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 STD/warts (unless melanoma) STD/warts

Dr. Simon Dawe Consultant Dermatologist West Hertfordshire NHS trust 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 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 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 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 Dermatology Nurses Rule: OK? Liz Farley Senior Dermatology Nurse Specialist

Nurses and the patient pathway GP Referral Psoriasis Nurse led clinic Leg ulcer Nurse led clinic Primary Care clinic Nurse support Childrens Eczema Nurse led clinic Doctors clinic Nurse support Nurse skin surgery Treatments: Ointments Phototherapy Behavioural treatment Nurse led drug monitoring clinic Discharge Patch testing Reaccess via Nurse led helpline

It’s all about team work … … thank you