This third article in a seven-part series looking at the identification and treatment of psoriasis, explores the active ingredients and action of the main topical treatments for psoriasis. Community nurses are perfectly placed to help patients take control of their skin condition, particularly in advising them on the benefits of topical treatments, which as they can be applied directly to the skin, allow the area to be targeted, lowering the level of absorption into the bloodstream and reducing side-effects (Psoriasis and Psoriatic Arthritis Alliance (PAPAA, 2017a).
The knowledge needed to diagnose skin conditions in primary and community care can be elusive, daunting and confusing. By using thorough history-taking, excellent physical assessment skills and thinking ‘outside the box’, healthcare professionals can formulate a differential and working diagnosis to improve patient access to appropriate management, including medications, lifestyle changes and referral as needed. Simple history-taking tools, relevant mnemonics and good resources can help patients to be managed quickly and effectively, and thereby improve outcomes and reduce the need for time delay in diagnosis. This article intends to demystify the dermatology conundrum and give healthcare professionals the tools to simplify the treatment of common skin conditions.
Psoriasis is a common skin problem that can cause significant distress to primary care patients, as well as representing a significant burden to healthcare resources. Often seen by communinity nurses, psoariasis is a condition that requires careful management as well as extensive knowledge of the different presentation. This article, the second in a series looking at the identification and treatment of psoriasis, examines the use of emollients in psoriasis treatment, focusing on the aims, benefits and efficacy of these topical treatments.
Community nurses will often encounter patients with psoriasis in their day-today work, and may be involved in delivering care directly or monitoring the condition. However, psoriasis has various presentations and knowledge of these variations is beneficial for all clinicians working in the community, particularly when it comes to understanding the range of treatments available. This article, the first in a series on psoriasis, will discuss the types of psoriasis that can be encountered, while future articles will examine the different treatment options that are currently available, focusing on the National Institute for Health and Care Excellence’s (NICE, 2016) treatment pathway for managing patients with psoriasis (see Figure 1). The series will focus on each of the steps in the pathway and how they relate to nurses working in the community.
Atopic eczema, also referred to as dermatitis, is an inflammatory chronic skin disease that commonly develops in childhood. This condition ranges from birth to 12 years old and affects both genders equally. Atopic eczema affects people of all ages but children in particular. The prevalence rate for atopic eczema is around 15–20% in children and 2–10% in adults (Scottish Intercollegiate Guidelines Network [SIGN], 2011), and accounts for 30% of all dermatological consultations in primary care (Shamssain, 2007).
Many people with skin conditions such as eczema, psoriasis and acne, as well as scars and old or unwanted tattoos, can find their self esteem is negatively affected. This article looks at skin camouflage, a cosmetic technique that can nonetheless provide patients with a way of lessening the psychological impact of skin conditions.
With so much choice, there can be uncertainty around which skin preparations to use in people with skin that is damaged or in danger of becoming compromised. However, community nurses are ideally placed to carry out skin assessments, provide education and work with patients to identify an effective emollient package. Patient choice is crucial and should be available to patients of all ages with vulnerable, dry or scaly skin conditions. Patient education and written management plans are also essential for the successful management of dry skin conditions. However, choosing one type of bath additive or emollient over another can create confusion for healthcare professionals and patients alike and this article sets out some basic principles for successful management.
Vulval health disorders can be painful and chronic conditions. The link between long-term painful illness and the mental wellbeing of patients is firmly established. Taking into account the nature of vulval health conditions, it is important to gain an understanding into the impact they can have upon a patient’s quality of life. As part of an initiative aimed at expanding insight into the realities of living with this type of problem, the British Association of Dermatologists surveyed 325 British women who had suffered, or were currently suffering, from a vulval health disorder.
The study took the form of an online survey, collecting mostly quantitative data, with some qualitative insights. Responses were gathered under the categories of demographics; vulval condition; treatment; physical impact; impact upon career and social life; impact upon romantic and/or sexual relationships, and effect on emotional and mental wellbeing. Eighty-nine percent of survey respondents reported that their vulval health disorder had negatively affected their emotional and mental wellbeing. Patients suffering with a vulval health disorder were twice as likely to have suffered with depression and 22% reported having contemplated self-harm or suicide as a result of their condition. Overall, vulval health conditions were found to have a significant impact on quality of life for patients, affecting every aspect to some extent.
Many skin conditions, while no longer requiring hospitalisation, still require a level of knowledge and skill from community nurses, particularly with assessment and diagnosis. Atopic eczema is one such skin condition and can cause significant discomfort, particularly when inflamed skin becomes virally infected, leading to to complications such as eczema herpeticum and molluscum contagiosum. Both of these viral infections can increase the discomfort of eczema, leading to a variety of symptoms including blisters, sore skin, itch and rash. It is important that community nurses are able to identify skin conditions of this type and know whether to treat themselves or refer on to dermatological specialist nurses for more specialised management.
Independent Age is a charity that provides an established voice for older people, the greatest users of the NHS. As we continue to live longer, putting more strain on services, we all need to prepare for what might be an uncertain future. As more people live for longer with chronic conditions, they will need support, much of it being required in the home.
