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Tattoos and permanent make-up have enjoyed great popularity during recent years. However, a careful consideration of the risks is made only rarely before each procedure. Above all the undefined pigment compositions create unforeseeable health and appearance problems. The family physician should be familiar with the techniques, materials, as well as the possible risks of tattoos and permanent make-up when advising patients. Medical complications include, among other things, infections, allergies, keloid and granuloma formation.

Acquired disorders of hair growth in women may present clinically either as effluvium or alopecia. The relevant pathologies include androgenetic alopecia, postpartum effluvium, tinea capitis, trichotillomania and alopecia areata.

Crohn's disease or ulcerative colitis may be preceded, followed or accompanied by a variety of extra-intestinal diseases affecting the skin and mucous membranes. Amongthe most important of these associated lesions are, for example, erythema nodosum and pyoderma gangrenosum.

Diabetes mellitus may be associated with dermatological lesions affecting the skin and mucous membranes. In some cases they may even provide the physician with a first indication that the patient may be suffering from diabetes. Typical examples include necrobiosis lipoidica, granuloma annulare, acanthosis nigricans and vitiligo.

Sexually transmitted infections caused by viruses include infections by the Herpes simplex virus (HSV), the human papillomavirus (HPV), and the human immunodeficiency virus (HIV). The diagnosis is established on the basis of clinical presentation and the direct demonstration of the antigen or antibodies.

Bacterial infections that can be transmitted by sexual contact are usually caused by the following organisms: Neisseria gonorrhoeae, Chlamydia trachomatis, Treponema pallidum and Klebsiella granulomatis. These pathogens can be detected with the aid of specific nutrient media, stained microscopic sections and serological and molecular biological methods.

Ectoparasites, such as lice and itch mites (scabies) as well as yeasts, may be transmitted not only by sexual contact, but also by less intimate skin contact. The nits of the louse are visible to the naked eye, while Candida albicans is detected under the microscope or by culture.

Numerous dermatological lesions can be provisionally diagnosed by the family doctor on the basis of such parameters as location, duration, degree of pruritus, involvement of the epidermis, and the age of the patient. Whenever a lesion is difficult to interpret or suspicious for malignancy, the patient should be referred to a specialist without delay. This is also mandatory in all such cases in which accepted therapeutic measures initiated on the basis of an apparently certain diagnosis on the part of the family doctor fail to cure the problem within a reasonable period of time.

In the treatment of exanthems, the first step is the elimination of the causal agent. Of great importance also is the symptomatic treatment of the cutaneous changes and such associated symptoms as itching and pain. The choice of the appropriate external medication and its vehicle will depend on the clinical findings, skin type, and the location of the skin lesions. The most important therapeutic principles are discussed taking drug-induced exanthema, acute urticaria and (herpes) zoster as examples.

Exanthema is characterized by extensive generalized eruptions of the skin and mucosa that show a typical temporal spread. Potential noxae include medications, foodstuffs, infections (viral, bacterial, mycotic, parasitic), and malignancies, but unexplained causes may also present. A knowledge of the cutaneous changes may contribute decisively to ensuring that specific diagnostic and therapeutic measures are initiated without delay.