Skin

Manage primary contact with patients who have a skin problem.
Work with patients to empower them to look after their own health and take responsibility for managing their skin problems.
Promote skin wellbeing by applying health promotion and disease prevention strategies appropriately including sun protection, occupational health advice and hand care.
Coordinate care with other primary care health professionals, dermatologists and other appropriate specialists, leading to effective and appropriate acute and chronic disease management including prevention and rehabilitation.
Make timely appropriate referrals on behalf of patients to specialist services, especially to rapid-access pigmented lesion (sometimes called skin cancer, mole or melanoma) clinics.

Knowledge Base

Symptoms:

Key issues in the diagnosis of skin problems will be eliciting of the appropriate signs and symptoms and subsequent investigation and/or referral of people presenting with:

Rashes

Hair loss

A disorder of their nails

Itch (also known as pruritus)

Pigmented skin lesions

Signs of infections of the skin

Bruising or purpura

Lumps in and under the skin

Photosensitivity and the red face.

Common and/or important skin conditions:

Eczema

Psoriasis

Generalised pruritus

Urticaria and vasculitis

Acne and rosacea

Infections (bacterial, viral and fungal)

Infestations including scabies and head lice

Leg ulcers and lymphoedema

Skin tumours (benign and malignant)

Disorders of hair and nails

Drug eruptions

Other less common conditions such as the bullous disorders, lichen planus, vitiligo, photosensitivity, pemphigus, pemphigoid, discoid lupus, granuloma annulare and lichen sclerosus.

Investigations:

Ability to take specimens for mycology from skin, hair and nail

Basic interpretation of histology reports

Skin biopsy.

Treatment:

Those commonly used in primary care (including an awareness of appropriate quantities to be prescribed and how to apply them)

Principles of protective care (sun care, occupational health and hand care)

An awareness of specialised treatments, such as retinoids, ciclosporin, phototherapy and methotrexate

The indications for, and the skills to perform, curettage, cautery and cryosurgery.

Emergency care:

Acute treatment of people presenting with skin problems or symptoms thought to be due to skin problems and appropriate referral if necessary. Including:

angioedema and anaphylaxis

meningococcal sepsis

disseminated herpes simplex

erythroderma

pustular psoriasis

severe nodulo-cystic acne

toxic epidermal necrolysis

Stevens-Johnson syndrome

necrotising fasciitis.

Prevention:

This will involve the following risk factors:

Sun exposure

Fixed factors: family history and genetics

Person-centered Care

Appreciate the importance of the social and psychological impact of skin problems on the patient’s quality of life, including, for example, the effects of disfigurement or sleep deprivation as a result of itching.
Identify the patient’s health beliefs regarding skin problems and either reinforce, modify or challenge these beliefs as appropriate.

Specific Problem-solving Skills

Intervene urgently when patients present with an emergency skin problem (see ‘knowledge base’ for examples).
Demonstrate a reasoned approach to the diagnosis of skin symptoms using history, examination, incremental investigations and referral.

Comprehensive Approach

Advise patients appropriately regarding lifestyle interventions including skin protection and occupational health advice.
Describe the side effects of common medicines used to prevent and treat other conditions that may cause skin problems.

Community Orientation

Describe the rationale for restricting certain investigations and treatments in the management of skin problems, e.g. prescribing of retenoids, access to phototherapy.
Describe the importance of occupational risk in the aetiology of skin disease.

Holistic Approach

Recognise how disfigurement and cosmetic skin changes fundamentally affect patients’ confidence, mood and interpersonal relationships.
Appreciate the importance of the social and psychological impact of skin problems on the patient’s quality of life, including, for example, the effects of disfigurement.
Recognise the impact that skin problems have on fitness to work.
Appreciate the importance of the social and psychological impact of skin problems on the patient’s family, friends, dependants and employers.
Empower patients to self-manage their skin conditions as far as practicable, e.g. eczema.

Context

Recognise how common skin problems are among the general population.
Recognise the risk of inappropriate referrals and under-referral.
Describe the need for close collaboration with primary care and specialist services in the management of many skin problems, e.g. pigmented lesions, psoriasis.

Attitude

Ensure that skin problems are not dismissed as trivial or unimportant by healthcare professionals.
Empower patients with chronic skin problems to manage the effects of disfigurement.

Science

Describe and implement the key national guidelines that influence healthcare provision for skin problems (e.g. the NHS cancer plan 2000).

Psychomotor Skills

Describe the indications for and be able to demonstrate that they have the skills to perform:curettage, cautery and cryosurgery, skin biopsy.
Demonstrate the ability to take specimens for mycology from skin, hair and nail.