• Some systemic therapies are contraindicated or at increased risk of complications with harmful alcohol intake, suboptimal blood pressure and diabetic control. Minimisation of these factors is very helpful.
New dermatology practice “hasn’t looked back”
• Supplying an up-to-date complete medical and medication history, as many systemic therapies have contraindications or interactions. • Providing a central point of care, especially when multiple specialists are involved (e.g. for rheumatic or ocular complications, or comorbidities). General important therapies, initiation include:
Practitioners play an especially role with patients on systemic especially in the lead up to of a biologic. Considerations
• Monitoring for toxicities of ciclosporin – blood pressure and renal especially. • Pre-immunosuppression work-up for the presence of chronic infections, autoimmunity or malignancy. Dermatologists will often order tests looking for tuberculosis, Hepatitis B and C, HIV, strongyloides exposure, varicella immunity, autoimmunity, paraproteinaemia. However, they rely on the GP to ensure that age-related malignancy screening is up to date, as immunosuppression should be avoided in the setting of active malignancy. A history of malignancy in the previous five years is a relative contraindication to immunosuppression.
L-R: Dermatologists Drs David Jenkins, Claudia Curchin and Hsien Herbert Chan Three dermatologists with strong connections to the Northern Rivers area have collaborated to form a new specialist practice, North Coast Dermatology, based in the Byron Bay Specialist Centre on Jonson Street. Australasian College of Dermatologists-certified doctors Claudia Curchin, Hsien Herbert Chan and David Jenkins opened North Coast Dermatology in March this year, and haven’t looked back since the first patients arrived. The practice treats all skin, hair, nail and mucous membrane problems. They explained: “Skin conditions such as keratinocyte skin cancer, melanoma, eczema, dermatitis, psoriasis, acne, vitiligo, hair loss, uncontrolled sweating, genital and oral dermatology, paediatric dermatology and contact dermatitis/allergy are very common, and form the basis of our work. As the interface between our inner health and the environment, the skin has the largest number of pathologies out of any organ – over 4000!”
• Ensuring vaccinations are up to date. Live vaccines are best given before treatment is started, as treatment must be stopped and washed out (with long half-lives) if a live vaccine is to be given. Inactivated vaccines are also best given off treatment to maximise the immune reaction, however, these can be given whilst on therapy if required.
Each dermatologist has published in peer-reviewed local and international publications, and worked as staff specialists in tertiary referral public hospitals. Dr Herbert Chan has a particular interest in research, and both he and Dr Curchin have undertaken additional training in confocal microscopy. The team brings together a wealth of specialist dermatology experience and expertise.
• A travel assessment is beneficial to try and predict and plan for any indicated immunisations.
The practice considers patient safety as paramount, so during the COVID-19 pandemic they have been rigorously screening patients for any illness before they enter the practice, which ensures a safe experience for all. At present, North Coast Dermatology is open Monday through Thursday, and is located at suite 6, 130 Jonson Street, Byron Bay. They are always happy to fit in urgent cases, and encourage General Practitioners to contact the practice (ph: 6685 8433), or individual dermatologists, if there is anything they can help with.
With more in the therapeutic toolbox, and collaboration between health practitioners, psoriasis patients can look forward to better outcomes. Indeed a bridge over troubled waters!
Founding North Coast Dermatology has been a homecoming of sorts. Dr Curchin grew up in the Northern Rivers, as did the partners of Dr Herbert Chan and Dr Jenkins. Both Dr Curchin and Dr Herbert Chan have been practicing locally for several years now, and Dr Jenkins has been working intermittently in the region.
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