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

The focus of this issue is on our largest and most visible organ, the skin. In this era of preventive medicine, it seems easy to tell our patients how to prevent skin problems: just stay out of the sun! However, the importance of sun exposure and vitamin D levels is becoming more and more apparent. Epidemiological evidence showing inverse relationships between multiple sclerosis and sun exposure has been available for years, and more recent evidence suggests that sun exposure may protect against juvenile (type I) diabetes mellitus. In adult populations, vitamin D may be important in preventing various neoplasias, and among older adults, it is protective against falls. It seems that once again, the more I learn the less I seem to know for sure. In any event, this month’s issue will provide lots of opportunity for useful learning. Our CME article this month is on “Common Skin Conditions among Older Adults in Long-Term Care” by Dr. Foy White-Chu and Dr. Madhuri Reddy. We have an article on “Older Adults and Burns” by Dr. Joel Fish and Dr. Kristen Davidge, and then in recognition of how much we value our looks, we have an article on “Facial Rejuvenation in the Aging Population” by Dr. Jeffrey Fialkov. As well, our cancer column this month is on a cutaneous malignancy, namely “Malignant Melanoma among Older Adults” by Drs. Wey Leong, Alexandra Easson and Michael Reedijk.

As well, we have our usual collection of articles on other important topics concerning older adults. “The Role of Peripheral Arterial Disease in the Pathogenesis of Diabetic Foot Disease: When to Refer for Vascular Surger” is by Dr. Robert Hinchcliffe and Dr. William Jeffcoate and provides practical advice to the primary care physician. Our Dementia column this month looks at “Dementia Related to Alcohol and Other Drugs” and is by Dr. Kiran Rabheru. Decubitus ulcers are a major health care problem among older adults, with multiple factors involved in their etiology and pathogenesis. A major factor is discussed in the article “The Role of Nutrition in the Prevention and Management of Pressure Ulcers” by Zena Moore and Dr. Seamus Cowman. As our population of patients with end-stage renal disease ages, the population undergoing transplantation is also aging. Combined with the prolonged survival that many patients currently experience after transplantation, we are seeing many more older renal transplant recipients. Some of the issues these patients present with are discussed in the article “Primary Care Issues in Renal Transplant Recipients” by Dr. Jeffery Schiff.

Enjoy this issue,
Barry Goldlist

It is common knowledge that the eyes are the key to a person’s soul. However, common knowledge is frequently wrong. Our first impression most likely comes from a person’s general appearance, particularly his or her skin. One just has to speak to a teenager with acne to understand the importance of skin to one’s self-image and that image as it is projected to others. The importance of “good” skin does not diminish with advancing age; hence, the increasing demand for cosmetic surgery and BoTox injections. Dermatologists and plastic surgeons can even become media personalities.

However, the skin is also a serious organ. Drs. Frank Powell and Maeve Mc Aleer have contributed our CME article on one of the commoner skin disorders afflicting older adults: “Rosacea: Relieving a Chronic Inflammatory Facial Disorder.” The skin is our largest organ and the first line of defence against a sometimes hostile environment. As with our other organs, it is also prone to dysfunction and disease, particularly if we do not care for it appropriately. We now know that environmental exposures are an important cause of skin dysfunction, and Barbara Brillhart gives us advice on how to prevent skin damage in her article “Preventive Skin Care for Older Adults.” John Kraft, Carrie Lynde, and Dr. Charles Lynde have contributed a general review article on “Skin Neoplasias in the Older Adult,” while Dr. David Ollila and Patricia Long discuss skin malignancy in their piece “Detection and Diagnosis of Cutaneous Melanoma.” Our final focus article covers “Second Malignant Neoplasms” by Drs. Miguel N. Burnier and Vinicius S. Saraiva.

As usual, we have a collection of articles on other topics. In our Cardiovascular Column, Drs. P.N. Sylaja and Philip Barber discuss “Thrombolysis for Acute Ischemic Stroke.” Our Nutrition Column, by Fatim Ajwani and Maria Ricupero, tackles the question “What’s the Skinny on Trans Fat?” Finally, Dr. Wilbert Aronow has provided our case study this month, entitled “An Older Woman with Peripheral Arterial Disease.”

Enjoy this issue,
Barry Goldlist