Volume 17 Number 2, Part 1 August 1987

Primary care phys ic ians ' errors in cu taneous d isorders 245

mary care physicians in handling these dermatoses should emphasize the importance of reliable di- agnostic criteria based on clinical features, rapid diagnostic technics, selected cultures, and skin biopsies. The physician who handles skin disor- ders should be able to perform the necessary tasks accurately or should recognize the value of refer- ring the patient to a consultant able to do so. One specific recommendation that alone would have prevented approximately one third of the errors noted in this survey is to require the demonstration of a fungal organism before the use of an antifungal preparation or the exclusion of such organisms before the use o f a topical corticosteroid.

The data shown in Tables III and IV should provide guidelines for medical educators as to which dermatoses tend to be confused and thus which disorders should comprise differential di- agnostic groups, For example, the tables indicate that there should be training to distinguish der- matophyte infections f rom other scaly, round (an- nular) lesions, such as nummular dermatitis, pso- riasis, pityriasis rosea, granuloma annulare, and seborrheic dermatitis; that bacterial pyodermas need to be distinguished f rom inflammatory der- matoses; and that scabies needs to be distinguished f rom a variety of widespread pruritic dermatoses.

It should be emphasized that this survey is not a study of physicians' accuracy; it is mainly a study o f disease states. There are no data herein from which one can calculate the rate of accuracy in

diagnosis or treatment o f the pr imary care physi- cians whose patients we saw. The survey, after all, deals only with cases in which errors were made, not with those managed correctly. The fact that we were able to col lect 260 such cases in a 20-month period does, however, suggest that er- rors of this type are commonly made. We did not record data on how overt or subtle the correct diagnoses were in these cases. We believe that this survey supports the conclusion that one way to reduce the morbidity, expense, and occasional threat to life from cutaneous disorders is to instill into the clinician a sense o f necessity for reliable, objective diagnostic criteria. Most physicians de- mand such precision when dealing with disorders of other body systems; the skin should be no ex- ception.

REFERENCES 1. Stern RS, Johnson M, DeLozier J'. Utilization of physician

services for dermatologic complaints--the United States, 1974. Arch Dermatol 1977;113:1062-6.

2. Cassileth BR, Clark WH, Lush EJ, et al. How well do physicians recognize melanoma and other problem le- sions? J AM ACAt) DERMATOt. 1986;14:555-60.

3. Wagner RF, Wagner D, Tomich JM, et al. Diagnosis of skin diseases: dermatologist vs nondermatologist [Rest- dent's Corner]. J Dermatol Surg Oncol 1985;11:476-9.

4. Ramsay DL, Fox AB. The ability of primary care phy- sicians to recognize the common dermatoses. Arch Der- matol 198 l;117:620-2.

5. Pariser DM, Caserio RJ, Eaglstein WH. Techniques for diagnosing skin and hair disease. New York: Thieme, 1986.

ABSTRACTS

Microbiological aspects of long-term therapy with minocycline

Meinhof W, Cremer S, Aachen B. Akt Dermatol t 986;12:214-16 (German)

Thirteen patients suffering from aene vulgaris were treated with minocycline, 100 mg daily, for a period of 90 days (minimum) to 257 days (maximum). During therapy the clinical picture improved considerably. The good result persisted even after treatment was stopped. No serious adverse reactions were seen.

The susceptibility of propionibacteria to minocycline was ex- amined before, during, and 27 to 53 days after therapy. Minimal inhibitory concentrations as well as inhibition zones were determined. During treatment, the microbial count was considerably reduced in the sebaceous follicles. In all tests the bacteria responded equally well to minocycline. Therefore, minocycline is a well-suited and highly effective drug for long-term treatment even in low doses. The

intestinal flora is hardly influenced. Consequently, no resistance prob- lems are to be expected in the treatment of ache by means of mino- cycline, 100 mg daily.

Yehudi M. Felman, M.D.

Lichen planus with esophageal stenosis

Bousser AM, Nilias G, Mosser C, et al. Ann Dermatol Venereol 1986;113:938-9 (French)

A 75-year-old woman presenting with dysphagia was demon- strated, by means of esophagoscopy with esophageal biopsy, to have severe erosive lichen planus of the upper part of the esophagus. She had had buecal lichen planus for several years.

Yehudi M. Fehnan, M.D.