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Contents
Introduction
Evidence about skin diseases in the past is scarce,
though a condition like psoriasis was described in
manuscripts dating to 900 BC. We know even less about
treatment, but before 1850 people must have relied
on natural materials to make oils, teas, lotions
and poultices. Efficacy would have been poor and
most people would have had to live with their condition.
‘Living with the condition’ is one of
the notable features of acne, eczema and psoriasis,
for many cases run a chronic course. No doubt this
contributes to the general, but incorrect, perception
that they are trivial and well down the scale of ‘real’ medical
problems. In fact, these conditions can be painful
and intensely distressing. Their psychological effects
can be even worse. Our culture is obsessed with glamour
and image – magazine photographs are electronically
retouched, a vast cosmetics market thrives, and TV
often links beauty with success. Of course, our faces
reflect what we are – they are a screen on
which our likes, dislikes, reactions and emotions
are displayed. Our skin is what other people see
and a part of our body with which they may come into
contact – so naturally, we all aspire to perfection,
or as close to it as we can get.
Skin disease undermines these aspirations, eroding
confidence and damaging relationships, social life,
self-image and self-esteem. Sleep disruption and
severe itching may increase stress and further lower
the quality of life. Eczema and psoriasis can cause
embarrassment, anxiety, anger or depression. Acne
can devastate the life of a teenager at a time when
the formation of relationships is so important.
Clearly, better treatment and more understanding
in society at large would help. In March 1997 a Parliamentary
advisory group identified how dermatology services
in the UK were impoverished and how poorly doctors
and nurses were trained, especially in the primary
care setting. Many organisations began investigating
how the situation might be improved, including some
pharmaceutical companies. Some have developed specific
resource packages which are aimed at healthcare professionals
to aid and encourage the development of dermatology
services.
The deficiencies in dermatology are reflected in
the expenditure of the NHS on acne, eczema and psoriasis.
The most recent data from 2000/2001 indicates a total
NHS spend on all skin disorders of £721 million.
Only about half of this (or about 1.5 per cent of
NHS spending) went directly on acne, eczema and psoriasis.
This modest expenditure is in part due to the low
cost of traditional medicines but this may rise in
the future – the new ‘biologicals’ derived
by genetic engineering come with a high price tag.
The past 50 years have seen great strides in the
treatment of these skin disorders. Real cures are
still elusive, but many people’s symptoms can
be managed and long periods of remission won. In
this booklet we look at the skin as an organ, consider
the three commonest skin diseases and why they occur,
and describe the role the pharmaceutical industry
has played. The booklet is not intended as a guide
to treatment, which has to be tailored to the individual
patient. However, it highlights the many recent and
important breakthroughs that have taken place and
which offer hope to people with skin disorders.
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