural com- Emeritus Professor, sional people do. The munities. Usually, there is very limited University of Leeds, UK medical model is, access to hospitals and medical specialists of course, not only for their patients. Developing Mental Health aims to support medical. If you consult those, either professionals or volunteers, a bank manager about Knowledge and Training who are caring for and treating mentally a debt, or a lawyer ill people. Effective treatment of the men- about buying a house, In addition to medical supplies, health tally ill has only been possible in the last they go through a care workers also need opportunities for 50 years, and so it is important now that similar process. The training and further education. This is anyone looking after them not only thinks first thing the profes- already provided for Dermatology in about their quality of life whilst ill, but also sional person has to • Community Dermatology some centres, such as the Regional Der- the possibility of appropriate treatment. do is work out what matology Training Centre at Moshi in But how do you start? the problem is, what In Mozambique Photo: Murray McGavin Tanzania. The vast majority of these general category it comes into, whether health workers, however, do not have Medical Model debt or house purchase. Then professional access to such centres and an alternative • What is this problem in terms of my Village young people in Tanzania This is where the so-called medical model problem solving is applied and, hope- professional expertise? is to send information to the workers is useful. Rational treatment can only begin fully, the professional comes up with the in their own situations. This is already Photo: Paul Buxton • In what way is it similar to the problems when the problem/diagnosis has been right procedure. However, they would not of some other people? being done by Community Eye Health, worked out quite precisely: then applying have done so had they not first decided • What was it that worked when we tried published by the International Centre for coun tries, four times a year (free to “Every day, in communities throughout the programme of treatment that is, in gen- what type of problem it was. Diagnosis to help them? Eye Health for the last 16 years. Current- developing countries). Thefounder of this the world, individuals urgently require eral, suitable for that specific diagnosis. is a similar process, but in the health Now, we will use the same, general ly, 16,000 copies are distributed to 178 Journal, Dr Murray McGavin, has said; health care, yet all too often a health field. • worker simply does not know what to programme for this individual. • Developing Mental Health do. Sadly, patients may even be harmed (2004), 2, 1–16 Issue No. 2 CONTENTS – simply through lack of knowledge”. Developing Mental Health Editorial: Issue No. 2 Andrew Sims 1 J Comm Dermatol 2004; 1: 1–16 Issue No.