Description of the Dermatology Service
Nurse Led Outpatient Clinics for Adults and Children with Eczema and Psoriasis.
How can people access the service?
Referrals are accepted via Choose and Book, letter or Dermatology Referral Form from GPs, Health Visitors, School nurses and Nurse Practitioners.
Please note that referrals for other dermatological conditions will not be accepted by the Tier Two Dermatology Service.
Management whilst awaiting appointment:
Eczema and psoriasis both improve with the frequent (ie at least twice daily) application of emollients (please note that aqueous cream is not suitable as a leave-on emollient) but should be advocated four times a day in acute flares.
Usually the greasier the emollient the better the effect but patient choice/acceptability and skin dryness should always govern prescribing choice.
Prescribing a lighter emollient for daytime use and a greasier emollient for night time use may improve compliance.
Patients should be advised to avoid soap products and use their emollient instead (this works better if applied to dry skin before entering water).
Topical steroids reduce inflammation and itch and should be prescribed twice daily where the skin is inflamed and a confident diagnosis has been made (topical steroids can make fungal infections, rosacea and acne worse).
They should be prescribed to use twice daily (with the exception of Elocon which should be used once daily) and applied after the generous application of emollient (as soon as this is no longer visible on the skin).
The steroid should be applied ‘accurately’ to any inflamed areas until completely clear and then immediately on rebound of the inflammation.
The Strength of steroid should be chosen based on the body area being treated and age of the patient (ie start with a mild steroid in babies or potent for scalp/hands in adults).
If steroid free days are not being achieved after 2 weeks and infection has been ruled out then the strength of steroid should be increased if the body site being treated allows.
If potent steroids are prescribed in psoriasis they should be done so in combination with a vitamin D analogue or tar treatment in order to prevent rebound.
The Emollient and Steroid Ladders below may assist with the choice of suitable emollients and topical steroids:
If there are signs of infection (ie weeping, crusting, widespread excoriation, sudden worsening and distress) oral Flucloxacillin, Erythromycin or Clarithromycin should be prescribed.
The Tier 2 Dermatology team are also very happy to give advice over the telephone.
Where is the service offered?
- Monday AM – Claire House, Lower Ince
- Tuesday AM – Boston House, Frog Lane, Wigan
- Wednesday AM – Prosser White Unit, Leigh Infirmary
- Wednesday AM – Boston House, Wigan
- Thursday PM – Boston House, Frog Lane Wigan
- Friday AM – Boston House, Frog Lane Wigan
First appointments will last approximately 40 minutes and follow up appointments 20 minutes.
Tier Two Dermatology
Telephone: 01942-482230 (Longterm Conditions Suite, Frog Lane)
Fax: 01942 482257