in any 12-month period; 14%
seek medical advice from GPs or
community practitioners; and
skin conditions (most notably
infection and eczema) are the
most frequent reason for GP visits
(Schofield et al, 2010).
And if that weren’t enough,
skin disease does kill — in 2005,
nearly 4,000 deaths were the result
of skin disease, with 1,817 being
due to malignant melanoma, the
most common cancer in the UK.
On a more day-to-day level, the
sheer volume of skin care products
available over-the-counter, both
cosmetic and medical, points to the
demand for attention.
Putting statistics aside,
the impact, both physical and
psychological of skin conditions,
surely justifies a call for adequate
provision within primary care.
Regardless of the severity, the huge
effect that skin conditions can have
on patient wellbeing and self-
esteem should not be overlooked
— no one can dispute the negative
comments that children with
eczema or psoriasis often have to
put up with at school; the anxiety
that teenagers battling with acne
experience; or the impact on work
and personal relationships of
any disease that affects a
person’s appearance.
The long-term, even lifelong,
nature of some conditions,
means that all members of the
multidisciplinary team need to
be educated and competent in
identifying and treating minor skin
disorders, with clear pathways of
care in place detailing when to
refer for specialist intervention, and
for specialists to be available —
unfortunately, this is often not the
case, with the UK having a‘chronic
shortage of consultant dermatologists’
(All Party Parliamentary Group on
Skin [APPGS], 2015).
SKIN CARE TODAY
2015,Vol 1, No 1
5
I have been a dermatology nurse for 31 years, the last 10 working in the
community, and I still struggle to comprehend the attitude of some GPs
towards long-term skin complaints. Promoting patient-centred care and
wellbeing is supposed to be at the top of the agenda for clinicians to prevent
hospital admissions and associated costs, however, dermatology still seems
to come low on the list of priorities. Part of my role is education around
managing long-term skin complaints, not only for parents and carers,
but also for clinicians, and I have found that there is a definite lack of
understanding from a large number of GPs as to the distress that some
of these conditions can cause.
One of my aims for the future is to educate clinicians on the importance of prescribing adequate
amounts of emollients to manage the condition effectively… do GPs not realise that 125g of an
emollient will not suffice for a month?
Education around the amount and potency of topical steroids is also an issue for many clinicians
in their ability to manage conditions such as atopic eczema, with ‘steroid phobia’ being a real issue.
When the patient presents their prescription to the pharmacist for their limited amount of topical
steroid after being told to apply it sparingly, they are then advised again on how to apply this
treatment very sparingly, until the poor patient is frightened to use any at all.
Let’s all make a big push forward in the education of dermatology, not only to clinicians who
manage these patients, but also to the patients who suffer from these conditions and allow them to
have a stronger voice when visiting their GPs.
Tina Diaz,
dermatology clinical nurse specialist, CAS Services, City of Coventry Heatlh Centre
SKIN CARE MATTERS
i
Given the facts and figures and
extent of the morbidity and mortality
caused by skin disease, it is hard to
understand why there is a lack of
adequate training in primary care
around dermatological conditions for
GPs, nurses and, indeed, pharmacists
(APPGS, 2012). Furthermore, since
October 2013, the DH has had no
policy lead for dermatology — with
clinical commissioning groups
(CCGs) commissioning their own
local skin care services.
While this might result in more
‘personalisation’of treatment — from
the local CCG rather than Whitehall
level — it goes nowhere towards
establishing the‘standardised ways
of how care is provided’, which
Simon Stevens is calling for (
Health
Service Journal
annual lecture:‘Simon
Stevens’on forward view for the
NHS’, 22 December 2014). There
seems to be confusion too as to how
dermatology services are funded, as
while some are down to local CCGs,
