Monkeypox is a viral zoonotic disease caused by the monkeypox virus. It can be transmitted from animals to humans, from humans to humans, and from contaminated environments to humans.A 41-year-old male, divorced with one daughter, initially presented with sore throat, myalgia, malaise, fever (up to 38.5°C), and cough. Examination revealed pharyngeal hyperemia and bronchitic pulmonary sounds, and laboratory tests showed leukocytosis, neutrophilia, and elevated CRP (55 mg/L). He was treated with clarithromycin twice daily for 10 days.One week later, he developed a rash on the neck, initially resembling urticaria. The patient had eaten mushrooms for the first time the day before. Initial treatment included sinopen, urbazone, and loratadine. The rash rapidly progressed to medallion-shaped lesions and generalized eruptions, prompting referral to dermatology. An initial diagnosis of pityriasis rosea was made, and topical corticosteroids were prescribed.The rash continued to evolve, presenting with vesicles, macules, and pustules. Infectious workup for syphilis, gonorrhea, and HIV was negative. Laboratory findings included lymphopenia, thrombocytopenia, leukocytosis, elevated IL-6, and increased IgE. Skin biopsy confirmed Pityriasis Lichenoides et Varioliformis Acuta (PLEVA). Treatment was adjusted to clindamycin three times daily and topical corticosteroids. Seven months later, during routine follow-up (as the patient is a pilot), antibodies to monkeypox were detected, suggesting a possible subclinical or atypical viral trigger.Progressive, polymorphic rashes may reflect immune-mediated or post-infectious processes, not just allergies. Awareness of emerging viral triggers and a multidisciplinary approach are crucial for accurate diagnosis and patient safety.This case highlights polymorphic skin eruptions evolving from urticaria to vesiculopustular lesions. PLEVA was confirmed by histopathology and supported by immunological abnormalities indicating systemic immune dysregulation. Retrospective monkeypox antibodies suggest a possible atypical viral trigger.Recognition of monkey pox  clinical and dermatological aspects facilitates its diagnosis and differentiation from other viruses which cause similar skin rashes, particularly Smallpox and Chickenpox.

Teledermatology (TD) is increasingly used in public care to facilitate the assessment and management of skin lesions through digital healthcare visits. By enabling patients to submit images of skin conditions for a remote evaluation, TD has the potential to improve access to specialist expertise and streamline care pathways. However, previous research indicates that physicians may experience uncertainty regarding diagnostic accuracy and clinical decision-making when assessing skin lesions digitally, highlighting a need for deeper understanding of clinicians´ experiences.The aim of this study is to explore physicians’ experiences of assessing skin lesions during digital healthcare visits in public primary care.A qualitative study design will be employed using focus group discussions. Data was collected through five to six sessions, each comprising four to six physicians working in digital public primary care. Participants had experience using teledermatology, in digital consultations. The focus group discussions explored perceptions of diagnostic confidence, clinic usefulness, challenges and educational needs related to digital assessment of skin lesions. Data were analyzed using a systematic qualitative content analysis in accordance with the methodological framework described by Dahlin-Ivanoff and Holmgren.The study is expected to generate in-depth knowledge of psysicians´perceptions of teledermatology, including perceived benefits, limitations and sources of diagnostic uncertainty. Findings are anticipated to identify key factors influencing clinical decisions-making, professional confidence and perceived patient safety in digital dermatology consultations. We will have analyzed the data and will present the results at the conference.This study provides insights into how teledermatology is perceived and used in everyday clinical practice. The findings will highlight both the potential of teledermatology to support clinical work and the challenges physicians encounter when assessing skin conditions without physical examination.By elucidating physicians´experiences of digital assessment of skin lesions, this study may contribute to the development of more affective teledermatology practices, targeted educational interventions and improved digital primary care services for patients seeking care for skin-related conditions.

Tension-type headache (TTH) and migraine are frequent reasons for consultation in primary care. Myofascial trigger point (MTrP)-directed procedures may provide short-term symptom relief, but evidence on durability is limited. Continuity in primary care offers an opportunity for longitudinal follow-up to track outcomes and support timely escalation or referral.To summarise randomised evidence on changes in headache frequency and intensity after MTrP-directed interventions in adults with International Classification of Headache Disorders (ICHD)-defined TTH or migraine, and to translate findings into practical primary care implications for follow-up, referral, and equity in longitudinal headache monitoring.The protocol was prospectively registered in PROSPERO (CRD42025641133). Eight databases were searched for randomised controlled trials (RCTs) published 2004–2024 (updated November 2025). Two reviewers independently screened and selected studies, extracted data, and assessed risk of bias using RoB 2. Narrative synthesis was undertaken due to substantial clinical and methodological heterogeneity.Seven RCTs (451 participants; predominantly TTH) were included. Interventions included lidocaine trigger point injections, dry needling, and botulinum toxin type A injections applied to clinically identified active MTrPs. Short-term reductions in headache intensity were consistent (typically 1.5–2.5 points on a 0–10 scale). Improvements in headache frequency were most evident in chronic TTH; evidence in migraine was limited. Follow-up was short (4–12 weeks), with variation in protocols and outcome timing, limiting conclusions on durability and comparative effectiveness. Risk of bias was limited by blinding and reporting limitations.The main evidence gap is limited follow-up duration. Primary care can help close this gap through structured, person-centred monitoring of headache days, pain intensity, acute medication use (including risk of medication overuse), and individual functional goals, with clear triggers for escalation or referral within a stepped-care pathway. Making this follow-up routine in primary care may help reduce inequities in access to ongoing assessment and timely specialist input.MTrP-directed procedures may offer short-term improvement in headache intensity and, in chronic TTH, headache frequency for selected patients with prominent myofascial features. Future standardised trials should include longer, primary care–relevant follow-up and consistent outcome time points to determine sustained benefit and inform practical care pathways.

Migraine is a common condition often treated in general practice. The Dutch GP guideline includes treatment recommendations.I It is unknown whether these are followed.How often do GPs see patients with migraine, and do they follow treatment recommendations?We used data from electronic health records (EHR) in general practices participating in the Nivel Primary Care Database in 2023. We selected patients with a migraine episode (ICPC-code N89). We assessed the number of contacts with the GP, prescribed medication, and referrals to secondary care. In a selection of newly diagnosed patients, we assessed 5-year care trajectories using data from 2019 to 2023.Data from 25,474 patients with migraine from 389 general practices were available. In 2023, 19 per 1000 adults in the Netherlands had a migraine episode registered in their GP’s EHR. 80% of these patients were women, and 86% between 18 and 64 years of age. Half of the patients with migraine contacted the GP in 2023. One out of five patients did not have GP contacts in the 5 years after diagnosis. In line with the guideline, the most prescribed acute medications for migraine were triptans (54%), and NSAIDs (26%). The most commonly prescribed preventive medications were betablockers (16%). 16% received an opioid prescription, whereas these are advised against in the guideline. More than a third of women 18-44 years received hormonal anticonceptives, which is not recommended. Care trajectory analyses showed that opioids and anticonceptives were mostly started before the migraine diagnosis, indicating these might not be related to migraine. Almost one out of ten patients with migraine received a referral to secondary care, mostly in the first half year after diagnosis.Medication use is underestimated as over-the-counter medication could not be assessed.Patients with migraine do not often contact the GP for their migraine, whether this is due to e.g. adequate coping, or limited perceived burden is unknown. A minority receives preventive medication and is referred to secondary care, the latter most likely for diagnosis. Whether the treatment is effective for these patients remains to be studied. Reducing opioid prescribing deserves attention.

Wound care is an important part of family medicine, particularly in settings where resources are limited and advanced dressings are not always accessible. Honey-based dressings are commonly used in community and primary-care settings, but their effectiveness in this context has not been fully reviewed.To our knowledge, no prior meta-analysis has focused specifically on the performance of honey-based dressings within primary-care settings.To synthesise contemporary evidence on the effectiveness, safety, and cost-efficiency of honey-based dressings for wound care in primary-care and community settings, supported by meta-analysis.This systematic review adhered to PRISMA guidelines. Comprehensive searches of PubMed, Embase, Scopus, Cochrane CENTRAL, and regional databases identified randomized and comparative studies published up to March 2025. Two reviewers independently performed study selection and data extraction, with discrepancies resolved by consensus. Risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Primary outcomes included healing time, wound-area reduction, infection clearance, pain, adverse events, and treatment costs. A random-effects meta-analysis was conducted, and heterogeneity was quantified using I² statistics.Twenty-three studies (12 RCTs; 11 observational) met the inclusion criteria. Honey-based dressings demonstrated significantly faster healing (mean difference −7.89 to −26.37 days), greater wound-area reduction (18–28%), and markedly higher infection clearance rates for burn wounds (OR 10.80). Several diabetic-foot-ulcer studies reported meaningful reductions in pain. Honey-based dressings were associated with a 20–50% reduction in treatment costs and no serious adverse events. Moderate heterogeneity was noted across wound types and honey formulations; however, pooled estimates consistently favoured honey.Honey-based dressings show clear clinical benefits, are generally safe, and can reduce overall treatment costs. Their easy availability and suitability for home care make them a practical choice in primary-care settings. These features fit well with the principles of family medicine and may help lessen care gaps in low-resource communities.Honey-based dressings represent an effective, safe, and low-cost wound-care solution suitable for routine use in primary care. Incorporating honey into standard wound-care protocols may accelerate healing, reduce clinic burden, and expand equitable access to quality care. These findings support consideration of honey dressings as a first-line option in general practice, particularly in resource-limited environments.

Symptoms are a significant part of family physicians' workload, accounting for about two-thirds of encounters in Canada. Headache is among the most common reasons for encounter (RFE), and understanding its evolution and chronicity is crucial.To determine the prevalence of headache in family practice and identify patient characteristics associated with persistent/recurrent symptoms and with short-term presentations.This study is part of a larger study of 12 common symptoms in family practice. A retrospective cross-sectional study of visits and a retrospective cohort study with longitudinal follow-up were conducted in southwestern Ontario using the DELPHI Electronic Medical Record database, based on ICPC-2-R coding. Patients with a new headache RFE were followed up to four years and assigned to 1 of 3 pathways: (1) Headache Remained: symptoms did not fit a diagnostic category and either persisted or resolved without further attention. (2) Headache Continued after Diagnosis: Headache placed in a diagnostic category, but patient continued to present the symptom as an RFE. (3) Diagnosis was made, and no subsequent headache visits occurred.Headache appeared in 254 encounters (1.7% of all visits). Of those, 81% were under 64 years; 81% were female; 31% had prior psychological conditions. Among 110 patients in the longitudinal analysis, 41% followed pathway 1 (85% having only one visit). 22% followed pathway 2 (mean episode of care of 14 months and 3.2 visits); all were prescribed medication, 92% were female, 58% had prior psychological conditions; the most common diagnoses were migraine (28%), anxiety (15%), and tension headache (11%). 36% followed pathway 3.Longitudinal findings indicate that new headache presentations resulted in three clinical trajectories. A smaller subgroup, often women with comorbid anxiety or depression, requires attention to psychosocial determinants and access to non-pharmacological approaches to prevent progression to chronic or analgesic-related headache.Headache remains a common RFE in family practice. Most patients without alarming symptoms can be reassured and treated accordingly. While many cases resolve quickly, a subset follows a persistent trajectory, particularly among younger women. These findings highlight the importance of an individualised approach and attention to psychosocial contributors in primary care.