Transcript Presentations

Dermatology Services for
Patients with Vulval Disease
• Current
– Monthly HHGH (VBw)
– Monthly WGH(FMT & PM)
– Quarterly joint Gynae/Derm (VBw & AH)
• Future
– Monthly SACH (VBw)?joint with GUM
Vulval Disease
All ages
• Lichen sclerosis
• Eczema: seborrhoeic, contact/irritant/ atopic
• Psoriasis
• Vulval pain syndromes
• Lichen planus
• VIN
• Immunobullous disorders
• Hidradentis suppuritiva
Vulval Disease
•
•
•
•
Dedicated clinic
Increased consultation time
Access to other specialities
Teaching opportunity?
Please don’t refer!
• Suspected vulval cancer
– (unless melanoma)
• STD/warts
Patch Testing Service
Dr. Simon Dawe
Consultant Dermatologist
West Hertfordshire NHS trust
Epidemiology
• Point prevalence of eczema in UK 20%
• Occupational dermatitis 29% of
occupational disease
• 4.5 % of population is allergic to nickel
• 1-3% of the pop are allergic to
ingredients of cosmetics
Patch and Photopatch Testing
• To allow confirmation of allergic
contact dermatitis and of photo
allergic contact dermatitis
• To differentiate between allergic and
irritant contact dermatitis
What is Patch testing?
• To illicit an immune response by
challenging already sensitized persons
to defined amounts of allergen and
assessing the degree of response
• Patch testing is not helpful in the
assessment of food allergic individuals
Patch Testing
Patch Testing at West
Hertfordshire NHS trust
Numbers Tested
• We offer a patch testing service at
SACH and HH
• Patch testing is arranged after an initial
clinical assessment and appropriate
batteries of allergens selected
• Yearly rate 168 patients per year
• We are in the process of setting up a
dedicated clinic whose remit may widen
Indications for referring for patch
testing
• Eczematous disorders where contact
allergy is suspected or is to be excluded
• Eczematous disorders failing to respond
to treatment as expected
• Chronic hand and foot eczema
• Persistant or intermittent eczema of the
face, eyelids, ears and perineum
• Complicated varicose eczema
Follow up caseload: HELP!!!
Follow up caseload: HELP!!!
• Huge reductions in commissioned follow
up activity (40%)
• CATS will increase complexity of
secondary care caseload
• Follow up caseload includes skin
surgery (good value for you!)
• Nurse activity now being counted
• ALL A MESS!
HELP!!!!
Dermatology Follow up case load implications of new: follow up 1:1.2 ratio
HHGH 31% patients no follow up appointments, SACH 31% patients no follow up appointments, HMH 42% patients no follow up appointments
Top ten diagnoses of those needing more than one follow up appointment
Diagnosis
No of
patients
Mean no of
FU in 12
months
Total no FU
slots in 12
months
Reason
Basal cell
carcinoma
328
1.52
499
Most are discharged after first excision, high recurrence sites and those
having curettage and cautery are followed up with an extra visit. Many have
multiple tumours
Eczema
dermatitis
325
1.94
630
Adults with difficult eczema on second line treatments such as azathioprine,
ciclosporin, oral steroids, PUVA or day treatment. Prevents hospitalisation
Some patients require 3 patch test appointments for investigation of allergic
contact dermatitis
Children followed up and supported in nurse led eczema follow up clinic to
avoid hospitalisation
Psoriasis
253
2.17
549
Represents those patients with complex disease on second line treatments.
Nurse psoriasis clinic and second line drug monitoring clinic in place.
Squamous cell
carcinoma
207
1.88
207
National guidance requires specialist follow up. Well differentiated tumours
already discharged. Many patients have multiple lesions
Melanocytic
naevi
206
1.37
282
Includes patients with multiple atypical naevi. Expert patient programme
being developed
Acne
199
1.92
382
Male Isotretinoin patients need a minimum of 3 follow up appointment,
Females need 5 visits to meet the EU pregnancy prevention programme
Actinic keratosis
199
1.59
316
Many patients have associated skin cancer. Trying to discharge all these but
they commonly are re-referred
Malignant
melanoma
95
1.91
181
Melanoma guidance requires 3 monthly follow up for 5 years. NICE indicates
should be dermatology specialist
Lichen sclerosis
70
1.84
129
Chronic condition requires follow up in small cohort of patients with difficult
disease; cancer risk
Leg ulcers
64
2.25
144
Should improve with development of community leg ulcer services
Dermatology Nurses Rule:
OK?
Liz Farley
Senior Dermatology Nurse Specialist
Nurses and the patient pathway
GP Referral
Childrens
Eczema
Nurse led
clinic
Nurse skin
surgery
Nurse led
drug
monitoring
clinic
Psoriasis
Nurse led
clinic
Leg ulcer
Nurse led
clinic
Doctors clinic
Nurse support
Primary Care
clinic
Nurse support
Treatments:
Ointments
Phototherapy
Behavioural
treatment
Discharge
Reaccess via Nurse
led helpline
Patch
testing
It’s all about team work …
… thank you