I love the summer. The sun, the heat, and all that naked flesh on display to every possible allergen means that the pharmacy has a long queue of patients just itching for us to look at their rash.
This is the time of year when you can guarantee that a combination of exposing an epidermis that hasn’t seen daylight for the past eight months to a thousand different species of flora and fauna, then adding the potentiating effect of UV light, leads to some quite remarkable reactions. And patients just love to walk in and strip off quicker than you can say, “Err – consultation room?”
Yes, we have become the centre for topical diseases and it seems we pharmacists either love or hate rashes. Why do we worry?
OK, they’re not easy to distinguish if you don’t know your macules from your pustules, but at least we have a whole range of stuff we can sell for them. Hot and sweaty in a fold of skin? Chuck some imidazole cream on it.
Red itchy bumps? Steroid. Dry and rough? Emollient. Sorted.
It’s easy, and we don’t even need one of those huge dermatology atlases that so many pharmacies have tucked away somewhere. You know, the ones full of pictures of extreme skin conditions such as necrotising fasciitis and leprosy, and all the pus-filled bits that even the GUM clinic won’t touch.
Granted, there’s a certain morbid fascination in such illustrations – like the crawl past a motorway accident – with everyone thinking, “Thank God my bum hasn’t got horny warts like those!”. It’s a bit disconcerting for the patient when you hold up an illustration for comparison against their body – having already flicked through acne, scabies and syphilis.
If only we had more practical experience with a tutor to point at the papules and say, “See that? That’s Morgellons disease…”
So I was surprised and disappointed when a GP friend with a dermatology specialism wouldn’t let me sit in on her clinic. “Oh no,” she said. “That won’t do any good. I can’t identify every discrete vesicle or confluent purpura by looking at it. The simple rule is to stop the patient’s natural inclination to strip off and show you the rash. Sit them down and take history.”
And she’s right. All rashes look the same, and even consultant dermatologists can’t distinguish one from another. But if a patient walks in and says, “I was working in the garden in a short-sleeved top, in the sun, and now I’ve got this itchy raised rash up my arms – is it meningitis?”, I don’t need to look to know the answer.
So maybe skin diseases aren’t the medical roulette wheel that I thought they were. A bit of Sherlock Holmes deduction can go a long way. Of course, I’ll still take a look – that’s what the patient expects.