Skin Care Today

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SKIN CARE TODAY 2017,Vol 3, No 1 7
SKIN CARE MATTERS i
SCT
groups and should direct patients
to these for additional support
if needed.
But, what is being done on the
ground? Luckily, one UK team that
includes nurses is showing the way
forward (‘Innovative patient care
shortlisted for top medical awards’—
. Last
year, the staff at St John’s Institute of
Dermatology at Guy’s and St Thomas’
hospital were named‘dermatology
team of the year’by the British
Medical Journal. The team introduced
a screening system, which aimed to
improve psychological support for
patients by applying the IMPARTS
(Integrating Mental and Physical
Healthcare: Research Training and
Service) system for patients with
severe psoriasis or eczema who often
have low self-esteem or depression.
The system asks patients to complete
a screening questionnaire via a
tablet computer, which is designed
to reveal any psychological issues
while they wait for their dermatology
appointment. This has allowed
the team to provide appropriate
psychological support while treatment
for skin conditions is arranged.
Another initiative is Skin Support
), a website
provided by the BAD, which provides
links to patient information leaflets,
support groups, self-help materials
and helplines, all of which can be
accessed and used by nurses. The
website acts as a hub providing
coordinated resources for people
with issues that go beyond their
skin condition and affect their
psychological health.
What can nurses take away from
this? Obviously, on a day-to-day
basis, simply acknowledging that a
patient with a skin condition may
also be experiencing some level of
psychological distress is a good starting
point, while providing extra time
and willingness to listen during any
assessment may help them bring up
any issues. Similarly, looking at the
patient holistically and not just seeing
the skin condition in front of you is also
crucial. Finally, when it comes to skin
disease, remember that appearances
are certainly not everything.
In spite of what the media portrays, no one
has perfect skin.With the widely used forms
of technology such as photoshop, it is easy to
create an ‘ideal’ body image. It is easy to forget
how common skin problems are.They can
vary from a simple skin tag to vitiligo, acne,
psoriasis, through to more severe diseases such
as ichthyosis (a thickened, scaly skin condition),
neurofibromatoses (tumours that grow along
nerve system) and rarer diseases.
Regardless of how visual these conditions are, we must acknowledge
the impact on that person’s life.The more visual the problems, the more
likely the judgement may be. However, conditions that are hidden may still
cause intimacy difficulties resulting in relationship problems for instance.
In other words, psychological distress is not limited to what is seen.
As nurses, we are presented with the physical symptoms and
address the options in treating these.When talking with the patient, the
psychological impact can become more defined as they describe aspects
of their lives that are affected.We have a responsibility to follow up if a
patient indicates self-harm or suicidal ideation.We are not necessarily
equipped for this response, but obtaining the correct input immediately
is vital.
It is well accepted in dermatology that skin conditions have strong
psychological connections. However, in the troubled times of the NHS,
some services such as skin camouflage are being removed unless
special funding is agreed.Time restraints and resources are few and
far between in both dermatology and mental health services.Yet, on
a positive note, there is a drive towards introducing psychological
experts into dermatology departments. It is evident through patient
questionnaires such as DLQI (Daily Living Quality Index), GAD-
7 (Generalised Anxiety Disorder 7-item scale) and PHQ-9 (Patient
Health Questionnaire), that there is a need to assist patients in dealing
with their psychological concerns.
In answer to the question: it appears that we are paying attention to the
psychological issues of skin disease, but there is still much to be done and
offered to support patients in their times of need. Healthcare professionals
need increased training and support to guide patients. Support can be
found outside the dermatology setting, including condition-specific support
groups, Changing Faces (charity helping people with disfigurements) and
alternative treatments such as hypnosis, counselling and meditation.
Tonia Goman, dermatology specialist nurse (inflammatory skin conditions)
and lead phototherapy nurse, Bristol Dermatology Centre,
Bristol Royal Infirmary; joint-chair of British Dermatology Nurse Group
(BDNG) phototherapy sub-group; skin camouflage practitioner