MEDICAL MATTERS:An online database is a one-stop shop for skin rash diagnoses, writes Muiris Houston
A CAREER decision I didn't have to grapple with was whether I would like to be a surgeon or not. The first indication that I wasn't cut out for this branch of medicine came when I struggled with anatomy classes. This was a sign that the 3D part of my brain is not as well developed as it might be.
Having said that, I have always been fairly handy with a needle and thread - in a medical sense that is. I enjoy stitching skin wounds; however, once we get deeper into the body, my surgical abilities decrease in direct proportion to the depth of the incision.
Another area of medicine I find challenging is dermatology. The reasons are less clear-cut: is it because of limited exposure to skin disease as an undergraduate? Has it something to do with being colour blind?
A well-respected dermatologist came up with what turned out to be an inspired suggestion: keep a dermatology atlas to hand in the consulting room and refer to it during the consultation.
So, the next time a "difficult" rash required diagnosis, I asked the patient if she would mind if I consulted Fry's Dermatology, at the time one of the best reference books available. Its unique selling point was a profusion of photographs of different skin conditions, produced to a high quality.
In a joint exercise interspersed with more details of her symptoms, my patient and I looked at the pictures together. Eventually, we reached a joint decision on the most likely diagnosis, followed by a prescription for the appropriate treatment.
Younger readers may be wondering what all the fuss is about but 20 years ago people did not have ready access to medical information. This collaborative approach to a medical problem felt quite revolutionary at the time.
Now of course, doctors expect patients to arrive with a presumptive diagnosis based on a quick Google of their symptoms. And where skin problems are concerned a website called www.visualdxhealth.com has replaced my dusty copy of Fry's Dermatology.
Enter the Skin Disease Finder at visualdxhealth.com and you will be directed to a line drawing of the human body.
Choose between male and female and specify the part of the body affected by your skin rash. You will then see some excellent pictures of different skin conditions that typically affect the area of the body you have indicated.
Alternatively, you can input a suspected diagnosis from a drop-down menu and, within seconds, an array of high-quality illustrations will appear on your screen. To complement the pictures, some written information on the condition can be downloaded as well.
I looked at the website last week to see how it responded to a query about scabies. Known as the great "mimic" of other skin disease, scabies can be a tricky diagnosis for a variety of reasons.
Picture-wise, the site is really good. The illustration of scabies burrows, which can be difficult to detect, was top notch. These are caused by female mites who burrow into the skin to lay their eggs. Typically, a burrow appears as a fine thread-like, scaly, line, between 3 and 10mm long.
The scabies mite, Sarcoptes scabiei, causes an intense itching, especially at night. This itching can persist for up to four weeks after the mite has been successfully eradicated. It is hard not to scratch the skin, which in turn causes secondary infection with bacteria; this changes the appearance of the rash and can make it extremely difficult to see the burrows underneath.
Often, more than one person in a household will experience symptoms.
Treatment requires persistence. Permethrin cream is applied to the skin from the neck to the bottom of the feet, with special attention to the areas between the fingers and toes.
The insecticide should be left on for eight to 14 hours, washed off and applied again one week later. All members of the household must be treated simultaneously to minimise the chance of re-infestation.
If you fancy playing skin detective, visualdxhealth.com's endless supply of moles, rashes, warts and more will certainly hone your skills as an amateur dermatologist.
• Dr Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he is unable to respond to individual medical queries