Dermatology Service – Wigan Borough

Dermatology

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 the GP Choose and Book system, letter or referral form from GPs, Health Visitors, School nurses, Community Matrons and Nurse Specialists.

Please note that referrals for dermatological conditions  other than Eczema or Psoriasis will not be accepted by the Tier Two Dermatology Service.


Management whilst awaiting appointment:

Emollients

Eczema and psoriasis both improve with the twice daily application of emollients (moisturisers) but these should be used four times a day in acute flares of Eczema and Psoriasis. (please note that aqueous cream is not suitable as a leave-on emollient as it contains Sodium Lauryl Sulphate which is  harmful in Eczema and Psoriasis).

Choosing Emollients

Emollients vary in the amount of grease or lipid that they contain and some are mixed with water.

The lighter  emollients contain the least grease and most water.

The amount of grease increases as we step up the ladder graduating to the very greasy emollients at the top which are just pure grease.

The lighter the emollient, the easier it tends to be to soak in.

These can be really helpful if the hands are affected, if greasier moisturisers are not acceptable  or if the skin is hairy.

However, this can also mean that more applications of emollient may be required to gain control of the skin condition.

Very greasy emollients are messier to apply and can stain bedding and clothing. However, they usually tend to work faster and do not usually contain preservatives.

They are therefore less likely than creams, gels and lotions to cause irritation or stinging.

Ointments and thicker creams also have a great barrier function if the face is affected and it can be useful to apply one of these before going out into the cold or before eating if the mouth is affected to avoid the irritation of food Creams that contain urea can be helpful where the skin is thickened or remains very dry despite the use of a greasy emollient.

These creams do tend to sting more though, especially if the skin is broken.

A greasier emollient at night and a lighter emollient throughout the day may be preferred initially but initially a greasier emollient may be required up to 4 times a day in order to obtain control.

It also depends on how dry the skin is as to how much grease is required.

A general rule is that the drier the skin, the greasier the emollient should be, so for example very dry skin is best treated with an ointment, moderately dry with a cream or gel, and slightly dry with a lotion.

Emollients for sensitive skin are available to purchase at your local pharmacy or supermarket and are also available on NHS prescription.

The choice of emollients that can be prescribed locally is based on the most current specialist recommendations and cost effectiveness.

These choices are demonstrated on the Emollient ladder below:

People with Eczema or Psoriasis should  avoid using any soap products (this includes all foaming products such as Sanex, Simple etc as these contain Sodium Lauryl Sulphate which is harmful in Eczema and Psoriasis) and use their emollient instead.

This should be applied to dry skin before entering water and simply washed off before leaving the bath or shower.

The greasier the emollient, usually the more of a ‘thicker, soapy’ feeling it has. If a face cloth or sponge is used, a clean one each day should be used as damp cloths and sponges provide a breeding ground for bacteria.

The bath water should be warm but not hot. If the water is too hot this may cause itching.

Take care to wash the bath and shower out thoroughly after you have used emollients as these can make them very slippy and dangerous. It is a good idea to use a slip resistant bath or shower mat toavoid any accidents.

It’s best to dry the skin by patting gently with the towel as opposed to rubbing and to apply emollient immediately after drying as this will help to trap moisture into the skin.

Topical Steroids

Topical steroids come in lotions, creams, gels and ointments.

They reduce inflammation and itch and should be prescribed only where the skin is inflamed and a definite diagnosis of Eczema or Psoriasis has been made as topical steroids can make fungal infections, rosacea and acne worse.

They should be prescribed to use once to twice 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, the diagnosis is certain and infection has been ruled out then the strength of steroid may 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.

Mild and Moderate topical steroids are available to purchase at your local pharmacy.

These are also available on NHS prescription along with potent and super potent steroids.

The choice of topical steroids that can be prescribed locally is based on the most current specialist recommendations and cost effectiveness.

These choices are demonstrated on the Steroid ladder below:


Where is the service offered?

Clinics are provided Monday to Friday from 8.30am until 6.00pm at:

Boston House, Frog Lane, Wigan, WN6 7LB

Claire House, Pheonix Way, Lower Ince, WN3 4NW

Leigh Health Centre, Leigh Infirmary, The Ave, Leigh, WN7 1HR

First appointments will last approximately 40 minutes and follow up appointments 20 minutes.


Contact details

Tier Two Dermatology
Boston House
Frog Lane
Wigan
WN6 7LB

Telephone: 01942-482230 (Longterm Conditions Suite, Frog Lane)
Fax: 01942 482257

E-mail:

Nicola.Broad@bridgewater.nhs.uk
Joanne.Richardson@bridgewater.nhs.uk
Rachel.Hilton@bridgewater.nhs.uk
Helen.Calderbank@bridgewater.nhs.uk


Our leaflets

Eczema – need to know more leaflet

Psoriasis – need to know more leaflet


Useful videos


Useful websites

www.eczema.org
National Eczema Society, patient and family support organisation

www.allergyuk.org

http://www.bad.org.uk/for-the-public/patient-information-leaflets

www.patient.co.uk

www.nhs.uk

www.skinsupport.org.uk

www.atopicskindisease.com

www.changingfaces.org.uk

www.nhsbsa.nhs.uk
Pre-payment prescriptions

www.nice.org.uk/guidance/CG57
Atopic Eczema guidelines under 12’s

www.mindandskin.co.uk

www.ancnesupport.org.uk


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