It is generally considered that the Family Practitioner should take a holistic and divergent view of illness. Every illness is understood in terms of physical, psychological and social factors. These skills must be developed on a solid foundation of clinical experience built on a broad training in medical and surgical specialties.

This month's journal gives some good examples of the challenges faced by Family Physicians. Dermatology accounts for a significant percentage of Family Practice consultations. One relatively common cause of a dermatological presentation is infestation with Scabies. On page 426 Dr J K H Luk gives a review of this condition which is common in elderly and immunocompromised populations in whom it may present with an atypical rash. No study has been performed to document the local incidence and there is no clear consensus on the most effective or even the safest treatment. We therefore have a common condition which can be difficult to diagnose and which raises a number of questions which can be best answered by community based research. Increasing the sharing of information between primary health care practitioners and the development of a solid local research basis is one of our biggest challenges.

We are all familiar with the patient on antibiotics for respiratory symptoms who presents with a rash. Is it a drug hypersensitivity or viral rash? Amongst the many cases of typical and atypical rash, of eczema, contact dermatitis and psoriasis will be the occasional presentation of a systemic condition. On page 444 Dr C C Mok provides a very helpful guide on Systemic Lupus Erythematosis. This condition occurs in around 0.1% of the population. It is a multisystem inflammatory disorder of unknown aetiology in which rash is only one potential presentation. It is a great mimic and provides challenges not only in diagnosis and treatment but in the management of psychological processes which may be aggravated both by the cerebral and metabolic complications of the disease itself and the effects of chronic illness on the individual and their social group.

Another systemic condition which may present with a rash is Henoch - Schonlein Purpura (HSP). On page 450 Dr Y W Cheng reminds us of the importance of sometimes looking for a rash which is not the initial clinical presentation. He believes that "many physicians will forget that HSP is one of the most important differential diagnoses in children presenting with abdominal pain". The astute clinician will need to be aware of this rare possibility whilst also considering that the child's abdominal pain may also be caused by constipation or even as a manifestation of family discord. A solid clinical acumen thorough history and logical data analysis is necessary to properly assess an apparently common and simple presentation.

Finally on page 436 Dr V S P Chan gives an excellent review of radiotherapy in palliative care. Although we will not be dispensing this treatment it is important that we as Family Practitioners understand the indications and complications of treatment. There are few challenges in Family Practice which compare with those of personalised palliative care. Here physical, psychological and social factors are an essential part of every interaction. In many ways this is when we as practitioners are at our most vulnerable. It is one of the greatest challenges. It is no coincidence that it is also one of the most rewarding areas of our profession.