- Usamah Khalid & Ivan Bristow
Scratching the surface of dermatology - PCDS spring meeting
Many thanks to podiatrist Usamah Khalid for providing this blog - a podiatrist's review of the recent Primary Care Dermatology Society's spring meeting held in Kenilworth, Warwickshire in March 2022.
The Primary Care Dermatology Society (PCDS) was founded in July 1994 by a group of GP's with an interest in dermatology and a passion to spread the word to primary care clinicians dealing with dermatological complaints. The PCDS welcomes members from a range of professions including podiatrists offering education to ensure they are confident and competent when dealing with complaints of a dermatological nature. Today, it’s membership exceeds 4,000 members.
Ivan Bristow, Usamah Khalid & Parmjit Sohal with PCDS chair Dr Tim Cunliffe (L-R)
On the 12th and 13th of March, the PCDS held their Annual Meeting in Kenilworth, Warwickshire and it was well attended, delegates were made up of consultant dermatologists, GP's, academics and podiatrists. The weekend of learning covered a range of topics pertinent to the primary care clinician including skin cancers, hair and nail disorders, common dermatoses in skin of colour and emergency dermatology. In addition, workshops including dermoscopy, skin surgery and emollient therapy were incredibly useful. It was great to have a go practicing punch biopsies and suturing on pig skin.
Dr Suchitra Chinthapalli kicked off the conference with her excellent presentation on skin cancer in skin of colour – it was refreshing to see the PCDS take an inclusive and diverse approach of including skin of colour when discussing skin disease. Diagnosis in darker skin types is often delayed as the typical presentation can vary when compared to skin disease in white skin which can have serious consequences especially with melanoma. Melanoma is the 5th most common cancer in the UK with an incidence of around 8,400 new cases every year.Morbidity and mortality is increased in skin of colour for a variety of reasons including reduced awareness in health professionals and the public, a lack of appropriate resources and patient information on melanoma skin cancer in skin of colour and poorer access to healthcare. Acral lentiginous melanoma is the most common form of melanoma in skin of colour frequently occurring on the soles of the feet and within the nail unit. Lack of visibility and awareness result in delayed presentation and diagnosis. . Podiatrists are uniquely placed to educate patients, to identify suspicious lesions and refer on when melanoma is suspected.
In skin of colour, squamous cell carcinoma is the most common form of skin cancer particularly affecting the lower limb. Once again, as podiatrists we have a role to play in offering patient education, screening and early recognition. In order to facilitate this, its important as practitioners we are educated ourselves and up to date in this field. Dermoscopy is a skill which we can use to improve our detection skills discerning benign from malignant ones.
Dr Suchitra Chinthapalli’s presentation was eye-opening and provided an incredible insight into understanding the diverse presentations of skin cancer in skin of colour and how this affects patient outcomes, an overall superb presentation which excellent clinical pearls and gems.
In the right hands and with appropriate training, a dermatoscope can assist in the recognition of melanocytic and non-melanocytic lesions, both cancerous and benign. Having been inspired by the dermoscopy workshop and with the expert assistance of Dr. Chin Whybrew, I couldn’t help myself and bought a DermLite DL4 W dermatoscope complete with a small area contact plate and magnetic phone clamp adapter for crystal clear photos that can be uploaded to patient notes as a baseline for future comparisons.
Dermoscopy session with Dr Chin Whybrew and Dr Julian Peace
The medical reps at the exhibition hall held a wealth of knowledge and were incredibly helpful, offering a discounts if products were purchased on the day. Exhibitors included skin care brands CeraVe and La Roche-Posay and Dermol to name a few and they were happy to offer free samples and training days on emollient therapy with the view of potentially becoming stockists of their products to offer to patients in private practice. I found the exhibitors friendly, knowledgeable and engaging and their presence certainly added great value to the overall conference.
Day 1 of the conference drew to a close and then came the evening dinner complete with a Bollywood theme Bhangra night which was absolutely fabulous, a three-course meal with entertainment in the form of bhangra dancing and a masterclass in all things bhangra. There was a boys versus girls dance off and the girls clinched the competition with a 3-2 lead on the boys. A perfect evening of socialising and partying, the perfect antidote to a busy day of learning.
Day 2 kicked off with Dermatological emergencies by Dr. Helen Frow, a GP turned consultant dermatologist who explained common and important dermatological emergencies in primary care and which warrants a referral to secondary care dermatology. An interesting portion was spent on Severe Cutaneous Adverse Reactions (SCARs) and it was intriguing to learn how common drugs used to treat podiatric conditions such as oral terbinafine for onychomycosis and allopurinol for gout prophylaxis can lead to Steven-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN). A worthy word of caution when understanding patients’ drug history in the case of allopurinol and a factor to consider when advising on oral terbinafine for the management of onychomycosis. Although rare, it is worth bearing in mind when assessing dermatological complaints of patients who have been on such therapies and presenting with complaints of skin and mucosal membrane involvement.
The day wrapped up with a quiz which had been running throughout the conference where photos of skin complaints were dotted around the various exhibitors and delegates were asked to jot down their preferred diagnosis based on photos and a small amount of history . I had a fair shot but was beaten by a GP colleague who amazingly got 13/15 questions correct and richly deserved her prize.
Overall, the PCDS are an excellent organisation whose conference was superbly organised, slick, informative and refreshing. If having read this, you are thinking you could do with brushing up on all things dermatology, I would implore you to join the PCDS, as an AHP member, you will not only gain a wonderful insight into a world of dermatology where presentations of disease would otherwise go unnoticed, you join a network of colleagues who could not be more inviting and welcoming to podiatrists and a network of like-minded individuals with a passion of pushing for the realm and scope of practice. We could all benefit from further learning and pushing the boundaries of what can be achieved if we broadened our horizons. At only £30 per year, it is exceedingly good value for money, not only do you get full access to their superb website – an invaluable resource – but access to their quarterly journal and discounted prices to their annual conferences and training events including dermoscopy and essential dermatology courses.
The burning question remains, could the PCDS’ acronym also stand for ‘Podiatrists Can Diagnose Skin? If you feel inspired, sign up to improve your knowledge and skill set in a safe and welcoming network and play your part in helping to improve patient outcomes.
I look forward to seeing many of you there at their next event.
Their Autumn meeting is set for September 22nd in Manchester. Further information can be found on their website: www.PCDS.org.uk