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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 - PowerPoint PPT Presentation
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West Hertfordshire HospitalsNHS Trust
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
West Hertfordshire HospitalsNHS Trust
Vulval Disease
All ages• Lichen sclerosis• Eczema: seborrhoeic, contact/irritant/ atopic• Psoriasis• Vulval pain syndromes• Lichen planus• VIN• Immunobullous disorders• Hidradentis suppuritiva
West Hertfordshire HospitalsNHS Trust
Vulval Disease
• Dedicated clinic
• Increased consultation time
• Access to other specialities
• Teaching opportunity?
West Hertfordshire HospitalsNHS Trust
Please don’t refer!
• Suspected vulval cancer – (unless melanoma)
• STD/warts
West Hertfordshire HospitalsNHS Trust
Patch Testing Service
Dr. Simon Dawe Consultant Dermatologist
West Hertfordshire NHS trust
West Hertfordshire HospitalsNHS 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
West Hertfordshire HospitalsNHS Trust
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
West Hertfordshire HospitalsNHS Trust
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
West Hertfordshire HospitalsNHS Trust
Patch Testing
West Hertfordshire HospitalsNHS Trust
Patch Testing at West Hertfordshire NHS trust
West Hertfordshire HospitalsNHS 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
West Hertfordshire HospitalsNHS Trust
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
West Hertfordshire HospitalsNHS Trust
Follow up caseload: HELP!!!
West Hertfordshire HospitalsNHS Trust
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!
West Hertfordshire HospitalsNHS Trust
HELP!!!!
West Hertfordshire HospitalsNHS Trust
Dermatology Follow up case load implications of new: follow up 1:1.2 ratioHHGH 31% patients no follow up appointments, SACH 31% patients no follow up appointments, HMH 42% patients no follow up appointmentsTop 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
Eczemadermatitis
325 1.94 630 Adults with difficult eczema on second line treatments such as azathioprine, ciclosporin, oral steroids, PUVA or day treatment. Prevents hospitalisationSome patients require 3 patch test appointments for investigation of allergic contact dermatitisChildren 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
West Hertfordshire HospitalsNHS Trust
Dermatology Nurses Rule: OK?
Liz Farley Senior Dermatology Nurse Specialist
West Hertfordshire HospitalsNHS Trust
Nurses and the patient pathway
GP Referral
Childrens Eczema
Nurse led clinic
PsoriasisNurse led
clinic
Leg ulcerNurse led
clinic
Primary Care clinic
Nurse support
Treatments:OintmentsPhototherapyBehavioural treatment
Doctors clinicNurse support
Discharge
Nurse skin surgery
Reaccess via Nurse led helpline
Patch testing
Nurse led drug
monitoring clinic
West Hertfordshire HospitalsNHS Trust
It’s all about team work …
… thank you