Dilliway G. Management of scabies. Practice Nurse 2002; 23(9): 57-60

Itching is the first symptom of scabies and it is important that families understand that it may not resolve for many weeks; this is not a sign that the treatment has failed. Topical treatments need to be applied carefully and nurses should explain this to parents.

• Dermatitis and the NPEF

Courtenay M. Nurse prescribing and dermatology. NTPlus 2002; 98(30):53-54

The treatment and management of atopic dermatitis, contact dermatitis and seborrhoeic dermatitis by nurse prescribers using the NPEF is discussed in this article. Emollients and topical corticosteroids are among the treatment options described.

Website: www.nursingtimes.net

• Managing chronic plaque psoriasis

Jackson K. Chronic plaque psoriasis: an overview. Nursing Standard 2002; 16(51): 45-55

Psoriasis can have considerable impact on quality of life and good nursing support is needed to manage it in both primary and secondary care. This article concentrates on chronic plaque psoriasis, which accounts for 85-90% of cases.

A holistic assessment is essential to inform the development of a care plan. It should include a psychological assessment and consider whether advice on stress management would be useful.

There is a variety of first-line treatment options for psoriasis, including coal tar, dithranol, vitamin D3 analogues, topical corticosteroids and tazarotene (Vitamin A derivative) and the use of each is discussed. Emollients are usually applied 30 minutes before another treatment. Scalp psoriasis can be particularly distressing and its management is highlighted.
Moderate-to-severe psoriasis will often require second-line therapy, usually in a hospital dermatology unit. It can include phototherapy, photochemotherapy and systemic drugs.

Patients need to have realistic expectations of treatment outcomes, understanding that treatment is not curative and will be lengthy. They also need information about the treatment itself.

The author points out that the scope of practice in dermatology nurse-led units is limited by the omission from the NPEF of any prescription-only medicines for psoriasis.

Website: Nursing Standard

• The causes of eczema and its treatment

Chiodo B. Eczema – an overview. Journal of Community Nursing 2002; 16(9): 46-49

This article discusses the different forms of eczema and the treatments which are available. The mainstay of treating eczema is keeping the skin moisturised and there is a wide range of emollients available. Triggers that make the condition worse should be avoided, cotton clothing and bedding help keep the skin cool, and biological washing powder and fabric conditioners should be avoided.

Website: www.jcn.co.uk

• Atopic eczema and self-management

Rees M. Managing atopic eczema. Primary Health Care 2002; 12(8): 27-32

Atopic eczema affects 15-20% of children in the UK at any one time and 2-3% of adults. It is an incurable condition that affects the quality of life of patients and their families. The approach of health professionals to patient education could be improved.

This article discusses how primary care nurses can empower patients to become experts in their own condition. Those patients who do not wish to can still be helped by improving concordance. Nurses should recognize patients’ autonomy and expertise and support any measure that makes them feel better, giving realistic advice about the possibility of cure or resolution. In return, patients can be asked to be open about all treatments they are taking.

Current primary care treatments are emollient bath oil, emollient soap substitute, and emollient cream/ointment. Soap should be avoided. Although there is currently little evidence of the effectiveness of emollient therapy from randomised controlled trials, their use is based on sound evidence about the importance of maintaining the water content of the skin.

Continuous complete emollient care requires commitment from people with atopic eczema and nurses should demonstrate the use of each component and follow up regularly. Often, people do not use enough emollient. They should be able to experiment till they find one that suits them and be prescribed it in sufficient quantities. Average monthly prescriptions should be for 300 ml of emollient soap substitute, 2000g of emollient cream/ointment and 500 ml of emollient bath oil. The author also discusses the treatment of exacerbations and infections in atopic eczema.

Website: www.primaryhealthcare.net

• Guidelines for emollient use

Holden C. et al. Advised best practice for the use of emollients in eczema and other dry skin conditions. Journal of Dermatological Treatment 2002; 13: 103-106.

This article proposes a set of simple guidelines for emollient therapy in eczema care. Their aim is to improve day-to-day management by primary care professionals and to promote consistent practice by patients.

A recent report from the Dermatological Care Working Group revealed inadequacies in the UK dermatology service and suggested that ‘expert patients’ were best placed to improve their self-management. Despite widespread recognition of the benefits of emollient therapy for eczema and other dry skin conditions, there are considerable variations in prescribing practice, with adverse effects on patient care. This area could benefit greatly from increased patient education and participation.

The article discusses the structure and function of the skin and how its barrier function can be restored with emollients. It then outlines an education strategy, pointing out that consistent advice from health professionals about the objectives and benefits of emollient therapy will help ensure that any emollient treatment regimen is successfully implemented.

The best practice guidelines for patients with eczema and dry skin conditions state that all health professionals involved in their care should understand the basic principles of emollient use. These patients should avoid soap and use an emollient substitute. That even when the condition is under control, a daily emollient routine is important and emollients should be supplied in sufficient quantities to be applied at least twice daily. And finally, patients should understand the relative benefits of emollients (to combat dry skin) and steroid creams (to reduce inflammation).

Over time, the aim is that patients manage their therapy and the number of flare-ups is reduced. An ‘ABC’ patient leaflet has been developed based on these guidelines which encourages patients to: Avoid soap; Benefit from emollients; and Control inflammation.

• Salicylic acid as treatment for cutaneous warts

Gibbs S. et al. Local treatments for cutaneous warts: systematic review. British Medical Journal 2002; 325: 461-464.

Topical treatments for cutaneous warts containing salicylic acid do have a therapeutic effect, according to this systematic review of local treatments.

The 50 trials included in the analysis generally provided poor evidence, with heterogeneity in design, methods and outcome. Data pooled from six placebo-controlled trials showed a cure rate of 75% for salicylic acid compared with 48% in controls. There was also some evidence for the efficacy of contact immunotherapy with dinitrochlorobenzene from two small trials. There was limited evidence for cryotherapy, topical flurouracil, intralesional interferons, photodynamic therapy and pulsed dye laser and no consistent evidence for intralesional bleomycin.

Website: www.bmj.com

• Psoriasis

Blake J. Psoriasis. Professional Nurse 2002; 18(3): 133-134.

This factfile examines the management of psoriasis, pointing out that the aim of treatment should be to minimize symptoms and reduce the impact of the condition on quality of life.

The various topical and systemic treatments are discussed and the different types of psoriasis delineated.

• Acne: causes and treatment

Greener M. Acne: the PN role. Practice Nurse 2002; 24(8): 52-57.

Practice nurses can do a great deal to prevent the physical and emotional consequences of acne, according to this article. It looks at the causes of acne, its epidemiology and treatment.