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Enhancing knowledge through home-grown paediatric skin atlases, practical paediatric CME

06 Jun 2016

The recent Paediatrics in Practice (PIP) 2016 held recently in Selangor was a success. On top of the launch of a locally published atlas, the conference also featured the introduction of DEBRA (Dystrophic Epidermolysis Bullosa Research Association), various presentations, a workshop and panel discussion on paediatric skin diseases by prominent specialists such as Dr. Tang Jyh Jong, Dr. Tan Wooi Chiang, Dr. Chan Lee Chin, Dr. Sabeera Begum and Dr. Leong Kin Fon. MIMS Doctor spoke to Dr. Thiyagar Nadarajaw, paediatrician and adolescent medicine specialist and Leong, a consultant paediatric dermatologist at the Kuala Lumpur Hospital about the PIP workshop and their thoughts on the atlas.

Realizing there is an unmet demand for paediatric dermatology atlases that are more relevant to communities with skin of colour, a group of specialists published their second atlas in conjunction with the PIP conference.

The atlas, named Atlas of Paediatric Diseases—Cutaneous Fungal and Atypical Bacterial Infection, is a 207-page atlas that illustrates 20 cases of skin diseases among children in the country, in both the rural and urban setting, said Leong, who is also editor of the atlas.

As the title indicates, the atlas features cases of skin infections caused by common and uncommon fungal and atypical bacterial infection in Malaysia. The cases included in the atlas are inflammatory tinea capitis, non-inflammatory tinea capitis, tinea corporis, tinea faciei, atopic eczema with secondary tinea infection (tinea incognito), tinea imbricata, hyperpigmented and hypopigmented pityriasis versicolor,  nappy candidiasis, chronic paronychia, sporotrichosis, penicilliosis in a HIV-infected patient, non-tuberculous mycobacterium infection (Mycobacterium marinum), non-tuberculous mycobacterium infection (Buruli ulcer), cutaneous tuberculosis (tuberculosis verrucosa cutis), erythema induratum of Bazin, tuberculoid leprosy, borderline leprosy, pitted keratolysis and early onset congenital syphilis.

A home-grown atlas such as this is sorely needed because it illustrates the disease spectrum in the country. Being a country with a tropical climate, the bulk of the population have skin of colour. Most medical atlases and books that are available in the market feature Caucasians. Unfortunately, their disease spectrum may look different compared to locals due to differences in skin colour, Leong elaborated.

Accordingly, atlases like this, which has images of dermatologic disease spectrum on skin of colour and clinical pearls, will benefit primary care practitioners, paediatricians and dermatologists working in tropical countries, said Leong.

Besides showcasing various dermatological disorders, the atlas also emphasizes on the importance of a thorough and systematic approach for diagnosis and management. Visual memorization of skin disorders is important but in patients with skin of colour, the dermatological lesion may appear differently. Additionally, different conditions may present in a similar manner. As such, comprehensive approach is vital.

Besides Leong, various other dermatologists also contributed to the development of the atlas. Kotra Pharma Malaysia played a big role as well in the atlas development by providing an unrestricted educational grant and other necessary support.

The atlas is the second of its kind. The first was launched in 2014 with the title Atlas of Paediatric Diseases—Dermatitis and Psoriasis. After the publication of the second atlas, the authors are not resting on their laurels. They are currently working on two more volumes—one on bacterial and viral infections and another on systemic infection with skin manifestations—which they hope will be published within the next 2 to 3 years.

Paediatrics In Practice (PIP)

The PIP is a continuing medical education (CME) programme jointly organized by the Malaysian Paediatric Association (MPA), Malaysian Medical Association (MMA) and Kotra Pharma. Its target audience are general practitioners (GPs) and key primary care physicians.

The nationwide CME programme focuses on common illnesses in children that majority of GPs and primary care physicians encounter in their daily practice, said Thiyagar, who is also the president of MPA. Sometimes, less common illnesses are included as well.

The reason for choosing GPs and primary care physicians as the target audience is because the two groups are first line healthcare providers and therefore, play a key role in appropriate diagnosis and treatment. At times, there may be some gaps in care for children at primary care level as some cases can be difficult to diagnose and manage. Moreover, according to 2006 statistics, there are only 25 dermatologists and two paediatric dermatologists in the Ministry of Health hospitals. [MOH Malaysia. Malaysia’s Health 2006. Available at www.moh.gov.my/images/gallery/publications/mh/Malaysia%20Health%202006-2.pdf Last accessed 24 May]

Therefore, PIP serves as a platform to bring together paediatricians and other experts in various illnesses to provide and share their knowledge with GPs and primary care physicians. This will help to bridge the gap with one objective—improve the healthcare of children in Malaysia. The objective is in line with Kotra Pharma's belief that everyone deserves a healthier tomorrow, added Thiyagar.

The PIP was first started in 2011 with its first conference held in Klang Valley. Every year, based on a dedicated theme, the CME is conducted in four to five major cities in the country. It is usually held in the north, south and east coast, and East Malaysia, he explained. Today, the PIP is in its 6th year and has successfully rolled out more than 20 CME programmes.

On top of that, the PIP has also expanded its scope and target audience. Since 2 years ago, the programme has been conducting an annual PIP specialist’s workshop which caters to paediatricians. The annual workshops are dedicated to more in-depth discussions and interactive case sharing sessions. Kotra Pharma has also supported and help brought PIP beyond Malaysia to neighbouring countries such as Myanmar, Vietnam and Cambodia, said Thiyagar.

Since its conception till now, the PIP has contributed immensely to enhance the knowledge of child health in paediatricians, primary care physicians and GPs. With continuous support and feedback, the programme will continuously improve and reach out to more clinicians in the country and around South East Asia.

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