Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies ....
Transcript of Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies ....
![Page 1: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/1.jpg)
Primary Care Dermatology Update
15.50 Lorraine Wooster Skin lesions – what to refer where 16.10 Liz Riches Treating Actinic Keratosis in Primary care 16.25 Lucy Scriven Update on Primary Care Dermatology Service 16.40 Louise Moss Inflammatory skin conditions – tips in diagnosis and management
North Derbyshire Primary Care Dermatology Service
![Page 2: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/2.jpg)
Lesions seen in GPSI clinic
Dr Lorraine Wooster
![Page 3: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/3.jpg)
31 year old woman
Firm feeling raised lesion on her forehead
Present for 18 months, possibly longer
![Page 4: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/4.jpg)
![Page 5: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/5.jpg)
![Page 6: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/6.jpg)
![Page 7: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/7.jpg)
![Page 8: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/8.jpg)
![Page 9: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/9.jpg)
![Page 10: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/10.jpg)
![Page 11: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/11.jpg)
![Page 12: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/12.jpg)
![Page 13: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/13.jpg)
![Page 14: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/14.jpg)
![Page 15: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/15.jpg)
![Page 16: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/16.jpg)
![Page 17: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/17.jpg)
![Page 18: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/18.jpg)
![Page 19: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/19.jpg)
![Page 20: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/20.jpg)
![Page 21: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/21.jpg)
![Page 22: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/22.jpg)
![Page 23: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/23.jpg)
![Page 24: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/24.jpg)
![Page 25: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/25.jpg)
![Page 26: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/26.jpg)
52 year old lady
Lesion on her thigh
Present for several yrs
Noticed incidentally during an examination
- Nodular area in centre
- 9mm diameter
- Multiple colours
![Page 27: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/27.jpg)
66 yr lady
Lesion on her upper arm
Present for 18 months
Increased in size and developed raised area within it over past 4 months
![Page 28: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/28.jpg)
![Page 29: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/29.jpg)
![Page 30: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/30.jpg)
Treating Actinic Keratosis in Primary care
Dr Liz Riches
![Page 31: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/31.jpg)
Actinic Keratosis • Common sun exposed sites in older people -
forehead, face, back of hands, bald scalp of men, and ladies legs
• Rough, raised and irregular, like stuck on cornflakes or may feel like grit
• May be hyperkeratotic
• May be single or multiple
• Risk of a single AK becoming SCC 1/1000 but marker of increased risk of skin cancer.
• The more you have the greater the risk of SCC or BCC
![Page 32: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/32.jpg)
![Page 33: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/33.jpg)
![Page 34: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/34.jpg)
![Page 35: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/35.jpg)
![Page 36: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/36.jpg)
![Page 37: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/37.jpg)
Red Flags
• Rapid growth
• Firm base/ nodule under scale
• Pain or tenderness
• Bleeding
• Immunosuppressed patient
![Page 38: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/38.jpg)
![Page 39: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/39.jpg)
![Page 40: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/40.jpg)
![Page 41: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/41.jpg)
Treating Actinic Keratoses
Do nothing- age/life expectancy/thin lesions/patient choice
Single AKs – depends on type
• Cryotherapy 5-10s FTC
• Curettage & Cautery
• Efudix – 5 flurouracil cream
• Actikerall for hyperkeratotic AK
Multiple AK • Field change – Efudix
• Other options – Solareze/ Picato/ Aldara/ Zyclara/PDT
![Page 42: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/42.jpg)
![Page 43: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/43.jpg)
Efudix
• Classified as ‘GREEN’ after specialist initiation; this includes initiation by GPwSi’s and GPs who have attended the Derbyshire AK pathway training
• Can also use for Bowens
![Page 44: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/44.jpg)
Using Efudix Cream
• Topical cytostatic that selectively destroys sun damaged skin cells with little injury to normal skin
• Apply at night with finger or cotton bud
• Apply once daily for 2 weeks
• If there is little or no change at 2weeks increase to twice daily
• The skin should become red, tender and weepy – this takes 10-28 days. Max treatment 4 weeks
• Stop and allow skin to heal – review 4-6w
![Page 45: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/45.jpg)
Resources
• JAPC guideline on managing AK – contains patient leaflet
• Drug rep materials
• PCDS treatment pathway www.pcds.org.uk
• www.BAD.org.uk – patient leaflets
![Page 46: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/46.jpg)
![Page 47: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/47.jpg)
GPSI Dermatology Service
Dr Lucy Scriven
![Page 48: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/48.jpg)
• Referrals from NDCCG into CRHFT has reduced from ~6300 per year to ~4000 per year
• ~50% of patients seen are discharged at their 1st appointment
• 10 % of patients are referred on to the hospital at 1st appointment
• Overall ~15% onward referral rate
• High patient satisfaction with the service • 100% had confidence in the doctor treating them • 98% felt that the appointment helped them manage
their skin definitely or to some extent • 98% very satisfied or satisfied with the location • 100% extremely likely or likely to recommend the
service to family or friends
![Page 49: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/49.jpg)
What to Refer
• Skin lesions where diagnostic uncertainty/ exists and malignancy not strongly suspected
• Bowen's Disease • Actinic keratosis • Eczema without allergic
component needing patch tests, UVB or Hospital
• Psoriasis thought not to require PUVA treatment or systemic therapies
• Acne vulgaris not requiring Isotretinoin
• Rosacea, seborrheic eczema, perioral dermatitis
• Lichen planus • Lichen simplex • Skin infections and
infestations including bacterial and fungal
• Scabies • Urticaria • Nail disorders • Non-scarring Alopecia • Disorders of
pigmentation Melasma, Vitiligo where diagnostic uncertainty exists
• Rashes
![Page 50: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/50.jpg)
What NOT to Refer – please!
• 2 WW referrals Suspected melanoma, Suspected SCC
• Urgent referrals
• Generalised Pruritus with no rash
• Scarring alopecia
• Blistering conditions
• PLCV
• Warts
• Cosmetic procedures
![Page 51: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/51.jpg)
PLCV
• Seborrhoeic warts
• Molluscum contagiosum
• Telangiectasia
• Spider angiomas (spider veins)
• Skin tags and papillomas
• Acquired naevi (moles)
• Benign haemangiomas
• Xanthelasma
• Viral warts
The GPSI Dermatology Service will only accept referral for surgical removal or cryotherapy of the following benign skin lesions if there is:
• significant pain • recurrent infection • recurrent bleeding • rapid growth or other
features suspicious of dysplasia/ malignancy
• subject to recurrent trauma leading to bleeding
![Page 52: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/52.jpg)
Removal of Sebaceous cysts
• The CCG will only fund surgical removal if one or more of the following criteria are met:
• On the face (not scalp or neck) and greater than
1cm diameter • Greater than 1cm diameter on body (including scalp
and neck) and • is associated with significant pain • or loss of function • or susceptible to recurrent trauma
• Please refer sebaceous cysts >2cm diameter to General surgery lumps and bumps
![Page 53: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/53.jpg)
Removal of Lipomas
• Only funded if • > 5cms and
• Associated with functional disability, significant pain or recurrent trauma
• Lipomas < 5cm should be observed
• NOT suitable for the GPSI service
• Refer to general surgery lumps and bumps
• NB – if >5cm, rapid growth and/or painful – refer to 2ww Sarcoma clinic
![Page 54: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/54.jpg)
Notes on Referring to the GPSI service • Must be done via e-referral
• Waiting times usually < 4 weeks
• The shortest wait may not be at your closest clinic!
• If referral criteria not met your referral may be rejected – please include as much information as possible in the letter and describe the rash or lesion
• Cryotherapy will be done at 1st appointment but other procedures will not
![Page 55: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/55.jpg)
Any Comments / Questions?
![Page 56: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/56.jpg)
Inflammatory Skin Conditions; Diagnosis and Treatment- Top Tips from the GPwSI Team!
Louise Moss
GPwSI Dermatology Moss Valley Medical Practice, Eckington
![Page 57: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/57.jpg)
Common pitfalls and Top tips….
• Generalised itchy rash
DON’T FORGET…
• Secondary infection
• Tinea Incognito
• Scabies
![Page 58: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/58.jpg)
Ok Doc !!
Can you
tell me
what this
rash is?
I’m afraid
you’ll need
to take
ALL
your
clothes off
first.
DON’T MISS AN INCH!
![Page 59: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/59.jpg)
Legs and toewebs
Fingernails and hands
Face
Scalp Trunk and axilla
Arms
Groin and genitals
Natal cleft
![Page 60: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/60.jpg)
Generalised Itchy Rash Differential diagnosis?
![Page 61: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/61.jpg)
0%
20%
40%
60%
80%
100%
0
5
10
15
20
Eczem
a
Acne
Psori
asis
Hand
eczem
a
Urt
icari
a
Nail
dystr
op
hy
Bact
folli
cu
litis
Scaly
sca
lps
Lic
he
n P
lan
us
P. ve
rsic
olo
r
Neuro
derm
atitis
Post
inflam
ato
ry h
yp
erp
igm
en
t
Urt
icari
a p
igm
en
tosa
Dru
g e
rup
tion
DLE
Tin
ea in
cog
nito
Vira
l exa
nth
em
Actinic
po
rokera
tosis
LS
& A
Peri
ora
l d
erm GA
P. ro
se
a
Tra
um
a
Ch
r p
aro
nychia
Sub
ung
ua
l h
ae
ma
tom
a
K. p
ilan
s
Alo
pe
cia
Lip
lic
kin
g c
helit
is
Von
Re
ckin
gh
an
se
urs
ca
fé a
u la
it s
po
ts
BX
O
Conta
ct a
llerg
ic d
erm
GPwSI Referrals, 2009 :- Rashes: Frequency of condition
Frequency
Cumulative frequency %
![Page 62: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/62.jpg)
ECZEMA – Treatment tips • How to get your treatment to work
![Page 63: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/63.jpg)
EMOLLIENTS
• for ALL patients with eczema
• USE ENOUGH! –at least 500g/mth
• The greasier the better
• Use one the patient likes
• Use instead of soap
• Consider allergic component - face/severe hand dermatitis with work Hx- use emoillient with no sensitisers-MIMs
![Page 64: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/64.jpg)
TOPICAL STEROIDS
• Start HIGH and step down
• Weekender regimen- daily 1wk, alt days 1 wk, 2x/wk 1 month
• cream for wet weepy eczema
• ointment for dry scaly eczema
• Give ENOUGH!
![Page 65: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/65.jpg)
TREAT INFECTION
GIVE WRITTEN INSTRUCTIONS
CONSIDER OCCLUSION
• Wet wraps / Comfifast suits
• Clothing
• Increases effect of steroid and emoillient
![Page 66: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/66.jpg)
Discoid Eczema
• Dermovate • Antibiotics • Zeroderm • Comfifast
![Page 67: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/67.jpg)
Varicose Eczema………………………
• Steroid
• Emoillent
• COMPRESSION!
![Page 68: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/68.jpg)
Chronic Venous Stasis Disease
• Always consider compression
• Ok to use >0.8 APPM
• If wet use potassium permanganate soaks, viscopaste bandages or ZipZoc
• If infected soak in Eczmol lotion
• Consider topical steroids
• TREAT OEDEMA
![Page 69: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/69.jpg)
THINK COMPRESSION!
• Single/Double layer tubigrip
<10mmHg
• Liner stocking preferred
• Flight stockings
• Class 1 stockings
• Give Stocking applicators
![Page 70: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/70.jpg)
Seborrhoeic Eczema
• Erythema and greasy fine yellowish scale
• scalp, eyebrows, eyelids ears, sides of nose, ant chest and axillae
• Overgrowth pityrosporum may be a trigger
• Extensive and stubborn ?HIV
• Anti-fungal/hydrocortisone combination Rx
![Page 71: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/71.jpg)
Common pitfalls…
![Page 72: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/72.jpg)
![Page 73: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/73.jpg)
![Page 74: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/74.jpg)
Tips on fungal infections
• Often asymmetric.
• Usually scaly (Epidermal).
• Look at the feet!
• Think Tinea Incognito (grows inexorably out – Eczema comes & goes).
![Page 75: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/75.jpg)
Scabies
![Page 76: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/76.jpg)
Psoriasis
![Page 77: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/77.jpg)
![Page 78: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/78.jpg)
![Page 79: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/79.jpg)
Psoriasis v Eczema
![Page 80: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/80.jpg)
Treating Psoriasis
GP Treatment
• Copious Emoillents!
• Urea & Salicytic Acid
• Steroid for face, hands, scalp and flexures
….or in combination
• Vitamin D analogues
• Tar creams
• Dithranol
Hospital Treatment
• Phototherapy - UVB & PUVA
• Methotrexate
• Ciclosporin
• Acitretin
• Biologics- TNF blockers
![Page 81: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/81.jpg)
Lichen Planus
![Page 82: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/82.jpg)
Drug Rash
• Usually urticated, papular generalised rash including face
• History important – new drug, change in dose?
• Common drugs :-
penicillins, sulphonamides, thiazides, allopurinol, phenylbutazone, Gold – later onset
![Page 83: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/83.jpg)
FINALLY …Remember all that itches is not dermatology!
• Anaemia – low ferritin
• Hypothyroidism – dry skin, hair loss
• Liver dysfunction
• Renal dysfuntion
• Diabetes
• Lymphomas
![Page 84: Primary Care Dermatology Update - northderbyshireccg.nhs.uk · AK pathway training ... •Scabies . Ok Doc !! Can you tell me what this rash is? I’m afraid you’ll need to take](https://reader031.fdocuments.in/reader031/viewer/2022021812/5cf90fc688c993bc7c8b5fe1/html5/thumbnails/84.jpg)
Thank you!