Dermatology

Dermoscopy – resources for practices

To help GPs and Practice Staff who may be new to dermoscopy this local training video has been produced covering:

• A guide by STHFT Consultant Dermatologist, Dr Thomas King, on what makes a good dermatological referral image and how to take them
• How to use and care for your Dermalite1 Dermatoscope
• How to use the PhotoSAF App to easily save and send images with referrals

Webinar Treating Actinic Keratoses and Bowen’s confidently in Primary care

Acne:

New local CCG resource for acne management and referral based on 2021 NICE guidance here:

PRESS – Dermatology Acne

Remember, always use a topical agent when treating with oral antibiotics. Topical acne treatments are very effective but can cause dryness and skin irritation. Decreasing frequency of application or switching to a cream-based formulation, should help. Please see further guidance here:

Acne – PIL

Eczema/Dermatitis:

Many cosmetic products, moisturisers and soaps contain both irritants and potential sensitisers/allergens that can exacerbate skin conditions. This includes steroid cream preparations – where possible use steroid ointment, not cream. and ask what over the counter products the patient is using on their skin. They may benefit from omitting regular cosmetic products and replacing with an emollient or soap substitute. Further information regarding emollient use and choice is available here:

PRESS – Dermatology Emollient Guide

Patient Information/Compliance:

The British Association of Dermatologists has a wide range of patient information leaflets that can be useful in guiding patients in how to manage their skin disease and understand their condition better.

These are available as pdfs here BAD Leaflets   and can be easily sent to patients using Accurx, or similar clinical text programmes.

Text for an Accurx template;

Dear X, Please find attached a leaflet on your skin condition from the British Association of Dermatologists. This contains useful information regarding your condition and how you can manage your skin going forward. Sincerely, X

Urticaria:

Be aware that the licensed dose of Fexofenadine is 180mg, not 120mg. In practice this is often increased to BD,TDS or even QDS by Dermatology and these increased doses could be considered in primary care, should the clinician be confident of the diagnosis. In clinical uncertainty please consider referral via CASES.

Actinic Keratosis:

Can be safely managed in primary care. There is a useful resource here to guide assessment, diagnosis and management in primary care: PRESS Dermatology – Actinic Keratosis

When using Efudix, it is important to counsel patients that they will get a local inflammatory reaction, which can be uncomfortable and distressing. This gradually gets worse during treatment but will settle shortly after treatment stops. Emollients can help.

Generalised Pruritus:

The PCDS (Primary Care Dermatology Society) has a useful guide to initial assessment and management prior to referral. This can be found here; Generalised Pruritus

PCDS:

The PCDS has excellent resources for primary care clinicians on the commonly presenting dermatology conditions and these are freely available here

PCDS

Referral Thresholds and management Guidance:

Recently the BAD released condition specific management and referral information, this is well laid out and easy to navigate:

BAD Referral and Management Information

Clinical Photography:

Whilst not obligatory, the addition of clinical photographs with referrals does often improve assessment, triage and management advice, and the CASES team would be grateful if clinicians could consider doing this. Dermoscopic images are particularly useful for lesions.

The nature and quality of the images is important, and a guide to taking clinical images is found here: Photography for Referral

Patient Support:

A great range of emotional support, self help tools and support groups for people with skin disorders is available at Skin Support and Alopecia UK for hair loss.

Changing Faces offers support and cosmetic camouflage for people with appearance altering skin conditions such as Rosacea and Melasma.

IAPT referral can also be considered locally for psychologically distressing skin conditions.

Referral guidelines from primary to secondary care