Dermatological Conditions Frequently Seen in General Practice

Common Skin Conditions for the Primary Care Clinician

Skin conditions account for a substantial portion of primary care visits. Developing skills in dermatological diagnosis and management enables clinicians to address many skin problems effectively while recognizing when dermatology referral is needed.

Visual pattern recognition is essential in dermatology. This article addresses common skin conditions, providing guidance on recognition, treatment, and appropriate escalation of care.

Approach to the Skin Examination

Systematic description of skin lesions facilitates accurate diagnosis and communication. Key features to document include morphology (macule, papule, plaque, etc.), color, distribution pattern, arrangement, and associated symptoms such as itching or pain.

Good lighting and magnification enhance the examination. When available, dermoscopy provides additional diagnostic information, particularly for pigmented lesions. Photography documents findings for monitoring over time.

Atopic Dermatitis

Atopic dermatitis is a chronic inflammatory skin condition characterized by pruritus and eczematous lesions in characteristic distributions. In infants, the face and extensor surfaces are commonly affected, while older children and adults typically have flexural involvement.

Management emphasizes regular emollient use to restore the skin barrier, avoidance of triggers, and appropriate use of topical corticosteroids or calcineurin inhibitors for flares. Patient education about the chronic nature of the condition and the importance of maintenance therapy is essential.

Psoriasis

Psoriasis is a chronic immune-mediated disease characterized by well-demarcated erythematous plaques with silvery scale, typically on extensor surfaces, scalp, and lower back. Nail involvement and psoriatic arthritis are common associated features.

Mild to moderate psoriasis can often be managed with topical therapies including corticosteroids, vitamin D analogs, and combination products. More extensive or severe disease may require phototherapy or systemic therapies, warranting dermatology referral.

Acne

Acne vulgaris is extremely common, affecting most adolescents to some degree. Lesions include comedones, papules, pustules, and in severe cases, nodules and cysts. The face, chest, and back are commonly affected.

Treatment is tailored to acne severity. Mild acne responds to topical retinoids and benzoyl peroxide. Moderate acne may require addition of topical or oral antibiotics. Severe nodulocystic acne often requires isotretinoin, which is best managed by dermatology.

Fungal Infections

Superficial fungal infections are common and include tinea corporis (body), tinea pedis (feet), tinea cruris (groin), and tinea capitis (scalp). KOH preparation or fungal culture can confirm diagnosis when clinical presentation is unclear.

Most tinea infections respond to topical antifungal therapy. Tinea capitis and extensive infections require systemic antifungal treatment. Onychomycosis, while often cosmetic, can be treated with topical or oral antifungals if desired.

Skin Cancer Detection

Skin cancer is the most common malignancy. Basal cell carcinoma, squamous cell carcinoma, and melanoma have characteristic features that enable clinical recognition. Regular skin examination, particularly in high-risk patients, facilitates early detection.

Any concerning pigmented lesion or non-healing growth should prompt biopsy or urgent dermatology referral. The ABCDE criteria help identify melanoma, though some melanomas may not display all features. When in doubt, refer.

Bacterial Skin Infections

Cellulitis and erysipelas are common bacterial skin infections requiring prompt antibiotic therapy. Distinguishing cellulitis from other causes of leg erythema and swelling, including stasis dermatitis and deep vein thrombosis, guides appropriate management.

Impetigo, folliculitis, and abscesses are other common bacterial infections. Incision and drainage is the primary treatment for abscesses, with antibiotics reserved for cases with surrounding cellulitis or systemic symptoms.

When to Refer

Dermatology referral is appropriate for uncertain diagnoses, suspected skin cancer, moderate to severe psoriasis, atopic dermatitis unresponsive to standard treatment, severe acne requiring isotretinoin, and unusual or widespread rashes.

Maintaining a low threshold for biopsy of concerning lesions ensures that skin cancers are not missed. When dermatology access is limited, developing skills in punch biopsy enables diagnostic sampling in primary care.

Conclusion

Skin conditions are a frequent reason for primary care visits. By developing pattern recognition skills and understanding evidence-based treatments for common dermatological conditions, clinicians can address most skin complaints effectively while appropriately identifying those requiring specialist evaluation.