Beauty Is Skin Deep

The skin is our largest organ and is the “face” that we show the world, yet it seems to be held in relatively low esteem by some medical practitioners. This is clearly not a logical position, as dermatological diseases can at times be lethal and may frequently result in severe impairment of quality of life. One only has to watch television ads or read magazines to realize that the general public has a very high regard for things dermatological. Dermatological medical practice rewards bedside clinical acumen more than many other specialties. Although high tech diagnosis is available in dermatology, most diagnoses are based predominantly on history and physical. I suspect that this makes dermatological practice particularly satisfying. Certainly, the dermatologists I know seem to love their practice.

Our focus articles this month are, of course, concerned with dermatology. For family doctors and internists, the skin can be an important source of information about other types of disease. This area is addressed in this month’s CME article “Skin Manifestations of Internal Disease in Older Adults” by Dr. William Lear and Jennifer Akroyd. Psoriasis is extraordinarily common in the general population, and is clearly more than just a skin disorder, although that is its most important manifestation. Like all chronic disorders, management can be quite tricky. This topic is covered in the article “Psoriasis in Older Adults” by Dr. Carrie Lynde, Dr. John Kraft and Dr. Charles Lynde.

Of course, we have our usual array of articles on diverse topics related to health care of the older adult. The management of hypertension, regardless of age, seems to be under constant evolution, and that is certainly very true of hypertension after the age of 80. This topic is ably reviewed in the article “Treating Hypertension in the Very Elderly Reduces Death and Disability: New Information from the HYVET Trial” by Drs. M. Faisal Jhandir, Robert J. Herman, and Norm R.C. Campbell. One of the major duties of a physician is to relieve suffering, particularly from pain. However, survey after survey shows that we do a poor job in pain management for those people with cognitive impairment. This shortcoming is addressed in the article “Pain Management in Moderate and Advanced Dementias” by Drs. Eric Widera and Dr. Alex Smith. The complicated issue of neuropathic pain and how we can reduce the suffering of those patients experiencing it is discussed by Dr. Jackie Gardner-Nix in her article “Neuropathic Pain in Older Adults.” I have a fondness for information developed at my own university, and progressive supranuclear palsy is a disorder first described at Toronto General Hospital and the University of Toronto. It is fitting that U of T has an internationally acclaimed Movement Disorders Program (now based at Toronto Western Hospital) and we are very proud to regularly publish articles from that group. This month’s contribution is “Diagnosis and Management of Progressive Supranuclear Palsy” by Dr. Amitabh Gupta and Dr. Susan Fox.

Enjoy this issue,
Barry Goldlist