In the past two decades the role of the advanced clinical practitioner (ACP) has emerged to relieve pressures within the healthcare workforce (Reynolds and Mortimore, 2021). Unless the ACP works within a specific specialty, ACPs require a broad knowledge of many specialisms, both medical and surgical, and an ability to work both within primary and secondary care (Reynolds and Mortimore, 2021). Therefore this clinical review, the second in a series of two articles, is designed to support ACPs across acute hospital settings and primary care in differential diagnosis, mimicking conditions, common investigations and treatment options outside a dermatology setting. Many ACPs feel uncomfortable with assessing and managing skin conditions because it is a complex specialty with a large number of potential diagnoses (over 2000) (Levell et al, 2013). However, those with less familiarity with dermatological conditions can develop their knowledge and experience and provide care for those with dermatological complaints.
In the previous article (McPhillips et al, 2021) the authors considered a systematic approach to consultation and physical assessment in a patient with a skin complaint. This clinical review explores the next steps for a novice ACP, considering some differential diagnoses and mimickers, common investigations and treatment options for a patient presenting with a skin complaint. Decision making in this area is crucial when caring and supporting a patient with a skin condition/complaint within this role. This article assumes the ACP will have knowledge and understanding of normal skin health, which is required prior to being able to hold a consultation with a patient with a skin problem, and is beyond the scope of this article to address.
Differentials
The possible list of differential diagnoses within the integumentary system is vast (Lynch, 1994). Although it is unlikely that those working outside the dermatology specialty will have a depth of knowledge around these differentials, it is important that all ACPs have developed some knowledge of common conditions, treatments and investigations, which will be covered in this clinical review. The high numbers of patients presenting with skin conditions, and the fact that skin conditions are the most common presentation to primary care in England and Wales (Schofield et al, 2011), makes it likely that all ACPs working in general settings will be presented with a patient demonstrating a skin complaint as some point in their career. Given the often distressing nature of such problems and the potential for ill health associated with skin conditions, it is important that ACPs have a firm baseline knowledge of this area and any red flags (Table 1).
Table 1. Red flags for dermatological emergencies
| Condition | Sudden onset | Fever | Malaise | Rapid onset/progression | Hypothermia | Demarcation | Blistering | Systemic symptoms | Mucosal involvement | Widespread involvement |
|---|---|---|---|---|---|---|---|---|---|---|
| Erythroderma | + | + | + | + | + | + | ||||
| Infection | + | + | + | + | + | + | + | + | ||
| Bullous disorder | + | + | + | |||||||
| Drug reaction | + | + | + | + | + | + | + | + | ||
| Malignancy | + | + | + |
Mimics
It is useful to be aware of mimics in skin presentations and to consider and investigate any potential differentials or causes. A common condition with several mimics is cellulitis. Conditions such as herpes zoster, vasculitis, venous disease (such as venous thrombosis and venous eczema), lymphoedema, dermatitis (including contact dermatitis), panniculitis, and necrotising fasciitis, along with several other conditions may present in a similar manner to cellulitis (Hirschmann and Raugi, 2012). As each of these conditions have their own required treatment and secondary concerns, it is important to distinguish them from cellulitis. This is where a thorough history and examination is vital in aiding this diagnostic process. Table 2 explores some common mimics where dermatological conditions bear significant resemblance to other diseases.
Table 2. Mimics
| Diagnosis | Mimic | Similarities | Differences with mimicker |
|---|---|---|---|
| Cellulitis | Necrotising fasciitis | Heat over areaSystemic symptoms fever, nausea, fatigue, tachycardiaSwelling/oedema | Severe painCrepitusSoft tissue fluctuanceRapid onset and expansionPain beyond erythemaSigns of severe sepsis once progressingNot responsive to antibiotics |
| Cellulitis | Venous disease/chronic venous insufficiency | Swelling/oedema | No systemic symptomsBilateral presentation of lower limbsFlaking skin, dry, and occasionally itchyLegs can leak fluidChronic venous insufficiency can result in ‘skittle/bowling pin’ shaped legs |
| Cellulitis | Contact dermatitis | Redness/erythema Swelling | Erythematous plaques—blistering or scalyCan be itchyNo systemic symptoms |
| Cellulitis | Erysipelas | Systemic symptoms such as fever, nausea, fatigueHeat and redness of areaSwelling/oedema | BlisteringDemarcation of erythema/more clearly definedBlistering |
| Cellulitis | Herpes zoster | Heat and rednessSwelling | Rash with pain (usually sharp)Sudden onset of feverItching/burning sensationRash that develops into blisters (scab over at approximately 7–10 days) |
| Cellulitis | Small vessel vasculitis | FeverMalaise | Bilateral to lower limbsUlcers/blistersPurpuraErythematous plaques |
| Cellulitis | Deep vein thrombosis | RednessSwellingPainWarmth/heat | Tense/hard skinNo systemic symptoms |
| Cellulitis | Lymphoedema | OedemaErythema | Bilateral to lower limbsPapules (wart like) and plaquesHyperkeratosisNo warmth/heat |
| Cellulitis | Eczema | ErythemaCan present with systemic symptoms | BlistersWeeping or crustingCan present with itch |
| Cellulitis | Erythema nodosum | RednessFeverNausea | Bilateral lower limbs (usually shin)Tender knots/lumps |
| Seborrheic keratosis | Melanoma | Itchy, not flat against surrounding skin, can vary in size, can appear on any area of the body, usually black or brown | Burning sensation in melanomaMelanoma may bleed and may have blurred borders. Melanoma can present with several colours in the one mole |
| Bowen’s disease | Psoriasis | Scaly, crusty, itchy, red pink, clearly defined edges | Psoriasis is covered with silvery coloured scales, which flake off |
| Rosacea | Systemic lupus erythematous (SLE) | Malar erythemaRed patchesSensitivity to sunlight | Sharper margins in SLE, rosacea not butterfly-like patternInflammation of nose and excess facial skin around nose in rosacea |
| Psoriasis | Eczema | Scaly patches, flaking, itchy | Scaly patches silvery in appearance in psoriasisEczema often greasy or oily |
Investigations
Obtaining a thorough history and physical examination can often allow for efficient diagnosis and treatment of the most common skin conditions. The identification or elimination of red flags can reduce diagnostic uncertainty and increase patient safety while delivering prompt, appropriate treatment.
There will be some presentations, however, that require further investigations to determine the nature of the condition before treatment can be commenced. Although many of these investigations require referral to a specialist service, some explorations can be undertaken by those outside of the dermatology specialty. It is important that ACPs are aware of treatments available, and their mode of action, as this will enable them to provide clear information to the patient before referral, gather informed consent for this process, and provide holistic care responsive to the patient’s needs (All Party Parliamentary Group on Skin, 2020).
Key investigations for a skin complaint
For an ACP, some basic and straightforward investigations that can help in confirming diagnosis and identification of a treatment plan can be requested. These investigations include swabs, allergy testing and skin, hair and nail sampling, alongside blood tests (discussed below). These investigations can also be carried out before referral to a specialist to speed up waiting times for results.
Swabs
A common and non-invasive investigation is the swab for microbiology. This is useful in conditions where bacterial infection is suspected and can aid in the identification of appropriate antibiotic choice if indicated. It is recommended that swabs be taken before the commencement of antimicrobial therapy (Cross, 2014). Wounds or skin conditions such as ulcers that have debris in situ require cleansing before swabbing, and those swabs obtained from lower limbs often have a positive growth from colonisation rather than infection (Public Health England (PHE), 2018). If swabbing a wound with exudate, gentle downward pressure to release fluid from the wound surface with the swab tip can ensure adequate sampling occurs. If swabbing an area that has previously been covered with a dressing or cream, care should be taken to remove and clean these away prior to obtaining the swab. Swabs should be taken using an aseptic non-touch technique to prevent cross contamination and therefore inaccurate results. Swabs are taken for culture and sensitivity but may be limited due to the efficiency and technique of collection (Ogai et al, 2018). In addition to microbiology swabs, viral swabs may be obtained where there is suspicion of herpes simplex or herpes zoster. To obtain a viral swab the swab is rubbed over and against the lesion or vesicle, rubbing the top/crust off with a sterile swab before collection.
Hair samples/skin scrapings/nail clippings
Other minimally invasive investigations involve the testing of skin scrapings, hair samples, and nail clippings. These are primarily used in investigation of suspected fungal presentations (PHE, 2017). The results, however, may take several weeks and, if these are being requested, it is good practice to advise the patient of the likely wait time for results to reduce anxiety and ensure that their expectations are met. Also if the patient is discharged from secondary care to primary care, or admitted to secondary care from primary care, the results of these investigations should be handed over as part of the admission/discharge letter and ongoing treatment plan.
Hair samples may be collected by means of plucking or cutting and can be assessed by microscopy (Adya et al, 2011). Hair microscopy can aid diagnosis of the cause of hair loss, such as alopecia or trauma (De Berker, 2002).
Skin scrapings are used in the investigation of suspected fungal infections and, once collected, are examined by microscope (Kurade et al, 2006). The skin should be cleaned with a 70% isopropyl alcohol wipe before collection and should be free of any topical preparations or debris. Skin scrapings are collected using a suitable specimen envelope.
Nail samples are not required for simple infections such as athlete’s foot or mild ringworm. They may, however, be useful where fungal infections have been resistant to topical treatment and oral treatment is being considered or in severe infection. As with skin scrapings, the nail should be clean and free of any creams or treatments (PHE, 2017). Full thickness nail clippings, obtained as far back as possible towards the nail bed are recommended, and debris from under the nail will be of benefit in aiding diagnosis.
Allergy testing
In those patients presenting with a suspected allergy, a referral can be made for allergy testing. It is worth noting that most referrals to allergy clinics should be for severe allergies or those impacting on nutritional state only and that those patients requiring patch tests should be referred to dermatology.
There are some simple steps that can be taken in patients presenting with a suspected allergy that is mild in nature. A food and activity diary can be a useful tool in identifying triggers and potential allergens. This requires the patient to record their diet and activities alongside any worsening or alleviation of symptoms so that patterns or themes can be identified. Once a trend is noticed, steps can be taken, with advice and support from dietetics to eliminate the suspect trigger. If there is a suspected food trigger, a trial of food elimination may be useful. This process may take time and the patient should be aware of this before undertaking this method. Although antihistamines may be useful in alleviating symptoms, they may mask some triggers and should ideally be avoided when using a food/activity diary or food elimination methods.
Blood tests
Blood tests can be an appropriate investigation where systemic infection is suspected or where the skin condition is suspected to be secondary to an underlying condition.
Patients with diabetes are at risk of certain skin conditions and infections and, therefore, blood glucose and haemoglobin A1c (HbA1c) are useful blood tests to obtain. Other potentially appropriate blood tests, dependent on the presenting complaint, may be for proteins (when there is a concern regarding connective tissue disease or vasculitis), blood-borne virus serology (to investigate any underlying infection such as hepatitis B, hepatitis C, HIV etc), renal, thyroid, and hepatic function tests to examine any underlying disorder or impact. Investigation of inflammatory markers and haematology will help to determine any systemic infection, and a full blood count (including white cells) will help to determine any potential haematological disturbance such as anaemia, neutrophilia or thrombocytopaenia (Table 3).
Table 3. Differential diagnosis, symptoms and blood tests
| Symptom/differential | Blood tests |
|---|---|
| Hair loss/thinning | Testosterone, liver function tests (LFTs), thyroid stimulating hormone (TSH), luteinizing hormone (LH), prolactin, ferritin, vitamin B12, total iron binding capacity (TIBC), dehydroepiandrosterone sulphate (DHEAS), androstenedione, full blood count (FBC) |
| Acne | LFTs, urea and electrolytes (U&Es), FBC, fasting lipids, fasting glucose, 25-OH vitamin D, TSH, TIBC, IgE, ferritin |
| Cellulitis | Blood cultures, FBC, C-reactive protein (CRP), bicarbonate, creatinine, phosphokinase |
| Systemic lupus erythematous (SLE) | FBC, LFTs, U&Es, TSH, TIBC, non-fasting glucose, total IgE, antinuclear antibodies (ANA) screen, extractable nuclear antigen (ENA), antineutrophil cytoplasmic antibodies (ANCA), anti-cardiolipins, rheumatoid factor, creatine Kinase, Type 3 procollagen, 25-OH vitamin D, complement C3, C4, vitamin B12, folate, lactate dehydrogenase, ferritin |
| Vitiligo | FBC, thyroid function tests, glucose, Hba1C |
| Erysipelas | CRP, erythrocyte sedimentation rate (ESR), FBC |
| Vasculitis | U&Es, LFTs, thyroid function tests, FBC, iron studies |
In suspected allergic reactions, including food allergies, a radioallergosorbent (RAST) test or allergen-specific IgE screen can be taken. Minor allergies can often be treated with topical treatments and/or antihistamines. Should the patient present with any red flags indicating anaphylaxis, however, this should be treated as a medical emergency.
Other investigations
Although beyond the scope of a general ACP, more specialist investigations such as digital dermatoscopy, tomography, microscopy, biopsy, and Wood’s light examination may be required but are undertaken by those experienced in the field of dermatology. If any of these investigations are required the patient should be referred to their local dermatology service.
It would also be worth noting that radiological examinations are rarely used in the diagnosis of skin conditions; they may, however, be used where an underlying disease or disorder is suspected.
Principles of therapy
Although many different therapies are available, this article will cover a few basic and common treatments. This will include those which ACPs may be able administer or commence, and a brief look at some that the ACP may be asked to explain to or discuss with their patients. Having some knowledge of treatments outside the scope of practice of the ACP can allow them to have an informed discussion with their patient, potentially allaying fears and supporting good onward referrals.
Topical therapy
Topical therapies are those treatments that are applied to the skin externally and offer a simple and non-invasive treatment for skin complaints. Their effect can be either local or systemic and can be suitable for a wide range of skin conditions such as acne, insect stings, pre-cancerous lesions, infections and skin affected by the inflammatory process. Patients (in particular children) may find topical therapy more acceptable than oral medications. A wide range of topical therapies are available (Box 1). Some of the benefits and disadvantages of topical therapy are outlined in Table 4. Discussing these with the patient before starting treatment may assist in adherence to treatment.
Box 1.Topical formulations for skin conditions
- Ointment
- Cream
- Lotion
- Topical solution
- Gel
- Foam
- Spray
Source: adapted from Mayba and Gooderham, 2018
Table 4. Benefits and disadvantages of topical therapy
| Benefits | Disadvantages |
|---|---|
|
|
Topical corticosteroids are divided into different levels of potency: mild, moderate, potent, and very potent (Joint Formulary Committee, 2021). The choice of topical steroid will be informed by the severity of the condition. Mild eczema, for example, will require a mildly potent topical corticosteroid (such as hydrocortisone 0.1%, 0.5%, 1.0%, or 2.5%) and conditions such as severe eczema require a moderately potent topical corticosteroid such as betamethasone dipropionate 0.05% or betamethasone valerate 0.1%. Very potent topical steroids are usually only prescribed by specialists (National Institute for Health and Care Excellence (NICE), 2021a). Stepping up or down of potency will be secondary to the response to current treatment. For example, a patient experiencing a worsening flare of eczema despite treatment may require a step up to a higher potency, and Bewley (2008) suggested that this guidance should be provided to the patient in a patient information leaflet.
Finger-tip units
Finger-tip units (FTUs) are a measurement of a topical steroid as squeezed from a standard tube (with a standard 5 mm diameter nozzle) on to an adult index fingertip from distal crease to tip of finger (Kalavala et al, 2007). When body mapping for the application of a steroid cream, 1 FTU is roughly the amount required to treat about 2% of the total body surface area (TBSA) of an adult, which can be calculated using the palmar method: one flat palmar surface of an adult patient’s hand is equivalent to 1% of TBSA (Kalavala et al, 2007). And 1 g of topical steroid would be the same as 2 FTUs. The ability to assess TBSA and the amount of topical steroid required can aid in prescribing that is cost effective and ensures that the patient receives as adequate amount of medication. Use of a body-mapping diagram can assist in raising staff and patient awareness of areas where the application of steroid is required.
Oral/IV therapies
This is a group of therapies that are taken orally or through the intravenous route, and include antibiotics and steroids. These are usually prescribed following a thorough review and with the availability of blood results and/or microbiology results.
Bacterial infections are usually treated with antibiotics and, unless severe, are usually given by the oral route. Antibiotics can treat a wide range of bacterial skin conditions (Sukumaran and Senanayake, 2016). Consultation with local formularies, where available, and the latest edition of the British National Formulary can assist in supporting safe and appropriate prescribing decisions.
Corticosteroids can be useful in the treatment of skin conditions that are secondary to conditions such as vasculitis, inflammatory diseases and autoimmune disorders. Although steroids can be given orally, the topical route is preferred whenever possible to reduce the risk of side effects. Long-term steroid use should be avoided if feasible (Coondoo et al, 2014).
Conditions such as psoriasis can, in severe presentations, be treated effectively with either immunosuppressants or biologics (often seen in the treatment of rheumatoid arthritis or Crohn’s disease). Eczema and atopic dermatitis may benefit from the initiation of an enzyme inhibitor. These work by fighting inflammation through the suppression of an immune system enzyme.
Acne is one of the most common presentations and occurs in over 80% of teenagers in the UK (Purdy and de Berker, 2011). Treatment options can range from topical benzoyl peroxide for acne in mild presentations (when less than half of face, back and chest is affected), to topical retinoid, antibiotic, or benzoyl peroxide in combination with systemic oral antibiotics in severe disease where all areas are affected, highly inflamed, and display many nodules and cysts (Onselen, 2017; NICE, 2021b). If this is unsuccessful, treatment with oral isotretinoin may be required, prescribed by a consultant dermatologist (NHS website, 2019). NICE (2021b) offers discussion and patient information around topics such as facial cleansing and diet in the management of a patient presenting with acne in a primary care setting. The psychological impact of acne and the risk of depression should also be considered (Onselen, 2017).
Phototherapy
Another treatment option is phototherapy. Also commonly known as light therapy, this is a non-invasive therapy where ultraviolet (UV) light is used to help reduce or control (rather than aiming to cure) symptoms of some skin conditions such as eczema, vitiligo and psoriasis. However, this is a treatment that would normally be beyond the scope of the ACP to instigate and would follow specialist dermatology review.
Treatment is often required several times a week for a period of months and is typically provided in a clinic or hospital environment. Initially, the skin may be sensitive and care should be taken to reduce any further UV exposure outside of treatment. Although considered a low-risk therapy, some side effects such as erythema, stinging or burning, and localised skin changes can occur (Davis et al, 2017). In patients presenting with erythema and burning secondary to phototherapy (usually within 4-6 hours of treatment) a topical steroid should be applied and contact made with the treatment provider (Singh et al, 2016).
Photodynamic therapy
Photodynamic therapy (PDT) is used in the treatment of abnormal cells. Treatment involves a light-sensitive medicine and a light source to destroy the cells. Alternatively, in some patients, PDT using daylight rather than conventional PDT in conditions such as actinic keratoses, may reduce the risk of pain associated with the therapy (Morton and Braathen, 2018). PDT can be used in some skin cancers as well as acne and warts. It can cause some discomfort post-treatment, alongside the risk of altered pigmentation and hair loss (over the treated area). This is a treatment option that ACPs need to be aware of but would require a specialist dermatology review.
Psycho-dermatology
This is a group of psychological treatments such as mindfulness, cognitive behaviour therapy (CBT), and habit reversal designed to complement other therapies for skin conditions. Stress can have a negative impact on skin health and, in turn, skin conditions can have a negative effect on both behaviour and mood. As with phototherapy and PDT, this is a treatment that would normally often be beyond the scope of the ACP to instigate unless further training in CBT is undertaken, and would follow specialist dermatology review; but it is important to be aware of this treatment option.
Although psycho-dermatology, PDT and phototherapy are undertaken by specialists in these areas, topical and antimicrobial therapies may be commenced by ACPs. Use of local and national guidance can assist in informing the most appropriate choice of therapy. However, if there is any doubt about the correct course of action, a second opinion should be sought.
As with any new presentation or complaint, an ACP must provide support and education to the patient and family. In many situations, the ACP may not be able to provide direct follow up and will be required to ensure that a full consideration of factors post-ACP interaction are discussed and topics such as waiting times and advice if the condition worsens are explored during the consultation.
Anticipatory guidance
Patients should be provided with advice on how to check if their condition worsens and informed about possible red flags to observe for. Worrying signs such as lesions anywhere on the skin that will not heal, prolonged or purpuric rashes, and moles that change in appearance or bleed/crust, should be investigated (Lowth, 2016).
If the patient has a carer or guardian, they should be provided with the guidance and education required to ensure the patient’s safety and wellbeing. Patients at risk of skin conditions caused by underlying conditions should also be provided with the information required to detect these at an early stage, this includes patients with diabetes, vasculitis and autoimmune disorders. Patients using intravenous drugs should be advised of the risks of poor skin health and educated on how to spot potential complications, and how to access treatment and investigations.
Patient education and health promotion
Patient education serves a vital role in the maintenance of skin health (Ryan et al, 2012). It is imperative that the patient is adequately educated and informed about any treatments prescribed, including side effects, the correct administration/application, and any expected outcomes.
Diet plays an important role in skin health and healing (Katta and Desai, 2014). Patients should be provided with both education and support if required to improve their diet and nutritional state. This may on some occasions require a referral to a dietitian.
Obesity is linked to a wide range of associated skin conditions such as cellulitis, infections, psoriasis, and hidradenitis suppurativa (Chacon et al, 2013) and weight loss advice and management may be an important step in treating and preventing conditions. Lifestyle choices may also impact on skin health (Addor, 2018) and two of the most common lifestyle factors are smoking and alcohol. It may be appropriate to discuss both smoking-cessation options and support for alcohol excess when treating a patient presenting with a skin condition. Intravenous drug use, as previously mentioned, is also a risk factor for skin conditions (Lavender and McCarron, 2013) and intervention and support should be provided to those patients who are accepting of this, and the information on the support available to those who are not, should they decide to seek it in the future.
It is worth noting that although diet, lifestyle and weight may all impact on skin health, some skin conditions themselves can offer a higher risk of other comorbidities. Psoriasis is one such condition and those patients presenting with psoriasis will have a higher risk of developing conditions such as hyperlipidaemia, diabetes and hypertension (Aldridge, 2014) and, according to Abuabara et al (2010), those patients have a reduced life expectancy by around five years. Therefore the ACP should take these risks into consideration, ensuring screening is appropriate, and offering health education and promotion.
Other areas of education may involve the patient’s living arrangements and social interactions. Contagious skin conditions, such as scabies, will continue to spread unless all those in close contact have received the appropriate treatment. Household environments may also play a role in skin health, for example exacerbation of eczema due to high levels of dust or household pets carrying ringworm. Educating the patient on the risk of such environmental factors may prevent recurrence and aid the treatment of their complaint.
If there is suspicion that the presenting skin complaint has arisen through self-harm or abuse then appropriate steps should be taken to safeguard the patient. Local policy and guidance should inform the pathway to follow. Poor skin health, as previously mentioned, can have a negative effect on both mood and behaviour. The patient’s demeanour and any concerns regarding their mental health should be noted during consultations and form part of the treatment plan or interventions should concerns arise.
Not all ACPs will feel comfortable providing education on these topics, knowing their knowledge may be limited and understanding that it is vital that the patient receives appropriate information. However a good basic knowledge of skin conditions will enable the ACP to guide the patient. ‘Safety netting’ is important here, where the health professional ensures the patient is aware of what to do if their condition does not improve or becomes worse, and knows how to access help.
Referral to specialists
Dermatology is a complex specialty and often the role of the ACP is not to diagnose or treat but instead to obtain a thorough, accurate history and to document the findings of their examination to provide strong foundations for the patient’s care pathway. Referral to a specialty will depend on the findings from the history and examination and may include referral to dermatology, tissue viability and cancer services. As skin ill health may be an indicator of an underlying condition, the ACP may find themselves referring to less obvious specialties such as cardiology or infectious diseases. If the ACP is unsure of the appropriate pathway for a particular patient, advice may be obtained from specialties before referral.
Conclusion
As more nurses take on ACP roles and work more autonomously, the level of knowledge required has also increased. However, skin problems, despite being a common presenting complaint, is an area that ACPs often feel less confident to diagnose and treat. This clinical review has discussed the decision making, investigations and treatment options for skin conditions that are key for ACPs to consider when caring for patients with these presentations. Basic investigations and treatment can be initiated and carried out by ACPs in various settings. However, these require ACPs to have a good understanding of investigations and treatment options, as well as aspects of education and safety netting to provide support to patients and families who are faced with a skin condition. It is hoped that this article has provided ACPs with a foundation to develop their practice knowledge and understanding of skin conditions and treatments.
KEY POINTS
- Understanding treatments and investigations can alleviate patient anxiety and increase concordance when treating skin conditions
- Patient education can be key to early intervention and prevention of skin conditions
- Skin conditions can have a negative impact on a person’s mental health and wellbeing
- Skin conditions may be secondary to underlying disease and infection
CPD reflective questions
- Reflect on your own knowledge of investigations and treatments for skin conditions and how increasing this knowledge could improve the care you give your patients
- Consider common skin presentations and which conditions might mimic them
- Think about your role in patient education—what areas of skin conditions and their treatments do you need to learn more about?