The goal of this novel publication is to improve both diagnostic and therapeutic skills
among primary care practitioners with regard to diseases and disorders of the skin, hair,
and nails. The Editor and publishers feel that this is a critical educational endeavor, and one
designed to improve overall patient care. Due to obvious constraints, graduate and primary
care medical education often contain very limited exposure to or training in dermatology.1
Despite this, those who deliver primary care are frequently called upon to manage skin
maladies. Consider these facts:

  • 5.3% of all medical office visits pertain to dermatological issues.2
  • Only 33% of patients with skin problems see a board-certified dermatologist first.3
  • Primary healthcare providers are the second most prolific purveyors of dermatological care in the US.3
  • 20%–36.5% of patients presenting in a primary care setting have at least one skin problem.4,5
  • Although skin problems may be secondary issues during a medical encounter, 60%–72% of the time the skin problem is actually the chief complaint and, therefore, the reason for seeking medical attention.5,6

These trends will likely persist as awareness of skin disease increases among the general
population due to professional educational campaigns, media influences, high-profile
personalities developing skin cancer, and direct-to-consumer medical advertising.

Limited direct access to board-certified dermatologists will also augment use of primary care
services for skin care; direct dermatological access may be difficult due to managed care
regulations and economic disincentives, very stringent documentation and preauthorization
requirements, and a shortage of dermatologists in select geographic locales.7 The trend
toward “cosmetic procedures only” practices further reduces the pool of dermatologists
available for medical consultation and care.

Despite the fact that primary care providers play a crucial role in delivery of cutaneous
health care, there is ample evidence that they are inadequately trained in this field. Multiple
comparative studies, summarized in a recent publication, clearly show a deficient ability of
those in primary care to diagnose and treat skin disease in an optimal manner.8 Moreover,
keeping abreast of the latest therapeutic advances in such a narrow discipline is difficult for
those charged with the overall health and welfare of their patients. Thus, we have the genesis
of Skin Therapy Letter. It is our hope that this streamlined publication and its associated
internet site ( will serve as methods to rapidly enhance your
diagnostic and/or therapeutic skills in the realm of cutaneous medicine, as well as to provide
tools to help you decide when expeditious dermatological referral is the most judicious
action to take.

Ted Rosen, MD



  1. Knable A, Hood AF, Pearson TG. Undergraduate medical education in dermatology: Report from the AAD Interdisciplinary Education Committee, Subcommittee on Undergraduate Medical Education. J Am Acad Dermatol 1997;36:467-70
  2. Cherry DK, Burt CW, Woodwell DA. National Ambulatory Medical Care Survey: 2001 summary. Adv Data 2003;337:1-44
  3. Thompson TT, Feldman SR, Fleischer AB Jr. Only 33% of visits for skin disease in the US in 1995 were to dermatologists. Dermatol Online J 1998:4:3.
  4. Branch WT Jr., Collins M, Wintroub BU. Dermatologic practice: Implications for a primary care residency curriculum. J Med Educ 1983;58:136-42
  5. Lowell BA, Froelich CW, Federman DG, et al. Dermatology in primary care: Prevalence and patient disposition. J Am Acad Dermatol 2001;45:250-53
  6. Fein S, Berman B, Magrane B. Skin disease in a primary care practice. Skinmed 2005;4:350-53
  7. Feldman SR. Comparing the diagnostic accuracy of dermatologists and nondermatologists. Arch Dermatol 2001;157:1645-46
  8. Federman DG, Kirsner RS. The primary care physician and the treatment of patients with skin disorders. Dermatol Clin 2000;18:215-21