1. 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

2. Vulval Disease All ages Lichen sclerosis
Eczema: seborrhoeic, contact/irritant/ atopic
Psoriasis
Vulval pain syndromes
Lichen planus
VIN
Immunobullous disorders
Hidradentis suppuritiva

3. Vulval Disease Dedicated clinic Increased consultation time
Access to other specialities
Teaching opportunity?

4. Please don’t refer! Suspected vulval cancer STD/warts
(unless melanoma)
STD/warts

5. Dr. Simon Dawe Consultant Dermatologist West Hertfordshire NHS trust
Patch Testing Service
Dr. Simon Dawe
Consultant Dermatologist West Hertfordshire NHS trust

6. 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

7. 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

8. 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

9. Patch Testing

10. Patch Testing at West Hertfordshire NHS trust

11. 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

12. 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

13. Follow up caseload: HELP!!!

14. 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!

15. HELP!!!!

16. 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

17. Dermatology Nurses Rule: OK
Dermatology Nurses Rule: OK? Liz Farley Senior Dermatology Nurse Specialist

18. 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

19. It’s all about team work …
… thank you